The meniscus is an important piece of cartilage in the knee joint that acts as a shock absorber between the thighbone (femur) and shinbone (tibia). However, tears in the meniscus are very common and can be debilitating if left untreated. Fortunately, advancements in meniscal repair systems have made it possible for surgeons to repair many once irreparable tears, allowing the meniscus to heal.
Arthroscopic Techniques for Meniscal Repair
Historically, a torn meniscus would often require a partial or complete removal (meniscectomy). This was because the inner portions of the meniscus received minimal blood flow, making healing difficult. Today, surgeons utilize arthroscopic techniques to access, visualize, and perform repairs of the meniscus through small incisions. Arthroscopy allows for less invasive surgery and quicker recovery compared to traditional open procedures. Keyhole views inside the joint provide surgeons precise targeting of tears. Sutures, anchors, needles, and other specialized instruments are used during arthroscopy to reattach torn pieces of cartilage back together.
The goal of repair is to restore the normal circular shape and mechanical function of the meniscus. Arthroscopic repairs are generally recommended for stable, peripheral tears in the well-vascularized outer third of the meniscus. Tears in the inner avascular zone are still not considered good candidates for healing. Repair may include vertical mattress sutures placed through the meniscus or all-inside devices that act as internal barbs or mini-staples to hold torn edges together.
Biodegradable Implants Promote Healing
One of the greatest advancements has been the development of biodegradable implants used during Meniscus Repair Systems. Made of materials like polylactic acid (PLA) and polyglycolic acid (PGA), these implants avoid the need for permanent foreign bodies left in the joint. As the body naturally metabolizes the biodegradable materials over time, they leave behind no artifacts or complications. The implants come in various configurations of arrows, darts, screws, or simple masses to reapproximate torn pieces of cartilage without the use of knots or exposure of suture material.
Their biocompatibility and gradual degradation over 6-12 months provides the necessary scaffolding and stabilized environment for healing cells to infiltrate the tear site. Several studies have demonstrated the implants' superiority over all-inside devices or simple vertical mattress sutures alone. They better restore normal hoop stresses on the meniscus and promote integration of ligament-like repair tissue within 4-6 weeks. Complete degradation coincides with full biological healing and restoration of mechanical function.
Post-Operative Rehabilitation Protocols
In order for meniscal repairs to heal properly, appropriate post-surgical rehabilitation protocols must be followed. This involves restricting activities for 6-12 weeks initially while maintaining range of motion. During this period, weight bearing is limited to toe-touch with the assistance of crutches or a knee immobilizer brace. Strengthening and sport-specific exercises are slowly introduced after the first 6 weeks as tolerated by the patient.
As healing occurs between 8-12 weeks, patients may progress their activities including walking or low-impact elliptical use without pain or swelling. Jogging on land can begin around 10-12 weeks with approval from their surgeon. Return to full activities like jumping or pivoting sports typically requires 4-6 months to ensure the repair tissue has fully remodeled and integrated. Patients are monitored clinically and radiographically during rehab to check healing status. Strict adherence to post-op protocols maximizes chances for healing versus failure requiring revision surgery.
Outcomes of Meniscal Repair
Recent long-term studies have found 80-90% healing rates for appropriately selected, all-inside repaired meniscal tears at 5 years follow-up. This compares favorably to healing rates under 60% when using just simple vertical mattress sutures previously. Additionally, repair has been shown to reduce longer term cartilage loss, improve function and decrease arthritic changes versus partial meniscectomy alone. While a meniscectomy addresses the symptom of pain in the short term, it initiates cartilage degeneration over 10-20 years which increases chances of future knee replacement.
In conclusion, advancements in Meniscus Repair Systems have shifted treatment paradigms. What was once seen as irreparable cartilage can now be repaired arthroscopically using biodegradable implants and rehabilitation protocols devised to encourage healing. This offers patients an anatomical solution that may avoid subsequent arthritis, maintains normal knee mechanics and has superior long term outcomes over partial removal of the meniscus. Improved technology and surgical techniques continue to expand indications and opportunities for healing tears once considered untreatable.
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