Torn meniscal cartilages and the consequences of missing meniscus tissue represent the major indications for operative arthroscopy of the knee. After recognizing the importance of the meniscus, clinicians made the shift away from complete meniscectomy to partial meniscectomy aided by the development of arthroscopic instrumentation. Despite extensive basic science data showing the importance of a complete meniscus for normal force transference, meniscus repair occurs in less than 10% of all meniscal tears found at arthroscopy. This paper will discuss the reasons for the common clinical approach and compare that approach with an aggressive approach of salvaging and replacing meniscus tissue, and will offer speculations about future directions for meniscus repair, reconstruction, and replacement.