The patient with meniscal injury may present with pain, swelling, or mechanical symptoms and often requires surgical intervention for symptom resolution. Treatment of such injuries relies on understanding the gross and microanatomic features of the meniscus that are important in maintaining meniscal function. The ability of the meniscus to participate in load bearing, shock absorption, joint lubrication, and joint stability depends on the maintenance of its structural integrity. The diagnosis of meniscal injury often can be made by clinical evaluation utilizing the history, physical examination, and plain radiographs. Magnetic resonance imaging can be useful in confirming the diagnosis when clinical findings are inconclusive. Treatment depends on tear pattern, vascularity, and an assessment of tissue quality. Surgical decision making for the treatment of meniscal injury is based on patient factors and understanding of the meniscal structure, function, and pathology.