In elite athletes, treating meniscal injuries is challenging due to high performance demands and the expectation of early return to play. Other than classical approaches, the clinician should consider age of the athlete and term of the season. Clinical approaches typically range from conservative treatment to surgical repair; conservative treatment includes activity modification, physiotherapy, non-steroidal anti-inflammatory drugs, and injections, while surgical decisions are based on the type, location, size, associated lesions, and knee stability of the tear. Repair is the priority for longitudinal, radial, complex, and anterior horn tears of the lateral meniscus, while a conservative approach is recommended for horizontal tears. For buckethandle and near-isolated tears of the medial meniscus, a shared decision is made with the athlete between meniscectomy and repair; tears in the peripheral region heal better. For degenerative tears, rest, strengthening, and injections are the preferred options. Posterior root tears should be repaired whenever possible to preserve meniscal function. In cases of meniscal injuries accompanied by an anterior cruciate ligament rupture, concurrent repair is preferred because it promotes stability.