Time for a paradigm change in meniscal repair: save the meniscus!

Abstract

impact on that risk, and it became obvious that the differentiation of tear types and repair techniques has resulted in significant progress over the last few years.In 2016, numerous advanced techniques for meniscal repair are being performed, regardless of the site of the tear [4,26]. There is no place in the knee that cannot be reached by the arthroscope. However, some of the repair techniques are in the early stages of development and require further improvement to reach global acceptance [24]. They appear very promising, as many surgeons have adopted them in a short period of time.Meniscus repair is gaining in popularity among an increasing number of surgeons. A better understanding, more sophisticated devices for meniscus repair and the increasing success rate might be some of the explanations. The increasing popularity of meniscus repair also includes meniscus lesions, which are associated with anterior cruciate ligament (ACL) injuries. At several European centres, meniscal repair procedures are now being performed in up to 40-60 % of all ACL reconstructions. In addition, these repairs are being extended increasingly to an athletic population and even professional athletes and football players. The medial meniscus in particular is becoming the focus of attention. As the main secondary stabiliser in anteroposterior laxity after an ACL injury, it is well known that this structure plays an important role in the long-term development of osteoarthritis and, as shown recently by Robb et al.[21], its absence negatively affects the fate of ACL graft survival. These are the reasons why efforts have recently been made to increase our understanding of medial meniscus tears [27], to rediscover certain types of injury like the meniscosynovial or ramp lesions [1,5,8,19,23,25] and to improve long-existing repair techniques [15,20].Another new development in meniscal repair relates to root tears, which have moved into focus over the last One of the most important clinical achievements highlighted at the third international meeting "The Meniscus: Preserve the future", held in Porto in early February this year [9], was the improvement made in the field of meniscal repair. The loss of the meniscus can be regarded as a pre-arthritic condition for the knee due to the loss of protective function [2,3]. However, the tear pattern has a crucial

The knee meniscus: management of traumatic tears and degenerative lesions

“…4 The success rate is, of course, high, even in DML 6 in terms of symptomatic relief and return to daily activities and sports. 41 Pooled results of Salata’s systematic review 42 demonstrated that total meniscectomy or removal of the peripheral meniscal rim, lateral meniscectomy, degenerative meniscal tears, presence of chondral damage, presence of hand osteoarthritis suggestive of a genetic predisposition and increased body mass index were all independent risk factors for poor clinical and radiological outcomes after arthroscopic menisectomy.…”

“…3,4 It is one of the most popular orthopaedic procedures. But long-term results, even with arthroscopic partial meniscectomy (APM), are not so good and the concept of meniscal preservation has therefore progressed over the years: 5,6 . Save the meniscus!…”

Novel Approaches in Meniscal Repair Utilizing Mesenchymal Stem Cells, New Generation Bioscaffolds and Biological Adhesives as Cell Delivery Vehicles

“…However it took time for these animal findings to be translated to human studies [59-61, 65,67,70,72] and for these experimental findings to be fed through to human clinical practice and the importance of the meniscus in entirety in knee joint articulation, weight bearing and load distribution became established. Even so, publications were still appearing as late as 2016 emphasising the importance of the preservation of the knee joint menisci to ensure optimal knee joint function three decades after meniscal removal had been shown to induce degenerative changes in other knee joint tissues [75].…”

Editorial Commentary: The Benefits of Three-Dimensional Computed Tomography Images to Evaluate the Safety of All-Inside Meniscal Repair

“…Under the slogan "save the meniscus," meniscal repair has been strongly recommended whenever possible. 2 From several repair techniques, inside-out repair with a small incision has been regarded as the standard procedure. However, the all-inside technique has been used worldwide since the introduction and further innovation of several all-inside repair devices.…”