Future directions in meniscal surgery

Abstract Despite the considerable technological advances in arthroscopic surgery in the past decade, it is of concern that meniscal repair is not being done in many cases where the meniscus tear is reparable and the patient, if properly informed, would desire it.There is accumulating evidence that the long-term benefits of meniscal repair significantly outweigh those of partial meniscectomy. But success must be tempered by looking at longer follow-up assessments than we are accustomed to doing.DeHaven found that the average time between surgery and failure was 4 years, in a study averaging 11 years of follow-up. Meniscal repairs in isolated tears of the meniscus are significantly less successful than repairs of meniscal tears associated with anterior cruciate ligament (ACL) reconstruction. There is evidence that isolated meniscal tears in ACL-stable knees occur in menisci that are significantly more degenerated compared with menisci having tears associated with ACL disruption. Improved techniques of meniscal repair include the abrasion of both sides of the tear site, the use of increased numbers of vertically oriented nonabsorbable sutures, the insertion of a fibrin clot into the tear site, and the development of completely inside-the-knee suturing techniques. In the future, meniscal repair will become simpler and faster to perform. As a result, more meniscal repairs will be attempted. Over the next decade, we will see increasing research in the role of meniscal allografts and collagen (or other material) substitutes for the meniscus in patients with segmental defects or complete loss of the meniscus.