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3 years ago

Meniscus Repair_TH_Gill_03 [Compatibility Mode].pdf

Meniscus Repair_TH_Gill_03 [Compatibility Mode].pdf

Partial Meniscectomy•

Partial Meniscectomy• When repair is not feasibleGuidelines for ArthroscopicResection• Remove all unstable fragments• Smooth remaining meniscal rim to remove suddenchanges in contour• Probe to gain information about mobility, texture t ofremaining rim• Protect peripheral rim and meniscocapsular junction• Use both manual and motorized tools• ? Leave more vs. less ?Why Repair?• Maintain load transmission• Minimize contact stress• Contribute to stability• Chondroprotective4

Predictors of SuccessfulMeniscal Repair• Acute > chronic• Traumatic > Nontraumatic» 73% vs. 42% (Venkatachalam 2001)• Tear location• Tear morphology» Longitudinal tear > complex / horizontal tear• Age of tear» Best results < 2-3 weeks (Jakob AJSM 1988)• Age of patient» < 30 y.o. = 12% failure, > 30 y.o. = 33% failure (Eggli AJSM 1995)Factors to Consider• Best healing rates (62-96%) with concomitant ACLR» Beware of arthrofibrosis !• Worse results in unstable knee (17-62%) Dehaven, 1990• Healing in stable knee» Clinical (subjective) criteria: 85-90% success» Objective evaluation of healing: 65-70%• Intra-substance degenerative changes inferiorhealing potential• Long term fate of asymptomatic partially healedmeniscus?“Tears That Should Be Repaired”(Shelbourne 1996)• Peripheral 10% to 30%• Within 3 or 4 mm of meniscocapsular junction• Vertical longitudinal tear > 10 mm long• Unstable tear to probing• No secondary degeneration or deformity• Active patient• Concurrent ligament stabilization or stable knee5

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