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.
    No preview · Article · Aug 2013 · The American Journal of Sports Medicine
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    ABSTRACT: Preservation of the meniscus has become the standard in sports medicine after evidence emerged that there was progressive chondrosis following total meniscectomy as performed over 40 years ago. In this chapter, we will address pertinent aspects of meniscal preservation; specifically addressing how meniscus repairs and partial resection are relevant to the cartilage surgeon. This will include the concept of the meniscus being a load distributor more than a shock absorber; the subset of meniscus pathology in the anterior cruciate ligament (ACL)-deficient knee joint will also be discussed. To allow a practical framework from which to direct patient care, general guidelines will be presented that will include the outcomes of meniscus repair in cartilage patients regarding tear configuration, age, and degeneration of the knee joint.
    No preview · Chapter · Jan 2014
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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.
    No preview · Article · Feb 2014 · Knee Surgery Sports Traumatology Arthroscopy
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