In this study, follow-up data was obtained in 90 of 117 consecutive meniscal repairs. In Group I, there were 68 meniscal repairs in conjunction with anterior cruciate ligament reconstruction, and in Group II, 22 isolated repairs in anterior cruciate ligament stable knees. Meniscal healing was assessed using the criteria established by Henning, by either arthroscopy or arthrography, at a mean of 7 months for isolated repairs and a mean of 10 months for repairs done in conjunction with anterior cruciate ligament reconstruction. Average time from injury to surgery was 19 months in Group I patients, and 14 months in Group II patients. The overall rate of successful healing was 82%. Group I repairs were successful 93% of the time compared to a 50% success rate in Group II (P less than 0.00005). Lateral meniscal repairs fared better than medial repairs in both groups. Although a smaller rim width yielded better overall healing, there was no difference in the mean rim width of the two groups. Patients with anterior cruciate ligament reconstruction did better than those with isolated meniscal repair, regardless of tear length. Older patients had better healing than younger ones. Overall, acute repairs were more successful than repairs of chronic tears. Even so, the chronic Group I patients had a 91% successful healing rate.

The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees

Background: The influence of standard meniscus treatment strategies regarding osteoarthritic progress, function, and sports activity has not been estimated in a direct long-term comparison.Hypothesis: Meniscal repair compared with partial meniscectomy (partial meniscal resection) decreases osteoarthritic changes and reduces the effect on sports activity in the long-term follow-up.Study Design: Cohort study; Level of evidence, 3.Methods: Eighty-one patients with an arthroscopic meniscus shape–preserving surgery after isolated traumatic medial meniscal tear (repair: n = 42; meniscectomy: n = 39) were examined clinically (Lysholm score, Tegner score) and radiologically (Fairbank score, compared with the uninjured knee); the follow-up was divided into midterm (3.4 years; n = 35) and long term (8.8 years; n = 46). Additionally, the influences of the preoperative sports activity level and age at surgery were evaluated.Results: In the long-term follow-up, no osteoarthritic progress was detectable in 80.8% after ...

Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears

Once described as a functionless embryonic remnant,162 the menisci are now known to be vital for the normal function and long-term health of the knee joint.§ The menisci increase stability for femorotibial articulation, distribute axial load, absorb shock, and provide lubrication and nutrition to the knee joint.4,91,152,153

Injuries to the menisci are recognized as a cause of significant musculoskeletal morbidity. The unique and complex structure of menisci makes treatment and repair challenging for the patient, surgeon, and physical therapist. Furthermore, long-term damage may lead to degenerative joint changes such as osteophyte formation, articular cartilage degeneration, joint space narrowing, and symptomatic osteoarthritis.36,45,92 Preservation of the menisci depends on maintaining their distinctive composition and organization.

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The Basic Science of Human Knee Menisci: Structure, Composition, and Function

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.

/pdf/arthroscopic-meniscal-repair-evaluated-by-second-look-20a8vei7fy.pdf

Arthroscopic meniscal repair evaluated by second-look arthroscopy:

We assessed the results of 198 meniscal tears that had a major segment in the central avascular region repaired with an arthroscopically assisted inside-out technique. There were 177 patients whose mean age was 28 years. Eighty-two percent were injured during sports, and 71% also required anterior cruciate ligament reconstruction. The menisci were evaluated by clinical examination (180 repairs) a mean of 42 months postoperatively, by follow-up arthroscopic evaluation (91 repairs) a mean of 18 months postoperatively, or both. At followup, 159 (80%) of the 198 tears were asymptomatic for tibiofemoral joint symptoms, and 39 (20%) required repeat arthroscopic surgery for these symptoms. Of the 91 repairs evaluated arthroscopically, 23 (25%) were classified as healed, 35 (38%) as partially healed, and 33 (36%) as failed. We recommend repair of meniscal tears that extend into the avascular region for select patients, including those in their 20s and 30s and highly competitive athletes. This study's reoperation rate of 20% should not be interpreted as the rate of meniscal healing, but as the incidence of tibiofemoral joint symptoms. Even though this is a higher rate than that reported for the repair of peripheral meniscal tears, we believe the benefits of a potentially functional meniscus outweigh the risks of reoperation.

Arthroscopic Repair of Meniscal Tears that Extend into the Avascular Zone A Review of 198 Single and Complex Tears

Summary Vascularity in the human meniscus is poor beyond 1-2 mm from the meniscosynovial junction, yet 22% of the tears in this series occur with a ≥3-mm peripheral white rim. It is possible to suture these tears with the wider peripheral white rims, but healing rates are reduced because it is more difficult to obtain a satisfactory vascular supply. This article describes the history of our efforts at obtaining blood supply for healing of meniscus tears with a peripheral white rim up to 5 mm. Resection of the peripheral white rim to the vascular bed was unsatisfactory because it reduced the size of the meniscus and, by 3 years, the subsequent degenerative changes in the knee were comparable to meniscectomy. Holes made in the rim with a biopsy needle were again unsuccessful at improving healing. The present technique involves using rasps to abrade the parameniscal synovium on both the superior and inferior surface of the peripheral white rim. None of the peripheral white rim is resected. In the first series of 240 patients in whom peripheral white rim resection or the biopsy punch was used, the failure rate of meniscus healing was 22%. In a subsequent series of 68 patients (52 males, 16 females) who had 81 meniscal repairs by means of the rasp for parameniscal synovial abrasion, the failure rate was 9%. The rasp appears to be the safest and most effective method to gain vascularity for healing of meniscus repairs. It is possible to obtain healing with 5-mm peripheral white rims without resection of any portion of this rim, thus maintaining the full size of the meniscus.

J. Roger Clark

Papers

Vascularity for healing of meniscus repairs