Summary:The surgical techniques required for repair of complex meniscal tears, including tears in the central one-third avascular region, are technically demanding. The technique requires that both superior and inferior sutures be placed in a stacking arrangement to completely approximate and close the meniscus tear site. This technique provides greater inherent stability to the meniscus repair site and also allows immediate knee motion. The use of many individual sutures meticulously placed to completely approximate and close the tear site permits more complex tears to be repaired, instead of excised, thereby retaining meniscus function. This article discusses the technique and principles important to meniscus repair.