Current concepts in meniscus surgery: resection to replacement

Abstract

More recently, increasing attention has been turned toward the preservation and restoration of the medial and lateral menisci of the knee. The literature is replete with studies that cite the important biomechanical roles that the menisci play in shock absorption and load distribution across the knee in addition to contributing to stability, joint congruence, articular cartilage nutrition, lubrication, and proprioception. 1 Kettlekamp D. Jacobs A. Tibiofemoral contact area Determination and implications. J Bone Joint Surg Am. 1972; 54: 349-356 PubMed Google Scholar , 2 Walker P. Erkman M. The role of the menisci in force transmission across the knee. Clin Orthop. 1975; 109: 184-192 Crossref PubMed Scopus (814) Google Scholar , 3 Levy M. Torzilli P. Warren R. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64: 883-888 PubMed Google Scholar , 4 Radin E. de Lamotte F. Maquet P. The role of the menisci in the distribution of stress in the knee. Clin Orthop. 1984; 185: 290-294 PubMed Google Scholar , 5 Shoemaker S. Markolf K. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate deficient knee Effects of partial versus total excision. J Bone Joint Surg Am. 1986; 68: 71-79 PubMed Google Scholar , 6 Beaupre A. Choukroun R. Guidouin R. Knee menisci Correlation between microstructure and biomechanics. Clin Orthop. 1986; 208: 72-75 PubMed Google Scholar , 7 Baratz M. Fu F. Mengato R. Meniscal tears The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986; 14: 270-275 Crossref PubMed Scopus (647) Google Scholar Published data supports that meniscal attrition after subtotal meniscectomy could be associated with degenerative processes in adjacent articular cartilage surfaces. 7 Baratz M. Fu F. Mengato R. Meniscal tears The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986; 14: 270-275 Crossref PubMed Scopus (647) Google Scholar , 8 Johnson R. Kettelkamp D. Clark W. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974; 56: 719-729 PubMed Google Scholar , 9 Jorgensen U. Holm S. Lauridsen F. Long term follow-up of meniscectomy in athletes A prospective longitudinal study. J Bone Joint Surg Br. 1987; 69: 80-83 PubMed Google Scholar , 10 Bolano L. Grana W. Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med. 1993; 21: 432-437 Crossref PubMed Scopus (152) Google Scholar , 11 Osti L. Liu S. Raskin A. Merlo F. Bocchi L. Partial lateral meniscectomy in athletes. Arthroscopy. 1994; 10: 424-430 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 12 Hede A. Larsen E. Sandberg H. Partial versus total meniscectomy. J Bone Joint Surg Br. 1992; 74: 118-121 PubMed Google Scholar , 13 Anderson-Molina H. Karlsson H. Rockborn P. Arthroscopic partial and total meniscectomy Long-term follow-up study with matched controls. Arthroscopy. 2002; 18: 183-189 Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar , 14 Schimmer R. Brulhart K. Duff C. Glinz W. Arthroscopic partial meniscectomy A 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy. 1998; 14: 136-142 Abstract Full Text PDF PubMed Scopus (118) Google Scholar Despite this body of work, arthroscopic meniscectomy remains one of the most commonly performed orthopaedic procedures. The development of an increasingly more sophisticated and scientific understanding and approach to knee problems and, in particular, the natural history of the meniscectomized knee has raised concern for the risk of late degenerative arthrosis. Multiple other factors have continued to heighten interest in meniscal surgery, including the trend in our society for all age groups to place greater emphasis on fitness and remaining active. This has raised the demand for normalizing knee function, not only after injury, but also at extended follow up. Patients, the media, and clinicians alike all focus more attention on the treatment as well as the prevention of osteoarthritis. Furthermore, as more advanced technical capability has evolved as far as knee surgery is concerned, there is an increasing tendency to carry out more comprehensive arthroscopic and reconstructive surgical methods. Expanding surgical indications and demand now exists for anterior cruciate ligament (ACL) reconstruction, articular cartilage biologic resurfacing, and correction of axial malalignment as well as meniscal preservation or replacement surgery. Interest in the meniscus continues to remain in the forefront of basic scientific work, clinical study, and novel technology development. The purpose of this publication is to review the current and potential future approaches to meniscal pathology, including decision-making and indications for meniscal resection versus repair, and to report on several of newest devices and methods for repairing meniscal tears and replacing and transplanting meniscal tissue.