Meniscal injuries in the cruciate-deficient knee

The appropriate treatment of meniscal pathology, in the knee with an associated cruciate insufficiency, is dependent on a thorough understanding of the patient's clinical symptom complex, activity level, and the demands that that individual places on his or her knee. In the individual whose lifestyle places high demands on the knee, there is a high failure rate of meniscal repair in the presence of cruciate insufficiency. This failure rate can be obviated by either concomitant stabilization of the anterior cruciate or by significant activity modification or bracing of the knee. In those individuals in whom stabilization is not indicated because of a low demand on the knee, meniscal surgery may be performed as an isolated procedure with anticipated good results. That includes both resection of nonrepairable tears for the knee that presents primarily as locking as well as meniscal repair of appropriate lesions. In the knee with posterior cruciate insufficiency, there is greater concern about the development of degenerative changes, especially in the medial compartment. The surgeon should be aggressive in attempts at preservation of the meniscus in this setting. Posterior cruciate stabilization is less predictable given the present state of the art. However, it is recommended in the face of progressive degenerative changes. Additional considerations include appropriately timed osteotomy, especially in the face of combination injuries to the posterior cruciate and posterolateral corner as well as in future the possibility of meniscal allograft transplantation.