Meniscus Repair and Transplantation Techniques

ABSTRACT

Modern meniscal repair incorporates multiple techniques and adjunctive measures. The classic inside-out repair remains the gold standard and is most appropriate for a bucket-handle type tear of the medial or lateral meniscus. The all-inside technique has gained in popularity recently and has outcomes that approach those of the inside-out repair with decreased morbidity but increased cost. The choice of this technique is most appropriate for small tears requiring few sutures to repair. Outside-in repair can also be employed and is preferred for anterior horn tears. Surgeons may use a hybrid technique that incorporates all techniques in some challenging cases. Meniscal debridement is used for degenerative tears that are not amenable to repair. Meniscal transplantation is an option for symptomatic meniscal deficiency in young, active patients. This article discusses the technical considerations for meniscal debridement, repair, and transplantation.

KEYWORDS

Meniscus - repair

REFERENCES

• 1 Brockmeier S F, Rodeo S A. Meniscal Injuries. Vol II. 3rd ed. Philadelphia/New York: W.B. Saunders; 2010
• 2 Arnoczky S P, Warren R F. Microvasculature of the human meniscus.  Am J Sports Med. 1982;  10 (2) 90-95
• 3 Clark C R, Ogden J A. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury.  J Bone Joint Surg Am. 1983;  65 (4) 538-547
• 4 Weiss C B, Lundberg M, Hamberg P, DeHaven K E, Gillquist J. Non-operative treatment of meniscal tears.  J Bone Joint Surg Am. 1989;  71 (6) 811-822
• 5 Talley M C, Grana W A. Treatment of partial meniscal tears identified during anterior cruciate ligament reconstruction with limited synovial abrasion.  Arthroscopy. 2000;  16 (1) 6-10
• 6 Stone R G, Frewin P R, Gonzales S. Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study.  Arthroscopy. 1990;  6 (2) 73-78
• 7 Greis P E, Bardana D D, Holmstrom M C, Burks R T. Meniscal injury: I. Basic science and evaluation.  J Am Acad Orthop Surg. 2002;  10 (3) 168-176
• 8 DeHaven K E, Black K P, Griffiths H J. Open meniscus repair. Technique and two to nine year results.  Am J Sports Med. 1989;  17 (6) 788-795
• 9 DeHaven K E, Lohrer W A, Lovelock J E. Long-term results of open meniscal repair.  Am J Sports Med. 1995;  23 (5) 524-530
• 10 Anderson K, Marx R G, Hannafin J, Warren R F. Chondral injury following meniscal repair with a biodegradable implant.  Arthroscopy. 2000;  16 (7) 749-753
• 11 Kurzweil P R, Tifford C D, Ignacio E M. Unsatisfactory clinical results of meniscal repair using the meniscus arrow.  Arthroscopy. 2005;  21 (8) 905
• 12 Siebold R, Dehler C, Boes L, Ellermann A. Arthroscopic all-inside repair using the meniscus arrow: long-term clinical follow-up of 113 patients.  Arthroscopy. 2007;  23 (4) 394-399
• 13 Cohen S B, Boyd L, Miller M D. Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: comparison of two all-inside meniscal devices.  J Knee Surg. 2007;  20 (3) 235-240
• 14 Borden P, Nyland J, Caborn D N, Pienkowski D. Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows.  Am J Sports Med. 2003;  31 (3) 374-378
• 15 Kocabey Y, Chang H C, Brand Jr J C, Nawab A, Nyland J, Caborn D N. A biomechanical comparison of the FasT-Fix meniscal repair suture system and the RapidLoc device in cadaver meniscus.  Arthroscopy. 2006;  22 (4) 406-413
• 16 Mehta V M, Terry M A. Cyclic testing of 3 all-inside meniscal repair devices: a biomechanical analysis.  Am J Sports Med. 2009;  37 (12) 2435-2439
• 17 Zantop T, Eggers A K, Musahl V, Weimann A, Petersen W. Cyclic testing of flexible all-inside meniscus suture anchors: biomechanical analysis.  Am J Sports Med. 2005;  33 (3) 388-394
• 18 Zantop T, Eggers A K, Weimann A, Hassenpflug J, Petersen W. Initial fixation strength of flexible all-inside meniscus suture anchors in comparison to conventional suture technique and rigid anchors: biomechanical evaluation of new meniscus refixation systems.  Am J Sports Med. 2004;  32 (4) 863-869
• 19 Marzo J M, Gurske-DePerio J. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.  Am J Sports Med. 2009;  37 (1) 124-129
• 20 DeBerardino T M. Arthroscopically assisted meniscal allograft transplantation.  Oper Tech Sports Med. 2005;  13 227-232
• 21 Fairbank T J. Knee joint changes after meniscectomy.  J Bone Joint Surg Br. 1948;  30B (4) 664-670
• 22 McNicholas M J, Rowley D I, McGurty D et al.. Total meniscectomy in adolescence. A thirty-year follow-up.  J Bone Joint Surg Br. 2000;  82 (2) 217-221
• 23 Burks R T, Metcalf M H, Metcalf R W. Fifteen-year follow-up of arthroscopic partial meniscectomy.  Arthroscopy. 1997;  13 (6) 673-679
• 24 Lee S J, Aadalen K J, Malaviya P et al.. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.  Am J Sports Med. 2006;  34 (8) 1334-1344
• 25 Cannon Jr W D. Arthroscopic meniscal repair. Inside-out technique and results.  Am J Knee Surg. 1996;  9 (3) 137-143
• 26 Johnson M J, Lucas G L, Dusek J K, Henning C E. Isolated arthroscopic meniscal repair: a long-term outcome study (more than 10 years).  Am J Sports Med. 1999;  27 (1) 44-49
• 27 Rubman M H, Noyes F R, Barber-Westin S D. Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.  Am J Sports Med. 1998;  26 (1) 87-95
• 28 Choi N H, Kim T H, Victoroff B N. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair.  Am J Sports Med. 2009;  37 (11) 2144-2150
• 29 Spindler K P, McCarty E C, Warren T A, Devin C, Connor J T. Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows.  Am J Sports Med. 2003;  31 (6) 929-934
• 30 Post W R, Akers S R, Kish V. Load to failure of common meniscal repair techniques: effects of suture technique and suture material.  Arthroscopy. 1997;  13 (6) 731-736
• 31 Rankin C C, Lintner D M, Noble P C, Paravic V, Greer E. A biomechanical analysis of meniscal repair techniques.  Am J Sports Med. 2002;  30 (4) 492-497
• 32 Barber F A, Herbert M A, Richards D P. Load to failure testing of new meniscal repair devices.  Arthroscopy. 2004;  20 (1) 45-50
• 33 Arnoczky S P, Warren R F, Spivak J M. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs.  J Bone Joint Surg Am. 1988;  70 (8) 1209-1217
• 34 van Trommel M F, Simonian P T, Potter H G, Wickiewicz T L. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone.  Arthroscopy. 1998;  14 (4) 360-365