Operations to treat meniscal injuries rank among the most frequent procedures performed by orthopedic surgeons. Ongoing research into the natural history, basic science, and biomechanics of meniscal injury has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics and function. The arthroscopic inside-out suture repair is currently the gold standard by which other meniscal repair techniques are judged. Although it is difficult to identify meniscal tears amenable to repair preoperatively, an assessment of patient factors and tear characteristics on the basis of magnetic resonance imaging and intraoperative findings will aid the decision to excise or repair. For successful repair the meniscal tear must have appropriate location and characteristics, without evidence of fraying or degeneration. Repair with the arthroscopic inside-out method affords anatomic reduction of the meniscus tear and allows stimulation of circulation, factors which contribute to healing of the repair. Coupled with careful dissection and needle placement, this method minimizes complications associated with meniscus repair.