The Meniscus

This clinical guide provides a special focus on the normal meniscal mechanism, body and function. Meniscal pathology and therapy are depicted in detail, followed by the presentation of long-term experience of meniscal transplantation and a look into the future of meniscal surgery.

During the last few decades, as the management of meniscal trauma has evolved, and knowledge gained on meniscal function, the orthopaedic surgeon has attempted to preserve the meniscus whenever possible. Arthroscopic meniscal repair has become the treatment of choice when the tear is located in the peripheral rim. Partial meniscectomy has become limited to such an extent that the deleterious effect of total meniscectomy is avoided. Meniscal allograft replacement, which has been available for the last two decades, is used when the patient is confronted with a painful total meniscectomy. Future research and experiments may suggest that partial meniscal replacement might be indicated in the presence of a painful knee compartment after failed meniscal repair or partial meniscectomy.

Basic Science.- Ontogeny-Phylogeny.- Anatomy.- Histology-Ultrastructure-Biology.- Biomechanics.- Synthesis.- Meniscal Lesions: Classification.- Traumatic Lesions: Stable Knee, ACL Knee.- Degenerative Lesions-Meniscal Cyst.- Meniscus and Osteoarthritis.- Synthesis.- Preoperative Clinical Examination and Imaging.- Clinical Examination: Standard X-Rays.- MRI, MR-arthrography and CT-arthrography.- Bone Scan.- Synthesis.- Technique.- Meniscectomy: Medial-Lateral.- Meniscal Repair: Biomechanics.- Meniscal Repair: Technique.- Meniscal Repair: Enhancement of Healing Process.- Meniscal Cysts.- Rehabilitation.- Synthesis.- Postoperative Evaluation.- Functional and Objective Scores. Quality of Life.- Postoperative Imaging: X-Rays, Arthro CT, Arthro MRI.- Results.- Meniscectomy: Global Results-Complications.- Meniscal Repair: Intra- and Postoperative Complications.- Meniscal Repair: Results.- Indications: Adults.- Traumatic Meniscal Lesions in a Stable Knee: Masterly Neglect, Meniscectomy, Repair.- Traumatic Lesions, ACL Knee: Masterly Neglect, Meniscectomy, Repair.- Degenerative Meniscal Lesions in a Stable Knee.- Lavage, Debridement, and Osteoarthritis.- Synthesis.- Meniscal Lesions in Children.- Classification: Discoid Meniscus, Traumatic Lesions.- Discoid Meniscus: Histology.- Technique of Meniscoplasty and Meniscal Repair in Children.- Meniscus Lesions in Children-Indications and Results.- Synthesis.- Post-meniscectomized Knee.- Postoperative Osteonecrosis of the Condyle: Diagnosis and Management.- Management of Early and Late Failure of Lateral Meniscus.- Synthesis.- Meniscal reconstruction- Allograft.- Basic Science.- Organization: Type of Grafts, Conservation, Regulation.- Meniscal Allograft: French Organization.- Open Technique.- Arthroscopic Technique Without Plugs.- Arthroscopic Technique with Bone Plugs.- Results and Indications.- Meniscal Reconstruction – Substitutes.- Menaflex (TM) Collagen Meniscus Implant: Basic Science.- Collagen Meniscus Implant: Technique and Results.- Actifit, Polyurethane meniscus implant: basic science.- Polyurethane Meniscus Implant: Technique.- Synthesis.- The Future.- The Future.- Conclusion.- General Conclusion.