Ideal Indications Meniscus Repair I Dr.RAJAT JANGIR JAIPUR
Ideal Indications Meniscus Repair KNEE INJURY COMMON SPORTS INJURY HOW TO DEAL SPORTS INJURY RETURN TO SPORTS AFTER KNEE INJURY BEST KNEE SURGEON DOCTOR IN JAIPUR #aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur #allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon To Know more about ACL Injury, Click the links below: 1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all" https://youtu.be/oWkIr8IXvr8 2. Everything about ACL Injury tear surgery in Hindi I https://youtu.be/bqpjkAkwZ14 3. Best Screw for ACL tear surgery in Hindi https://youtu.be/1LGpU1NHiIs 4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir https://youtu.be/SIAPWiMbOqs 5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ? https://youtu.be/NEJRPKskJTI 6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ? https://youtu.be/EXpgy19Jxzw 7. PRP injection therapy in Partial ACL TEARs https://youtu.be/qyG1EYgS87E Dr.RAJAT JANGIR(Asso Prof.) Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) Ligament and Joints Clinic 67/34 Mansarovar Jaipur Whatsapp: shorturl.at/gnAEP Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com Google Page: https://g.page/KNEE-Shoulder-SURGERY?... Facebook: https://www.facebook.com/Ligamentandj... * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
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Ideal Indications Meniscus Repair I Dr.RAJAT JANGIR JAIPUR
- 1. Ideal indications for Meniscus Repair Dr.Rajat Jangir Consultant Arthroscopy Surgeon, Jaipur
- 3. Zones Poulsen M, Johnson D. Meniscal injuries in the young, athletically active patient. The Physician and sportsmedicine1870.
- 4. Why to do it ?? ● Restore Function ● Maintain Load transmission ● Minimize Contact Stress ● Contribute to Stability ● Chondroprotection Type to enter a caption.
- 5. Question ???? ..….But then should every TEAR be repaired ? No “Appropiate & informed decision required” Only 20% repairable *Fairbank et al. JBJS 1948;30B:664-70 *Chatain et al. Knee Surg 2001;9:15-18.
- 6. Principle for Repair • Stimulation of the healing potential • Stabilization of the defect * *Newman A, Daniels A, Burks R. Principles and Decision Making in Meniscal Surgery. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1993;9(1):33-51.
- 7. Stimulation of healing potential Peri-meniscal synovial abrasion Trephination Fibrin clot placement
- 8. Stabilization of the Defect ●Incomplete ●Short tear length <1cm ●Augmented by suture approximation, immobilization, and postoperative non-weight bearing.
- 9. Inverse Correlation • Rim width • Tear Length • Patient age • Knee instability/ACL deficiency • BMI Success Rates Johnson (1999) 76% Jakob (1998) 78% Ryu (1988) 87% Long term healing rate? Re-tears? Restore normal function? Literature: Success rate
- 12. When to repair
- 13. Avoid repairing…. ● Chronic complex tears ● Degenerative tears ● Unstable knee (without reconstruction)- retear 40% ● Associated Grade IV osteochondral defects
- 15. Meniscal Repair versus Resection Repair is Indicated if score ≤4
- 16. Dr.RAJAT JANGIR
- 17. Approach meniscal tears like fracture fixation !
- 18. ● Perpendicular placement of implants every 5 mm ● Grab circumferential fiber bundle to ensure optimal purchase strength ● Ensure that implants are not proud (intra-or extraarticular) ● Avoid stuffing the meniscus with stress riser inducing implants ● Rehabilitation: Individualized
Editor's Notes
- The “red-red zone” is located on the very outer edge of the meniscus and receives the most blood. The “red-white” zone is located in the middle 1/3 of the meniscus at the junction between the vascular and avascular portions of the meniscus. The “white-white” zone is the innermost aspect of the meniscus and comprises the avascular portion. The further out the lesion, the more likely the meniscus will heal
- Following removal - Cartilage overloading and aggravated degeneration THE BIG QUESTION
- Stimulation is accomplished by perimeniscal synovial abrasion and/or fibrin clot placement. Stability can be present inherently on the basis of incompleteness (the tear not extending the full thickness of the meniscus) or short tear length and can also be augmented by suture approximation, immobilization, and postoperative non-weight bearing.
- Flap tears, radial tears, or vertical tears with secondary lesions that extend into avascular inner 2/3 of meniscus, except in young teenagers Ligamentous ligamentous instability (w/ ACL insufficiency, the rate or re-tearing approaches 40%, especially in younger active individuals, and therefore ACL reconstruction should be performed at the same surgery; ) Chronic complex tears. ¢ Degenerative tears. ¢ Unstable knee (without reconstruction). Rule of thirds: ¢ ACL deficient knee – 30%. ¢ ACL stable knee – 60%. ¢ ACL reconstructed knee – 80-90%. ¢ Associated Gd. IV osteochondral defects. ¢ Old age.
- Nondisplaced meniscal tears in the peripheral vascular zone, especially when identified in a subacute set- ting, may already have undergone some early healing response. Often this includes fibrovascular scar formation lining the tear margins. Similar to debridement of bony edges in fractures and nonunions, the meniscal tear margins should be prepared by rasping these surfaces to improve apposition and optimize the healing surfaces. A variety of mechanical rasps are available, including forward-angle, back-angle, double-sided, and 90-degree double- sided instruments. An arthroscopic motorized shaver can also be used for gentle debridement of these edges. The goal is to establish a surface free of interposed material, ideally demonstrating punctate bleeding, which indicates vascular supply sufficient for reliable healing. This can usually be demonstrated by restricting the arthroscopic inflow prior to tourniquet inflation
- INDIVIDUALIZE – protection, WB, Motion, Return to Sport