AANA/SOMOS Course Materials (August 2021)-MENISCUS REPAIR EXPANDING the “TARGET

MENISCUS REPAIR EXPANDING the “TARGET – RICH” ENVIRONMENT

Pdf Summary

This comprehensive presentation by Dr. Nicholas Gaglione from the Zucker School of Medicine focuses on meniscus repair, a common orthopedic knee procedure with about 1 million arthroscopies annually for meniscal pathology and a rising 37% trend in repairs over eight years. The meniscus is critical to knee biomechanics, and preserving it is vital because meniscal resection increases knee contact pressures and risk of osteoarthritis (OA).<br /><br />A detailed case of a 14-year-old male with a chronic displaced lateral meniscal bucket handle tear illustrates the typical clinical challenges and repair decisions. Key surgical options include resection or repair, with repair techniques such as inside-out, outside-in, and all-inside suturing methods. State-of-the-art repair favors vertical mattress sutures, precise insertion depth, and sometimes release of the medial collateral ligament (MCL) to access tight compartments without causing residual laxity or morbidity, backed by clinical studies affirming safety and functional outcomes.<br /><br />Biologic augmentation with fibrin clots, platelet-rich plasma (PRP), and marrow venting show promising evidence in enhancing healing rates and reducing failure. Postoperative protocols emphasize individualized rehabilitation focused on controlled range-of-motion progression and weight-bearing tailored to repair type and concurrent ACL status. Outcomes reveal meniscal repair as effective, with lower osteoarthritis rates compared to partial meniscectomy.<br /><br />Long-term studies underscore that meniscectomy, especially partial lateral meniscectomy, alters knee kinematics, increases OA risk, and contributes to decreased performance in athletes. Repair versus resection outcomes in ACL reconstruction patients show meniscal repair does not worsen short-term outcomes and maintains joint integrity better over time, though failure and OA rates increase with longer follow-up.<br /><br />In conclusion, meniscal repair—when tissue is viable and patient factors considered—is beneficial. Advances in arthroscopic techniques, biologics, and postoperative care are expanding the “target-rich” environment for improved meniscus preservation, enhancing knee function and long-term joint health.

Keywords

meniscus repair

arthroscopy

meniscal pathology

knee biomechanics

osteoarthritis risk

bucket handle tear

suture techniques

biologic augmentation

postoperative rehabilitation

ACL reconstruction