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Introduction Trephination is a needling technique that creates small tunnels in the red vascular zone of the meniscus to promote healing.The purpose was to investigate whether trephination of the meniscus, when combined with all-inside repair, would improve healing compared to all-inside repair without trephination.Materials and Methods 18–45-year-old patients with a meniscal lesion in the red or red/white zone were included in a single-center double blinded clinical randomized trial. The primary outcome was the patient reported outcome KOOS (Knee Osteoarthritis Outcome Score) ‘Sport’ 0–100 subscale. If randomized to the trephination group, trephination was performed with an 1x10 mm. awl before an all-inside suture repair of the meniscus.Results 108 patients were randomized intraoperatively to either trephination or no-trephination and then all-inside meniscal suture. 55 (50.9%) patients had trephination (aged 27.7±6.4y, 38% females [n=21]); and 53 (49.1%) patients did not have trephination (aged 26.6±6.6y, 36% females [n=19]). No between-group difference in the primary outcome (KOOS Sport at 12 months, p=0.150) or age, sex, weekly hours of sport, location of meniscal injury or self-reported outcomes were observed (p>0.05). Both the intervention group and the control group improved on the primary outcome, KOOS Sport after 12 months (mean change 43.5 points (CI: 34.7–52.3) vs. 51.2 points (CI: 43.6–58.8)). Across groups, the reoperation rate was 37 % (40/108). There were no differences between groups in clinical healing.Conclusion Adding trephination to all inside meniscal suture of lesions in the vascular zone is not effective in improving patient reported outcomes or clinical healing rates.