PARTIAL MENISCECTOMY
- Meniscal injury leads to partial meniscectomy in the
majority of cases, as a result of the anatomy of the tear,
underlying degeneration of the substance of the menis-
cus, or distance from the blood supply (Klimkiewicz
and Shaffer, 2002). - Meniscal tears that do not fall into the category of stable
(with possible spontaneous healing), or repairable,
should be treated with partial meniscectomy to remove
unstable fragments, eliminate mechanical symptoms,
and reduce pain and associated swelling (Greis et al,
2002 a). - Indications for partial meniscectomy include com-
plete oblique, radial, horizontal, degenerative, or
complex tears, and tears located in the white–white
zone (Klimkiewicz and Shaffer, 2002). - The goal during meniscectomy is to remove nonfunc-
tioning tissue, maximize meniscus preservation, and
create a stable configuration of the remaining tissue.
OUTCOMES
- As previously outlined, the meniscus serves a chondro-
protective function in the knee. - Precocious arthropathy may result from partial or
total meniscectomy. This is thought to be secondary to
the increased contact stresses on the articular surfaces.
•Total meniscectomy in previously normal knees results
in significant arthrosis in two-thirds of patients by 15
years from surgery (Andersson-Molina, Karlsson, and
Rockborn, 2002). - Better outcome is noted after successful repair com-
pared to resection, with lower incidence of degenera-
tive change after 5 years (Klimkiewicz and Shaffer,
2002). - More rapid degeneration is noted after lateral meniscec-
tomy compared to medial meniscectomy (Klimkiewicz
and Shaffer, 2002; Rodeo, 2001; Jaureguito et al, 1995).
•The factor with the greatest impact on long-term out-
come is whether articular damage is present at the
time of partial meniscectomy (Greis et al, 2002b).
•Other factors that influence risk of future arthritis
include amount of resection (more resection, higher
risk), type of resection (radial resection destroys the
meniscus ability to convert compression forces to
hoop stresses), associated instability, overall weight-
bearing alignment, body habitus, age, and activity
level (Klimkiewicz and Shaffer, 2002). - Results of partial meniscectomy remain good or
excellent in over 90% of patients not demonstrating
articular cartilage damage at the time of meniscec-
tomy, and this declines to approximately 60% if
damage is present (Greis et al, 2002b). In general,
80–90% of patients have documented good to excel-
lent results within the first 5 years after partial menis-
cectomy (Klimkiewicz and Shaffer, 2002).- Functional results do not always correlate with radi-
ographic findings. Up to 50% of patients at 8 years after
partial meniscectomy versus 25% in untreated knees
will demonstrate radiographic changes (Greis et al,
2002 a; Klimkiewicz and Shaffer, 2002; Jaureguito
et al, 1995). - Meniscus repair is successful in approximately 80%
of cases. Healing rates increase to approximately 95%
in the setting of concomitant ACL reconstruction
(Greis et al, 2002b).
COMPLICATIONS- Complications specific to meniscus repair include
neurovascular injuries. - The peroneal nerve is at greatest risk with lateral
meniscus repair. The popliteal artery, popliteal vein,
and tibial nerve are also at risk. - The saphenous nerve, particularly the infrapatellar
branch, is at greatest risk with medial repair.
•Failure of repair resulting in the need for repeat
arthroscopy is possible, and the risk increases as indi-
cations for repair are extended. - Meniscus repair done concurrently with ACL recon-
struction increases the risk of motion loss; however,
the appropriateness of staged repair remains contro-
versial.
MENISCAL SUBSTITUTES- Substitutes for meniscus tissue injury, or loss, are in
development. - Current replacements include meniscal allograft
transplantation and collagen meniscal implants.
MENISCAL ALLOGRAFT TRANSPLANTATION- Meniscal allograft transplantation has been in human
use for over 10 years. - The allograft tissue is most commonly fresh-frozen or
cryopreserved. Fresh allografts have also been used;
however, logistical difficulties in the routine use of
fresh grafts make them impractical for widespread use
(Greis et al, 2002b). - Immune response against the transplant has been
shown; however, frank rejection does not appear to
occur (Rodeo, 2001).
348 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE