A Way Forward
Meniscal tears are the most common
traumatic pathology presenting to the
modern day knee surgeon.The menisci
act as important load sharers and shock
absorbers in the knee and meniscectomy
massively increases the future risk of
developing osteoarthritis of the knee.
In the past, meniscal tears were
treated by open total meniscectomy.
Subsequently, efforts were made to
repair meniscal tears where possible,
but this involved difficult open techniques
with significant potential complications.
More recently, technical advances have
enabled meniscal tears to be repaired
arthroscopically very effectively, and
meniscal preservation, where possible,
is now the vogue.
The menisci have a naturally poor
blood supply, which comes from the
periphery and supplies only the outer
1/3 of the tissue.Thus, many tears even
if stitched back together would not
actually have the natural tendency to
heal, and thus the repair would in time
fail.The indications for meniscal repair
are, therefore, quite specific.
Indications for meniscal repair
- Younger patients, as meniscal tissue
in older patients is more likely to be
- Fresh traumatic tears.
- Tears in the peripheral vascularised
Relative contraindications to
- Widespread degeneration within
- Complex degenerative tears.
- Tears in the inner poorly-vascularised
Overall, somewhere in the region of
approximately 20% of meniscal tears
are actually repairable. My personal
preference in terms of surgical technique
is the use of the Smith & Nephew
Fast-Fix meniscal repair device, which
consists of a suture attached to two tiny
anchors, linked by a slip knot, allowing
a fully arthroscopic repair technique.
The results of meniscal repair are now
well-reported, with success rates in the
region of 90% at 5 years. However, the
true benefit of meniscal repair will really
show itself in 10 or 20 years time, when
we hope to see significantly reduced
rates of osteoarthritis in the knee.
For those patients with a completely
absent meniscus from previous surgery,
one option is the technique of meniscal
allograft transplantation.This involves
surgical implantation of donor meniscal
tissue. Meniscal transplantation has gained
significant popularity in the US, with
over 4000 meniscal transplants having
already been performed to date. Meniscal
transplantation has been shown to provide
good pain relief, with success rates in
excess of 80% at 5 years’ follow-up. Again,
the real proof of this procedure will be
the degree to which degenerative
changes in the knee may be delayed
or avoided in the longer term.
One further highly interesting recent
development is the Menaflex Collagen
Meniscal Implant.This is a prosthetic
collagen scaffold, manufactured from
bovine Achilles tendon, which is surgically
fixed into the defect in a meniscus.
Feasibility studies have demonstrated
biocompatibility and excellent ingrowth
of meniscal-like tissue into the scaffold
after implantation, with early clinical
studies demonstrating decreased pain
and increased function.
The possibility of using genetic
engineering to regrow one’s own
damaged meniscal tissue in-situ is still
a long way off, but genuine and exciting
progress in the area of meniscal surgery
is being made, and the motto of ‘
preservation where possible, meniscal
replacement where indicated
certainly holds true.
An Update on
Surgery for the
mr ian mcdermott
Consultant Knee Surgeon –
The London Knee Clinc
For further information on arthroscopic knee surgery, meniscal tears, meniscal repair, meniscal transplantation
or the Menaflex Collagen Meniscal Implant, please contact us at:
The London Knee Clinic, St Olaf House, 27 Tooley Street, London SE1 2PR
Tel: +44 (0) 20 7407 3069 Fax: +44 (0) 20 7407 3138 Email:[email protected]
Figure ( ii. ) –
Fast-Fix Meniscal Repair.
Figure ( iii. ) –
The Menaflex Collagen
Figure ( i. ) –
View of a