摘要:

The early history of arthroscopic peripheral meniscus repair is described with four reported cases in 1975 as the main subject. Surgeries on 33 menisci of 33 knee joints performed from 1969 to 1988 are summarized.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The meniscus has several roles that contribute to successful knee function. There is a high prevalence of acute and chronic meniscal injury. Long-term studies have documented the detrimental effects of total meniscectomy. Research has proven that the peripheral meniscus is vascularized and can heal when injured. This has led to the development of techniques for meniscal repair. Here we discuss our indications for meniscal repair. We repair selected acute and chronic longitudinal tears in the vascularized region of the meniscus. We also repair longitudinal tears near the vascular regions with fibrin clot augmentation. Complex, degenerative, and flap tears are not generally selected for repair. We recommend associated anterior cruciate ligament reconstruction when the knee is unstable. Proper patient and tear selection will result in greater success in meniscal repair. Further research is needed to determine whether repaired menisci can prevent the onset and progression of the degenerative knee changes that are common in the postmeniscectomy knee.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The purpose of this studs was to determine the incidence, severity. and associated factors in the development of degenerative arthritis in anterior cruciate ligament (ACL)-deficient knees. Data were obtained on 328 patients including 198 comparative values covering history, physical examination, and radiographic scoring. The average interval since ACL injury was 20 years (range 15–52). Treatment subgroups included no surgery, meniscectomy, intraarticular ACL reconstruction, extraarticular reconstruction, and combinations of these. All patients had some radiographic signs of osteoarthritis. The single most predictive factor in the development of osteoarthritis was time since meniscectomy (not time since ACL injury), regardless of associated surgical procedures. As a group, patients who never underwent any surgical procedure had significantly less arthritis (subjectively and objectively). The second best subgroup was those who underwent intraarticular reconstruction with the menisci intact. Partial and total meniscectomy were indistinguishable. Intraarticular ACL reconstruction resulted in a lower incidence of subsequent meniscal tear compared to those left unstable. Protection of uninjured and salvage of torn menisci may afford the best chance of slowing or preventing osteoarthritis in the ACL-deficient knee. Reconstruction of the ACL protects the menisci and facilitates preservation of articular cartilage.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The rationale and indications for open meniscus repair are presented, along with the techniques for both medial and lateral meniscus repair, and aftercare principles. Early (2-year), intermediate (5-year), and long-term (10-year) results, which support the continued application of meniscus repair for suitable cases, are summarized.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The Henning system of inside-out meniscal repair is one of many methods available. Although technically difficult, it is probably the most versatile for meniscal suturing, and produces good coaptation of the meniscus tear. Freshening of the tear site by rasping and insertion of fibrin clots have improved the procedure's success rate, and posterior incisions for needle retrieval have lowered the incidence of neurovascular complications. From a group of 160 repairs, results of 117 meniscal repairs were assessed by arthroscopic second look or arthrogram. The most notable finding was finding that meniscal repairs performed synchronously with anterior cruciate ligament (ACL) reconstruction did significantly better than isolated meniscal repairs in knees with stable ACLs (82% versus 48% successful outcomes). Satisfactory results dropped off in both groups as rim width and tear length increased. Repairs of lateral meniscal tears did better than medial tears. Surprisingly, older patients did as well as younger ones.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Inside-out meniscus repair using the zone-specific cannula system is safe, effective, and technically easy to perform. This arthroscopic technique enables proper visualization, preparation, and repair of all viable meniscus tears—even those not approachable by open methods. Each zone-specific cannula is designated for a specific zone of the meniscus rigidly contoured to match the anatomy of the femoral condyles and tibial spines. The chosen cannula can be precisely positioned adjacent to the torn meniscus for passage of a double-armed suture in a horizontal or vertical mattress pattern. Sutures are captured and tied over the capsule by using a limited posteromedial or posterolateral exposure while protecting the neurovascular structures.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The outside-in technique of meniscal repair offers several advantages over inside-out techniques, including less risk to neurovascular structures. This technique is reliable with good results in selected cases.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The all-inside meniscus repair provides the surgeon with an arthroscopic method of suturing posterior horn tears from posterior with an entirely intracapsular vertically oriented suture. This method employs special instrumentation for suture placement and arthroscopic knot tying.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Meniscus repair was first described in 1885. It has become popular during the last 20 years with the introduction of knee arthroscopy. Long-term results are only now becoming available. This review analyzes some of the most important studies in the literature, and shows that meniscus repair in a stable knee has an excellent long-term prognosis. In terms of knee function, osteoarthrosis, and sporting ability, the results are better than with partial meniscectomy. Nevertheless, patients often prefer partial meniscectomy because the rehabilitation is much shorter.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

It is well recognized that complete meniscectomy ablates hoop stresses and increases surface strain in articular cartilage and commonly results in arthritis. In addition, in anterior-cruciatedeficient knees, medial meniscectomy increases instability. To reverse these trends, free meniscal transplantation has been developed. To determine the success of this procedure, 43 of these transplantations performed in 1986–1991 were studied prospectively. Patients included 29 men and 14 women, ages 19–42. Seven underwent meniscal transplantation alone, 24 combined with anterior cruciate ligament reconstruction, and 13 combined with osteotomy. Transplantation was performed with arthrotomy. Fresh menisci were used in 16 cases and cryopreserved in 27. Follow-up currently extends from 2 to 7 years. Success was verified directly with arthroscopy in 28 cases, and 15 were clinically “silent” and remain unstudied arthroscopically. Success, as measured by healing of the rim and lack of shrinkage or degeneration, was felt to be achieved in 20 of the 28 cases. Factors associated with unfavorable results were grade-IV articular changes of the femoral condyles, which probably explains the failure in osteotomy cases. Lack of articular congruence, compliance, and smoothness of these knees was considered to be the reason for deterioration of meniscal structure. Meniscal transplantation is felt to be a reasonable undertaking in young patients who have undergone complete meniscectomy, but have grade-IV articular disease.

ISSN:1062-8592    

出版商:OVID    

年代:1993

数据来源: OVID