Meniscal Repair

The meniscus is a treatment quandary. They provide a vital role in knee mechanics and protection of the cartilage surfaces, acting as a shock-absorber, as well as a stabiliser to protect the ligaments around the knee. For this reason, it seems important to preserve them as much as reasonably possible.

Due to frequently supporting our body-weight, they have minimal blood supply and instead rely largely on joint fluid for nourishment. This limits their propensity to heal, as blood supply is generally a primary necessity for bodily tissue to heal successfully. It is thought for this reason that many meniscal injuries are better off cut out rather than repaired; with the additional benefit that patients can return to immediate activity without repair and issues are unlikely to arise until later in life, when the joint cartilage wears away due to increased pressure.

Modern repair techniques can employ biological enhancement to the meniscal tissue, such as a blood-clot graft. It remains to be seen whether such such techniques are truly of benefit, but early research is positive.

Repair techniques depend on the particular injury pattern but ostensibly involve suture repairing the torn ends together, often with small incisions outside the knee to tie these down. Root tears of the meniscus usually include a tunnel through the tibia to recreate the root connection of the meniscus, attached with small prostheses. A rare procedure called meniscal centralisation involves a series of sutures that anchor the meniscus tightly down to the periphery of the tibia, to hold it in place.

Mr O’Bryan advocates for meniscal repair as much as is reasonably possible, but this is dependent on patient wishes as well as their age, and factors regarding the specific meniscal injury.