Document Title: McLaughlin-TO-Mar93.shtml
Article Title: Arthroscopic Meniscus Repair: Recommended Surgical Techniques for Complex Meniscal Tears
Authors: Jeffrey R. McLaughlin, M.D., and Frank R. Noyes, M.D.
Publication: Techniques in Orthopaedics, Raven Press, New York.
Date: March 1993
Volume 8, Number 2, pages 129—136
Keywords: meniscal repair, menisectomy avoidance, meniscal preservation, inside-outside technique, careful suturing, complex meniscal tears, surgical repair techniques.

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Comments: This classic article is a must-read for anyone whose surgeon has recommended partial or full menisectomy. Please note that partial menisectomy is not much better than full menisectomy, as the first paragraph of the main text of this article makes clear. Losing even a small portion of a meniscus is a recipe for premature osteoarthritis, and so preserving every ounce of meniscal tissue should be a top priority. The value of meniscal repair, carefully done via suturing (using the techniques described in detail in this article), is clear. (Only if the meniscus has been shredded or otherwise extremely severely damaged is partial menisectomy appropriate. Few meniscal injuries fall into this category.) Dr. Noyes is considered a pioneer in the realm of meniscal-repair techniques; the suturing methods he devised in the 1980s are still the gold standard today. (It is interesting to note that the concept of meniscal repair is over a century old. Thomas Annandale, a British surgeon, foresightfully inaugurated the field in 1885.)

Summary: The surgical techniques required for repair of complex meniscal tears, including tears in the central one-third avascular region, are technically demanding. The technique requires that both superior and inferior sutures be placed in a stacking arrangement to completely approximate and close the meniscus tear site. This technique provides greater inherent stability to the meniscus repair site and also allows immediate knee motion. The use of many individual sutures meticulously placed to completely approximate and close the tear site permits more complex tears to be repaired, instead of excised, thereby retaining meniscus function. This article discusses the technique and principles important to meniscus repair.

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