Expansion of indication for arthroscopic meniscal repair

Abstract

Conventionally, arthroscopic meniscal repair was indicated for tears without apparent degeneration located in the vascular region; however, in our experience, prognosis of partial meniscectomy in competitive athletes had been unsatisfactory. Consequently, in our current clinical practice, we have attempted to repair the meniscal tear in an avascular region or those with degeneration using the fibrin clot. In this presentation, surgical procedure of our technique is outlined and its short-term results are presented. In the repair procedure, arthroscopic inside-out technique using a zone-specific cannula is mostly employed while outside-in technique is utilized for repair of tears in the anterior region. The fibrin clot is intraoperatively prepared from the patient blood that is sterilely obtained from the vein of the foot on the operative side. The leading suture is placed at each end of the clot. Thereafter, the clot is introduced into the joint and attached to the repair site as in the inside-out meniscal suture technique. From 2012 to 2014, 23 torn menisci were repaired using this technique. In this series, only isolated meniscal tears in 10 medial and 13 lateral menisci were included. Status of healing was assessed with clinical examination, MRI. Second-look arthroscopy was performed for limited cases. Clinical healing was attained in 18 of the 23 knees. No significant difference in healing rate in types and location tears was demonstrated. Second-look arthroscopy showed satisfactory healing of the repaired site with reparative tissue.