Reachout Orthopedics - Issue 1

SAVE THE MENISCUS AGAIN! Nicolas Pujol 1 , Philippe Beaufils 1 1  Orthopaedic Department, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France npujol@ch‑versailles.fr M eniscectomy is still one of the most popular and frequent orthopaedic procedures in the world. However, the long-term results, even following arthroscopic “so-called partial” meniscectomy, are not so good [10] and the concept of meniscal preservation has, therefore, progressed over the years [13]. However, the meniscectomy rate remains too high, even though robust scientificpublications indicate the advantages of meniscal repair or non-removal procedures in traumatic tears [4, 12]. It is worrying to note the considerable gap between these publications and daily practice. Moreover, the increase in meniscus repairs among meniscectomies is slow all over the world [3, 5]. Fight against false ideas There are still many artificial and incorrect reasons for orthopaedic surgeons to perform meniscectomies rather than meniscal repairs. All of them have to be discussed and deleted from our subconscious minds. 1. “I think that meniscectomy is a safe, quick and easy procedure for me; so it will be the same for the patient”. Wrong! There are some publications comparing meniscectomy and meniscal repair, especially on the lateral side. The time of return to sports is faster after lateral meniscectomy and the patient sometimes never recovers his/her preinjury level. 2. “The meniscal repair procedure requires a long learning curve and is only dedicated to a few simple lesions located in the vascular area of the meniscus. The failure rate is high”. Wrong! All the literature reviews of meniscal repair bring together recent papers with modern techniques and old papers with devices and techniques that are no longer in use. They should be carefully separated and analysed. So the overall rate of failure and subsequent meniscectomy is around 20%. When looking at the recent literature using modern devices, techniques and selected indications, this rate is instead close to 7–10% [8]. The results have to be compared with those of arthroscopic meniscectomy for a similar lesion, that is to say, most of the time, vertical longitudinal traumatic lesions. The problem is that reparable (and Practice Guide 21 Meniscectomy is still one of the most popular and frequent orthopaedic procedures in the world. However, the long- term results, even following arthroscopic “so-called partial” meniscectomy, are not so good and the concept of meniscal preservation has, therefore, progressed over the years. However, the meniscectomy rate remains too high, even though robust scientific publications indicate the advantages of meniscal repair or non- removal procedures in traumatic tears.