Arthroscopic repair of the meniscus

Abstract

From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated.Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated.Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR.Tears in the peripheral third are more likely to heal than those in the inner thirds.Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR.‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques.Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes.Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment.Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059

Isolated lateral meniscus rupture in dogs: case report

“…Menisci are intra-articular structures composed of circumferential bundles of collagen, presented in the dogs in a transversal form with a triangular shape covering half to two thirds of the joint surface of the corresponding tibial plateau, medially presenting larger dimensions with a polygonal shape and laterally circular (THIEMAN et al, 2009;FOX et al, 2015, DECAMP et al, 2016VAQUERO-PICADO et al, 2018).…”

“…The main function of menisci is to transmit load and absorb intra-articular impact, besides increasing the congruence and the area of contact between the bones, decreasing the stress on the articular cartilage and playing a role in the absorption of shocks by measuring greater osteoarticular stability (JONES et al, 2006;FOX et al, 2015;VÉREZ-FRAGUELA et al, 2017, VALEN et al, 2017VAQUERO-PICADO et al, 2018).…”

Clinical practice and post-operative rehabilitation after knee arthroscopy varies according to surgeon's expertise: a survey among Polish Arthroscopy Society members.

“…Due to its hypovascularity and hypocellularity, a meniscus tear does not heal spontaneously [2,3,4] and prolonged untreated damage may lead to the development of osteoarthritis [5,6,7]. Current orthopedic practice aims to preserve meniscal integrity and restore its function [8,9,10,11]. A variety of arthroscopic methods of meniscus repair is used, including different meniscus suturing techniques, which are often modi ed to increase the effectiveness of the surgery [12,13,14,15].…”

Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among Polish Arthroscopy Society members.

“…Due to the hypovascularity and hypocellularity of the meniscus, meniscus tears do not heal spontaneously [2,3,4], and prolonged untreated damage may lead to the development of osteoarthritis [5,6,7]. Current orthopaedic practice aims to preserve meniscal integrity and restore function [8,9,10,11]. A variety of arthroscopic methods of meniscus repair are used, including different suturing techniques, which are often modi ed to increase effectiveness [12,13,14,15].…”