In 2003 our team at the Cincinatti Sportsmedicine Research and Education Foundation undertook research to study the outcome of meniscal repair in young active patients in whom removal of meniscal tissue would likely result in a major loss of function and future joint breakdown [see original publication].
Particularly we wanted to evaluate the results of removing meniscal tissue from the central region of the meniscus where blood supply is virtually absent despite the meniscus still functioning to protect the joint.
X-rays and other imaging techniques have been used to demonstrate the insidious progression of joint surface destruction after meniscectomy.
From the perspective of healing, the meniscus can be divided into three areas. The outer one-third has good blood supply and is called the 'vascular' or 'red' zone. Blood supply diminishes as one progresses towards the flattened inner aspect - and this inner two thirds is called the 'avascular' or 'white' zone.
Knee surgeons refer to the junctions between these zones, where tears frequently occur, as -
according to the vascularity of the edges of the tear.
Research has shown that tears in the outer red zone heal well but tears in the inner part of the white zone do not usually heal. But there is limited research data about tears of the outer part of the white zone, ie the area >4mm from the meniscal pheriphery.
Importance of Surgical Technique
Meniscal tears heal primarily by migration of cells from the edge of the meniscal rim. We stress to our colleagues the importance of meticulous technique in bringing the two surfaces of the torn meniscus into close opposition. We abrade the wound edges and use multiple non-absorbable sutures (stitches) every 4-5 mm. Vertical sutures are stronger. We fill the gap with fibrin clot if there is any loss of tissue at the repair site, and sometimes use a 'micropick' in the notch near the ACL to induce some local bleeding. We do not use fixation devices (eg arrows) to hold the edges together as we find it hard to get a meticulous closure.
With 75% having no symptoms at follow-up, we feel that it is very worthwhile to attempt repair in these young patients.