Document Title: Noyes-AJSM-Jul02.shtml
Article Title: Arthroscopic Repair of Meniscal Tears Extending into the Avascular Zone in Patients Younger Than Twenty Years of Age
Authors: Frank R. Noyes MD and Sue D. Barber-Westin
Publication: The American Journal of Sports Medicine, Baltimore
Date: July 2002
Volume 82, pages 711-715
Keywords: Meniscal repair, biomechanical importance of fully intact menisci, pediatric knee injuries, knee biomechanics, component interdependency, compression and shear stressing, physiological forces, bearing surfaces, articular surfaces, meniscal cartilage, knee longevity.

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Comments: An absolutely superb article. Frank Noyes and Sue Barber-Westin, both highly esteemed researchers in the realm of knee longevity, point out that a meticulous inside-out vertical divergent suture technique is well worth the extra time and effort on behalf of the surgeon. They recommend meniscal repair over partial menisectomy, particularly in cases where the patient is young. The article brilliantly illustrates how important the menisci are to proper knee functioning and overall joint longevity. Even a loss of a small portion of a meniscus is a recipe for serious problems (premature osteoarthritis) later on, and for this reason meniscal repair is far superior to partial menisectomy. Note that although this article focuses on people under 20 years of age, the profound value of meniscal repair applies to older people as well. Dr. Noyes is the pioneer in the world of meniscal repair, and his method of careful suturing the damaged meniscus remains the gold standard of meniscal repair surgery. Noyes and Barber-Westin make it unequivocally clear that tears to the avascular central third are very much amenable to repair.

ABSTRACT

Background: Limited data are available regarding repair results of meniscal tears extending into the central avascular region.

Hypothesis: Meniscal tears extending into the avascular region can be successfully repaired in patients less than 20 years old.

Study Design: Prospective cohort study.

Methods: We examined the results of 71 meniscal repairs (64 knees) for tears extending into the central avascular region in patients 19 years of age or younger; 67 were examined clinically (mean, 51 months after surgery) and 36, by follow-up arthroscopy (mean, 18 months).

Results: In 53 of 71 (75%) meniscal repairs patients had no tibiofemoral compartment symptoms and there were no clinical failures. In 18 (25%) meniscal repairs, patients showed tibiofemoral symptoms or a failed repair was detected on follow-up arthroscopy. In the subgroup of 45 knees with meniscal repair and anterior cruciate ligament reconstruction evaluated clinically, 39 (87%) patients rated their knee as normal or very good, 2 (4%) as good, 3 (7%) as fair, and 1 (2%) as poor.

Conclusions: A stable repair of complex meniscal tears that extend into the avascular region can be obtained using a meticulous inside-out vertical divergent suture technique. We recommend repair, particularly in young active patients in whom removal of complex tears would result in major loss of meniscal function and the risk of future arthrosis.

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