Reachout Orthopedics - Issue 1

repaired) lesions are not comparable to irreparable (and resected) lesions because the indications are different. The location (red–red vs white–white zone), the quality of the meniscal tissue, the aetiology (traumatic vs degenerative) are different. Just imagine a study such as “prospective randomised evaluation of the short- and long-term benefits of meniscus repair in meniscectomies in young patients with reparable lesions”. Impossible to perform!! In any case, the respective indications for meniscectomy and repair do not conflict but are instead complementary. 3. Patient and society: “I saw professional athletes on television and they returned to their preinjury level quickly after a meniscectomy, so please, doctor, do the same for me, even if I am not a professional athlete and even if my lesion is reparable”. Wrong! There are specific indications for surgery in the professional athlete that should not be extended to the global population. Reasonably Extend the Indications Meniscus repair techniques have been widely developed and many different lesions can now be repaired with good mid- to long-term results [8]. First, by improving the techniques not only in terms of biomechanics (strength) but also in terms of biology: vascular access channels [15], marrow stimulation [2], synovial flaps, fibrin clot [9] and PRP [14] have been proposed as additional tools for treating complex lesions. Other biological advances are currently being evaluated. Second, and this is probably the critical point, using the correct indications. In stable knees, the best indication for repair is a vertical traumatic tear located in the red–red zone, with “minimal” damage to the meniscal tissue; this is, in fact, a very rare entity! Horizontal cleavage in the peripheral zone, in young athletes, can be also considered for repair [6]. These particular lesions correspond to overuse lesions. They are easily treated using an open or arthroscopic technique [7] with good mid- to long-term results [11]. The risk of failure in repaired vertical lesions located in the white–white zone or in extensive complex degenerative horizontal tears is high. Except in very young patients, these lesions can be treated by meniscectomy or left alone, depending on the symptomatology. The question is, however, how we should treat vertical lesions associated with moderate meniscal damage and some horizontal limited cleavages, oblique tears, root lesions with some retractions and large meniscal flaps? In these questionable indications, meniscectomy is naturally the alternative. Young age (related to meniscal damage), the degree of coronal deformity, sports activity and a lateral meniscus are the main factors indicating meniscal repair rather than meniscectomy in these complex lesions. Again, repair and meniscectomy are not two concurrent techniques. They are complementary and can even be proposed in conjunction in the same knee, enabling the removal of the unstable part of the meniscus and the repair of the peripheral rim, which is so important biomechanically. In some cases, we are confronted by complex lesions in the meniscus occurring in young patients. In these cases, the concept of meniscal preservation should be pushed. The meniscus is not fully reparable, but it is possible to repair the majority of the lesions, while removing only the most damaged tissue. Again, this is particularly true in lateral meniscal lesions, stable or stabilised knees and young patients. This concept: salvaging the meniscus in complex tears (with partial meniscectomy and meniscal repair) was evaluated in our study at a long-term follow-up [1]. The results were encouraging, with a low rate of complications and a good protective effect in the remaining meniscal tissue from degenerative changes. In conclusion, the concept of meniscal repair and preservation can be extended to some specific indications. Not all meniscal lesions can be repaired. However, all reparable meniscal lesions must be repaired. If it is not possible fully to repair some complex lesions in young patients, a partial meniscectomy can be associated with the repair. Please, save the meniscus again and again! References available on request Healthcare.India@springer.com Source: Nicolas Pujol, Philippe Beaufils. Save the meniscus again! Knee Surg Sports Traumatol Arthrosc . 2018; 1–2. DOI 10.1007/s00167-018-5325-4. © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018. Meniscus repair techniques have been widely developed and many different lesions can now be repaired with good mid- to long-term results. 22 reachOut Orthopedics