The knee meniscus: management of traumatic tears and degenerative lesions

[摘要] If it is torn, take it out! Take it all out! Even if you just think it’s torn, take it out. Those were the slogan words by Smillie in 1967 referring to meniscal injuries.1 Fortunately, things have changed dramatically and the management of the torn meniscus is now plurally based on basic science knowledge, new diagnostic tools, technical improvements and better long-term outcome assessment: 1. Basic science demonstrated for a long time the crucial role of the menisci in the knee homeostasis. It also demonstrated the repairability of the meniscus thanks to the peripheral vascularity which allows a healing process.2 2. New diagnostic tools, first MRI and then arthroscopy, gave us a better understanding of the meniscal lesions. Saying the meniscus is torn is not sufficient. These tools show the precise tear pattern, the exact location, the extent, the associated injuries such as anterior cruciate ligament (ACL) or articular cartilage. There is not one but several meniscal tears and we have to distinguish them: traumatic tears, which can be classified as a fracture, and degenerative lesions, classified as a disease. Their management is completely different. 3. Technical improvements have accompanied medical advances. Arthroscopy itself was a revolution and not just a tool. It allowed better assessment and partial meniscectomy with fast recovery and low morbidity. Meniscus repair techniques improved progressively. Biological enhancers have also been proposed. But as with all revolutionary tools, arthroscopy had some adverse effects, sometimes resulting in overuse.

[学科分类] 神经科学

[关键词] knee;meniscus;meniscus repair;meniscectomy;degenerative meniscal lesions;consensus;guidelines