Meniscal Repair

Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 10/2009; 25(9):1033-44. DOI: 10.1016/j.arthro.2008.12.010
Source: PubMed


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.

Download full-text


Available from: Sebastian Kopf
  • Source
    • "Many patients who have sustained knee injuries desire treatment options that will enable them to continue sports participation. Over the past several years, the sports medicine community has seen an increase in the use of biological agents, including cell-based therapies for this purpose.78 The introduction of stem cells, specifically mesenchymal stem cells (MSCs), into the clinical setting has opened new knee treatment horizons (Figure 1).12 "
    [Show abstract] [Hide abstract]
    ABSTRACT: The relationship between biological tissue healing following knee injury or surgery and long-term clinical outcome has come to the forefront of sports medicine practice. This has led many knee surgeons to incorporate biologically mediated healing factors into the management of knee injuries. In particular, the clinical use of mesenchymal stem cells has opened new horizons. Relevant studies were identified through a search of PubMed from January 2000 to April 2011, combining the term mesenchymal stem cells with articular cartilage, anterior cruciate ligament, and meniscus. Relevant citations from the reference lists of selected studies were also reviewed. Knee injury treatment with mesenchymal stem cells shows potential. Most reports represent animal model studies; few advances have been translated to human clinical applications. Mesenchymal stem cell use to promote healing following knee injury is likely to increase. There are scientific methodological concerns and ethical and legal issues regarding mesenchymal stem cell use for treating knee injuries.
    Preview · Article · May 2012
  • Source
    • "Human menisci are populated by different cell types, responding differently to various stimuli released from the matrix [64, 65]. Different cells have already been used in studies on meniscal healing: mesenchymal stem cells (MSCs) deriving from synovial or bone marrow, chondrocytes, and fibrochondrocytes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Meniscal injuries in the vascularized peripheral part of the meniscus have a better healing potential than tears in the central avascular zone because meniscal healing principally depends on its vascular supply. Several biological strategies have been proposed to enhance healing of the avascular area of the meniscus: abrasion therapy, fibrin clot, organ culture, cell therapy, and applications of growth factors. However, data are too heterogeneous to achieve definitive conclusions on the use of these techniques for routine management of meniscal lesions. Although most preclinical and clinical studies are very promising, they are still at an experimental stage. More prospective randomised controlled trials are needed to compare the different techniques for clinical results, applicability, and cost-effectiveness.
    Full-text · Article · Jan 2012
  • Source
    • "Human menisci are populated by different cell types that might respond differently to various stimuli released from the matrix [13, 14]. Cell-based therapy has significantly contributed to develop tissue-engineering strategies consisting of cells-scaffold constructs able to promote healing in an avascular environment [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Meniscal tears are the most common knee injuries and have a poor ability of healing. In the last few decades, several techniques have been increasingly used to optimize meniscal healing. Current research efforts of tissue engineering try to combine cell-based therapy, growth factors, gene therapy, and reabsorbable scaffolds to promote healing of meniscal defects. Preliminary studies did not allow to draw definitive conclusions on the use of these techniques for routine management of meniscal lesions. We performed a review of the available literature on current techniques of tissue engineering for the management of meniscal tears.
    Full-text · Article · Jan 2012 · Stem cell International
Show more