Why a Meniscectomy Fails

Laasonen, E. M.; Wilppula, E.

doi:10.3109/17453677608988758

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…The literature is now replete with reports of both animal and clinical studies documenting mechanical alterations2, 6,8,32,36,4I,47,48 in the knee joint followed by clinical deterioration. 9,11,15,17,24,[26][27][28][29]34,35,37,41,53 Multiple attempts have been made to delineate meniscus function. Shrive49 in 1978 documented a spacer effect of the meniscus, which implied a load sharing function.…”

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confidence: 99%

Arthroscopic meniscal repair evaluated by second-look arthroscopy

Morgan¹,

et al. 1991

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Of 353 arthroscopic peripheral meniscal repairs performed using the "outside to inside" suturing technique with rasp preparation of the tear region, 74 repairs (50 medial and 24 lateral) were assessed by second-look arthroscopy and are the basis of this report. Results were graded as either healed, incompletely healed, or failed; these findings were correlated with clinical symptoms and associated ACL deficiency. Overall, asymptomatic healing occurred in 84%, with 65% healed and 19% incompletely healed. The failure rate was 16%. All failures were symptomatic while all healed and incompletely healed menisci were asymptomatic. Failure was associated with ACL deficiency in all cases. No failures occurred in either an ACL uninjured knee or an ACL reconstructed knee. Failure was also associated with tear location in the posterior horn of the medial meniscus. Eleven of 12 failures (92%) involved posterior medial meniscal tears with only 1 failure located posterolaterally. Visual evidence of healing required a 4 month time interval.

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confidence: 99%

Arthroscopic meniscal repair evaluated by second-look arthroscopy

Morgan¹,

et al. 1991

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“…As the menisci are fundamental structures for the maintenance of knee homeostasis, playing a key role in knee biomechanics, meniscal tissue should be preserved whenever possible and partial or total meniscectomy should be left as the final option. indeed, long-term follow-up studies have shown that virtually all meniscectomized knees develop arthritic changes over time (14); therefore, when considering treatment options for a patient complaining of pain due to a meniscal tear, conservative options should be considered as a first-line therapy before surgical treatment. this study was conducted with the purpose of evaluating a non-operative treatment protocol designed to reduce pain and improve lesion healing in patients with degenerative meniscal tears.…”

Section: Discussionmentioning

confidence: 99%

“…the extrinsic pathway, occurring mainly in the vascular area of the lesion, is based on the network of capillaries that supply the lesion with undifferentiated mesenchymal cells as well as nutrients that induce healing. the intrinsic pathway is based on the self-repair capacity of the meniscal fibrocartilage and the synovial fluid (14). Although, to date, no substance has been found to induce predictable, spontaneous meniscal healing, a recent in vitro study conducted on human synovial cells stimulated with HA (17) showed that treatment with HA (0.1 mg/mL) increases the expression of tGF-β1 and VEGF.…”

Section: Discussionmentioning

confidence: 99%

A new hydrogel for the conservative treatment of meniscal lesions: a randomized controlled study

Zorzi

Rigotti

Screpis

et al. 2015

Joints

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Purpose: this study aimed to investigate the efficacy of intra-articular (iA) administration of a hydrogel formulation obtained from a hyaluronic acid (HA) derivative (HYADD4 ® ) in the management of meniscal tears and in meniscal tear repair. Methods: fifty subjects with degenerative meniscal tears were enrolled into this single-site, observer-blind, parallel-group study. Clinical evaluations were performed at baseline and after 14, 30 and 60 days. Clinical outcomes included: pain reduction (Visual Analog scale), improvement of knee functionality (WoMAC questionnaire), reduction in length and depth of the meniscal lesion (MRi-confirmed) and sF-36 questionnaire scores. Local tolerability and safety were also investigated. Results: a significant reduction in VAs pain (p< 0.001) in favor of HYADD4 ® was recorded at day 14 and maintained at all the follow-up assessments. Data on knee functionality were in line with the VAs pain assessment results. A significant reduction in length and depth of the meniscal lesion, assessed using MRi, was found in the HYADD4 ® group compared to the control group (p<0.001). Conclusions: the results of this study may indicate a new treatment option in the conservative management of patients complaining of pain due to meniscal tears. the MRi data suggest that the hydrogel formulation of HA used in this study may also play a role in the healing process of the lesion. Level of evidence:Level i, prospective randomized clinical trial.

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The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed

Hede

Larsen

Sandberg

1992

International Orthopaedics

157

126

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Two hundred patients were randomly selected for either a partial or a total meniscectomy for a meniscal tear during open operation. They were followed for a median of 7.8 years after operation. After partial meniscectomy, posterior horn tears had the worst outcome, but this was only apparent when more than two-thirds of the meniscus had been removed. The amount of meniscal tissue excised was inversely related to the function of the knee, except with bucket-handle tears treated by partial meniscectomy. Patients with bucket-handle, anterior and posterior horn tears had similar functional results after total meniscectomy. Preservation of the peripheral rim of the meniscus following partial meniscectomy produces the best functional results.

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Why a Meniscectomy Fails

Cited by 7 publications

References 10 publications

Arthroscopic meniscal repair evaluated by second-look arthroscopy

Arthroscopic meniscal repair evaluated by second-look arthroscopy

A new hydrogel for the conservative treatment of meniscal lesions: a randomized controlled study

The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed

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