DeHaven, Arthroscopy 1985 - Meniscus Repair

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Meniscus Repair

DeHaven·Arthroscopy·1985·89 citations·Commentary

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This 1985 editorial compares open and arthroscopic meniscus repair as arthroscopic techniques were first emerging. It asks whether the new arthroscopic approach can match open repair on safety and efficacy for peripheral meniscal tears. The author frames repair as an alternative to meniscectomy for preserving meniscal function.

Key Findings

The author's series of 155 open meniscus repairs since 1976 had only 8 retears (5%), with no neurovascular complications or deep infections. Open repair of peripheral tears was already a reliable, low-complication procedure.
Only 15-20% of all torn menisci are peripheral lesions suitable for open repair. This is why most tears still end up treated by meniscectomy, and why extending repair to more tear types matters.
Early arthroscopic repair caused popliteal artery laceration, peroneal and saphenous nerve palsy, and deep infection, even in highly experienced arthroscopic surgeons. Safety, not morbidity, was the central concern with the new technique.
Posteromedial or posterolateral incisions to isolate neurovascular structures make arthroscopic repair a combined arthroscopic-open technique. This offsets much of the cosmetic and morbidity advantage of going all-arthroscopic.
Deep infection and septic arthritis were usually linked to tying sutures over external bolsters outside the skin. Consensus shifted to tying sutures beneath the skin over capsule or deep fascia.
Collagen maturation time to return to strenuous activity is identical for open and arthroscopic repair. The rehabilitation timeline is dictated by healing biology, not by the surgical approach.
Avascular-zone tears are considered nonrepairable and treated by partial meniscectomy, though experimental vascular access channels were being studied to expand the repairable zone.

Board PearlOnly peripheral vascular-zone meniscal tears heal reliably; avascular tears are treated by partial meniscectomy.

Meniscus Repair

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Meniscus Repair

DeHaven·Arthroscopy·1985·89 citations·Commentary

|

This 1985 editorial compares open and arthroscopic meniscus repair as arthroscopic techniques were first emerging. It asks whether the new arthroscopic approach can match open repair on safety and efficacy for peripheral meniscal tears. The author frames repair as an alternative to meniscectomy for preserving meniscal function.

Key Findings

The author's series of 155 open meniscus repairs since 1976 had only 8 retears (5%), with no neurovascular complications or deep infections. Open repair of peripheral tears was already a reliable, low-complication procedure.
Only 15-20% of all torn menisci are peripheral lesions suitable for open repair. This is why most tears still end up treated by meniscectomy, and why extending repair to more tear types matters.
Early arthroscopic repair caused popliteal artery laceration, peroneal and saphenous nerve palsy, and deep infection, even in highly experienced arthroscopic surgeons. Safety, not morbidity, was the central concern with the new technique.
Posteromedial or posterolateral incisions to isolate neurovascular structures make arthroscopic repair a combined arthroscopic-open technique. This offsets much of the cosmetic and morbidity advantage of going all-arthroscopic.
Deep infection and septic arthritis were usually linked to tying sutures over external bolsters outside the skin. Consensus shifted to tying sutures beneath the skin over capsule or deep fascia.
Collagen maturation time to return to strenuous activity is identical for open and arthroscopic repair. The rehabilitation timeline is dictated by healing biology, not by the surgical approach.
Avascular-zone tears are considered nonrepairable and treated by partial meniscectomy, though experimental vascular access channels were being studied to expand the repairable zone.

Board PearlOnly peripheral vascular-zone meniscal tears heal reliably; avascular tears are treated by partial meniscectomy.

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