[Arthroscopic meniscal repair with bioresorbable implants].
OBJECTIVE
Restoration of the shape and function of a torn meniscus.


METHODS
Complete or large incomplete longitudinal tear of the medial and lateral meniscus close to the base, large flap tear, so-called bucket-handle tear.


METHODS
Degenerative meniscal tissue. Unstable knee joint without concomitant surgical stabilization. Complex meniscal tear or radial tear. Tear in the central avascular region. Gonarthrosis. Joint infection. Local skin disorders.


METHODS
Visualization of the meniscal tear and revitalization of the tear margins with a meniscal rasp or shaver. Introduction of the implant using the surgical technique required and repair of the tear. Percutaneous trepanation of the meniscal base ("needling") to improve healing.


METHODS
Full weight bearing only with the knee joint extended in an orthosis until after the 6th postoperative week. Knee flexion up to 30 degrees without weight bearing for the first 2 postoperative weeks with physiotherapy, then up to 60 degrees for another 4 weeks. Short movable knee orthosis with 0-0-90 degrees in the 7th-12th postoperative week. After the 12th postoperative week, continuation of physiotherapy without orthosis, until range of movement has been achieved and the knee-stabilizing muscles have regained their strength. Full sporting capacity after 6 months.


RESULTS
The healing rate for meniscal repair with bioresorbable implants is between 86% and 95% and is comparable with the average healing rate for open (84-88%) or arthroscopic suture techniques (98%). Between July 1999 and June 2001, a meniscal tear was treated with Clearfix screws in 65 patients. 60 patients (92%) had a follow-up examination on average 18 months postoperatively. Six patients underwent further arthroscopic surgery as a result of pain (four times healed, twice not healed). Another three patients complained of pain on weight bearing at the follow-up examination and had clinically positive meniscus signs. These patients were then evaluated as "treatment failures". The clinical healing rate was therefore 92% (55 out of 60).
Bohnsack
Michael
M
Orthopädische Klinik der Medizinischen Hochschule Hannover, Klinik II im Annastift, Anna-von-Borries-Strasse 1-7, D-30625 Hannover, Germany. bohnsack@annastift.de
Rühmann
Oliver
O
D020341:Absorbable Implants; D020679:Arthroscopes; D001696:Biomechanical Phenomena; D006801:Humans; D007103:Immobilization; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008592:Menisci, Tibial / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D013165:Splints; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D000070600:Tibial Meniscus Injuries