Meniscus preservation; rationale, repair techniques and results

It is inescapable that loss of part or all of the structure of the meniscus of the knee alters the biomechanics of knee function leading to a gradual deterioration of the chondral surface, which ultimately will result in osteoarthritis. The goal of the knee surgeon should therefore be to preserve as much as possible the function of the meniscus. Classic teaching is that many meniscal tears, which are peripheral and longtitudinal, will heal if sutured and protected during a slow healing process. However it is clear that other tear configurations can heal if given the opportunity by adequate preparation of the meniscus rim, careful suturing and delayed rehabilitation. Thus some radial tears, horn avulsions, double longtitudinal tears and retears, previously thought to be irreparable, can be sutured with good results. Over 12 years, 288 meniscus repairs were undertaken in 265 patients ranging in age from 12 to 70 years. Most were repaired at the time of anterior cruciate ligament reconstruction, although 55 were isolated repairs. While the average time from injury to surgery was 11.7 months (1 - 72), one third of patient's already had chondral damage of at least Outerbridge Grade 2. The purpose of this paper is to report on the more difficult meniscus repair techniques and as such formal follow up was not undertaken to determine the final outcome of these patients. Never the less it is estimated from known data that there was a retear rate in the order of less than 10%. There have been three complications, 2 infections and one temporary neuropraxia of the common peroneal nerve; all of these healed completely with appropriate treatment. Therefore we recommend that meniscus repair should be undertaken if a clinical case for meniscal preservation exists, even if the appearances are not those classically recommended.