Complex meniscal tears can involve multiple planes and may create distinct flaps within the meniscus. These tears often present with various patterns and directions, leading to a complex array of tear configurations. This complexity poses a significant surgical challenge, making it difficult to decide between resection and repair. Globally, there is a growing trend in clinical practice towards “saving” the meniscus whenever feasible, acknowledging its vital role in knee biomechanics and its role in preventing further development of osteoarthritis. Choosing to repair rather than resect aims to preserve the meniscus’s essential functions and enhance long-term patient outcomes. This shift reflects an expanded understanding of the meniscus’s importance in joint health and the advantages of retaining as much of the natural tissue as possible.