Arthroscopic meniscal repair using an exogenous fibrin clot

Abstract

In this series of 153 meniscus tears, 8% were isolated whereas 92% were in conjunction with anterior cruciate ligament (ACL) tears. Exogenous fibrin clot was injected with a blunt needle in the seam of the tear. One to 2 ml of clot was sufficient to fill an average defect. When gaps could not be closed, such as with a radial split or flap in the posterior one-third of the meniscus, a fascia sheath was used to cover these defects and the exogenous clot was injected under the cover of the sheath. ACL-deficient knees were stabilized with an intraarticular reconstruction. Overall results were 64% healed, 24% incompletely healed, and 12% failed (less than 50% of vertical height of tear healed). In ACL-associated knees, the failure rate was 1.5% for tears in which surgery occurred up to two months after the time of injury. The failure rate for tears surgically treated two months to several years after injury was 20%. Complex tears had an even higher failure rate of 22%. It is these tears that will be treated with the fascia sheath. The isolated tear failure rate was 41% without the exogenous fibrin clot versus 8% with the exogenous clot. Complications included retear and popliteal neurovascular injury. Repair of almost all menisci in young active athletes is possible using the transarticular arthroscopic technique with a posterior incision. Repairs of tears of less than two months' duration from the time of injury to surgery result in significantly higher healing rates than those of more chronic tears. Isolated repairs heal significantly better with exogenous fibrin clot injection.