AANA Lab Course 913 - Advanced Knee Course-Advanced Techniques _ Pushing the Envelope in Meniscus Repair Faculty Lecture

Advanced Techniques _ Pushing the Envelope in Meniscus Repair Faculty Lecture_ Michael A. Zacchilli, MD

Pdf Summary

This presentation by Dr. Michael A. Zacchilli focuses on advanced meniscus repair techniques, discussing epidemiology, biomechanics, imaging advances, surgical options, and patient outcomes for different tear types: ramp lesions, horizontal cleavage tears, and radial tears.<br /><br />Key imaging advancements include IVIM diffusion weighted MRI correlating vascularity with meniscal zones, confirming poorer vascularity in torn meniscus red zones, especially the posterior horn of the lateral meniscus. dGEMRIM techniques can differentiate meniscal tear grades by T1 relaxation times, indicating tissue quality and glycosaminoglycan content.<br /><br />Surgical resources such as "pie crust" techniques to increase medial compartment space during meniscectomy allow improved access, showing comparable short-term functional outcomes to controls.<br /><br />Ramp lesions—posteromedial meniscocapsular tears—occur in 9-13% of ACL injuries and cause increased tibial translation and rotational instability. Diagnostic MRI sensitivity improves with 3T scanners, but many ramp tears go undetected preoperatively. Biomechanical and clinical studies demonstrate that all-inside repairs restore stability effectively, especially when performed via posterior portals. Repairs show high healing rates (up to 97.8% on second-look arthroscopy) and better restoration of knee kinematics than untreated tears.<br /><br />Horizontal cleavage tears traditionally have been treated with meniscectomy. However, data indicate higher complication and failure rates with repair, though short-term outcomes show improvements and repair success rates around 77%, higher than previously thought. Meniscectomy provides symptomatic relief but may accelerate osteoarthritis progression.<br /><br />Radial tears compromise meniscal function and are deemed severe; repairs achieve 22–55% complete healing with good 2-3 year clinical outcomes. Rip-stop suture techniques are recommended to enhance repair durability.<br /><br />Overall, contemporary techniques emphasize mensical preservation using anatomic and biomechanical principles supported by advanced imaging. Repair approaches demonstrate better joint stability and potentially improved long-term outcomes compared to meniscectomy, urging surgeons to tailor treatment strategies based on tear morphology and patient factors.

Keywords

meniscus repair

ramp lesions

horizontal cleavage tears

radial tears

IVIM diffusion weighted MRI

dGEMRIM

pie crust technique

ACL injuries

meniscectomy

meniscal preservation