Since King, 1936 classic research:“For meniscal lesions to heal they must communicate with the peripheral vasculature of the meniscus.” a lot of things have been said. Nowadays, proper patient selection plays a key role in successful outcomes. What do you think?
https://youtu.be/J6kWWoP4Hig
Presentation Meniscal Injury
Dear Gustavo
Meniscal tears are exceedingly common. Because the meniscus serves many vital functions to the knee joint, the preservation of meniscal tissue through meniscal repair is ideal. However, not all meniscal tears are amenable to repair, and each case must be critically assessed for repair suitability. It has been well documented that meniscal healing is enhanced in the setting of concurrent anterior cruciate ligament (ACL) reconstruction. This may influence the indications for repair, as well as the repair technique. Meniscal repair techniques have evolved over time from initial open repairs to inside-out and outside-in suture repairs to newer all-inside repair devices. The current gold standard remains inside-out vertical mattress suture repairs. All-inside repairs are best reserved for special circumstances, such as in the setting of concurrent ACL reconstruction
DearGustavo,
I think the classic principle that you cite above remains valid today. I think meniscal suture should be done in injuries which have the chance to heal. Such cases are the strict peripheral longitudinal tears which are located in a vascularized zone, although with scarce blood supply.
Dear Gustavo
Criteria are:
1. Age of patient
2. Time of injury (Acute or Chronic)
3. Area of injury
4. How extended is the injury
5. Complexity of injury
6. Activity of patient
So young active patient with acute extended unstable tear of meniscal injury situated in the red zone mainly and without ligament injuries (or injuries that are planned to be repaired or reconstructed during surgery), would be better to have this fixed.
Criterias are established for the repair, but all teras are not suitable for repair. Result after repair is also important than to repair only. Peripheral Bucket handle tear more than 1 cm with ACL reconstruction is the most accepted criteria I think.
http://link.springer.com/chapter/10.1007/978-3-662-49376-2_11
http://link.springer.com/chapter/10.1007/978-3-662-49376-2_9
Thank you Ibrahim for sharing with us both chapters you wrote. I hope I can also share with you some review about the Meniscus soon..; )
I´ve just uploaded my new presentation called Meniscal Injury.
I hope you like it!👍
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