The history of treating meniscal lesions has been characterized by firm belief in "radical" surgery, with serious long-term consequences for the individual and society. The menisci play a critical protective role for the knee joint through shock absorption and load distribution. Currently, the consensus in surgical treatment of meniscal tears is to preserve as much functional meniscal tissue as possible. Still, meniscal lesions are common, especially in the osteoarthritic knee. For health professionals, these lesions present a challenge in choosing the treatment that is best for the patient in both the short term and long term. A degenerative lesion, in the middle-aged or older patient, could suggest early-stage knee osteoarthritis and should be treated accordingly. Surgical resection of nonobstructive degenerate lesions may only remove evidence of the disorder while the osteoarthritis degradation proceeds. Well-designed randomized, controlled clinical trials are needed.