Meniscus repair

Biomechanics, vascularity of the meniscus, and results of meniscectomy(even by arthroscopy) with a significant rate of secondarychondral damage led to the concept of meniscus preservation. It canbe done by abstention (no treatment of a meniscal lesion) or bymeniscal repair.Meniscus repair is now an accepted procedure. Open technique isa safe technique. Arthroscopic techniques were first developed asin-out or out-in techniques requiring a posterior open approach toavoid any neuro-vascular damage. All inside techniques were thendeveloped, using bio-absorbable devices or, more recently, stitches.Clinical results are good, especially regarding the rate of secondarymeniscectomy (21% in the symposium of the French ArthroscopySociety). The healing rate is assessed by objective imaging technique,that is to say arthro CT scan. In the SFA prospective study,76% of the meniscal tears have a surface healing of more than 50%.Indications mainly depend on two factors : location of the lesionand stability of the kneeLesions in the red-red zone or red-white zone are the best indications.On the contrary, indications for meniscal repair should bevery selective in the case of white-white zone lesions.In conjunction with ACL tear, menisci should be preserved as muchas possible by meniscal repair or by abstention if the meniscal lesionis stable.In all the cases, ACL should be reconstructed. Onstable knees the best indications of repair are a peripheral verticallesion in a young patient or a horizontal cleavage in a young athlete(open technique).Prognostic factors are: time until surgery, extension of the lesion,and side (lateral is better than medial meniscus).