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Meniscal repair.

Yoon KH, Park KH - Knee Surg Relat Res (2014)

Bottom Line: The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint.Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy.In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT
The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

No MeSH data available.


Related in: MedlinePlus

Illustration of the pull-out repair of the posterior root of the medial meniscus.
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Figure 4: Illustration of the pull-out repair of the posterior root of the medial meniscus.

Mentions: While lateral meniscal root tears are commonly associated with acute ACL injuries, medial meniscal root tears often occur secondary to degenerative joint changes58,59,64). Shelbourne and Heinrich65) recommended nonoperative treatment for lateral meniscus tears, such as posterior horn tears and peripheral or posterior third tears that does not extend further than 1 cm in front of the popliteus tendon. Ahn et al.66) reported good clinical outcomes and complete healing at second-look arthroscopy after all-inside meniscal repairs using a suture hook for the lateral meniscus tears combined with ACL injuries. Unstable root tears of the posterior horn of the medial meniscus can be treated either by the aforementioned all-inside repair techniques or by the pull-out repair. The pull-out repair principle is that the meniscus should be repaired to a freshened posterior bony bed. A posteromedial portal or posterior tran-septal portal can be used for additional visualization of the medial meniscal root and its insertion site67). If the introduction of an ACL guide is limited because of the medial femoral condyle (MFC) and soft tissue overlying the posterior cruciate ligament, notchplasty for removal of the synovium and 3 to 5 mm of the articular cartilage from the posterior aspect of the MFC can be performed59). Drilling is carried out from the anterolateral tibia to the base of the root footprint using an ACL guide and then sutures are passed through the meniscus using a suture shuttle device, pulled out through the bone tunnel, and tied anteriorly (Fig. 4)16). Lee et al.26) reported that all patients were able to return to their previous life activities with little or no limitation at a mean of 31.8-month follow-up and all the patients who underwent second-look arthroscopy showed complete healing. Kim et al.28) reviewed 22 meniscal root repairs using a pull out technique for a mean of 25.9 months. They observed significant improvement in functional scores and significant decreases in meniscal extrusions on MRI. However, only 64.7% of the patients who underwent follow-up MRI showed complete healing of the meniscus on MRI. Seo et al.68) reviewed 21 meniscal root repairs with pull out techniques for 13.4 months. They reported that complete healing was not observed in any of the patients who underwent second-look arthroscopy regardless of the improvement in subjective clinical scores.


Meniscal repair.

Yoon KH, Park KH - Knee Surg Relat Res (2014)

Illustration of the pull-out repair of the posterior root of the medial meniscus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061409&req=5

Figure 4: Illustration of the pull-out repair of the posterior root of the medial meniscus.
Mentions: While lateral meniscal root tears are commonly associated with acute ACL injuries, medial meniscal root tears often occur secondary to degenerative joint changes58,59,64). Shelbourne and Heinrich65) recommended nonoperative treatment for lateral meniscus tears, such as posterior horn tears and peripheral or posterior third tears that does not extend further than 1 cm in front of the popliteus tendon. Ahn et al.66) reported good clinical outcomes and complete healing at second-look arthroscopy after all-inside meniscal repairs using a suture hook for the lateral meniscus tears combined with ACL injuries. Unstable root tears of the posterior horn of the medial meniscus can be treated either by the aforementioned all-inside repair techniques or by the pull-out repair. The pull-out repair principle is that the meniscus should be repaired to a freshened posterior bony bed. A posteromedial portal or posterior tran-septal portal can be used for additional visualization of the medial meniscal root and its insertion site67). If the introduction of an ACL guide is limited because of the medial femoral condyle (MFC) and soft tissue overlying the posterior cruciate ligament, notchplasty for removal of the synovium and 3 to 5 mm of the articular cartilage from the posterior aspect of the MFC can be performed59). Drilling is carried out from the anterolateral tibia to the base of the root footprint using an ACL guide and then sutures are passed through the meniscus using a suture shuttle device, pulled out through the bone tunnel, and tied anteriorly (Fig. 4)16). Lee et al.26) reported that all patients were able to return to their previous life activities with little or no limitation at a mean of 31.8-month follow-up and all the patients who underwent second-look arthroscopy showed complete healing. Kim et al.28) reviewed 22 meniscal root repairs using a pull out technique for a mean of 25.9 months. They observed significant improvement in functional scores and significant decreases in meniscal extrusions on MRI. However, only 64.7% of the patients who underwent follow-up MRI showed complete healing of the meniscus on MRI. Seo et al.68) reviewed 21 meniscal root repairs with pull out techniques for 13.4 months. They reported that complete healing was not observed in any of the patients who underwent second-look arthroscopy regardless of the improvement in subjective clinical scores.

Bottom Line: The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint.Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy.In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT
The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

No MeSH data available.


Related in: MedlinePlus