The role of meniscal repair for prevention of early onset of osteoarthritis

Abstract

Background: The meniscus plays an important role in the integrity of the knee joint. Therefore, meniscus tissue preserving techniques for the therapy of meniscus injuries seem to be reasonable. One of the important questions is whether meniscal repair can prevent the knee joint from early onset of osteoarthritis.

Methods: According to the review of the current literature, the principles of a successful meniscal repair are explained and the functional outcome and its impact on the prevention of osteoarthritis are analyzed in this article.

Results: Current data show a positive impact of a successful meniscus repair on the functional outcome in long-term. By this a protective effect on the development of osteoarthritis via the repair of meniscus lesions to restore the meniscus integrity can be confirmed. However, higher rates of re-operations in context to meniscus suturing have to be considered.

Conclusion: Due to the improved functional outcomes as well as preventive effect on the development of osteoarthritis within the knee joint in long-term, it is of importance to preserve as much meniscus tissue as possible in meniscus therapy. Patients previously have to be informed about the higher revision rate in context to meniscus suturing.

Keywords: Meniscus; Meniscus repair; Osteoarthritis of the knee; Prevention; Review.

Fig. 1

Schematic drawing: Mensical cross section, different tear types and their suturing potential. R-R: red-red-zone, R-W: red-white zone. W-W: white-white-zone: a longitudinal tear, b bucket handle tear, c radial tear, d flap lesion, e flap lesion with meniscal root participation. Different meniscal tear types: especially large bucket handle tears and radial tears that extend to the meniscal rim should be considered to be repaired

Fig. 2

Meniscus suture. Forty two years old woman, medial meniscus left knee: performed meniscus suture in the red-white area in an early degenerative knee joint. To support endogenous meniscal regeneration by vascular supply a trephination of the meniscus basis was performed prior to the suture. (published in (Zellner & Angele, 2017))

Fig. 3

Preparation of the meniscus lesion. Refreshing of the margins of a meniscus tear by a rasp to induce a slight bleeding as an obligate procedure before meniscus suture to enhance meniscus regeneration (published in (Zellner & Angele, 2017))

Fig. 4

X-ray post subtotal meniscectomy. Forty two year old man: X-ray of a left knee joint 7 years after subtotal meniscectomy. It shows a lost joint line on the medial site and signs of osteoarthritis of the knee (published in (Zellner & Angele, 2017))