MENISCAL REPAIR
Dr. Biren Nadkarni has specialization in performing Meniscal Repair surgery.
Meniscal repair can be considered as a process of preparing a torn meniscus with the help of a keyhole surgery. It is a very minimally invasive procedure that has undergone as an outpatient. There are some factors that affect the success of the procedure and they are tear age, location and pattern, age of the patient and the associated injuries. the major meniscal functions are to distribute stress across the knee during the weight bearing for providing shock absorption and they also serve as a secondary joint stabilizer and also provides articular cartilage nutrition and lubrication and also helps in facilitating joint gliding and helps in preventing hyperextension and it also helps in the protection of the joints margin.
During knee flexion the femoral condyles glides on the tibial plateau in conjunction with tibial internal rotation. This translation prevents the femur from contract in the posterior margin of the tibial plateau. The the meniscus is divided into three zones:
- Red Red
- Red white
- White white
The zones are divided by vascularization and their healing potential. The red red zone is a periphery zone of the meniscus. The great red room is also very well vascularised and it also has excellent healing rate. patients differ in vascularization of the medial and lateral meniscus that varies between 20 30 and 10 25 % width. The red light zone is the middle third and it has a little less vascularization than the red red zone but it can also heels sometimes. The white white zone has no blood capillaries atol and therefore it cannot heel at all.
Epidemiology
Meniscal lesions are the most common intra articular knee injury in the United States of America and they are also a very frequent cause of surgical procedures performed by the surgeons. The mean annual incidence of meniscal lesions is 0.066%. There are more male patients that undergo this procedure then the female patients. The male patients are 59.5% and they undergo isolated meniscal repair compared with the female patients who are 31.5%. Generally the meniscal tears are very common in the middle aged people and the elderly people because it happens by long-term degeneration.
One third of the lesions by young patients are caused while playing a particular sport and they are all sports-related injuries which happens because of the cutting or twisting movement that happen during sports and hyperextension or the action with great force. More than 80% meniscus ears are accompanied by anterior cruciate ligament injury. Meniscal lesions in children are different than those found in the adult patient as in the childrens more than 70% isolated meniscal lessons that are caused because of the time by sport related to setting of the knee.
Indication for procedure
Non-operative treatment is highly successful in the treatment of meniscal tears in young athletes or young people and repair of the torn menisci is open required. Repair of a meniscal lesion should be strongly considered if the tear is verified and longitudinal with concurrent ACL reconstruction in the younger patients. The probability of healing is decreased in complex or degenerative tears, Central tears and tears in unstable knees. Meniscal tears amenable to repair include unstable years which are less than 1 cm in length and carrying in the outer 20% to 30% to on the periphery in the so-called red red zone.
Indication for surgery
The decision whether a lesion is treated surgically or non surgically is the first decision making after a definitive diagnosis of meniscal tear in your knees. Does decision is based on the patient’s factors for example age, compliance etc. When the tear is unstable then a surgery is necessary. A degenerative tear aur unknown degenerate weight is Apple is treated non-surgical e in the other cases such as non relative tears or tears which are symptomatic the tears are treated surgically. The second season that the patients need to make is whether meniscal repair is appropriate. None of the normal surgical treatment seems appropriate total meniscectomy is the only option left with the patient. The factors that should have been taken into consideration while making decisions include the clinical evaluation of the tear and the related lesions and the people also need to consider the exact type, location and the extent of the meniscal tear. If meniscal repair is performed combined with ACl reconstruction the success rate is influenced whether the influence is positive or negative is studied in several studies with different conclusions.
Outcome measures
And overall meniscal repair success rate is about 85 to 90%. Patients who are undergoing an ACL reconstruction can enjoy it and improved outcome of meniscal repair. People who have a history of ACL reconstruction had significantly worse meniscal repair success rate. In most of the studies it was found that a second MRI is needed to confirm whether the lesion is healing or not properly and the patient is also considered as being healed when there is no lesion when the second MRI and the patient is able to use his normal life activities.
Surgical techniques
Meniscal repair can be performed by open inside, out inside and all inside techniques. But not all the meniscal tears have the ability to heal and the meniscal tear pattern and the presence of adequate vascularity are both key. When meniscus repair is carried out under arthroscopic visualisation in the same manner as the inside out, the outside in and the all inside technique some common steps which are independent of the techniques have to be followed.
Complications
Scientists have studied the complications of about 10,000 patients who have gone through meniscal repair. Out of those 10,000 patients 168 patients had complications and complications were infections, anesthetics complications, instrument failure, ligament injury, fractures etc. With hemarthrosis being the most common complication and neurological injuries being the least common. No vascular injuries reported till now and there was an impressive 7% incidence of saphenous neuropathy by Austin.
Meniscal repair can be considered as a very good surgical procedure that helps in repairing a torn meniscus with the help of a keyhole surgery. It is also a very safe process.
Consult Dr Biren Nadkarni for Meniscal Repair Surgery