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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
SPORT RELATED INJURIES
Minerva Ortopedica e Traumatologica 2009 August;60(4):317-29
Meniscus repair techniques
Rapley J. H., Barber F. A.
Plano Orthopedic and Sports Medicine Center, Plano, TX, USA
The intact knee meniscus cartilage contributes to normal knee function and stability. These specialized cartilage structures function to distribute loads, increase joint lubrication, provide stability, and enhance proprioception. When damage to the meniscus occurs, the surgeon has two options for treatment. The torn meniscus can be resected, or carefully repaired recognizing the limited healing potential of the meniscus and the increased risks associated with a meniscal repair. An overview of the basic science related to the meniscus, the clinical evidence for meniscal healing, and the various tear configurations are reviewed. Several techniques for meniscal repair are presented, including the classic suture techniques consisting of outside-in, inside-out, all-inside, and repairs using implantable devices. Meniscal repair systems and their basic materials, structure, and function are discussed. The evolution of repair devices and a description of the current self-adjusting suture based devices available are covered. Newer versions of these self-adjusting devices incorporating ultra high molecular weight polyethylene sutures have significantly improved the prior versions. The clinical evidence and the biomechanical data for these repair techniques can offer a profile of which meniscal tears are most likely to heal. Rehabilitation after meniscal repair focuses on the variables of early motion, weight bearing, and safe return to sports specific activities. Current trends in meniscus repair are presented and the future trends which may facilitate meniscal healing including advances in stem-cell research, growth factor influence, gene transfer methods and outcomes, and soft tissue meniscal scaffolds for recreation of the meniscus.