摘要:

Meniscectomy has been practiced for almost 100 years. Although the initial results were encouraging, concerns have been raised over the long-term development of gonarthrosis. Biomechanical studies have shown an increase in peak loads on the Joint surfaces correlated to the amount of meniscus tissue removed. In several long-term studies, the frequency of joint space narrowing as a sign of early gonarthrosis is significantly increased after open meniscectomy. Results are usually better after open partial meniscectomy, and after partial arthroscopic meniscectomy several studies indicate good functional and subjective results even with continuing sports participation at 10 to 15 years after the initial surgery. The rate of joint space narrowing, however, is increased compared with normal knees, and reaches almost 50%, but mostly the roentgenographic changes are nonsymptomatic. Ligament instability increases the risk of gonarthrosis even further. A conclusion based on the findings in follow-up studies with a 10− to 15-year perspective is that arthroscopic partial meniscectomy is a good therapy with predictable and satisfactory results in stable knees.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Mentseal repair using the inside-out technique is a well accepted technique and the most commonly used one. There have been main reports showing premature development of chondrosis in patients who have undergone partial or total meniscectomy The techniques for repair have expanded over the last 15 to 20 years. The common goal is to maintain the meniscus in an anatomically, biologically, and biomechanically advantaged environment to maximize the opportunity for healing. The authors have refined their techniques and indications for mentscal repair, and this report summari/es their indications, techniques, and results for meniscal repair using the inside-out method. In a review of 301 meniscal repairs using the inside-out technique, factors associated with statistically significantly improved healing included combined anterior crucrate ligament reconstruction and meniscus repair, small rim size. short tear length, and no history of locking. There were trends favoring repairs with acute tears over chronic tears, lateral meniscal tears over medial tears, and the use of fibrin clot. Successful outcomes were not associated with patient age.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The outside-in technique has been demonstrated to be effective for repair of most meniscal tears Peroneal nerve injury is easily avoided during lateral meniscal repair using this technique because the starting point for needle entry is controlled. There are several advantages of this technique sutures can be placed without the need for a rigid cannula, precise suture placement is possible because only small needles are used, visualization is facilitated because there are no instruments between the meniscus tear and the arthroscopic view, and the repair can be performed with small incisions with minimal dissection. This technique can be adapted for use of either permanent or absorbable suture, and is useful for suturing a meniscal replacement device (such as a meniscus allograft or collagen meniscus implant) or for securing materials such as a fibrin clot or a carrier containing growth factors to a repair site.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The T-Fix suture anchor permits an all-inside meniscal repair. This avoids risk of injury to the posterior medial and posterior lateral neurovascular structures as well as soft tissue entrapment. Although technically challenging to master, vanous techniques using this device allow repairs of vertical, horizontal, and complex flap tears. The device, composed of a polyacetal bar and braided polyester suture, is well tolerated by the joint. There is no evidence of articular damage or lingering problems from the plastic bar. This device is safe and effective for use in meniscal repair.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Although inside-out and outside-in meniscal repair preceded the all inside technique, there is a wave of current interest in the latter methods because they avoid a posterior incision, thus protecting the popliteal neurovascular structures, and make the procedure faster than the older techniques. Currently there are fewer than half a dozen methods available, some of which have not been cleared for general use by the U.S. Food and Drug Administration. However, over the next few years we will see other modified and improved techniques developed. Because of the newness of the techniques, there is scant literature reporting results.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Meniscal repair is preferable to meniscectomy, and there are many techniques described. However, the postoperative care restrictions often preclude the patient's rapid return to activity and make a repair seem less desirable. Although meniseectomy is not as physiologic as a successful meniseus repair, many surgeons resist performing a repair because of the technical challenges such a repair presents. A restrictive and troublesome aftercare program also makes the meniscal repair less attractive. What is the appropriate aftercare program? Wide variation exists in published postmeniseus repair rehabilitation programs. Few objective assessments of these variables are available. A comparison of a “slow” rehabilitation program that restricts weight bearing, limits motion, and delays the return to sports for 6 months with an “accelerated” program permitting unlimited weight bearing, full motion, and no restrictions on pivoting sports showed no difference in meniscal repair healing. This comparison supports an aggressive aftercare program, especially for repairs done in conjunction with an anterior cruciate ligament reconstruction.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Long-term results (average 5 to 11 years) of meniscus repair are discussed, based on review of the current English literature. Success rates of 73% to 100% have been documented in spite of repaired menisci being subjected to significant stresses. Clinical data indicate most patients have excellent or good function, and radiographic data demonstrate that successful repairs also function biomechanically.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Because of the knee pain and arthritic changes that can occur with excision of the meniscus, meniscal transplantation has been explored as a means to decrease or prevent these sequelae Knowledge of immunology and methods of preservation and sterilization is needed to assess the feasibility of the procedure. Experimental studies have found that the allografts can heal, repopulate with host cells, and have normal appearance. Early clinical evidence has shown meniscal allografts can be successful in decreasing patients' symptoms and increasing their activities. However, strict patient selection criteria are required for success. With the studies to date lacking long-term follow-up, cautious optimism is appropriate because of concerns over graft durability and capacity to impede arthritis.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The meniscus cartilage has been shown clearly to be an extremely important structure of the knee joint. The meniscus serves several functions, including load distribution, force transmission across the joint, lubrication, and joint stability. Consequently, it has been shown that loss of the meniscus cartilage of the knee increases the concentration of stresses on the articular surfaces of both the femur and the tibia, causes knee joint instability, and frequently leads to osteoarthritis, which may produce irreversible damage to the joint surfaces. Although new and unproved surgical techniques to repair torn meniscus cartilage have been described in recent sears, little progress has been made in efforts to replace the meniscus with various types of prostheses. Prosthetic replacement of the meniscus has been difficult, if not impossible, because of the necessity of exact matching of the size and the shape of the lost meniscus, as well as the unique and extremely complex biomechanical and biochemical properties of the normal meniscus. Consequently, since 1984, the authors have used tissue engineering techniques to develop a resorbable collagen scaffold that would support ingrowth of new tissue and eventual regeneration of the lost meniscus tissue. This collagen-based implant has been shown in numerous animal studies to support ingrowth and maturation of the meniscus fibro-chondrocytes and the development of a mature and functional new tissue matrix. This article summarizes some of the authors' laboratory findings as well as the initial clinical results obtained in two human feasibility studies.

ISSN:1062-8592    

出版商:OVID    

年代:1999

数据来源: OVID