The arthroscopic meniscal repair. Techniques and clinical experience.
Conservative meniscal repair should limit resection to only pathologic portions of the meniscus. The periphery of the meniscus is well vascularized, enabling healing of longitudinal tears. Sutures that perforate the meniscus vertically usually lead to stable healing. In arthroscopic meniscal surgery, isolated tears are sutured from within the joint, usually using techniques related to specially developed instrumentation. Our system uses three curved cannulas of various radii and a specific needle of 1.2 mm thickness, and can be operated by one hand while the joint is distracted with an AO/ASIF femoral distractor. In our series of 54 arthroscopic meniscal repairs, 42 (78%) healed without reinjury. Retears occurred in 12 patients, and were refixed again using the same techniques. Our experience has led us to conclude that the type of meniscal tear most suitable for arthroscopic repair is a vertical longitudinal lesion that involves the vascularized zone; abrading the synovial surfaces is helpful, as is positioning the sutures tightly together; the repair should be checked at 4 months by arthroscopy or by arthrogram; and a combination of nonabsorbable and resorbable sutures is most satisfactory. We believe that with experience arthroscopic meniscal repair becomes a less involved procedure than open repair, and that in the future such repair will be successfully extended to the more centrally located lesions.
Jakob
R P
RP
Department of Orthopaedic Surgery, University of Bern, Switzerland.
Stäubli
H U
HU
Zuber
K
K
Esser
M
M
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D002404:Catheterization / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D009339:Needles; D012008:Recurrence; D012421:Rupture; D013536:Suture Techniques / Q000295:instrumentation; D000070600:Tibial Meniscus Injuries