This chapter will discuss whether to perform meniscal repair and centralization or resection in the aging athlete. “Aging athlete” will refer to those who are 40 years or older as conventionally, this age is used as a cutoff for older patients. (1) “Athlete” in this chapter will include professional and amateur athletes to weekend warriors.

In the general population, approximately 6% of acutely injured knees involve the meniscus. (2) Therefore, it is not a rare incidence for orthopaedic surgeons to treat meniscus injury in athletes. It is now widely accepted that the meniscus should be repaired whenever possible, as highlighted in the slogan “save the meniscus”. A plethora of publications have shown that patients receiving meniscal repair have better long-term clinical outcome compared to patients who had meniscal resection. However, tears localized in Cooper zone 3 (white-white zone) or highly degenerative tears in an osteoarthritic (OA) knee are poor candidates for repair and may consider conservative treatment or resection. Meniscal extrusion may result from OA and/or meniscal root tears. Meniscal extrusion leads to less coverage of the tibial plateau, subjecting it to greater stress and subsequent cartilage damage. Centralization is a technique used to reduce the extruded meniscus. Although different techniques have been reported, the goal is to reduce the extruded meniscus to the tibia, thereby protecting the tibiofemoral joint surface.(3,4)

In the general population, repair should always be the first option for traumatic meniscal tears, and only in cases when the meniscal injury is not amenable to repair and conservative treatment fails, should resection be considered.(2) However, for athletes, clinical decision making may not be as clear cut. Additional considerations such as, the patient's sport level, time in season or career, tear type, and location, may be required. Additionally for elite athletes, there may be pressure from parents, coaches and other stakeholders. The surgeon needs to be equipped with knowledge and techniques based on evidence to offer personalized treatment that best accommodates the patient's needs. For the purpose of this chapter, we presume that conservative treatment options have been exhausted, and surgical intervention is considered.