AANA Middle East Arthroscopy Master Course (International)-Meniscectomy

Meniscectomy_Repair

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Dr. Robert Hunter presented at the AANA Middle East Arthroscopy Master Course in Dubai (Sept 2019) on meniscus pathology and management strategies. He disclosed consulting and royalty relationships with Smith & Nephew, and institutional support from several orthopedic device companies. Dr. Hunter emphasized meticulous technique in meniscectomy and repair, highlighting precise portal placement and leg positioning for optimal visualization.<br /><br />A key teaching was controlling knee alignment (valgus/varus) to improve visualization of the medial compartment, especially in cases with ACL insufficiency causing pivot shift and joint space narrowing. He stressed the importance of preserving loadbearing capacity during meniscectomy, cautioning that each meniscal tissue removal reduces its function and advising respect for articular cartilage.<br /><br />Meniscal tear management is influenced by tear morphology (vertical, radial, flap, degenerative), location (vascular zones red-red, red-white, white-white), size, and patient factors. Repair is ideal for acute, stable vertical tears under 1 cm in the vascular red-red zone. Dr. Hunter described his posterior-to-anterior repair approach: posterior third repaired all-inside, middle third inside-out or outside-in, and anterior third outside-in technique using specific instrumentation.<br /><br />He described an MCL relaxation technique to improve medial knee access and the use of microfracture near the ACL insertion to promote marrow element recruitment and enhance meniscal healing, citing animal studies demonstrating significantly better healing rates with microfracture.<br /><br />Dr. Hunter reviewed generations of all-inside repair devices and presented biomechanical data showing all-inside repairs performed comparably to inside-out techniques after fatigue testing. He emphasized combining careful surgical technique, appropriate device selection, and biological augmentation (microfracture) to optimize meniscus repair outcomes. The lecture concluded with affirming the importance of maximizing visualization and respecting knee biomechanics during meniscal surgery.

Keywords

meniscus pathology

meniscectomy technique

knee alignment

ACL insufficiency

meniscal tear management

vascular zones

posterior-to-anterior repair

MCL relaxation technique

microfracture healing

all-inside repair devices