Abstract
The meniscus plays an important role in preventing osteoarthritis of the knee. Repair
of a meniscal lesion should be strongly considered if the tear is peripheral and longitudinal,
with concurrent anterior cruciate ligament reconstruction, and in younger patients.
The probability of healing is decreased in complex or degenerative tears, central
tears, and tears in unstable knees. Age or extension of the tear into the avascular
area are not exclusion criteria. Numerous repair techniques are available, and suture
repair seems to provide superior biomechanical stability. However, the clinical success
rate does not correlate well with the mechanical strength of the repair technique.
Biologic factors might be of greater importance to the success of meniscal repair
than the surgical technique. Therefore, the decision on the most appropriate repair
technique should not rely on biomechanical parameters alone. Contemporary all-inside
repair systems have decreased the operating time and the level of surgical skill required.
Despite the ease of use, there is a potential for complications because of the close
proximity of vessels, nerves, and tendons, of which the surgeon should be aware. There
is no clear consensus on postoperative rehabilitation. Weight bearing in extension
would most likely not be crucial in typical longitudinal lesions. However, higher
degrees of flexion, particularly with weight bearing, give rise to large excursions
of the menisci and to shear motions, and should therefore be advised carefully. Long-term
studies show a decline in success rates with time. Further studies are needed to clarify
the factors relevant to the healing of the menisci. Tissue engineering techniques
to enhance the healing in situ are promising but have not yet evolved to a practicable
level.
Key Words
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Article info
Publication history
Published online: February 27, 2009
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
