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30 years of age following a contact
injury. Posteromedial tibial edema
and meniscocapsular separation can
help raise awareness of the presence of
these lesions. Ramp lesions contribute
to rotatory instability and are often
associated with high-grade pivot shift.
Isolated ACL reconstruction in the setting
of a ramp lesion fails to restore native
knee kinematics. Ramp repair and ACL
reconstruction obliterates the pivot shift
in this challenging population. 22
Augmentation of meniscal repair
healing is an area of active research. Low
morbidity and cost-effective strategies
may include meniscal trephination,
synovial abrasion, and notch
microfracture (Figure 5). Application
of a fibrin clot has data to support its
use. Orthobiologics such as platelet-rich
plasma (PRP) and bone marrow aspirate
concentrate (BMAC) have unknown
impact on meniscal healing. 23
Rehabilitation guidelines following
meniscal repair continue to evolve
despite a paucity of evidence supporting
specific protocols. There are data to
24
suggest that weightbearing improves
meniscal compression and may aid
healing following repair of vertical
longitudinal (i.e., bucket handle) and
horizontal cleavage tears. However, early
weightbearing is likely detrimental to
healing and leads to an extrusion force
in root, radial, and complex patterns. 25,26
Protected range of motion is important
for joint nutrition and likely aids meniscal
healing. Flexion weightbearing increases
the load on the meniscus and should be
avoided in early rehabilitation. Patients
should avoid deep flexion, tibial rotation,
running, and cutting for several months
following surgery. Activity progression
27
should then follow both time- and
criteria-based progression, with formal
clearance for return to play.
In conclusion, surgeons are
encouraged to “SAVE THE MENISCUS.”
A high index of suspicion, knowledge
of evolving techniques, selective
augmentation of meniscus healing, and
individualized rehabilitation will optimize
the outcome of meniscal repair. Figure 5. Notch microfracture: a) awl placement in the notch and b) access to marrow elements.

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