Arnoczky and Warren mapped the microvascular anatomy of both menisci in 20 cadaver knees using India ink perfusion and Spalteholz tissue clearing. The central question: which zones have enough blood supply to support healing? This paper defined the biological basis for selective meniscal repair over routine meniscectomy.
The meniscus was once treated as an essentially avascular, expendable structure — total meniscectomy was standard, and repair was considered experimental fringe surgery. Arnoczky and Warren gave that practice a biological reckoning: the peripheral 10–30% has real blood supply, and King's 1936 principle (healing requires vascular access) means that zone is surgically repairable.
When you see a peripheral longitudinal tear in the red zone, this paper is why you repair rather than excise. When you see a tear at the posterolateral lateral meniscus near the popliteal tendon, the peripheral wall is avascular there. The usual repair biology does not apply, even if the tear looks peripheral on imaging or arthroscopy.
This work directly enabled the red-red / red-white / white-white zone classification that still drives operative decision-making today and is a standard board exam topic on meniscal pathology.
Arnoczky and Warren mapped the microvascular anatomy of both menisci in 20 cadaver knees using India ink perfusion and Spalteholz tissue clearing. The central question: which zones have enough blood supply to support healing? This paper defined the biological basis for selective meniscal repair over routine meniscectomy.
The meniscus was once treated as an essentially avascular, expendable structure — total meniscectomy was standard, and repair was considered experimental fringe surgery. Arnoczky and Warren gave that practice a biological reckoning: the peripheral 10–30% has real blood supply, and King's 1936 principle (healing requires vascular access) means that zone is surgically repairable.
When you see a peripheral longitudinal tear in the red zone, this paper is why you repair rather than excise. When you see a tear at the posterolateral lateral meniscus near the popliteal tendon, the peripheral wall is avascular there. The usual repair biology does not apply, even if the tear looks peripheral on imaging or arthroscopy.
This work directly enabled the red-red / red-white / white-white zone classification that still drives operative decision-making today and is a standard board exam topic on meniscal pathology.