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Review
. 2016 May 19;6(1):71-89.
doi: 10.11138/mltj/2016.6.1.071. eCollection 2016 Jan-Mar.

Meniscus tear surgery and meniscus replacement

Javier Vaquero  1 , Francisco Forriol  2
Affiliations
Review

Meniscus tear surgery and meniscus replacement

Javier Vaquero et al. Muscles Ligaments Tendons J. .

Abstract

Objective: the menisci are easily injured and difficult to repair. The aim of this study was to analyze the current state of meniscal surgery aimed at preserving morphology and conserving the biomechanics of the knee to prevent joint degeneration.

Methodology: a search of the electronic medical literature database Medline was conducted, from http://www.ncbi.nlm.nih.gov/pubmed. The search was not limited by language. Candidate articles were identified by searching for those that included the keywords meniscus, surgery, suture, implant, allograft. The limits were included for clinical research and clinical trials. Basic research was not included. The studies selected were evaluated and classified in three different categories: basic science, reconstruction (suture and meniscectomy) and implants (scaffolds and allograft).

Results: the consequences of meniscectomy performed at a young age can lead to a joint cartilage degeneration twenty years later. There are few surgical options for the repair of meniscal injuries in order both to preserve the meniscus and to ensure the long term survival of the knee joint, meniscectomy, repair, suturing the tear, or reconstruction, when a meniscal allograft or synthetic substitute is used to replace the meniscus, but the biomechanical properties of the native meniscus are not reproduced entirely by the scaffolds that exist today.

Conclusion: therapies that successfully repair or replace the meniscus are therefore likely to prevent or delay osteoarthritis progression.

Keywords: allograft; knee; meniscus; scaffolds; suture.

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Figures

Figure 1
Figure 1
Sheep meniscus, vessels border between the red and the white area (Spaltenholz technique).
Figure 2
Figure 2
a) Different types of meniscal tears: 1. horizontal, 2. vertical flap, 3. radial tear, 4. horizontal tear, 5. longitudinal tear; b) longitudinal tear; c) meniscus torn; d) meniscus pearl.
Figure 3
Figure 3
Experimental trephination in sheep meniscus: 4 months post-op without repair signs.
Figure 4
Figure 4
Sutured meniscus.
Figure 5
Figure 5
Sutures should mantained the tear edges in contact during the hoop stresses.
Figure 6
Figure 6
a) Collagen scaffold, b) scaffold 1 year post-op, c) scaffold reabsorbtion, 3 months post-op, d) second-look, scaffold integration with synovium reaction.
Figure 7
Figure 7
Frozen meniscus allograft with bone blocks before implantation.
Figure 8
Figure 8
Meniscus allograft presented a good meniscus –capsule integration, in a second look 9 months after surgery.
Figure 9
Figure 9
Meniscus shrinkage.
See this image and copyright information in PMC

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