Document Title: Rubman-AJSM-Jan98.shtml
Article Title: Arthroscopic Repair of Meniscal Tears that Extend into the Avascular Zone: A Review of 198 Single and Complex Tears
Authors: Marc H. Rubman, MD, Frank R. Noyes, MD, and Sue D. Barber-Westin
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: January-February 1998
Volume 26, Number 1, pages 87-95
Keywords: meniscal repair, biomechanics, knee longevity, long-term consequences, advantages over partial menisectomy.

(Reference-denoting numbers appear in the same point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This excellent article, filled with deeply penetrating insight that remains undiminished by the passage of time, is a classic in the field of meniscal repair. Dr. Noyes is a pioneer in the realm of dealing with meniscal injuries, and this article makes the importance of preserving every ounce of meniscal tissue abundantly clear. Because losing even a small portion of a meniscus can increase the loadings (compression and shear) on the articular-cartilage surfaces many-fold, meniscal-injury patients should ask their surgeons specifically about meniscal repair (instead of partial menisectomy, i.e. "trimming" or "cleaning up" the meniscus). Sadly, since partial menisectomy is so easily done (no special skills are required) and quickly performed (thus much cheaper from the viewpoint of the surgeon), the vast majority of meniscal tears are still being dealt with via partial menisectomy, thus with the surgeon not making any effort to first repair the meniscal tear. (As with all articles in which Sue Barber-Westin is an author, this article has an extremely insightful discussion section. So, be sure to read the discussion thoroughly.)

ABSTRACT

We assessed the results of 198 meniscal tears that had a major segment in the central avascular region repaired with an arthroscopically assisted inside-out technique. There were 177 patients whose mean age was 28 years. Eighty-two percent were injured during sports, and 71% also required anterior cruciate ligament reconstruction. The menisci were evaluated by clinical examination (180 repairs) a mean of 42 months postoperatively, by follow-up arthroscopic evaluation (91 repairs) a mean of 18 months postoperatively, or both. At followup, 159 (80%) of the 198 tears were asymptomatic for tibiofemoral joint symptoms, and 39 (20%) required repeat arthroscopic surgery for these symptoms. Of the 91 repairs evaluated arthroscopically, 23 (25%) were classified as healed, 35 (38%) as partially healed, and 33 (36%) as failed. We recommend repair of meniscal tears that extend into the avascular region for select patients, including those in their 20s and 30s and highly competitive athletes. This study’s reoperation rate of 20% should not be interpreted as the rate of meniscal healing, but as the incidence of tibiofemoral joint symptoms. Even though this is a higher rate than that reported for the repair of peripheral meniscal tears, we believe the benefits of a potentially functional meniscus outweigh the risks of reoperation.

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