Meniscus Preservation: Repair to Replace (2025 Annual Meeting)-Meniscus Preservation: Repair to Replace

Video Transcription

Video Summary

This video features a comprehensive expert panel discussion on meniscus repair and replacement. Pat Smith from Naples, Florida, introduces a lineup of specialists who cover anatomy, biology, techniques, and clinical outcomes.<br /><br />Key highlights include:<br /><br />1. Meniscus Biology and Healing: Ashish Bedi reviews meniscal vascularity, noting healing potential is highest in the red-red zone and improves with modern repair constructs in red-white zones. Biologic augmentation such as marrow stimulation or fibrin clots may help but lack definitive clinical evidence. Complex tears, especially radial and root tears, remain challenging to heal.<br /><br />2. Repair Techniques: Travis Mack emphasizes repairing as much meniscus as possible with all-inside, inside-out, or hybrid techniques, tailored to tear type and tissue quality. Early repair, especially within six weeks and with concomitant ACL reconstruction, yields better healing. Repair of radial, bucket-handle, and Elmore tears requires anatomic reduction and stable fixation.<br /><br />3. Ramp Lesion Management: Romain Seil discusses the high prevalence (~20-30%) of ramp lesions in complex ACL tears. These often need a posterior medial approach for repair using suture hook techniques with absorbable PDS sutures, as non-repair increases meniscal damage and knee laxity.<br /><br />4. Root Repair and Centralization: Aaron Critch advocates early root repair to prevent cartilage degeneration and highlights new direct suture anchor techniques with ripstop sutures. Centralization procedures are increasingly used to reduce meniscal extrusion, especially when >3 mm, improving outcomes.<br /><br />5. Meniscus Transplantation: Rachel shares indications, surgical options, and expectations for meniscus allograft transplantation in symptomatic deficiency cases. While transplants can reduce pain and improve function, return to high-level sports is limited, and proper patient selection and managing expectations are vital.<br /><br />6. Case Discussions: The panel reviews diverse clinical scenarios—from older adults with chronic ACL deficiency to young athletes with complex tears—emphasizing individualized decision-making based on tear pattern, tissue viability, patient goals, and concomitant pathology.<br /><br />7. Technical Pearls: They stress anatomic repair with proper tensioning to avoid iatrogenic damage, the importance of preoperative alignment assessment (addressing varus deformity when needed), and judicious use of biologics given limited current evidence. Rehabilitation must be tailored to tear type and repair security.<br /><br />Overall, the discussion underscores that modern meniscus surgery strives to preserve native tissue whenever possible, employing advanced repair and augmentation methods. Early intervention and precise, tailored techniques improve healing potential, while meniscus replacement remains a critical option for irreparable tears, balancing benefits against realistic patient expectations.

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Keywords

meniscus repair

meniscus replacement

meniscal biology

meniscal healing

repair techniques

ACL reconstruction

ramp lesion

root repair

meniscus transplantation

anatomic repair

biologic augmentation

rehabilitation