Meniscal repair is indicated for patients under age 50 or those in their fifties who are athletically active. Tears in the peripheral one-third vascularized region5 are well suited for repair and have high success rates. Arnoczky and Warren5previously described the vascu- larity of the menisci If an athlete suffers a meniscal root tear, the three options for treatment include: non-operative rehabilitation, surgery to trim out the area of torn meniscus or surgery to repair (stitch together) the torn meniscus. Root tears are repaired whenever possible based on their importance in limiting future knee arthritis. Repair ca Expanding Meniscus Repair Indications - Horizontal Cleavage Tears and Root Tears Peter R. Kurzweil, MD Memorial Orthopaedic Surgical Group Long Beach, CA Horizontal cleavage and Root Tears HCT -Traditionally Taught by Professors to Resect or Leave Alon
, except in cases in which the patient is a poor surgical candidate (significant comorbidities or advanced age), diffuse Outerbridge grade 3 or 4 OA of the ipsilateral compartment, non-symptomatic chronic meniscal root tears, and/or significant limb malalignment unless concurrently corrected (32, 55) Indications for a meniscal root repair include acute, traumatic root tears in patients with nearly normal or normal cartilage and chronic symptomatic root tears in young or middle-aged patients without significant preexisting osteoarthritis
Repair Indications Although meniscal preservation isimportant, only certain types of tearsare amenable to repair. Factors thatcontribute to good healing potentialand low failure rates have been wellstudied. The relative indications ofmeniscal repair are summarized inTable 1 Meniscal tears are common sports-related injuries in young athletes and can also present as a degenerative condition in older patients. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies Indications and Contraindications for Meniscal Root Repairs Meniscal root tear repairs should be considered in all patients who have a fairly normal activity level, knee ipsilateral compartment chondromalacia Grade II or less, and in those who may have a concurrent ligament reconstruction with evidence of extrusion of the meniscus The main indications for meniscal repair include (7,8): Acute, traumatic root tears in patients who have yet to develop osteoarthritis, with the goal of preventing arthritic changes in the future; Chronic symptomatic root tears in young or middle-aged athletes without significant pre-existing arthritis
Mensical root repair should be considered for patients with fairly normal activity levels and in those undergoing concomitant ligament reconstruction. Contraindications include: advanced arthritis, grade 3 to 4 (which is not amenable to a cartilage repair procedure) and significant malalignment The current trend when dealing with meniscus tears is preservation whenever possible. This way, meniscal repair techniques have significantly developed in recent years. There have been advances in both surgical techniques (e.g., techniques for root tear repair) and related devices Indications: Nontraumatic meniscal root tears without severe degenerative changes (Kellgren-Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament injuries Meniscus repair. Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully repaired depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is longer than for a meniscectomy Indications for surgical management of meniscal root tears include (1) isolated symptomatic MMRTs with minimal arthritis, (2) failure of nonsurgical management with continued activity-limiting pain, and (3) lateral meniscal root tears concomitant with an anterior cruciate ligament (ACL) tear
The transtibial meniscal root repair is emerging as the gold standard treat-ment due to its ability to restore a large footprint at the meniscal root's native at - tachment site and restore normal joint contact pressures.28,32,35,45 Additionally, preparing 2 transtibial tunnels to se The indications for meniscal root repair with a peripheral stabilization suture are clinical and radiographic evidence of complete detachment of the medial meniscus at or near (0-9 mm) the posterior root attachment with significant extrusion of meniscal tissue outside the joint, confirmed during arthroscopy The meniscus is important for load distribution, shock absorption and stability of the knee joint. Meniscus injury or meniscectomy results in decreased function of the meniscus and increased risk of knee osteoarthritis. To preserve the meniscal functions, meniscal repair should be considered as the first option for meniscus injury. Although reoperation rates are higher after meniscal repair. Medial meniscal root tears are often disabling injuries that can occur in isolation during low-velocity, deep knee flexion maneuvers in middle-aged patients. The most common meniscal root tear pattern is a radial tear near the root attachment (type II). Root tears are often associated with meniscal extrusion, identified on magnetic resonance.
The transtibial meniscal root repair is emerging as the gold standard treatment due to its ability to restore a large footprint at the meniscal root's native attachment site and restore normal joint contact pressures. 28, 32, 35, 45 Additionally, preparing 2 transtibial tunnels to secure the meniscal root to its attachment site further. The current trend when dealing with meniscus tears is preservation whenever possible. This way, meniscal repair techniques have significantly developed in recent years. There have been advances in both surgical techniques (e.g., techniques for root tear repair) and related devices. However, anatomical knowledge is crucial, and learning curve time for any technique should be considered Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 2014; 42:3016. Faucett SC, Geisler BP, Chahla J, et al. Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness The meniscal blood supply enters from the outer rim of the meniscus with only 25% of the meniscal tissues being perfused. 24 Since good perfusion is a prerequisite for healing after a meniscal repair, the cross-section of the menisci is being divided in a red-red (outer zone), a red-white (middle zone), and a white-white (inner zone)
Rehabilitation Protocol for Meniscus Repair This protocol is intended to guide clinicians and patients through the post-operative course for a meniscus repair. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. If you have questions, contact the referring physician One of the most frequent indications for arthroscopic knee surgery is a meniscal tear. 1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures. 2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. Partial. Indications for repair are acute root avulsions as well as selected chronic root avulsions in the absence of osteoarthritis . Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique [ 13 , 14 ]
For lateral meniscal radial root repair with an all-inside meniscal repair device, the knee is placed in a figure-of-4 position. Ideal viewing of the lateral meniscus should be from an anterolateral portal with FAST-FIX 360 all-inside meniscal repair device entry guided by a slotted cannula via an anteromedial portal to reduce the risk of vascular injury. 6 There may sometimes be a requirement. .g. bucket-handle) in the red-red and red-white zones. These devices are not to be used for meniscal tears in the avascular zone of the.
Today, with increased understanding of the impact of meniscal loss and the principles of meniscal repair and healing, meniscal preservation is viewed as an increasingly realistic and important goal in the management of meniscus tears. JAAOS - Journal of the American Academy of Orthopaedic Surgeons21 (4):204-213, April 2013 Indications for type II medial meniscus root repair are clinical and radiographic evidence of a radial tear within 0 to 9 mm from the medial meniscus root attachment, conﬁrmed during arthroscopy.9 The characteristic ghost sign, indicated by a sudden disappearance of a well-deﬁned meniscal structure
Video 1. The transtibial 2-tunnel root repair technique in a patient with a posterior medial meniscal root tear. The patient is placed in the supine position on the operating table. Standard anterolateral and anteromedial portals are created and the root tear is assessed with a probe for its severity and tear pattern Meniscus surgery is common, and surgical indications and techniques continue to evolve. After highlighting relevant anatomy and emerging magnetic resonance (MR) imaging techniques, this article reviews the current indications and techniques used for meniscus surgery, evaluates the use of MR imaging protocols with and without arthrography, and focuses on MR imaging interpretation of the. Arthroscopic Meniscus Repair: Minimally invasive surgery to repair torn knee cartilage Overview Arthroscopic meniscus repair is an outpatient surgical procedure to repair torn knee cartilage. The torn meniscus is repaired by a variety of minimally invasive techniques and requires postoperative protection to allow healing. Physical therapy is useful to regain full function of the knee, which. Meniscal transplant surgery is a type of surgery that replaces your missing or damaged meniscus with a meniscus from a cadaver donor. The surgery usually takes place under general anesthesia. Your knee has 2 wedge-shaped pieces of cartilage, 1 on each side of your knee. Each one of these pieces is called a meniscus.
Meniscal repairs are most commonly performed arthroscopically and can use inside-out, outside-in, or all-inside approaches. 16,24,34,45 While early repair techniques involved open, inside-out, and outside-in methods, there has been an increase in the use of all-inside techniques in the past decade, 36 perhaps because of the improvement of repair devices. 17 However, these techniques have a. . The amount of meniscal resection is less in 35% of cases, which shows partial healing of the meniscus. Revision of meniscal repair is another option and two small series reported 25 to 33% failure rate for the procedure
For introduction of allograft meniscus into the knee ⊲ Root repair system or other rigid targeting guide - Meniscal Repair and Resection Set (AR-4555S) ⊲ 2.4 mm drill or guide pin - Arthrex Drill Tip Guide Pin, 2.4 mm (AR-1250L) ⊲ Suture passing device (two) - Arthrex Zone Navigator (AR-7900), ZoneNavigator Anterio Meniscal root tears are defined either as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion. 10 20 Meniscal root tears have been previously classified into five types 21: (1) partial root tear, (2) complete radial root tear, (3) complete root tear with a. Indications for meniscal repair Traumatic meniscal tears in young active patients, as meniscus preservation, gives longer term cartilage protection. Locked knee, due to a bucket handle tear of the meniscus, is considered an orthopaedic emergency Recognition of specific tear patterns, including full-thickness radial tears, complex tears, and root tears will be emphasized. Variations of surgical techniques, such as transtibial pull-out for root tears, novel all-inside techniques, gold standard repair techniques, and transplantation will be covered A meniscus tear is a common knee injury. Most of the time, rest, ice, and pain meds are enough to help you feel better. But if they don't work, you may need surgery. Find out what is involved.
Meniscal injury is common, and the medial meniscus is more frequently injured. Younger and elderly patients typically sustain different types of tears. Optimal diagnosis and management is essential to prevent long term sequelae. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury The TRUESPAN™ Meniscal Repair System represents the next generation in all-inside meniscal repair devices. TRUESPAN is an implant and delivery system with a robust design and low-profile that is simple to deploy and versatile. Instructions for use are found in the information that accompanied the product packaging Objective Anatomic repair of the torn meniscal root using transosseous sutures through the proximal tibia. Indications Nontraumatic meniscal root tears without severe degenerative changes (Kellgren-Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament injuries Repair of Horizontal Meniscal Tears 30 patients across 10 centers 2 year f/u with MRI at 1 year, x-rays @ 2 years) ROOT Tears Patients often > 50 years old, overweight, non-athletic. Not typical repair indications Typical MRI shows ghosting on lateral view, extrusion on coronal vie
- Indications for Meniscal Root Repair • No OA • Young, active patients • Acute injury Feel Better. Do More. 303303‐233‐233‐1223‐1223 PanoramaOrtho.companoramaortho.com • repair. Tears. Indications for root repair 1. Chronic symptomatic root tear 2. Medial meniscus extrusion >3mm 3. Bone marrow edema 4. Varus malalignment of knee upto 3 degrees 5. Outerbridge 2 or Kellegreen-L a w r e n c e < 3 Contrindication for surgery is if varus is more than 3 degrees ,and poor prognosis is there if varus is more than 5 degrees. Menisectom Studies reporting the outcomes following meniscal root repair are generally limited to case-series or cohort studies. It is perhaps unsurprising that the results are somewhat conflicting (48,65,67,79,80,81) given that the indications for meniscal root repair techniques have evolved and that several different surgical techniques are described
A meniscus root repair is done by taking the torn meniscal root and tacking it down to the bone, using strong sutures. During this procedure, Dr. Verma will find the torn root and pull it against the tibia. He places sutures in the meniscal attachment, then threads the sutures through a hole that is pre-drilled in the front of the tibia.. The meniscal roots are responsible for maintaining placement and stability of the meniscus, and patients who have sustained a meniscal root tear often require surgery to properly repair the root or a meniscectomy. Studies have shown that a meniscal root repair procedure results in less stress in cartilage post operation 1 It's sometimes possible to repair a torn meniscus, especially in children and young adults. If the tear can't be repaired, the meniscus might be surgically trimmed, possibly through tiny incisions using an arthroscope. After surgery, you will need to do exercises to increase and maintain knee strength and stability Meniscal Repair & ACL recon. Seil R, OTSR 2009 Healing of meniscal repair. lih.lu 7 chl.lu ISAKOS Classification Anderson AF, AJSM 2011 Indications Types of lesions From Verdonk & Vererfve. The Meniscus - Beaufils & Verdonk (Springer 2010) Root Repair & Radial tear repair No WB Straight Leg Brace ROM 0-0-90 0-6 weeks Meniscal repair. 1. Indications Rim width - Distance of meniscal tear from meniscosynovial junction-Warren & Arnockzy < 3 mm-high rate 3-5 mm - variable >5 mm - not suitable for repair Cannon-Success rate 74% with rim widths 2 to 3.9mm , 50 % with rim widths 4 to 5 mm. 2
JuggerStitch™ Meniscal Repair Device. For product information, including indications, contraindications, warnings, precautions, potential adverse effects and patient counseling information, see the package insert and information on this website. To obtain a copy of the current Instructions for Use (IFU) for full prescribing and risk. Meniscal Repair: Overview: Meniscal tears occur in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear A meniscus tear requires a blood supply to heal which is present only in the peripheral third of the meniscus. Indications for repair mainly depend on location of the lesion and stability of the knee. Meniscal repair in the ACL deficient knee results in poorer results. Different arthroscopic techniques can be divided into three main groups. . Dehaven et al first stated the best indication for surgical repair was a tear within 2 mm of the peripheral junction 4 126 Lee et al. Reivew of Refixation of Medial Meniscus Posterior Root Tear al.10). The MMPRT is usually a radial tear located within 10 mm from the posterior root insertion of the meniscus. Such tears are common in Eastern countries, such as Korea, where a floor-based lifestyle is habitual and traditional11). In these populations
an athlete suffers a meniscal tear, the three options for treatment include: non-operative rehabilitation, surgery to trim out the area of torn meniscus, or surgery to repair (stitch together) the torn meniscus. The treatment chosen will depend on the location of the tear, the athlete's sport, ligamentous stability of th Patients who underwent inside-out meniscus repair demonstrated significant improvements on subjective outcome measures at a 2-year follow-up, regardless of the meniscal tear zone. Inside-out meniscal repair is recommended for potentially reparable meniscus tears in all 3 vascular zones. Root Repair meniscal root repair guide is placed through the medial portal at the footprint of the native posterior medial root attachment (white arrow). Fig 4. Left knee viewing from the lateral portal. A FlipCutter drill is used to create a tunnel at the anterior medial meniscus root attachment (white arrow). e2 M. DEFRANCE ET AL
Medial meniscus posterior root tear (MMPRT), including root avulsions and radial tears adjacent to the root, is biomechanically similar to total medial meniscectomy. 2,25,28 An MMPRT results in medial meniscal extrusion, which dramatically impairs hoop tension, which allows correct intra-articular load transmission 16 and for which the medial meniscus is approximately 90% responsible, thereby. The medial meniscus is a semilunar fibrocartilage structure that covers approximately 50% of the medial tibial plateau. 11 It is broader posteriorly, measuring approximately 11 mm in width, and becoming narrower anteriorly toward the anterior meniscal root. Some authors divide the meniscus into 3 segments (anterior horn, body, and posterior horn) while others divide it into 5 zones that are. A torn meniscus causes pain, swelling and stiffness. You also might feel a block to knee motion and have trouble extending your knee fully. Conservative treatment — such as rest, ice and medication — is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own
Trans-osseous repair of the root maintains hoop stresses in the meniscus and prevents extrusion, thereby offering some protection from cartilage degeneration. (Fig. 7) Fig. 7 a and b - Arthroscopic photos of a posterior root lateral meniscal tear with meniscal extrusion in the setting of ACL rupture. The root is not attached posteriorly Management of meniscal root tears has recently changed. Current options include nonoperative therapy, partial meniscectomy, and meniscal root repair. Meniscal root repair is intended to restore native joint biomechanics, though not all patients are candidates for surgery nor are all root tears amenable to repair
D. Anchor repair - insert anterior suture anchor - pass sutures through meniscus and tie down - technique used in meniscal transplant. 4. Meniscal Root Repair. Definition - tear of insertion of posterior horn of meniscus - difficult to fix - must repair down to bone. Technique - ACL guide - drill hole up into mensical root insertio The indications for partial meniscus substitution are restricted to adult patients with the following profile: patients with post-meniscectomy symptoms, chondral injuries up to grade 2 according to International Cartilage Repair Society (ICRS)-criteria, stable knees or knees stabilized in the same procedure and a preserved meniscal rim The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol. 2004 Oct. 33(10):569-74. . Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT. Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows The chapters dedicated to the surgical management of meniscal pathology - including partial meniscectomy, meniscus repair, meniscal root repair and meniscal allograft transplantation - include step-by-step descriptions of various operative techniques, including pearls and pitfalls for the reader in addition to classic case examples Indications for meniscal repair include patients with an acute history whose cartilage has a normal or near normal appearance, as well as patients with chronic symptoms without preexisting significant osteoarthrosis. 25, 35, 42 Contraindications include diffuse chondral injuries grades 3 and 4, uncorrected misalignment, root lesions with.
It is often observed after meniscectomy (1,6,7), meniscus root tears (8), discoid LM (6,9) and in aging (10-12). Consequently, meniscal extrusion initiates osteoarthritis (OA) and is accompanied by its progression (13-16). Posterior root tear (PRT) is an avulsion injury or radial tear within 1 cm of the meniscal attachment site. L Meniscal Repair Indications for Repair. Only 20% repairable. 1. Red / Red longitudinal tear - outer 3mm / meniscocapsular junction. 2. Red / White longitudinal tear - only one side of tear vascularised. 3. Young patient. Contraindications to repair . 1. White / White. 2. Complex / Horizontal / Radial / Degenerative tears. 3. Tears that are. The goal of meniscal transplant surgery is to replace the meniscus cushion before the articular cartilage is damaged. The donor meniscus is intended to take the place of the native meniscus, relieve knee pain, and prevent the progression to osteoarthritis. Allograft Preparation. Healthy cartilage tissue is taken from a cadaver (human donor) and. Most of the time a traumatic lesion is a vertical or a longitudinal tear. Meniscal tears are either due to an excessive force applied to a 'normal' meniscus or a normal force acting on a degenerative meniscus. The most common mechanism of injury is a twisting injury on a semi-flexed limb through a weight bearing knee
View Evaluation_Treatment_and_Outcomes_of_Meniscal_Root_Tears.pdf from AA 1| Evaluation, Treatment, and Outcomes of Meniscal Root Tears A Critical Analysis Review. Meniscus repair: Meniscus repairs are typically performed in certain patterns of tears and in certain locations. It is important to understand the indications, success rates, and potential complications of these types of procedures. This procedure is most common in younger patients and often during concomitant surgical procedures such as. . A stable knee is important for successful meniscus repair and healing
A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci.When doctors and patients refer to torn cartilage in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae.Menisci can be torn during innocuous activities such as walking or squatting.They can also be torn by traumatic force encountered in. 6. Increase portal size and draw meniscus allograft into knee 7. Secure the meniscus a. Tie posterior root suture over button (1 fixation point) b. Repair posterior horn with all-inside devices (2 fixation points) c. Repair body using outside-in or inside-out technique (2 fixation points) d. Place anchor for anterior horn (1 fixation point) e (11.3%) was largely reserved for patients with partial stable type 1 tears or those with grade 3 or 4 osteoarthritis in which a meniscal root repair is contraindicated.3,12 One suture anchor repair and 1 open reduction internal fixation were performed in patients with type 5 injuries pathoanatomy. in throwers may be due to tightness of the posterior-IGHL which shifts the glenohumeral contact point posterosuperiorly and increases the shear force on the superior labrum. SLAP lesion increases the strain on the anterior band of the IGHL and thus compromises stability of shoulder. Associated conditions
Incidence: 7 - 14% in patients undergoing ACLR. Normal LM root attachment. LM root tear. 16:13 Grade Three Pivot Shift Repair, Ultra Tape. 16:50 - Fast Fix - Inside Fixation. Courtesy of Charlie Brown. 18:42 Inside-Out Meniscal Repair Technique. Still the Gold Standard for Meniscus Repair. 20:13 Fibrin Clot Meniscus Repair. The meniscus is the soft rubbery bumper cushion that sits between the thigh bone and the leg bone. There are two menisci in the knee; a medial (inside) and a lateral (outside) meniscus. These structures act as shock absorbers that decrease the stress seen by the articular cartilage found on the end of the thigh bone and leg bone
Indications for meniscal repair include patients with an acute history whose cartilage has a normal or near normal appearance, as well as patients with chronic symptoms without preexisting significant osteoarthrosis. 25 25 Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment Lateral Meniscus Transplantation: Indications and Case Presentation. FEATURING Martin Lind. 122 views MCL Reconstruction MCL Repair Medial Femoral Condyle Medial Plica Syndrome Medial Plication Meniscal Cyst Meniscal Repair Meniscal Root Repair Meniscectomy Meniscus Transplantation Microfracture Mosaicplasty MPFL Reconstruction MPFL Repair. Learn the Arthroscopic lateral meniscal repair with fibrin clot and bone marrow aspirate using Smith and Nephew Fast Fix 360 system surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Arthroscopic lateral meniscal repair with fibrin clot and bone marrow aspirate using Smith and Nephew Fast Fix 360.