In order to help preserve the integrity and function of meniscus, a repair should strongly be considered over a resection. There are currently several different implants and techniques that are used to achieve successful outcomes.
The current trend with repairing injuries to the meniscus is to keep all tissue intact whenever possible. Although repair techniques and devices have significantly improved since being introduced, in cases of total or complex traumatic lesions there continues to be many challenges.
The knee joint consists of a meniscus structure that is made up of a lateral and medial component located between the tibial plateau and femoral condyle. Each structure is a complex tissue comprising of cells, extracellular matrix molecules, as well as region specific vascularization and innervation.
Both the medial and lateral menisci (pleural for meniscus) are vital components in a healthy knee joint, and the main stabilizing ligaments include the transverse ligament, medial collateral ligament, and the meniscofemoral ligaments. In comparison to the medial menisci, the lateral menisci covers a larger area of the tibial plateau, and has a greater variety of thickness, shape, size, and mobility.
In the U.S., meniscal injuries are the most common type of intra-articular knee injuries, as well as the most common cause for surgical procedures by Phoenix orthopedic surgeons. With the amount of reported meniscal injuries each year, the annual incidence is 66 per every 100,000 persons. Typically, injuries are more common with men, and the right knee is injured more often than the left.
Classification of Meniscal Tears
Depending on how deep the tear is, the injury is observed as either a full or partial thickness, and a full thickness injury is categorized as unstable or stable. To help ensure a proper repair of the meniscus, a correct diagnosis is essential. This can include detailed information on the patient’s history, modern imaging techniques, and a thorough physical examination.
The classification of a meniscal injury depends on the thickness, location, and amount of stability.
- Red-Red Tear – A tear at the peripheral vascularized area is referred as a red-red tear.
- Red-White Tear – A tear of the middle third area is a red-white tear.
- White-White Tear – A tear of the inner avascular area is a white-white tear.
Meniscus Repair Techniques
Many repair techniques have been developed and applied to surgically repair meniscus injuries. As techniques go through continuous development, the four main techniques include:
- Outside-in
- Inside-out
- Open repair
- All-inside arthroscopic technique
A large amount of research has concentrated on the reliability and efficiency of repair techniques with achieving functional and anatomical restoration with the meniscus. With peripheral meniscus tears, successful outcomes by using these techniques with younger patients is fairly frequent, and the success rates vary from 63 to 91 percent. Additional follow up studies do need to be conducted in order to determine the long-term outcomes.
A tear in the avascular area of the meniscus is usually more complex and is often associated with poor outcomes following the repair. It is an ongoing challenge for researchers and clinicians to improve the treatment and recovery with this type of injury. Many different therapeutic approaches have been developed for this type of injury and have varying results.
The main treatment technique that is preferred and used with avascular area meniscal tears is a partial meniscectomy. The advantage with this technique is that long term outcomes are improved because less damage is done to the meniscus, and the biomechanical functions of the knee are able to be better preserved.
Inside-Out Technique is Preferred
With the many different repair techniques that have evolved and are available, the inside-out technique is a classic repair that many Phoenix sports medicine surgeons prefer. Although newer techniques may make repairs easier, the inside-out technique still offers many advantages.
Because of the versatility with the inside-out technique, most of the tear patterns to the meniscus are able to be addressed, and the long-term outcomes have proven results. With this versatility and positive outcomes, the inside-out technique is considered to be the gold standard in repairing meniscus tears.
Although there are many advantages with the inside-out technique, it can be associated with an increased surgical time, an increase in the risk of neurovascular injuries, as well as post-operative pain. Currently, the all-inside devices have been significantly improved, and clinical results along with fixation strength results have become comparable to the inside-out technique.
Many orthopedic surgeons in Phoenix now prefer this technique. However, this technique can also result in possible disadvantages, such as an increased risk with device problems, technical errors, neurovascular risks, cost, and possible meniscus damage due to the use of a larger diameter of insertion needles.
The all-inside technique, outside-in technique, and inside-out technique all have their own advantages, disadvantages, and indications. The top knee doctors in Phoenix and Scottsdale such as Dr. Sumit Dewanjee evaluate each patient thoroughly with an exam and imaging studies.
The actual decision of whether to repair a meniscus or shave it may end up being an intraoperative decision. For treatment with the leading orthopedic surgeon Phoenix and Scottsdale trust, call (480) 449-3979 today!
References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161498/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882713/
