Meniscal Repair

Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 10/2009; 25(9):1033-44. DOI: 10.1016/j.arthro.2008.12.010
Source: PubMed

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.

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    ABSTRACT: The purpose of this study was to analyze histologic, biochemical, and biomechanical differences between zonal, regional, and anatomic locations of porcine menisci. We evaluated six menisci removed from pigs. Medial and lateral menisci were divided into three regions: anterior, middle, and posterior. In each portion, the central zone (CZ) and peripheral zone (PZ) were examined histologically (hematoxylin & eosin, safranin O/Fast green, and picrosiriusred staining), using scanning electron microscopy, biochemically (hydroxyproline assay for collagen content and dimethylmethylene blue assay for glycosaminoglycan [GAG] content), and biomechanically (compression testing). Collagen content in the CZ was lower than that in the PZ. GAG content in the CZ was higher than that in the PZ. GAG content in the PZ of the posterior portion was significantly higher than that in the anterior and middle portions. Compression strength in the CZ was higher than that in the PZ. The differences in cellular phenotype, vascular penetration, and ECM not only between CZ and PZ but also among the anterior, middle, and posterior portions were clarified in the immature porcine meniscus. This result helps further our understanding of the biological characteristic of the meniscus. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
    Journal of Orthopaedic Research 12/2014; 32(12). DOI:10.1002/jor.22687 · 2.97 Impact Factor
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    ABSTRACT: Background Arthroscopically assisted all-inside meniscal repair has become a popular treatment for meniscal tears. Previous studies have suggested a beneficial effect of concomitant anterior cruciate ligament reconstruction on meniscal repair outcomes. The effect of prior cruciate ligament reconstruction (predating the meniscal injury) on meniscal repair success is unreported. The aim of this study was to assess the success of meniscal repair in our practice. Further aims were to analyze the effect of concomitant- and past-anterior cruciate ligament reconstruction on meniscal repair outcomes. Methods Retrospective review of all patients undergoing arthroscopic meniscal repair during a 53 month period was performed. Mean followup was 13.5 months (mean 6–50). The primary outcome measure was meniscal reoperation. Results Sixteen of 104 patients required reoperation, giving an overall meniscal repair success rate of 85%. Patients undergoing concomitant anterior cruciate ligament reconstruction enjoyed significantly improved outcomes (91%, p = 0.049), while those with a past history of anterior cruciate ligament reconstruction had significantly worse meniscal repair success rates (63%, p = 0.016). Conclusions Arthroscopic meniscal repair in a selected patient group offers good success rates, especially when performed with concomitant anterior cruciate ligament reconstruction. We have identified a subgroup of patients, those with a past history of anterior cruciate ligament reconstruction predating the meniscal injury, who appear to have relatively poor outcomes from meniscal repair. Potential reasons for this finding are discussed. Level of Evidence Level IV, case series.
    The Knee 09/2014; 21(6). DOI:10.1016/j.knee.2014.08.014 · 1.70 Impact Factor
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    ABSTRACT: The meniscus plays important roles in knee function and mechanics and is characterized by a heterogeneous matrix composition. The changes in meniscus vascularization observed during growth suggest that the tissue-specific composition may be the result of a maturation process. This study has the aim to characterize the structural and biochemical variations that occur in the swine meniscus with age. To this purpose, menisci were collected from young and adult pigs and divided into different zones. In study 1, both lateral and medial menisci were divided into the anterior horn, the body and the posterior horn for the evaluation of glycosaminoglycans (GAGs), collagen 1 and 2 content. In study 2, the menisci were sectioned into the inner, the intermediate and the outer zones to determine the variations in the cell phenotype along with the inner–outer direction, through gene expression analysis. According to the results, the swine meniscus is characterized by an increasing enrichment in the cartilaginous component with age, with an increasing deposition in the anterior horn (GAGs and collagen 2; P < 0.01 both); moreover, this cartilaginous matrix strongly increases in the inner avascular and intermediate zone, as a consequence of a specific differentiation of meniscal cells towards a cartilaginous phenotype (collagen 2, P < 0.01). The obtained data add new information on the changes that accompany meniscus maturation, suggesting a specific response of meniscal cells to the regional mechanical stimuli in the knee joint.
    Journal of Cellular and Molecular Medicine 09/2014; 18(10). DOI:10.1111/jcmm.12367 · 3.70 Impact Factor