knee injuries are very common in young populations in these fast growing life. all you needs to know about meniscus injury & surgery related to it

1. By Dr. Ranveer Patel
Orthopaedic Surgeon, Shreeji Orthopaedic Care

2.  Menisci are considered as crucial structures for
1. Knee stability
2. Shock absorption
3. Nutrient distribution to the articular cartilage
 Due to their location, extreme forces & contact sport
activities, they are more susceptible to injury.
 Menisci have poor potential to heal due to limited
vascularity in major part of meniscus.

5.  Restore function
 Maintain load transmission
 Minimize contact stress
 Contribute to stability
 Chondroprotection

6.  Acute symptomatic tears
 Longitudinal/vertical bucket handle tears
 Peripheral (red-red), middle(red-white), inner(white-
white) >7-10 mm
 Unstable, >5mm displaced into notch
 Associated ACLR or chondral procedure
 Patient preferred

7.  Chronic complex tears
 Degenerative tears
 Unstable knee (without reconstruction)- retear 40%
 Associated Grade IV osteochondral defects

8.  Meniscal tear can be treated by
1. Conservative method
applies in < 5mm partial thickness tear, short
radial tear & short full thickness vertical or
oblique tears
2. Surgical repair
3. Partial or complete meniscectomy : rarely performed

9. Various surgical technique have been applied to
improve healing of the meniscus. several methods are
 Basic methods like needling, abrasion, trephination &
gluing
 Complicated methods like synovial flaps, meniscal
wrapping or application of fibrin clots.
 procedure usually done in following ways;
1. All inside fixation devices
2. Inside-out
3. Outside-in repair

11.  It has become very popular because of
1) less time consuming &
2) reduces the risk of development of grave
neurovascular complications.
 Currently, a plethora of devices for all-inside meniscal
repair are being used. Most of these have been tested
in vitro.

12.  One of the devices that have been recently been introduced
is the fast-fix meniscus repair system (smith & nephew.)
 This system can be used for vertical, horizontal, or oblique
meniscal tears.
 Double extracapsular 5mm implant bar anchors
 2-0,non-absorbable, UHMW polyethylene ULTRABRAID
Suture
 Built in adjustable depth penetration limiter is adjustable
from 10 mm to 188 mm from tip of the needle
 The curved delivery needle is optimally shaped to allow
vertical mattress sutures to be inserted on either femoral or
tibial surfaces of meniscus

13.  There are 4 generation described:
 First-Generation all inside repairs : curved suture
hooks were used
 Second-Generation all inside repair : T-fix which
consisted of polyethylene bar with attached no.2-0
braided polyester suture

14.  Third-Generation all inside repair : bio absorbable
meniscal repair devices including arrows, screws, darts
& staples. most of this devices were composed of rigid
poly-L-lactic acid which has been linked to some
problems of erratic degradability
 Fourth-Generation all inside repair : composed of
suture combined with small anchors & a pre-tied
slipknot
Some examples are as follows:

18.  First diagnostic arthroscopy is performed, to note the
morphology of the meniscal tear, tear length & the rim
width, at the time of surgery.
 Tear is identified & tear edges are freshened with a
meniscus rasp & shaver.
 Each fast-fix device contains two 5-mm polymer suture
bar anchors with a pre-tied self sliding knot of No. 0
non absorbable USP braided polyester suture material.

21.  In addition, a split cannula facilitates easy insertion of
the device into the knee joint. & functions as a depth
penetration limiter, & a knot pusher-suture cutter.
 Using a meniscal depth probe, the desired length of
penetration is determined & the depth limiter is
trimmed accordingly; this was followed by
introduction of fast-fix delivery needle through the
split cannula. the needle was then withdrawn from
meniscus using smooth motion.

25.  Trigger is then slid forward to advance 2nd implant.
After inserting 2nd implant, delivery needle is removed
from the knee joint, such that ends of suture were left
free.
 The pre-tied self-sliding knot was tensioned with help
of knot pusher-suture cutter.

29.  Less surgical time
 Ease of performance
 Compressible sutures, less rigid, safer in contact with
cartilage
 Healing rate is much higher.
 High success rate
 No intra-articular or extra-articular complications
such as neurovascular injury

30.  Increase Risk of Arthrofibrosis
 Learning curve
 Long term results not documented
 Cost

31.  Arthroscopic all-inside meniscal repair devices appear
to be a safe & effective procedure with high success
rate.
 Pre-measurement of the desired depth using a
meniscal depth probe is required & should be followed
by trimming of depth-limitation device.