[Meniscus reconstruction. Established and innovative methods].

Abstract

After the first description of meniscus repairs in the literature it took nearly a century until they were routinely performed in orthopaedic surgery. The scientific basis for meniscus reconstruction needed to be elaborated, including the study of the anatomy, and for instance the vascularisation and the function of the meniscus. After the first experiences with open repair, several arthroscopic techniques have been developed. It has been shown that several factors could influence the healing rate of meniscus lesions. One of the major factors is knee stability. Meniscus repairs performed in conjunction with reconstruction of the anterior cruciate ligament (ACL) have shown higher healing rates (generally > 75%) than isolated repairs, either in stable (50-75% healing rate) or in unstable knees (< 50% in some studies). The localization of the tear is probably the most important factor influencing the healing rate of meniscus repairs. Peripheral tears which are located in the vascular zone of the meniscus heal better than centrally located tears in the avascular area. Many efforts have been provided to enhance the vascularity in this part of the meniscus. None of the proposed techniques have been proven to be definitively effective, or they are too demanding for routine use. Conventional meniscus suture techniques are time-consuming, technically demanding and necessitate incisions at risk for neurovascular structures. In order to simplify meniscus repair several new implants have been developed. They have different forms and are made of different materials among which some are biodegradable. The first clinical results with these techniques are encouraging. However, some new complications have been described. Their incidence and the fate of intraarticular biodegradable devices still has to be defined, especially in the long-term. The present study describes the actual knowledge of meniscus repair and presents the new techniques. It also shows that several questions concerning meniscus repair still need to be answered, and points out the need for further controlled studies.