Treatment of Meniscal Injuries in Young Athletes

ABSTRACT

The young, active patient with a meniscal tear poses a significant challenge for the surgeon. Multiple factors influence the treatment of meniscal pathology and the ultimate goal of meniscal surgery should be to remove only torn and nonfunctional tissue by limited meniscectomy or to repair amenable tears. The chondroprotective significance of the meniscus has influenced the current treatment of meniscal injuries in young athletes with the emphasis on repairing meniscus tears to include complex tears and tears in the avascular zone. Partial meniscectomy and meniscal repair techniques have provided good long-term clinical success and return to activity. The decision to debride versus repair a meniscus depends on tear pattern, location, and the patient's willingness to comply with postoperative restrictions. In patients with symptomatic meniscus deficiency, meniscal allograft transplant is an option that may provide pain relief but may not allow return to sports. The purpose of this article is to provide a succinct review of the diagnostic and management principles for the young, active patient with a meniscal tear.

KEYWORDS

Meniscus - meniscal - meniscectomy - repair - allograft

REFERENCES

• 1 Baratz M E, Fu F H, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report.  Am J Sports Med. 1986;  14 (4) 270-275
• 2 Renstrom P, Ljungqvist A, Arendt E et al.. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.  Br J Sports Med. 2008;  42 (6) 394-412
• 3 Greis P E, Bardana D D, Holmstrom M C, Burks R T. Meniscal injury: I. Basic science and evaluation.  J Am Acad Orthop Surg. 2002;  10 (3) 168-176
• 4 Krause W R, Pope M H, Johnson R J, Wilder D G. Mechanical changes in the knee after meniscectomy.  J Bone Joint Surg Am. 1976;  58 (5) 599-604
• 5 Lee S J, Aadalen K J, Malaviya P et al.. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.  Am J Sports Med. 2006;  34 (8) 1334-1344
• 6 Lintner S A, Levy A, Kenter K, Speer K P. Glenohumeral translation in the asymptomatic athlete's shoulder and its relationship to other clinically measurable anthropometric variables.  Am J Sports Med. 1996;  24 (6) 716-720
• 7 Seedhom B B, Dowson D, Wright V. Proceedings: Functions of the menisci. A preliminary study.  Ann Rheum Dis. 1974;  33 (1) 111
• 8 Shoemaker S C, Markolf K L. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision.  J Bone Joint Surg Am. 1986;  68 (1) 71-79
• 9 Voloshin A S, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study.  J Biomed Eng. 1983;  5 (2) 157-161
• 10 Wojtys E M, Chan D B. Meniscus structure and function.  Instr Course Lect. 2005;  54 323-330
• 11 Fairbank T J. Knee joint changes after meniscectomy.  J Bone Joint Surg Br. 1948;  30B (4) 664-670
• 12 Abdon P, Turner M S, Pettersson H, Lindstrand A, Stenström A, Swanson A J. A long-term follow-up study of total meniscectomy in children.  Clin Orthop Relat Res. 1990;  (257) 166-170
• 13 McNicholas M J, Rowley D I, McGurty D et al.. Total meniscectomy in adolescence. A thirty-year follow-up.  J Bone Joint Surg Br. 2000;  82 (2) 217-221
• 14 Englund M, Lohmander L S. Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy.  Arthritis Rheum. 2004;  50 (9) 2811-2819
• 15 Roos H, Laurén M, Adalberth T, Roos E M, Jonsson K, Lohmander L S. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls.  Arthritis Rheum. 1998;  41 (4) 687-693
• 16 Lohmander L S, Roos H. Knee ligament injury, surgery and osteoarthrosis. Truth or consequences?.  Acta Orthop Scand. 1994;  65 (6) 605-609
• 17 Accadbled F, Cassard X, Sales de Gauzy J, Cahuzac J P. Meniscal tears in children and adolescents: results of operative treatment.  J Pediatr Orthop B. 2007;  16 (1) 56-60
• 18 Cannon Jr W D. Arthroscopic meniscal repair. Inside-out technique and results.  Am J Knee Surg. 1996;  9 (3) 137-143
• 19 Fung L, Wong B, Ravichandiran K, Agur A, Rindlisbacher T, Elmaraghy A. Three-dimensional study of pectoralis major muscle and tendon architecture.  Clin Anat. 2009;  22 (4) 500-508
• 20 Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P. Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients.  Arthroscopy. 2008;  24 (7) 810-816
• 21 Siebold R, Dehler C, Boes L, Ellermann A. Arthroscopic all-inside repair using the Meniscus Arrow: long-term clinical follow-up of 113 patients.  Arthroscopy. 2007;  23 (4) 394-399
• 22 Baker B E, Peckham A C, Pupparo F, Sanborn J C. Review of meniscal injury and associated sports.  Am J Sports Med. 1985;  13 (1) 1-4
• 23 Hede A. Treatment of meniscal lesions in the knee. Epidemiological, clinical and experimental aspects.  Dan Med Bull. 1993;  40 (3) 317-331
• 24 Hede A, Jensen D B, Blyme P, Sonne-Holm S. Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982-84.  Acta Orthop Scand. 1990;  61 (5) 435-437
• 25 Jones J J, Burks R, Owens B D, Sturdivant R X, Svoboda S J, Cameron K L. Incidence of meniscal injuries in the U.S. military: Demographic and occupational risk factors in a high risk population.  J Athl Train. In press
• 26 Metcalf M H, Barrett G R. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees.  Am J Sports Med. 2004;  32 (3) 675-680
• 27 Terzidis I P, Christodoulou A, Ploumis A, Givissis P, Natsis K, Koimtzis M. Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation.  Am J Sports Med. 2006;  34 (7) 1170-1175
• 28 Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness.  Arthroscopy. 2004;  20 (9) 951-958
• 29 Zaslav K, Cole B, Brewster R STAR Study Principal Investigators et al. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial.  Am J Sports Med. 2009;  37 (1) 42-55
• 30 Shelbourne K D, Benner R W. Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries.  J Knee Surg. 2009;  22 (3) 187-190
• 31 Shelbourne K D, Martini D J, McCarroll J R, VanMeter C D. Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears.  Am J Sports Med. 1995;  23 (2) 166-169
• 32 Apley A G. The diagnosis of meniscus injuries; some new clinical methods.  J Bone Joint Surg Am. 1947;  29 (1) 78-84
• 33 Evans P J, Bell G D, Frank C. Prospective evaluation of the McMurray test.  Am J Sports Med. 1993;  21 (4) 604-608
• 34 Muellner T, Weinstabl R, Schabus R, Vécsei V, Kainberger F. The diagnosis of meniscal tears in athletes. A comparison of clinical and magnetic resonance imaging investigations.  Am J Sports Med. 1997;  25 (1) 7-12
• 35 Boden S D, Davis D O, Dina T S et al.. A prospective and blinded investigation of magnetic resonance imaging of the knee. Abnormal findings in asymptomatic subjects.  Clin Orthop Relat Res. 1992;  (282) 177-185
• 36 Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review.  Br Med Bull. 2007;  84 5-23
• 37 Arnoczky S P, Warren R F. Microvasculature of the human meniscus.  Am J Sports Med. 1982;  10 (2) 90-95
• 38 Shelbourne K D, Dickens J F. Digital radiographic evaluation of medial joint space narrowing after partial meniscectomy of bucket-handle medial meniscus tears in anterior cruciate ligament-intact knees.  Am J Sports Med. 2006;  34 (10) 1648-1655
• 39 Burks R T, Metcalf M H, Metcalf R W. Fifteen-year follow-up of arthroscopic partial meniscectomy.  Arthroscopy. 1997;  13 (6) 673-679
• 40 Schimmer R C, Brülhart K B, Duff C, Glinz W. Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course.  Arthroscopy. 1998;  14 (2) 136-142
• 41 Cole B J, L'Insalata J, Irrgang J, Warner J J. Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study.  J Bone Joint Surg Am. 2000;  82-A (8) 1108-1114
• 42 Chatain F, Adeleine P, Chambat P, Neyret P. Société Française d'Arthroscopie . A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up.  Arthroscopy. 2003;  19 (8) 842-849
• 43 Anderson L, Watts M, Shapter O et al.. Repair of radial tears and posterior horn detachments of the lateral meniscus: minimum 2-year follow-up.  Arthroscopy. 2010;  26 (12) 1625-1632
• 44 Choi N H, Kim T H, Son K M, Victoroff B N. Meniscal repair for radial tears of the midbody of the lateral meniscus.  Am J Sports Med. 2010;  38 (12) 2472-2476
• 45 Tenuta J J, Arciero R A. Arthroscopic evaluation of meniscal repairs. Factors that effect healing.  Am J Sports Med. 1994;  22 (6) 797-802
• 46 Griffin L Y, Albohm M J, Arendt E A et al.. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005.  Am J Sports Med. 2006;  34 (9) 1512-1532
• 47 Rubman M H, Noyes F R, Barber-Westin S D. Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.  Am J Sports Med. 1998;  26 (1) 87-95
• 48 Scott G A, Jolly B L, Henning C E. Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing.  J Bone Joint. 1986;  68A 847-861
• 49 Rimmer M G, Nawana N S, Keene G C, Pearcy M J. Failure strengths of different meniscal suturing techniques.  Arthroscopy. 1995;  11 (2) 146-150
• 50 Johnson M J, Lucas G L, Dusek J K, Henning C E. Isolated arthroscopic meniscal repair: a long-term outcome study (more than 10 years).  Am J Sports Med. 1999;  27 (1) 44-49
• 51 McCarty E C, Marx R G, DeHaven K E. Meniscus repair: considerations in treatment and update of clinical results.  Clin Orthop Relat Res. 2002;  (402) 122-134
• 52 Haas A L, Schepsis A A, Hornstein J, Edgar C M. Meniscal repair using the FasT-Fix all-inside meniscal repair device.  Arthroscopy. 2005;  21 (2) 167-175
• 53 Kotsovolos E S, Hantes M E, Mastrokalos D S, Lorbach O, Paessler H H. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system.  Arthroscopy. 2006;  22 (1) 3-9
• 54 Powell J W, Barber-Foss K D. Injury patterns in selected high school sports: a review of the 1995-1997 seasons.  J Athl Train. 1999;  34 (3) 277-284
• 55 Cohen S B, Anderson M W, Miller M D. Chondral injury after arthroscopic meniscal repair using bioabsorbable Mitek Rapidloc meniscal fixation.  Arthroscopy. 2003;  19 (7) E24-E26
• 56 Anderson J M. Multinucleated giant cells.  Curr Opin Hematol. 2000;  7 (1) 40-47
• 57 Borden L S, Perry J E, Davis B L, Owings T M, Grabiner M D. A biomechanical evaluation of one-stage vs two-stage bilateral knee arthroplasty patients.  Gait Posture. 1999;  9 (1) 24-30
• 58 Chang H C, Nyland J, Caborn D N, Burden R. Biomechanical evaluation of meniscal repair systems: a comparison of the Meniscal Viper Repair System, the vertical mattress FasT-Fix Device, and vertical mattress ethibond sutures.  Am J Sports Med. 2005;  33 (12) 1846-1852
• 59 Lozano J, Ma C B, Cannon W D. All-inside meniscus repair: a systematic review.  Clin Orthop Relat Res. 2007;  455 134-141
• 60 DeHaven K E, Lohrer W A, Lovelock J E. Long-term results of open meniscal repair.  Am J Sports Med. 1995;  23 (5) 524-530
• 61 DeHaven K E, Sebastianelli W J. Open meniscus repair. Indications, technique, and results.  Clin Sports Med. 1990;  9 (3) 577-587
• 62 Arnoczky S P, Warren R F, Spivak J M. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs.  J Bone Joint Surg Am. 1988;  70 (8) 1209-1217
• 63 Hunter D J, Zhang Y, Sokolove J, Niu J, Aliabadi P, Felson D T. Trapeziometacarpal subluxation predisposes to incident trapeziometacarpal osteoarthritis (OA): the Framingham study.  Osteoarthritis Cartilage. 2005;  13 (11) 953-957
• 64 Milachowski K A, Weismeier K, Wirth C J. Homologous meniscus transplantation. Experimental and clinical results.  Int Orthop. 1989;  13 (1) 1-11
• 65 Matava M J. Meniscal allograft transplantation: a systematic review.  Clin Orthop Relat Res. 2007;  455 142-157
• 66 Verdonk P C, Demurie A, Almqvist K F, Veys E M, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.  J Bone Joint Surg Am. 2005;  87 (4) 715-724
• 67 Verdonk P C, Verstraete K L, Almqvist K F et al.. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 (8) 694-706
• 68 Wirth C J, Peters G, Milachowski K A, Weismeier K G, Kohn D. Long-term results of meniscal allograft transplantation.  Am J Sports Med. 2002;  30 (2) 174-181