Indications for Meniscus Repair

The Sports Medicine and Shoulder Department of Orthopaedic Surgery, Hospital for Special Surgery, NY 10021, USA.
Clinics in sports medicine (Impact Factor: 1.22). 01/2012; 31(1):1-14. DOI: 10.1016/j.csm.2011.08.012
Source: PubMed


The function and anatomy of the menisci are fundamental to the chondral protection and biomechanics of the knee joint. Healing of the meniscus after meniscal damage is crucial to preservation of its function. The ability to maximize healing after meniscal repair depends on accurate selection of repairable tears based on tear type and biology, patient selection and tear etiology, concomitant pathology, and meticulous repair technique. A thorough understanding of surgical indications and attention to each component of the algorithm that guides the decision for meniscal excision or repair improve identification of repairable meniscal tears, improve healing rates, and optimize surgical outcomes.

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    ABSTRACT: Over the past 2 decades there has been a profound shift in our perception of the role of the meniscus in the knee joint. Orthopaedic opinion now favors salvaging and restoring the damaged meniscus where possible. Basic science is characterizing its form (anatomy) and functionality (biological and biomechanical) in an attempt to understand the effect of meniscal injury and repair on the knee joint as a whole. The meniscus is a complex tissue and has warranted extensive basic science, translational, and clinical research to identify techniques to augment healing and even replace the meniscus. The application of quantitative magnetic resonance image sequencing to the meniscus and articular cartilage of the affected compartment promises to add a quantifiable outcome measure to the body of clinical evidence that supports restoration of the meniscus. This article discusses the recent advances and outcomes in the pursuit of meniscal restoration with particular focus on the use of augmentation strategies in meniscal repair, meniscal imaging, and translational strategies.
    The American Journal of Sports Medicine 08/2013; 42(4). DOI:10.1177/0363546513498503 · 4.36 Impact Factor
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    ABSTRACT: This systematic review explored reported outcomes addressing femoroacetabular impingement (FAI), specifically those comparing labral debridement to labral repair. In addition, the quality of the evidence was evaluated for the purposes of making treatment recommendations. Three databases (MEDLINE, EMBASE, and PubMed) were searched for comparative studies involving labral repair and debridement during FAI surgery. Two reviewers conducted a title, abstract, and full-text review of eligible studies and the references of these studies. Inclusion and exclusion criteria were applied to the searched studies, data were extracted, and a quality assessment was completed for included studies. Six eligible studies involving 490 patients were identified. The most commonly reported outcome measure was the modified Harris hip score (MHHS) (50 %). All studies reported that labral repair had greater postoperative improvements in functional scores (modified Harris hip, non-arthritic hip, hip outcome, and Merle d'Aubigne scores) compared to labral debridement. Five studies reported statistically significant improvements with labral repair. MHHS were pooled to demonstrate a clinically important difference in favor of labral repair by 7.4 points in three studies. The mean individual study quality can be considered fair. However, the overall quality of the body of evidence in this review is rated as low according to GRADE guidelines. This review demonstrates a reporting of better clinical outcomes with labral repair compared to labral debridement in all studies with five of six studies reporting statistically significant improvements (of repair over debridement). However, given the lack of high quality evidence and associated limitations in study design, these results should be interpreted with caution. Consequently, definitive treatment recommendations require further investigation with well-conducted clinical trials. This systematic review enables the discussion of best evidence practice for the surgical managing of a labral tear associated with FAI. LEVEL OF EVIDENCE: III.
    Knee Surgery Sports Traumatology Arthroscopy 02/2014; 22(4). DOI:10.1007/s00167-014-2886-8 · 3.05 Impact Factor
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    ABSTRACT: The use of platelet-rich plasma (PRP) to improve clinical outcome following a soft tissue injury, regeneration, and repair has been the subject of intense investigation and discussion. This article endeavors to relate clinical and basic science strategies focused on biological augmentation of the healing response in anterior cruciate ligament (ACL) and meniscus repair and replacement using PRP. Therein, a translational feedback loop is created in the literature and targeted towards the entire multidisciplinary team. Ultimately, it is hoped that the theoretical benefits of PRP on soft-tissue interfacial healing will emerge clinically following a careful, focused characterization at the benchtop, and prospective randomized controlled clinical study.
    The journal of knee surgery 08/2014; 28(01). DOI:10.1055/s-0034-1387166 · 1.44 Impact Factor
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