Objective To evaluate the therapeutic efficacy of arthroscopic surgery for meniscus injuries of the knee and its impact on joint function. Methods A retrospective analysis was conducted on patients with knee meniscus injuries treated at the Department of Orthopedics, Ruzhou First People’s Hospital, from September 2023 to October 2025. Patients were divided into observation group (undergo arthroscopic surgery) and control group (undergo conventional open surgery) based on different surgical approaches, 46 cases in each group. Clinical outcomes, knee joint scores (Lysholm scores, International Knee Documentation Committee (IKDC)), visual analog scale (VAS) scores, quality-of-life scores were compared between the two groups. Simultaneously, the occurrence of complications were recorded. All outcome measures were assessed at the 6-month postoperative follow-up. Results After treatment, the clinical effective rate in the observation group (97.83%) was significantly higher than that in the control group (71.74%) (P＜0.05). Both groups showed improvement in Lysholm scores, IKDC scores, and , VAS scores compared to pre-treatment levels (all P＜0.05), but the observation group demonstrated significantly better various aspects of quality-of-life scores than the control group (all P＜0.05). No serious complications such as deep infection or lower limb deep vein thrombosis occurred in either group. Three cases of joint effusion were observed in the observation group, and two cases of poor incision healing occurred in the control group. There was no statistically significant difference in the incidence of complications between the two groups (P＞0.05). Conclusion Arthroscopic surgery can effectively treat meniscus injuries of the knee joint, helping to restore joint function, alleviate patients’ pain, and improve their quality of life. Arthroscopic surgery should be prioritized in medical institutions with appropriate equipment. For primary-level units with limited resources, open surgery still holds clinical value under strict indication control.