Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods

This study examined the effect of four different methods for treating intrasubstance meniscal lesions. Forty patients (21 men, 19 women; age 30.4 years, range 16-50) with an isolated and symptomatic painful horizontal grade 2 meniscal lesion on the medial side (documented with MRI) were included. Patients were randomly assigned by the birth date to one of four treatment groups: group A, conservative therapy (n = 12); group B, arthroscopic suture repair with access channels (n = 10); group C, arthroscopic minimal central resection, intrameniscal fibrin clot and suture repair (n = 7); and group D, arthroscopic partial meniscectomy (n = 11). The average length of follow-up was 26.5 months (range 12-38 months). Follow-up evaluation consisted of clinical examination with the findings recorded according to the IKDC protocol, radiographs, and control MRI. Group A had 75% normal or nearly normal final evaluation at follow-up, group B 90%, group C 43%, and group D 100% normal or nearly normal at follow-up. These short-term results indicate that intrasubstance meniscal lesions can be treated best by performing partial meniscectomy. To preserve the important function of the meniscus, arthroscopic suture repair with access channels might give even better medium- to long-term results. Conservative treatment is often not satisfactory. Additionally, our findings show that MRI examinations are not superior to accurate clinical examinations.