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Journal of Clinical Orthopaedics and Trauma logoLink to Journal of Clinical Orthopaedics and Trauma
. 2022 Mar 3;27:101810. doi: 10.1016/j.jcot.2022.101810

Current concepts on meniscal repairs

Surasak Srimongkolpitak a,∗, Bancha Chernchujit b
PMCID: PMC8904242  PMID: 35282657

Abstract

The specific meniscus injury pattern were divided into many patterns. Nowadays, the meniscus root injury, radial tear meniscus, bucket handle tear meniscus and Ramp lesion were particularly focused on many way to manage and still controversial a lot of issues. Meniscus root tears (MRTs) and Ramp lesion are the most ignored, or misdiagnosed causes of chronic knee pain. Most patients delayed seeking treatment, consequently resulting in cartilage loss, and leading to the condition progressing to osteoarthritis knee. This has resulted in the rate of MR and Ramp repair increase significantly. The bucket handle meniscus tear trend to strong saving the anatomical meniscus and avoid to menisectomy. This article, on the other hand, will reveal you how to save and secure a nearly native meniscus fixation. In case of the radial meniscus, the partial meniscectomy is still used to treat this type of injury today, but it does not prevent degenerative changes from occurring, which can lead to unfavorable outcomes. Meniscal repair is a popular procedure for treating radial tears as an alternative to surgery. However, this pattern of meniscus tear can be difficult to repair and has a high failure rate, the arthroscopic meniscus repair techniques are published.

Keywords: Meniscal root tear, Bucket handle tear, Ramp lesion, Radial meniscus tear, Meniscus extrusion, Mason-Allen repair technique

1. Meniscus root injury

Injuries of the MR account for 12 to 14% of all the meniscus injuries, with a prevalence of 60–70 per 100,000 population. In addition, 7–8% can be discovered by coincidence, while performing other knee arthroscopy procedures. Approximately two-thirds are tears to the medial meniscus root, and about one-third being to the lateral meniscus root.1

The lateral meniscus root tear (LMRT) is more common in younger patients and is often associated with the anterior cruciate ligament (ACL), or multiple knee ligament injuries. By contrast, a medial meniscus root tear (MMRT) is more common in patients aged 40 years or over, often without there being a ligament tear, but with degenerative cartilage. The cartilage of the knee will deteriorate if left untreated for a long time.

The meniscus root is a robust structure and provides the attachment point of every knee meniscus. It is divided into anterior and posterior roots, where the anteromedial meniscus root provides the largest attachment point for the anterior intercondylar crest, and it is 9.2 mm from the anteromedial meniscus root to ACL, while the anterolateral meniscus root is attached to anterolateral 5 mm from the center of the ACL. The attachment point near the ACL footprint is at risk of injury during ACL reconstruction. The attachment site for the posteromedial meniscus root is 8.2 mm in front of the posterior cruciate ligament (PCL), while the attachment point for the posterolateral meniscus root is 12.7 mm in front of the PCL2 (Fig. 1).

Fig. 1.

Fig. 1

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Demonstrates the anatomy of the meniscus root of the left knee, including, both medial, and the lateral meniscus root.

Physical examination in MMRT has established that the source of tenderness occurs along the posteromedial joint line at the posterior of the knee, and a McMurray's test yielded a positive result. Additionally, LMRT has been characterized by a severe pivot shift test, as is often associated with ACL injury, and the occurrence of LMRT increases rotatory instability.

LaPrade3 proposes the following MRT classifications: Type I – a stable and partial radial tear, found in 7% of injuries; Type II – a totally radial tear, with a root tear gap of 9 mm found in 68%; , Type III - a complete tear accounting for the remaining 6%, and root detachment with bucket-handle tear,; Type IV – a complex radial oblique tear exhibiting total root detachment, accounts for 10% of cases,; Type V – a bone avulsion fracture of the root attachment, which accounts for 9% of cases (Fig. 2).

Fig. 2.

Fig. 2

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LaPrade classification of meniscal root injury.

MRI has been considered a gold standard in diagnosis of MRT. It assesses five positive findings, as shown in (Fig. 3). 1) In coronal T2FS knee a herniated meniscus found outside the margin of the proximal tibia, termed as meniscus extrusion; 2) A missing meniscus near the PCL, known as a ghost sign, detected in the sagittal T2FS knee; 3) In coronal T2FS, a gap in the meniscal root is termed a cleft sign; 4) In axial T2FS, a linear signal is found at the fracture site; 5) Bone marrow is often found subject to bone edema, and contusion under the tear.4

Fig. 3.

Fig. 3

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Right knee MRI showing medial meniscus root tear A) meniscus extrusion; B) ghost sign (MRI T2FS sagittal view); C) cleft sign (MRI T2FS coronal view); D) bone marrow edema under the medial tibial plateau.

For elderly patients, conservative treatment has been a mainstay treatment. For such patients, a large area of cartilage degradation exists that there is a higher chance of the failure meniscal root repair.5

The surgical treatment carried out has been a meniscus root repair, in consideration of the following indications which are the acute or chronic MRT, and have healthy articular cartilage (Outerbridge grading <2) (Fig. 6). By assessing the deformity of the knee joint (malalignment), joint space narrowing, ligament injury that may be determined to have already been present before treatment. For patients with joint-space narrowing, a malalignment greater than 5°, or a BMI larger than 30 kg/m2 constitutes a relative contraindication for meniscus root repair surgery, resulting in a high rate of failure.6

Fig. 6.

Fig. 6

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Shows the magic point percutaneous release, A) draw a posterior edge of the tibia, intersect with the joint line and draw the point up to proximal 1.2 cm. Use the No.18G needle to puncture this point in an extension position and apply valgus force to hear a ‘popping’ sound and B,C) Left knee arthroscopic images showing joint space before and after release showed a markedly wider joint space.

The main treatment methods for the meniscus root procedure include: a transtibial pull-out repair; a suture anchor repair; debridement and menisectomy; meniscal root reconstruction; high tibial osteotomy; and extrusion reduction, which by follows:

The transtibial pull-out method7 was the first and most widely used method of MR repair. This technique has a high mechanical strength and not need the specialized equipment. The advantages included, the facilitation of anatomical repair, high accuracy, and a supply of marrow blood issuing from the tibial tunnel, promoting healing. But the danger is that there may be a large separation between the footprint, and the tear site and tibial fixation sites, giving rise to increased vulnerable to the ‘bungee effect’. Self-healing could also be compromised if the fixing site moved as little as 1–2 mm. In addition, if other surgical methods were required, such as high tibial osteotomy, or ligament reconstruction, there would be a high risk of tunnel convergence, or tunnel jamming (Fig. 4).

Fig. 4.

Fig. 4

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Shows the transtibial pull-out root meniscus repair technique, and suture anchor fixation.

The authors used Maurice et al.8 (Fig. 5), using a soft anchor technique in combination with three normal anterior incisions, eliminating the requirement for an incision behind the knee. The soft anchor technique could be used in combination with other procedures like HTO, or ligament reconstruction without there being any tunnel convergence issues.

Fig. 5.

Fig. 5

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Shows the meniscus root repair technique by soft suture anchor of the right knee, where A) exhibits the soft anchor suture; B) the transtibial tunnel created to drag the soft suture anchor down from the joint, into the tibia; C) shows the soft suture anchor being pulled up to deploy the knot; D, E) represent the Mason-Allen suture method; F) shows an example of repairing of meniscus root using soft suture anchor technique.

Another significant problem encountered during MMRT surgery was that the surgical area is very narrow and limited as the MCL attached narrows the medial knee space and makes it difficult to insert suturing instruments. Occasionally, surgical instruments could damage the articular cartilage. As a result of these issues, the author reported a strategy called “Magic point release”9 (Fig. 6) to increase working area and improve visibility.

Meniscectomy, or debridement, was once a popular procedure. But its popularity has declined significantly in recent years, as surgeons have gained more information about MRT, increasing the preference to repair meniscus roots much more than in the past.

Lee et al.10 reported a new surgical technique called ‘meniscus root reconstruction for chronic injury with a large gap’. The ‘gracilis graft’ acts as a soft tissue bridge between the native meniscus root footprint, and the grafted meniscus root footprint, allowing for faster healing. Sutures cut through the meniscus root are less likely at the reconstruction site. They could also be secured to the bone with an interference screw, allowing for better tension control than the suture to post technique. However, this would depend on the surgeon's knowledge and ability, and there would be a risk of donor site morbidity. As a result, there has been no long-term follow-up (Fig. 7).

Fig. 7.

Fig. 7

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Shows the right knee undergoing meniscus root reconstruction, A) showing posterior medial root meniscus reconstruction with gracilis graft in patients with increasing gap; B, C) showing follow-up MRI after meniscus root reconstruction and complete healing has been achieved.

In patients with knee malalignment, the authors frequently combine MR repair with correction alignment by carrying out high tibial osteotomy (HTO), particularly in those with suspected long-term MRT. In practice, radiographic imaging of the one-leg-standing knee was indicated to evaluate joint space and the tibiofemoral axis before planning a corrective alignment procedure.11 Alignment might help in the attachment of the MR repair, because it reduces pressure on the repair site (Fig. 8). Several studies, however, imply that meniscus root repair might not be required. The results in the instance of HTO were not significantly different. However, in my opinion expressed the combined meniscus root repair technique with HTO was used to enhance anatomic healing of the meniscus root, decrease load to the medial knee compartment leading to more achieve MR repair and stop progressive osteoarthritis of the medial knee compartment.

Fig. 8.

Fig. 8

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A) One-leg–standing view of right knee, showing significantly narrowing medial joint line; B) MRI image showing cleft sign; C, D) Knee arthroscopic image showing MMRT and the repair. E) Post-operative radiographic image with HTO.

Extrusion reduction is a new technique that has been performed in combination with meniscus root repair in the knee.12 It has been thought to be beneficial in reducing stress at the repair site, improving shock absorption efficiency, and lowering the risk of future osteoarthritis. At short-term follow-up, Chung et al.13 found that patients had an improved Lysholm score, IKDC, as well as a decrease in KL grading evident from knee radiography imaging (Fig. 9). This procedure should be continued indefinitely.

Fig. 9.

Fig. 9

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Shows arthroscopic extrusion reduction techniques: A) transtibial pull-out technique; B.) all-inside suture anchor extrusion reduction technique of the right knee.

Patients who underwent meniscus root repair were shown to have a good clinical outcome when they obtained postoperative rehabilitation. The patient was only allowed to bear weight on the toes, and the range of motion was limited to 0–90°. The weight could be gradually increased after 6 weeks, and 3 months following surgery, the patient was able to return to performing usual activities. Knee flexion greater than 90°, should be avoided for at least 4 months, and for at least 6 months, there should be no squatting or jumping. Approximately 9–12 months after surgery.

2. Bucket handle tear

Bucket-handle meniscal tears account for 10%–26% of all meniscus tears and are characterized by a vertical or oblique longitudinal tear with an attached fragment displaced away from the meniscus's periphery and displacement of the inner segment into the intercondylar notch.14,15

The mechanical symptom of a meniscus tear in the bucket handle included locking, joint line pain, knee instability, and inability to achieve full extension. Because locked knee motion and special tests were frequently negative, the associated cruciate ligament could not be assessed.16

Bucket handle tears can be detected with MRI, especially when more than one characteristic radiologic indication is detected such as absent bow tie in sagittal view, fragment in intercondylar notch in coronal view, coronal truncation sign in coronal view, anterior flipped meniscus sign and double PCL in sagittal view are considered (Fig. 10).17

Fig. 10.

Fig. 10

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Showed MRI findings in bucket handle meniscus tear A.) Fragment in intercondylar notch at medial meniscus in coronal view MRI T2FS (white circle) B.) Double PCL sign at medial meniscus in sagittal view MRI T2FS C.) Truncation sign at medial meniscus in coronal MRI T2FS (Blue arrow) D.) Absent bow tie sign at posterior horn medial meniscus in sagittal MRI T2FS.

According to the authors' preferred surgical technique, we would consider four factors: tissue quality, meniscus reduction, healing stimulation, and secure fixation. Bancha et al.9 proposed and published the article in arthroscopy technique called “Magic point released”. We need adequate space to repair the medial meniscus, particularly because the medial tight compartment causes cartilage deterioration.

The meniscal-capsular junction was freshened up using a shaver and trephination technique, preparing the tissue surface for healing stimulation. The tissue quality was confirmed that the bucket-handle meniscal tear was amenable to repair, especially red-red and red-white zone or peripheral part of meniscus had a higher potential healing after repairing.

For preventing anatomical bucket handle repair mismatch, the meniscus reduction preferred to perform the inside-out technique by using a zone specific device from the anterior part to the body of the meniscus like a zip. Because of the irreducible bucket handle in these situations, there was a lot of scar tissue. The fibrous tissue was released through the knee's posterior compartment. (Fig. 12).

Fig. 12.

Fig. 12

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Showed inside-out repair technique in bucket handle of the lateral meniscus tear A.,B.) the lateral meniscus turned into the intercondylar notch and floated in coronal and sagittal view MRI T2FS C.) The lateral meniscus flip into the intercondylar notch at coronal view MRI T2FS C.) Arthroscopy view showed the zone specific device used inside-out repair from anterior horn to body of lateral meniscus D.) widening gap and irreducible the lateral meniscus to the meniscocapsular E.) fibrous tissue was released via posterior compartment of the knee F.) More mobilized the lateral meniscus and be able to reduce anatomical the lateral meniscus.

Circumferential vertical repair on both the upper and lower surfaces is the rule of secure fixation, which includes repairing the undersurface of the meniscus as well; otherwise, the meniscus would flip upward and a gap will occur beneath it, which will lead to failure (Fig. 11, Fig. 12). The turn menisci are distorted, bulbous, and have varying degrees of degeneration in the event of chronic bucket handle tears. Surface contact rather than suture-point contact is achieved with the Mason-Allen inside-out repair approach.18 (Fig. 13).

Fig. 11.

Fig. 11

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Showed inside-out repair technique in bucket handle medial meniscus tear A.) Double PCL sign at medial meniscus in sagittal view MRI T2FS B., C.) Arthroscopy view showed the longitudinal medial meniscus tear with filling into the intercondylar notch D.) Zone specific device used inside-out repair from anterior horn to body of medial meniscus E.) The posterior horn of medial meniscus was repaired by all-inside technique F.) Completely repaired at medial meniscus at least 6 stiches with hybrid technique.

Fig. 13.

Fig. 13

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Showed Mason-Allen inside-out repair technique in chronic bucket handle of the medial meniscus tear A.) Obviously deformed the medial meniscus in sagittal view MRI T2FS B.) The medial meniscus flip into the intercondylar notch at coronal view MRI T2FS C.) Arthroscopy view showed the body of medial meniscus filled into the intercondylar notch with closing the ACL D.) fresh tissue preparation after shaver and trephination E.) Mason-Allen inside-out repair technique at anterior to body of the medial meniscus F.) The knot tie closely the capsule and retrieval of sutures is done through the small wound.

The all-inside approach was used to repair the posterior horn meniscus, regardless of the fact that lateral meniscus repair had a higher risk of neurovascular injury. The average distance between the popliteal vessels and the posterior edge of the lateral meniscus was 17.3 mm in 90° of flexion compared to 11.3 mm in extended knee joints in the present research.19 The popliteal artery is in the line of instruments when doing an all-inside repair of lateral meniscal posterior horn tears located 5–10 mm from the lateral meniscal root via the conventional anterolateral portal.20 The knots were tied one by one close to the capsule for secure fixation and to avoid tying with the superficial branch of the saphenous nerve.

Postoperatively, Isometric exercises begin immediately after surgery, and the patient is ambulated on protected weight-bearing for the first two weeks with the knee immobilized in full extension with a brace. A range of motion exercise is commenced at 2 weeks of the postoperative period while the patient carries on with the isometric exercises. Often, the patient can straight-leg-raise at 2 weeks of the post operative period.

3. Ramp lesion

The Ramp lesion was reported in 17 of 183 isolated ACL reconstructions, resulting in a 9.3% incidence.21 Ramp lesions occurred 16.6% of the incidence in this patient population, especially in patients younger than 30 years of age, male patients, revision ACLR, preoperative side-to-side laxity >6 mm, and simultaneous lateral meniscus tears.22,23 Posteromedial visualization and posteromedial probing of the MM's posterior horn can improve in the detection of a high rate of ramp lesions that would otherwise go undiagnosed with conventional anterior visualization.24

There are 5 types of medial meniscocapsular tears, with type 1: being meniscocapsular lesions. These lesions are found in the synovial sheath's periphery. Probing mobility is limited. Type 2: lesions are partial superior lesions. These lesions are stable and only a trans-notch technique may be used to diagnose them. Probing mobility is limited. Type 3: partial inferior or concealed lesions that are not evident using the transnotch approach but are strongly suspected when there is significant mobility during probing. Type 4: full tear in the red-red zone with extensive probing mobility. Type 5: Double tear (Fig. 14).25

Fig. 14.

Fig. 14

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Classification of medial meniscocapsular tear (Ramp lesion).25

Many radiologists neglected to mention the Ramp lesion that was detected on MRI and determined that MRI had a low sensitivity (48%). On sagittal fat-saturated, T2-weighted images, a meniscal Ramp lesion and concomitant posteromedial tibial bone bruise pattern may be seen. The presence of a ramp lesion is indicated by 1. increase in signal intensity at the peripheral margin of the posterior horn of the medial meniscus at the meniscocapsular junction 2. posteromedial tibial bone bruise and posterior medial meniscal contusion (Fig. 15).26

Fig. 15.

Fig. 15

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Showed MRI findings Ramp lesion A.) increase in signal intensity at the peripheral margin of the posterior horn of the medial meniscus at the meniscocapsular junction in sagittal view MRI T2FS (yellow arrow) B.) Posteromedial tibial bone bruise and posterior medial meniscal contusion in sagittal view MRI T2FS (white circle).

In the case of ACL deficiency with Ramp lesion, external rotation and anterior translation laxities increased by up to one-third more than in the case of ACL deficiency alone, and nearly native knee functions were not achieved with ACL reconstruction alone, but could be successfully addressed via surgical Ramp repair.27 According to Dugas et al., there was a trend toward increased contact pressure and contact area in knees with meniscocapsular separation, as well as a trend toward a return to more normal circumstances after meniscocapsular repair, in 10 fresh-frozen cadaveric knees.28

No excessive anterior translation of the posterior horn of the medial meniscus probing from the anteromedial portal and measured less than 1.5 cm from the posteromedial portal were indicators to define the stable Ramp lesion. The clinical outcomes in stable Ramp lesion were treated with abrasion and trephination alone during ACL reconstruction resulted in similar clinical outcomes compared with those treated with surgical repair.29 For author prefers the all-inside repair technique (Fig. 16), Posteromedial compartment was inspected via trans-notch approach and then created the low posteromedial and high posteromedial portal (working portal) and posterolateral (viewing portal). The size of the Ramp lesion was determined by probing, then the lesion was debrided and the margins of the tear were shaved with a shaver. The all-inside suture hook repair is performed by manually, with the sharp tip penetrating the MM's peripheral wall from the outside to the inside. Next, the suture hook is passed through the central part (inner portion) of the MM. The free end of the suture in the posteromedial space is grasped and brought up to the high posteromedial portal. The knot is tied with a knot pusher. We recommended that 3–4 knots be used to provide the most stable repair site, and that the repair be completed using the probe to ensure the quality of the final repair.

Fig. 16.

Fig. 16

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Showed All-inside repair technique in Ramp lesion at left knee A.) Outside view showed a posterolateral portal for viewing portal and both of high and low posteromedial portals for working portal B.) Arthroscopy view showed a Ramp lesion and high and low posteromedial portals C.) Arthroscopy view showed a shaver debrided and prepared the meniscocapsular junction before repairing D.) The suture hook sutured by all-inside technique from a peripheral side to central side E.) Arthroscopy view showed a lateral meniscus was sutured by 2 stitches all-inside technique F.) The knot is tied with a knot pusher and probe confirmed quality of the repair site.

Postoperative rehabilitation, the active and passive range of motion is limited to 0–90° in the first 6 weeks with toe touch weight bearing and progression to full weight bearing by postoperative week 3. Jogging is permitted after week 12, pivot activity at 6 months, and full activity at 9 months for all patients.

4. Radial meniscus tear

Radial meniscus tears cut through the longitudinal collagen bundles that extend from the free edge to the periphery, running perpendicular to the meniscal axis and tibial plateau. Radial tears were found in 15% of patients with meniscal tears.30 Radial tears were detected in 7% of arthroscopy-detected meniscal tears in patients with a preoperative diagnosis of knee OA and/or chronic meniscal tears.31

Meniscal hoop stress is compromised in this radial meniscal tear pattern, resulting in a severe loss of function, and the likelihood of meniscal extrusion. A complete radial meniscal tear impairs the medial meniscus' ability to bear load and has been equated to total meniscectomy. According to biomechanics, radial tears are similar to total menisectomy, in that they reduce the contact area, and increase focal contact stress on articular cartilage, resulting in knee osteoarthritis.32

In comparison to all other morphologic tear patterns, medial meniscus radial tears result in the most damage to the posterior horn and are associated with the highest incidence of ipsilateral cartilage injury. Lateral radial tears are more common in younger individuals (the mean age being 32 years) and are associated with a higher incidence of ACL damage, (36%), compared to medial meniscus radial tears (8%).33 A 100% radial tear involving the rim, reduces the in-situ force of the lateral meniscus, and results in medial displacement, and valgus rotation of the tibia, though a radial tear of up to 66% width had no effect. The clinical significance is that a complete radial tear might result in there being excessive stress concentration at a focal area of the cartilage, which could increase the risk of osteoarthritis in the future.34

Only 37% of radial tears were being accurately detected by MRI. Radial tears can sometimes only be observed in one view, such as the coronal, or the axial view. In the MRI coronal view, a radial tear of the posterior horn may seem to resemble a “cleft,” whereas in MRI sagittal view, it may appear as “ghost/truncated."35 A tear at the junction of the horn and body - obliquely oriented relative to both coronal and sagittal planes - appears as a “marching cleft” extending away from the free edge. The detection rate of radial tears can be improved to 89% by scrutinizing the MR imaging findings36 (Fig. 17).

Fig. 17.

Fig. 17

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Showed MRI findings in radial meniscus tear A.) Cleft sign at medial meniscus in sagittal view MRI T2FS B.) Cleft sign at lateral meniscus in coronal view MRI T2FS C.) Ghost sign at medial meniscus in coronal MRI T2FS D.) Truncated sign at posterior horn medial meniscus in sagittal MRI T2FS E., F.) Marching cleft sign at medial meniscus in sagittal view MRI T2FS G., H.) Meniscus extrusion from radial tear at posterior horn medial meniscus in coronal view MRI T2FS.

Meniscus repair is important in restoring meniscal function, according to biomechanical studies. Radial tears in patients with OA are commonly treated with partial meniscectomy.37 The management the treatment of radial tears was divided into two categories: partial tear (inner edge), in which partial menisectomy is performed, and complete tear, performed all inside horizontal mattress suture (Fig. 18), inside-out horizontal mattress suture, and Transtibial tunnel pull-out repair (Fig. 19).38

Fig. 18.

Fig. 18

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Showed All-inside repair technique in radial meniscus tear A.) Cleft sign at medial meniscus in coronal view MRI T2FS B.) Arthroscopy view showed first stitch sutured by all-inside technique C.) Arthroscopy view showed second stitch sutured by all-inside technique D., E.) Arthroscopy view showed third stitch sutured by all-inside technique (FAST-FIX 360 S&N) F.) Completely repaired at posterior horn medial meniscus by 3 stiches all-inside technique.

Fig. 19.

Fig. 19

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Showed Hybrid repair technique (transtibial pull-out and All-inside repair technique) in radial meniscus tear A.) Cleft sign at medial meniscus in coronal view MRI T2FS B.) Arthroscopy view showed tibial tunnel was created by aiming device C.) Arthroscopy view showed PDS was inserted for preparing shuttle the fiber tape suture D.) Arthroscopy view showed fiber tape was pull down to the anteromedial of the tibia E.) Arthroscopy view showed Medial meniscus sutured by all-inside technique (FAST-FIX 360 S&N) F.) Completely repaired at posterior horn medial meniscus by 3 stiches all-inside technique and transtibial pull-out technique.

Author preference suggested three issues provide to the good outcomes in meniscus repair that stable fixation to counter hoop stress, biological with vascularity increasing healing potential. Meniscus repair should ensure that trephination, and debridement of the unstable area of the meniscus are carried out, and that all inside horizontal mattress sutures use at least 2 or 3 stitches, in particular, for the two sutures which are performed on either side of the lesion - one applied to the periphery, and the other, being to the axial, along the free edge, using an all-inside (hybrid implants, or suture passer approach). However, due to very close proximity to a neurovascular buddle, and to the popliteus tendon - located in the posterior horn of the lateral meniscus - deployment of an implant should be discounted in order to avoid any risk of damaging these structures. The efficacy of the repair site was evaluated by flexion and extension of the knee, confirming the repair site's stability (Fig. 20, Fig. 21).39 Meniscal repair techniques with a biologic component - such as inserting a fibrin clot at the repair site or performing concurrent marrow-stimulation to promote meniscal healing - have been documented in several studies.40

Fig. 20.

Fig. 20

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Showed All-inside repair technique in radial meniscus tear A.) Cleft sign at medial meniscus in sagittal view MRI T2FS B.) Arthroscopy view showed a posterior horn medial meniscus in completely radial tear pattern C.) Arthroscopy view showed the trephination for promoting the tissue healing by K-wire No. 1.6 D.) Arthroscopy view showed suture passer sutured by all-inside technique E.) Arthroscopy view showed medial meniscus sutured by all-inside technique (FAST-FIX 360 S&N) F.) Completely repaired at posterior horn medial meniscus by 3 stiches all-inside technique.

Fig. 21.

Fig. 21

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Showed All-inside repair technique in radial meniscus tear A.) Cleft sign at lateral meniscus in coronal view MRI T2FS B.) Arthroscopy view showed a posterior horn medial meniscus in completely radial tear pattern C., D.) Arthroscopy view showed a lateral meniscus was sutured by all-inside technique E.) Arthroscopy view showed a lateral meniscus was sutured by 2 stitches all-inside technique F.) Completely repaired at posterior horn lateral meniscus by 2 stiches all-inside technique.

Patients who underwent a radial meniscus tear repair were shown to have a good clinical outcome when they obtained postoperative rehabilitation. The patient was only allowed to bear weight on the toes, and the range of motion was limited to 0–90°. The weight could be gradually increased after 6 weeks, and 3 months following surgery, the patient was able to return to performing usual activities. Knee flexion greater than 90°, should be avoided for at least 4 months, and for at least 6 months, there should be no squatting or jumping. Approximately 9–12 months after surgery, patients can begin taking on sports activities. To preclude chance of injury they should be advised that before participating in any physically sport, to make sure that there are adequate levels of strength, flexibility, and balance.

Contributor Information

Surasak Srimongkolpitak, Email: mikemiky88@gmail.com, mikesportarthroscopy@gmail.com.

Bancha Chernchujit, Email: bancha61@yahoo.com, drbancha@msn.co.th.

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