Abstract
Meniscus repair is now an accepted procedure, but many questions remain, regarding the results, indications versus meniscal resection. How to assess the results of meniscal repair?
Clinical results doesn’t allow to assess the healing rate. Some failure of healing can be asymptomatic. There is thus a need for an objective assessment of the healing process: by arthroscopy (but it is invasive); by MRI but the hypersignal in the meniscus area is difficult to interpret. The best way seems to be arthro CT, even if it is a quite invasive technique.
Indications: Indications mainly depend on two factors: location of the lesion stability of the knee
1. Location of the lesion.
In case of lesions in the red-red zone or red-white zone: the healing potential is good ameniscectomy would be total and would lead to secondary degenerative changes. it is thus the best indications for meniscal repair
In case of lesions in the white-white zone: the healing potential is poor the meniscectomy would be partial with usual good long term results.
Indications for meniscal repair should be very selective in this occurrence
2. Etiology
2.1. ACL Tears Meniscectomy is the key of degenerative process after ACL rupture. ACL reconstruction is able to preserve meniscal status
We must thus preserve the menisci as much as possible: by doing a meniscal repair in case of unstable extended lesions by abstention if he meniscal is table.
In all the cases, ACL should be reconstructed.
Results of meniscal repair in this context are good both in terms of clinical results and healing rate
Isolated meniscal repair should be only considered in presence of 4 criteria: symptomatic meniscal lesion, no functional instability, non repairable meniscal lesion, low demanding patient
2.2. Stable Knees
Meniscectomy remains the most frequent procedute in this condition with good functional results. But, according to the long term FU results (> 10year) (multi-centre study of the SFA 1996), the rate of asymptomatic knees is only 60% on the medial side, and 50% on the lateral side. The rate of joint line narrowing is 28% on the MM and 40% on the lateral side. The recovery after lateral meniscectomy is often long with a high rate of rearthroscopy (14%). There is a specific complication on the lateral side: rapid chondrolysis by young patients.
Meniscal repair should be thus proposed as often as possible
The best indcation is a peripheral vertical lesion by a young patient.
The rate of secondary meniscectomy is about 10% but the rate of complete healing is only 50 to 60% according to the literature.
Prognostic factors are: time to surgery: recent lesions have a better prognosis (12 weeks ?) extension of the lesion side of the lesion: lateral lesion is better than medial one.
Intrameniscal horizontal cleavage grade 2 lesion by young patients is a specific indication which gives good results and avoids a total meniscectomy.
Conclusion: Meniscectomy and meniscal repair are not opposite techniques but complementaries technique.
Meniscal repair should be recommended for red-red or red-white zone to preserve the meniscus and thus the cartilage, specially on ACL unstable knees, lateral side, young patients (children+++).
But many questions remain: which strength do we need ? what about shear forces is there any secondary degenerative changes of the meniscal tissue with an increasing risk of iterative tear which long term results with the new devices ?
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
