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Meniscus Repair   Kevin R. Stone, M.D. Ann W. Walgenbach, RNNP,  Abhi Freyer, Thomas J. Turek  Stone Research Foundation San Francisco XXIV Congress of the Spanish Arthroscopy Association
Meniscal Tears ,[object Object],[object Object],High Risk activities ,[object Object],[object Object],[object Object],[object Object],Incidence 1,2 American   Academy of Orthopaedic Surgeons
A young patient with a  lateral  meniscus-deficient knee is doomed to the development of osteoarthritis, pain, and reduced knee function. What happens in a  medial  meniscus-deficient knee?   It varies. Implications of Tears:
Biomechanical Considerations ,[object Object],[object Object]
Biomechanical Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 Ferrer-Roca O, Vilalta C. Lesions of the meniscus. Part I: Macroscopic and histologic findings. Clin Orthop. 1980;146:289-300. 2 DePalma AF.  Diseases of Knee: Management in Medicine and Surgery . Philadelphia: Lippincott; 1954
Diagnosing Tears ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Symptoms Clinical Examination
Complex Meniscal Tears ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 2 3 4 Courtesy of John Crues, MD
Meniscal Tears ,[object Object]
Meniscal Tears ,[object Object]
Meniscal Tears ,[object Object],T1 Sagittal T2 Sagittal
Bucket Handle Tears Courtesy of John Crues, MD
Meniscal Tears ,[object Object],T1 Sagittal T2 Sagittal
Meniscal Tears Locked Knee
Meniscal Tears Unstable Fragment
Meniscal Tears Displaced Fragment
Meniscal Cysts ,[object Object]
Popliteal (Baker’s) Cyst ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient GC: Baker’s Cysts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrameniscal Ossicle
Repair versus Meniscectomy:  the Reason to Repair ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Preserve the Meniscus whenever possible
Fairbank’s Changes: Meniscus Excision ,[object Object],[object Object],[object Object],[object Object],[object Object]
Degenerative Radiographic Changes ,[object Object],[object Object],PA Flexion
Meniscectomy: What Not to Do Movie
Degenerative MR Changes ,[object Object],[object Object]
Degenerative MR Changes ,[object Object],[object Object]
Dogma of Meniscus Biology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],I  II  III
Success rate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Example: SA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],T1 MRI
SA: Preoperative Images STIR MRI: acute trauma PD MRI T1 MRI: Torn ACL
SA: Meniscoresis Movie
SA: Postoperative X-Ray
Patient Example: VT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VT: Tear Identification Medial compartment: probing the meniscus
VT: Tear Identification Lateral compartment: identification of the tear
VT: Meniscal Repair “ Hay Bale” Suture Technique (“Bala de Heno”)
Patient example: CD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],T1 MRI
CD: Preoperative Images AP X-ray Lateral X-ray MRI: Torn ACL
CD: Stable Peripheral Tear ,[object Object]
CD: Bucket Handle Tear: Excise or Repair? ,[object Object]
CD: Postoperative X-Ray
Surgical Technique: Suture Repair ,[object Object],Movie
Bucket Handle Tears repair young – fail old
Bucket Handle repair: Suture Technique Movie
Bucket Handle Repair
Fixation Devices ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bionix Arrow Bionix Implants, Inc.
Fixation Devices ,[object Object],[object Object]
Acufex T-Fix Sutures ,[object Object]
Meniscus Reconstruction Collagen Meniscus Implant (CMI)
CMI: Pre Op Versus Post Op Preoperative MRI: Meniscal Tear Arthroscopic view of tear Regenerated meniscus 6.6 Months Post-CMI Histology of regenerated meniscus 6.6 Months Post-CMI MRI 3 years post CMI
Meniscus Replacement ,[object Object]
Meniscus Repair: Rehabilitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Meniscal Tears: Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Decreasing the impact loading the knee joint:
Conclusions ,[object Object]
Thank You

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