A selective approach to meniscus lesions has evolved to replace the traditional approach of total meniscectomy for all tears. The rationale is to preserve as much functional meniscus tissue as possible in the hope of decreasing the risk of late degenerative sequelae and still relieve the symptoms associated with the meniscus tear. The principles that should be considered for the various treatment options of leaving certain tears alone, meniscus repair, partial meniscectomy, and total meniscectomy have been reviewed. The early to intermediate results of this selective approach are encouraging and warrant continuation of its use. It should be emphasized, however, that continuing follow-up studies are necessary to establish whether the primary goal of improving long-term results following meniscus surgery will be achieved.