Meniscal Repair: Indications, Techniques, and Outcome

Augmentation Techniques for Meniscus Repair

“…In adults, medial meniscus tears are often associated with cartilage lesions and/or concomitant ligament damage. 16 Medial and lateral meniscus tears are usually categorized based on the anatomic location of the tear, vascularity of the tissue where the tear occurs, and the tear pattern (radial, longitudinal, horizontal, circumferential, root lesions, bucket handle, oblique/flap tears, and complex degenerative tears). 16,24 Meniscal root tears are defined as radial tears or an avulsion of the insertion of the meniscus.…”

“…16 Medial and lateral meniscus tears are usually categorized based on the anatomic location of the tear, vascularity of the tissue where the tear occurs, and the tear pattern (radial, longitudinal, horizontal, circumferential, root lesions, bucket handle, oblique/flap tears, and complex degenerative tears). 16,24 Meniscal root tears are defined as radial tears or an avulsion of the insertion of the meniscus. 25,26 Due to failure of the meniscus to convert axial loads into hoop stresses, these types of injuries alter load sharing and the continuity of circumferential fibers leading to progressive arthrosis-like changes in the knee.…”

“…The decision as to whether conservative nonsurgical treatment should be preferred to surgical treatment is highly dependent on the size, pattern, and location of the tear; the patient's age, health status, and activity level; and the surgeon's experience. 16 Although a considerable number of patients having traumatic or degenerative meniscus lesions are treated nonoperatively, meniscus lesions that seem to be mechanically unstable, complex tears, and mostly degenerative meniscus lesions that are symptomatic are often removed by meniscectomy. 24 Arthroscopic partial meniscectomy (APM) is still the most frequent orthopaedic procedure in orthopaedic surgery, although there is evidence that more conservative treatments should be preferred as the first-line treatment when not associated with an acute tear, such as with an ACL tear.…”

“…15 Recently, there has been a shift toward attempting repair of tears previously deemed irrepairable since preservation of the meniscus structure is expected to maintain meniscus function and prevent degenerative changes to the joints. 16 Satisfactory results have been reported for repair of some horizontal cleavage tears 36 and radial tears, 37 for tears extending into the avascular portion of the meniscus 38 and for patients 40 years and older at the time of surgery. 39 Rehabilitation after meniscus repair surgery usually begins with early active range of motion and restoration of strength exercises, followed by a return to low-impact daily activity within 1 month and return to sports usually at 4 to 6 months, when appropriate functional goals are reached and the patient no longer has point tenderness over the repair site.…”

“…Healing is more difficult in the case of other tear patterns such as radial, horizontal, fragmented, or white-white (W-W) displaced bucket handle and in the case of complex, chronic, or degenerative tears. 15,16 When meniscal tears occur in the peripheral vascularized area of the meniscus, repair by suturing leads to satisfactory clinical improvement in 70 to 90% of patients. Nonetheless, the clinical failure rate can be as high as 20 to 24% depending on, among other factors, the status of the anterior cruciate ligament (ACL), 17 while incomplete healing corresponding to structural failure is yet higher than the clinical failure rate.…”