Meniscal tearing after ACL reconstruction

The knees of 72 patients with unilateral anterior-cruciate- ligament (ACL) injury were analyzed before ACL reconstruction as well as by follow-up arthroscopy on the day of staple removal. At ACL reconstruction 31 lateral menisci and 40 medial menisci were found to be normal. 28 lateral menisci and 24 medial menisci were treated surgically, while 13 lateral menisci and 8 medial menisci with small or incomplete meniscal tearing were not treated. At follow-up arthroscopy there were 3 new cases of lateral meniscal tearing and 3 new cases of medial meniscal tearing in the groups diagnosed as normal prior to surgery. Two of the 13 cases with small or incomplete lateral meniscal tearing required resection, 8 healed and the other 3 demonstrated no progressive change. Four of the 8 cases with small or incomplete medial meniscal tears healed, 3 exhibited no progressive change and one required surgical treatment. There was no correlation between meniscal tearing and knee instability as indicated by a positive Lachman test or a positive pivot shift sign. The results of the present study indicate that ACL reconstruction prevents progressive changes in meniscal tears and will prevent secondary osteoarthritis, and that some small tears of the lateral meniscus require no surgical treatment.     

Suture of new and old peripheral meniscus tears

A prospective study of repaired vertical peripheral tears of the meniscus in fifty patients (nine women and forty-one men) was carried out from January 1977 to June 1980. All tears were confirmed preoperatively by arthroscopy. Forty-three medial and seven lateral menisci were repaired. Fifteen tears were treated within two weeks and thirty-five were operated on as long as seven years after injury. Only eight patients had a meniscal tear that was not accompanied by injuries of either the anterior cruciate ligament or the collateral ligaments, or both. At a mean follow-up of eighteen months (range, six to thirty-nine months), forty-two patients (84 per cent) had clinically apparent healing of the sutured meniscal tear. Repeat arthroscopy was done in twenty-seven (64 per cent) of these patients, four to twenty-nine months (mean, twelve months) after the operation. The arthroscopy proved that all of these repaired tears had healed. Eight patients had a second tear after the initial repair: four were reruptures at the sutured area and four were new ruptures in another area of the meniscus and were associated with fresh trauma. All of these patients subsequently had an arthroscopic meniscectomy.     

关节镜下修补半月板桶柄样撕裂的临床疗效分析

目的 探讨关节镜下修补半月板桶柄样撕裂的临床疗效.方法 关节镜下对61例63个桶柄样撕裂的半月板行修补手术,男38例,女23例;年龄16～47岁,平均27岁.内侧半月板后体部至前体部区域撕裂及外侧半月板胴肌腱前方区域撕裂采用标准的白内向外缝合技术;内侧半月板后角区域撕裂采用经两个后内侧入路的全关节内缝合技术;外侧半月板后角区域撕裂采用经前方关节镜入路的全关节内缝合技术.结果 61例63个半月板随访时间24～66个月,平均38个月.其中51例(53个半月板)行二次关节镜检.44个半月板(83%)完全愈合,5个半月板(9.4%)部分愈合,4个半月板(7.5%)不愈合.61例患者均进行临床评估,其中53例(87%)无临床症状,4例(6.5%)有部分临床症状,4例(6.5%)绞锁复发.总体评估:失效率为7.9%(5/63),成功率92.1%(包括完全愈合、部分愈合、无临床症状及部分临床症状者).结论 对于发生在红一红区或红一白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,可以获得约92%的成功率.     

Arthoscopic meniscal repair in conjunction with anterior cruciate ligament reconstruction: Factors affecting the healing rate

Ninety-eight of 121 consecutive patients who underwent arthroscopy-assisted meniscal repair in combination with anterior cruciate ligament reconstruction were evaluated by second-look arthroscopy with an average interval of 16 months (range, 6 to 63 months). Of the 98 meniscal repairs, 73 had completely healed, 13 had incompletely healed, and 12 had not healed. Six possible factors that may have affected the healing of the repaired menisci were statistically analyzed. There were no statistically significant differences between the three groups with respect to sex, age, tear site on the medial or lateral meniscus, or residual anterior laxity as measured using the KT-1000. The factors that had a statistically significant impact on healing rate were the rime width and meniscal locking. Negative correlations with the healing rate were observed in menisci that were repaired in the central third zone and that had been locked or could be locked by probing at the time of surgery.     

Diagnostics of degenerative meniscal tears at 3-Tesla MRI compared to arthroscopy as reference standard

Introduction The goal of this study was to evaluate the diagnostic performance of 3-Tesla MRI for the assessment of degenerative meniscal tears in clinical practice. Materials and methods In patients with chronic knee pain, a negative history of acute trauma and a mean age of 52 years, 3-Tesla MRI were performed a few days prior to arthroscopy. In 86 menisci, diagnostic values of 3-Tesla MRI for the detection of degenerative tears were evaluated using arthroscopy as reference standard. The MRI classification, for meniscus diagnostics, described by Crues was used. Results At arthroscopy, all tears identified (19 horizontal, 7 complex, 3 radial) were degenerative as confirmed by histological examination. MRI grade II lesions had a prevalence of 24% and a rate of 24% of missed tears, whereas grade I lesions were not associated with a torn meniscus at arthroscopy. For meniscal tears, (grade III) sensitivity and specificity of 3-Telsa MRI was 79 and 95% for both menisci, 86 and 100% for the medial meniscus, and 57 and 92% for the lateral meniscus. The best diagnostic performance was found for complex tears, horizontal tears showed relatively good results, poor results were documented for radial tears. Conclusion For the medial meniscus, where horizontal and complex tears were more prevalent, 3-Tesla MRI shows a higher accuracy than for the lateral meniscus. Particularly with regard to the medial meniscus, 3-Tesla MRI could be effectively used when a degenerative tear is suspected. Nevertheless, in regard to a remarkable number of false positive and false negative findings the diagnostic value of a 3-Tesla MRI investigation should not be overestimated.     

The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction

Purpose: To determine the clinical sequelae of nondegenerative peripheral vertical medial meniscus tears treated with abrasion and trephination alone (stable tears) or suture repair (unstable tears). Type of Study: Cohort follow-up. Methods: At the time of anterior cruciate ligament reconstruction, 548 patients had nondegenerative peripheral vertical medial meniscus tears that were either left unsutured or repaired. Of 548 menisci, 233 were stable and were abraded and trephined (AT group), 139 were stable and left in situ (Situ group), and 176 were unstable and were repaired with sutures (Suture group). An unstable tear was defined as a torn meniscus that could be displaced into the intercondylar notch with a probe. Patients who had no medial or lateral meniscal tears at the time of ACL reconstruction served as a control population (No Tear group, n = 526). Subjective follow-up was obtained with a modified Noyes questionnaire. Results: Objective follow-up was obtained at a mean of 4.8 ± 1.7 years postoperatively. Subjective follow-up was obtained at a mean of 7.3 ± 3.4 years postoperatively. At a mean of 3.7 years (range, 4 months to 10.7 years) after the reconstruction, a subsequent arthroscopy was required for 14 patients (6.0%) in the AT group, 15 patients (10.8%) in the Situ group, 24 patients (13.6%) in the Suture group, and 15 patients (2.9%) in the No Tear group; these numbers were not statistically significant. The mean total subjective score was not statistically significantly different between groups. Conclusions: Repaired unstable peripheral vertical medial meniscus tears have a failure rate of 13.6%, most retears occurring more than 2 years after repair. Of stable peripheral vertical medial meniscus tears treated with abrasion and trephination, most (94%) remain asymptomatic without stabilization.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 270–274     

What is the terrible triad?

In 1936 Campbell asserted that "impairment of the anterior crucial and mesial ligaments is associated with injuries of the internal cartilage." O'Donoghue in 1950 called attention to "that unhappy triad (1) rupture of the medial collateral ligament, (2) damage to the medial meniscus, and (3) rupture of the anterior cruciate ligament" and recommended early surgical intervention. In 1955 he reported 33 cases with both medial collateral (MCL) and anterior cruciate ligament (ACL) tears, but there were only three lateral meniscus tears reported. Based on a recent report by Shelbourne and Nitz that questions the validity of this unhappy triad, a review of all arthroscopically confirmed acute injuries of second degree or worse to the ACL and MCL was undertaken. Of a total of 52 knees reviewed, 50 knees had third-degree ACL tears and two had second-degree ACL tears. One of the second-degree tears was associated with a second-degree MCL and one with a third-degree ACL tear. Neither had an associated meniscus tear. Forty-five third-degree ACL tears were associated with third-degree MCL tears (group 1) and five with second-degree MCL tears (group 2). Eighty percent (36 knees) of group 1 had lateral meniscus tears. Only 29% of group 1 (13 knees) had associated medial meniscus tears. None of these medial meniscus tears was isolated. Eighty percent (four knees) of group 2 had lateral meniscus tears with only one associated medial meniscus tear. Again, there were no medial meniscus tears in the absence of a lateral meniscus tear. We did not find the combination of injury originally described as the unhappy triad.     

Clinical results of meniscus repair in patients 40 years and older

The critical role that the meniscus plays in the knee along with the advantages of preserving as much of the meniscus as possible have both been well documented. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. However, some researchers have reported less favorable results in older patients. To determine the results of meniscus repair in older patients, patients 40 years and older who underwent arthroscopically assisted meniscus repair were prospectively followed up. Thirty-seven patients were included in the study, all of which had a minimum 2-year follow-up (average, 26.5 months). The average age of the patients at the time of the repair was 44.2 years (range, 40 to 52 years); 26 were males and 11 were females. There were 19 left knees and 18 right knees included in the study. Twenty-two patients had associated anterior cruciate ligament reconstructions. Physical examination at follow-up included swelling, joint line tenderness, locking, and McMurray testing and radiographs. Five of 37 menisci repaired (13.5%) were symptomatic at latest follow-up. All of these patients had joint line tenderness and two had a positive McMurray test. Three of these patients had repeat arthroscopy confirming that the meniscus had not healed. Because of the small number of patients with symptoms at follow-up, the authors feel that meniscus repair in patients 40 years and older is an effective treatment for peripherally located meniscus tears. With 86.5% of the patients having good clinical results, these findings are comparable with other studies with a younger population and signify that repair of peripheral tears is indicated in this age group especially in conjunction with anterior cruciate ligament reconstruction. The findings suggest that the location and meniscal tear, rather than the age of the patient, determine the potential for successful repair. (Arthroscopy 1998 Nov-Dec;14(8):824-9.)     

Arthroscopic meniscal repair evaluated with repeat arthroscopy

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.     

Discoid lateral meniscus: prevalence of peripheral rim instability

The purpose of this study was to determine the prevalence of peripheral rim instability in discoid lateral meniscus. A consecutive series of 112 patients (128 knees) (mean age 10.0 years [range 1 month to 22 years]) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 1993 and 2001 was reviewed. Of those discoid menisci classified intraoperatively (n = 87), 62.1% (n = 54) were complete discoid lateral menisci and 37.9% (n = 33) were incomplete discoid lateral menisci. An associated meniscal tear was present in 69.5% (n = 89) of all knees studied. Overall, 28.1% (n = 36) of discoid lateral menisci had peripheral rim instability: 47.2% (n = 17) were unstable at the anterior-third peripheral attachment, 11.1% (n = 4) at the middle-third peripheral attachment, and 38.9% (n = 14) at the posterior-third peripheral attachment. Thirty-one of the 36 unstable discoid menisci underwent repair of the peripheral meniscal rim attachment. One patient underwent a complete, open meniscectomy. Peripheral rim instability was significantly more common in complete discoid lateral menisci (38.9% vs. 18.2%; P = 0.043) and in younger patients (8.2 vs. 10.7 years; P = 0.002). The frequency of peripheral instability mandates a thorough assessment of meniscal stability at all peripheral attachments during the arthroscopic evaluation and treatment of discoid lateral meniscus, particularly in complete variants and in younger children.     

Non-operative treatment of meniscal tears

In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.     

The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears

Purpose: The purpose of this study was to document the accuracy of joint line tenderness in the diagnosis of meniscal tears. Type of Study: Prospective cohort study. Methods: There were 104 male recruits (age range, 18 to 20 years; mean, 19.2 years) with suspected meniscal lesions who underwent arthroscopy. A thorough history and physical examination was performed on each patient by a physician with 4 years’ experience on arthroscopic knee surgery. Twenty-six (25%) patients sustained injuries while in the Turkish Army, and 78 patients (75%) sustained injuries before they came to the army. On physical examination, assessment of joint line tenderness at the lateral and medial joint lines was performed with the patient’s knee flexed 90°. The accuracy, sensitivity, specificity, and positive and negative predictive values of joint line tenderness for medial and lateral sides were calculated based on arthroscopic findings. Results: In 104 knees, the diagnosis was correct in 71 (68%) and incorrect in 33 (32%) knees. A total of 37 medial meniscal tears and 27 lateral meniscal tears were identified at arthroscopy. Other pathology included 11 anterior cruciate ligament (ACL) tears, 5 medial femoral chondral lesions, 4 chondromalacia patellae, and 1 medial plica. No discernable abnormalities were seen in 21 knees. A preoperative diagnosis of a medial meniscal tear was made in 54 knees and 32 were confirmed at arthroscopy. A lateral meniscus tear was suspected in 27 knees and confirmed in 25. Five medial meniscus and 2 lateral meniscus tears were seen at arthroscopy. These had not been suspected with tenderness over the joint line. The accuracy of the test was lower with the presence of ACL lesions and condromalacia patella. Conclusions: I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). However, for medial meniscal tears, rates are lower.     

Zone-specific inside-out meniscal repair: technical limitations of repair of posterior horns of medial and lateral menisci

Arthroscopy was performed on 15 cadaveric knees to assess the technical limitations of a zone-specific inside-out meniscal repair system (Linvatec Zone Specific II; Linvatec Corp, Largo, Fla) for accessing the posterior regions of the menisci. In addition, this system was compared with an all-inside technique (Bionx Arrows; Bionx Implants Inc, Blue Bell, Pa). Linvatec meniscal sutures and Bionx Arrows were placed arthroscopically in both medial and lateral menisci in all 15 cadaveric knees before open dissection was performed to evaluate device placement. Results showed that the Linvatec sutures may not adequately access a longitudinal 16.1-mm region of the posterior horn of the medial meniscus that is accessible with Bionx Arrows. In addition, the zone-specific inside-out technique excluded a statistically significantly larger region of the posterior horns of both menisci. With the Linvatec sutures, placement was difficult in the most posterior 14.9 mm of the medial meniscus and 10.8 mm of the lateral meniscus; with the Bionx Arrows, placement was difficult in only the most posterior 6.1 mm of the medial meniscus (P = .004) and 5.3 mm of the lateral meniscus (P < .006).     

Meniscal lesions in so-called "isolated" ruptures of the anterior cruciate ligament. Apropos of 59 cases

Between December 1984 and March 1987, i.e. a period of 27 months, the authors operated on 59 "isolated" fresh ruptures of the ACL with routine evaluation of the posterior horns of the medial and lateral menisci. Lesions were investigated either by arthroscopy (23 cases) or by anterior arthrotomy with routine medial and lateral retro-ligamentous counter-incision (36 cases). This revealed 21 lesions of the medial meniscus (i.e. 35.5%) and 38 lesions of the lateral meniscus (i.e. 64.5%). Lesions of both menisci were present in 16 knees (27%) and only 16 knees (27%) were found to be free of any meniscal lesion. The majority of meniscal lesions were viable and could be sutured in 86% of cases for the medial meniscus and 87% of cases for the lateral meniscus. From the standpoint of operative technique, posterior lesions are relatively poorly visualized by arthroscopy (notably concerning the posterior horn of the medial meniscus though it is easier to assess the stability of the meniscus by this technique using the palpating hook. Lesions are well visualized by medial and lateral retroligamentous counter-incisions, but it is difficult to assess meniscus stability. Finally it should be noted that all of these ruptures of the ACL were dealt with by reconstruction of the central pivot either by suture and a strengthening procedure (semitendinous) or by ligament plasty from the outset.     

Results of rasping of meniscal tears with and without anterior cruciate ligament injury as evaluated by second-look arthroscopy

Purpose: Meniscal rasping without suturing has been experimentally shown to stimulate vascular induction in tears in the avascular zone of menisci, resulting in meniscal healing. The goals of this study were to arthroscopically assess the results of meniscal rasping and analyze the factors affecting meniscal healing. Type of Study: Retrospective cohort study. Methods: Forty-eight torn menisci in 47 patients (age range, 14-47 years; average, 24 years) treated arthroscopically with the meniscal rasping technique were evaluated by second-look arthroscopy. The interval between the injury and the time of surgery ranged from 3 weeks to 13 years. There were 35 lateral and 13 medial meniscal tears associated with 44 anterior cruciate ligament injuries; 28 of the menisci had a full-thickness longitudinal tear and the other 20 had a partial-thickness tear. The length of the tears ranged from 10 to 33 mm (mean, 14.4 mm). The distance from the capsule to the tear ranged from 1 to 9 mm (mean, 5.0 mm). Results: Thirty-four menisci (71%) healed completely (without a marked visible unhealed area), 10 (21%) healed incompletely, and 4 (8%) showed no evidence of healing. There were no relationships between outcome and age, gender, injured side, or time from injury and rasping. Both the distance from the capsule to the tear and the length of the tear were longer in the unhealed menisci. Stable tears had a high healing rate after meniscal rasping. Conclusions: Meniscal rasping without suturing is an easy procedure to perform and seems to be a reliable way to repair longitudinal tears in the avascular region of the meniscus, although the healing potential of the procedure is affected by the distance from the capsule to the tear site and the length and the stability of the tear.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 5 (May-June), 2003: pp 463–469     

Arthroscopic treatment of cysts of the menisci. A preliminary report

A retrospective clinical study evaluated the results of arthroscopic management of cysts of the menisci. From 1979 to 1984, 24 patients with a diagnosis of meniscal cysts associated with tears of the semilunar cartilage were treated with partial meniscectomy and cyst decompression. The mean age was 29.9 years (range, 14-52 years). Each patient had tenderness over the joint line with a palpable mass. There were 25 cases of meniscal cysts, with one patient having a bilateral cyst. Twenty-two cysts involved the lateral meniscus, and three cysts were on the medial side of the knee. The follow-up period ranged from 16 to 48 months (mean, 33.5 months). All patients had a meniscal tear; most tears were either horizontal or transverse, with or without flap formation. The pathology was in the middle or anterior one-third of the meniscus. The arthroscopic surgery consisted of partial excision of the meniscal tear, leaving a peripheral rim at times, coupled with aspiration of the cyst material or manipulation of its contents into the joint cavity. No cyst recurred, and in every patient except one, preoperative symptoms disappeared. All patients but one were satisfied with the results. Two patients had a second arthroscopy, and no evidence of instability of the peripheral rim was found.     

Internal derangement of the knee: diagnosis by arthrography, arthroscopy, and arthrotomy

Three hundred eighty-four cases involving all patients with meniscal or anterior cruciate ligament tears were examined surgically by 16 orthopedic surgeons over two distinct 12-month periods. The incidence of both menisci (ipsilateral knee) torn was 3.9%, and the ratio of medial to lateral meniscal tears was 2.7:1. Twelve percent of cases had tears of the anterior cruciate ligament, 70% of which were found with a concomitant medial meniscus tear. Arthrography was completely accurate in 73.2% of cases, and arthroscopy was accurate in 94.9%. When clinical impression, arthrography, and arthroscopy were combined, the overall diagnostic accuracy was 96.8%.     

Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis

Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 +/- 13 (mean +/- SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper-tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p less than 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Results of isolated meniscal repair evaluated by second-look arthroscopy

Thirty-six isolated torn menisci in 35 patients (average age, 24 years) which had been repaired arthroscopically using an inside-out technique were evaluated by second-look arthroscopy. The time from meniscal repair to second-look arthroscopy ranged from 2 to 10 months with a mean of 5 months. The indications for meniscal repair were a longitudinal or oblique tear located at the outer half of the meniscus. Twenty (56%) were graded as excellent, 10 (28%) as good, and 6 (16%) were graded as poor. Neither age nor length of time between injury and repair affected meniscal healing. The medial meniscal repairs showed better results than the lateral repairs (rate of excellent results: medial, 82%; lateral, 44%; P < .01, χ-squared tes). The rate of excellent results for those with normal meniscal bodies at the time of repair was 79%, which was significantly higher than that seen in the cases with deformed and/or superficial damage to the meniscal body (36%; P < .05, χ-squared test).     

Microvasculature of the human medial meniscus: operative findings.

The purpose of our study was to weigh the probability of a successful meniscus repair on the basis of the microvasculature of the human medial meniscus. In a series of 105 patients who underwent an anterior cruciate ligament reconstruction between January 1985 and December 1986, we chose the 40 patients who had a subtotal medial meniscectomy (38%) to study the microvasculature of the human medial meniscus adequately; the other patients had either an intact meniscus (23%), a meniscus repair (29%), or an already removed meniscus (10%). Forty medial menisci, from 40 male patients with an average age of 27 years, having an anterolateral and/or anteromedial chronic knee laxity and an associated meniscal pathology, were subdivided into two groups: (a) 20 tears restricted to the posterior horn, and (b) 20 bucket-handle tears observed under light microscopy. Meaningful capillary plexuses penetrating into the meniscal stroma were found in 18 of 40 menisci (45%). They were easier to identify in posterior horn tears (55%) than in bucket-handle tears (35%), and were found especially in younger patients (22 years on the average). Therefore, we encourage meniscus repairs even in chronic tears, particularly in younger patients and in posterior-horn tears.