Page 9 - SMU_Summer 2019 Issue 2_Web

T reatment of the knee meniscus remains

one of the most common entities in
orthopaedic practice. Classic thinking has

guided surgeons toward repair of only a
small subset of tear patterns, mainly red-

red vertical longitudinal tears in the setting
of traumatic knee injury. Other tear patterns typically

have been treated with partial meniscectomy, often
leaving the patient functionally meniscus deficient.

However, we now appreciate the critically There is growing evidence to support
important role that the meniscus plays the expansion of meniscus preservation.
in chondroprotection, shock absorption, Consequently, the incidence of meniscal
load distribution, proprioception, joint repair doubled from 2005 to 2011.
5
lubrication, and secondary stabilization. 1 Similarly, 70% of patients expect that
Meniscal compromise leads to altered their meniscus will be repaired when they
mechanics that may hinder daily go into surgery, and the primary focus
life activities and eventually lead to for the majority of patients is future risk
osteoarthritis (OA). A systematic of OA. Meniscal repair has been shown
2
6
review suggests 53.5% of patients treated to reduce the relative risk of OA nearly
with meniscectomy went on to develop 3-fold compared with meniscectomy, and
OA within a mean 13 years. It has it can restore articular contact pressures
3
also been suggested that as little as a to near-normal levels. Evidence suggests
7,8
10% meniscectomy is associated with that meniscal repair can also lead to
significantly lower athletic performance and success in challenging tear patterns,
damage to the knee joint. Improved tear including horizontal cleavage, radial,
4
recognition, innovative surgical techniques, and complex tear patterns. Horizontal
methods for biologic augmentation of and radial repairs have demonstrated as
meniscal healing, and understanding of high as 91% and 90% clinical success rates
rehabilitation have helped to expand the (Figure 1). Age also seems to have less
9,10
indications for meniscal repair. Surgeons of a negative impact on repair success,
are encouraged to consider meniscal and patients older than 40 years have
repair and to “SAVE THE MENISCUS.” shown good results. Our knowledge of
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Figure 1. Horizontal cleavage tear: a) before and (b) after repair.

Summer 2019, Issue 2 | sportsmed.org 7 