The Management Of Meniscal Tears In The ACL-Deficient Knee

Comparative Outcomes of Radial and Bucket-Handle Meniscal Tear Repair: A Propensity-Matched Analysis

“…28,44 Radial tears have a very poor prognosis because the perpendicular orientation of the tear in relation to the meniscal fibers can compromise the circumferential distribution of vertical compressive loads on the tibia, described as “hoop” stresses. 7,17,30 Historically, partial meniscectomy has served as the cornerstone for the operative management of radial meniscal tears, 9,27,37 despite the risk of arthrosis after meniscectomy. 6,32 A number of techniques have been developed for repairing radial meniscal tears since attention has increasingly turned toward meniscal preservation.…”

All-Inside Meniscal Repair Using a New Flexible, Tensionable Device

“…Meniscal repair using suture placed “inside-out” has become the gold standard to which other techniques are compared, with 10-year success rates of approximately 90% when performed with concurrent anterior cruciate ligament reconstruction (ACLR). 5,14,16,20,29…”

All-Inside Meniscal Repair

“…Conversely, complex tears may be better managed with partial meniscectomy. These tears include degenerative tears, radial tears, and tears with horizontal cleavage planes or multiple flaps 43. Oblique, undersurface tears can also be problematic because they often extend from the vascular zone to avascular zone.…”

“…Less common, trephination may be used to improve short-term vascular access to the red-white zone of the meniscus 22. Last, exogenous fibrin clot may be useful in the setting of isolated meniscal repair 7,43. Fibrin clot enhances the local healing environment by placing factors found in the peripheral blood, such as growth factors, fibrin, and platelets, at the site of repair (Figure 6).…”

“… 22 Last, exogenous fibrin clot may be useful in the setting of isolated meniscal repair. 7 , 43 Fibrin clot enhances the local healing environment by placing factors found in the peripheral blood, such as growth factors, fibrin, and platelets, at the site of repair ( Figure 6 ). This produces a healing milieu similar to the setting of concurrent ACL reconstruction.…”