Meniscal Considerations in Cartilage Surgery

  • Christian Lattermann
  • Chaitu Malempati


Preservation of the meniscus has become the standard in sports medicine after evidence emerged that there was progressive chondrosis following total meniscectomy as performed over 40 years ago. In this chapter, we will address pertinent aspects of meniscal preservation, specifically addressing how meniscus repairs and partial resection are relevant to the cartilage surgeon. This will include the concept of the meniscus being a load distributor more than a shock absorber; the subset of meniscus pathology in the anterior cruciate ligament (ACL)-deficient knee joint will also be discussed. To allow a practical framework from which to direct patient care, general guidelines will be presented that will include the outcomes of meniscus repair in cartilage patients regarding tear configuration, age, and degeneration of the knee joint.


Meniscus Repair Inside-out Meniscectomy ACL deficiency Extrusion 


  1. 1.
    Hede A, Jensen DB, Blyme P, Sonne-Holm S. Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982–84. Acta Orthop Scand. 1990;61(5):435–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30B(4):664–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Gillquist J, Oretorp N. Arthroscopic partial meniscectomy. Technique and long-term results. Clin Orthop Relat Res. 1982;(167):29–33.Google Scholar
  4. 4.
    Henning CE. Current status of meniscus salvage. Clin Sports Med. 1990;9(3):567–76.PubMedGoogle Scholar
  5. 5.
    Majewski M, Stoll R, Widmer H, Muller W, Friederich NF. Midterm and long-term results after arthroscopic suture repair of isolated, longitudinal, vertical meniscal tears in stable knees. Am J Sports Med. 2006;34(7):1072–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Noyes FR, Barber-Westin SD, Chen RC. Repair of complex and avascular meniscal tears and meniscal transplantation. Instr Course Lect. 2011;60:415–37.PubMedGoogle Scholar
  7. 7.
    Clark CR, Ogden JA. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am. 1983;65(4):538–47.CrossRefPubMedGoogle Scholar
  8. 8.
    Anderson AF, Irrgang JJ, Dunn W, et al. Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med. 2011;39(5):926–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang Y, Dempsey AR, Lloyd DG, et al. Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):970–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee SJ, Aadalen KJ, Malaviya P, et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med. 2006;34(8):1334–44.CrossRefPubMedGoogle Scholar
  11. 11.
    Kazemi M, Li LP, Savard P, Buschmann MD. Creep behavior of the intact and meniscectomy knee joints. J Mech Behav Biomed Mater. 2011;4(7):1351–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Zielinska B, Donahue TL. 3D finite element model of meniscectomy: changes in joint contact behavior. J Biomech Eng. 2006;128(1):115–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Chang A, Moisio K, Chmiel JS, et al. Subregional effects of meniscal tears on cartilage loss over 2 years in knee osteoarthritis. Ann Rheum Dis. 2011;70(1):74–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Brophy RH, Farooq Rai M, Zhang Z, Torgomyan A, Sandell LJ. Molecular analysis of age and sex-related gene expression in meniscal tears with and without a concomitant anterior cruciate ligament tear. J Bone Joint Surg Am. 2012;94(5):385–93.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756–69.CrossRefPubMedGoogle Scholar
  16. 16.
    Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res. 2000;18(1):109–15.CrossRefPubMedGoogle Scholar
  17. 17.
    Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G. The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy. 2009;25(2):123–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD. Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med. 2011;39(2):289–95.CrossRefPubMedGoogle Scholar
  19. 19.
    Wieser K, Betz M, Farshad M, Vich M, Fucentese SF, Meyer DC. Experimental loss of menisci, cartilage and subchondral bone gradually increases anteroposterior knee laxity. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2104–8. Epub Nov 30 2011CrossRefPubMedGoogle Scholar
  20. 20.
    Englund M, Roos EM, Roos HP, Lohmander LS. Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection. Rheumatology (Oxford). 2001;40(6):631–9.CrossRefGoogle Scholar
  21. 21.
    Gratz KR, Wong BL, Bae WC, Sah RL. The effects of focal articular defects on cartilage contact mechanics. J Orthop Res. 2009;27(5):584–92.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Flanigan DC, Harris JD, Brockmeier PM, Siston RA. The effects of lesion size and location on subchondral bone contact in experimental knee articular cartilage defects in a bovine model. Arthroscopy. 2010;26(12):1655–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Schinhan M, Gruber M, Vavken P, et al. Critical-size defect induces unicompartmental osteoarthritis in a stable ovine knee. J Orthop Res. 2012;30(2):214–20.CrossRefPubMedGoogle Scholar
  24. 24.
    Biedert RM. Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):104–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27(9):1275–88.CrossRefPubMedGoogle Scholar
  26. 26.
    Maak TG, Fabricant PD, Wickiewicz TL. Indications for meniscus repair. Clin Sports Med. 2012;31(1):1–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Barrett GR, Field MH, Treacy SH, Ruff CG. Clinical results of meniscus repair in patients 40 years and older. Arthroscopy. 1998;14(8):824–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Shelbourne KD, Gray T. Meniscus tears that can be left in situ, with or without trephination or synovial abrasion to stimulate healing. Sports Med Arthrosc. 2012;20(2):62–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. 1983;11(3):131–41.CrossRefPubMedGoogle Scholar
  30. 30.
    Okuda K, Ochi M, Shu N, Uchio Y. Meniscal rasping for repair of meniscal tear in the avascular zone. Arthroscopy. 1999;15(3):281–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Vanderhave KL, Moravek JE, Sekiya JK, Wojtys EM. Meniscus tears in the young athlete: results of arthroscopic repair. J Pediatr Orthop. 2011;31(5):496–500.CrossRefPubMedGoogle Scholar
  32. 32.
    Noyes FR, Chen RC, Barber-Westin SD, Potter HG. Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med. 2011;39(5):1008–17.CrossRefPubMedGoogle Scholar
  33. 33.
    Papachristou G, Efstathopoulos N, Plessas S, Levidiotis C, Chronopoulos E, Sourlas J. Isolated meniscal repair in the avascular area. Acta Orthop Belg. 2003;69(4):341–5.PubMedGoogle Scholar
  34. 34.
    van Trommel MF, Simonian PT, Potter HG, Wickiewicz TL. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy. 1998;14(4):360–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Sethi PM, Cooper A, Jokl P. Technical tips in orthopaedics: meniscal repair with use of an in situ fibrin clot. Arthroscopy. 2003;19(5):E44.CrossRefPubMedGoogle Scholar
  36. 36.
    Piontek T, Ciemniewska-Gorzela K, Naczk J, Jakob R, Szulc A, Grygorowicz M, Slomczykowski M. Complex meniscus tears treated with collagen matrix wrapping and bone marrow blood injection: a 2-year clinical follow-up. Cartilage. 2016;7(2):123–39.CrossRefPubMedGoogle Scholar
  37. 37.
    Tienen TG, Heijkants RG, Buma P, De Groot JH, Pennings AJ, Veth RP. A porous polymer scaffold for meniscal lesion repair–a study in dogs. Biomaterials. 2003;24(14):2541–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Vangsness CT Jr, Farr J 2nd, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind controlled study. J Bone Joint Surg Am. 2014;96(2):90–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Whitehouse MR, Howells NR, Parry MC, Austin E, Kafienah W, Brady K, Goodship AE, Eldridge JD, Blom AW, Hollander AP. Repair of torn avascular meniscal cartilage using undifferentiated autologous mesenchymal stem cells: from in vitro optimization to a first-in-human study. Stem Cells Transl Med. 2017;6(4):1237–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christian Lattermann
    • 1
  • Chaitu Malempati
    • 2
  1. 1.Department of Orthopedics, Division of Sports MedicineBrigham and Women’s Hospital, Harvard UniversityBostonUSA
  2. 2.Orthopedic DepartmentUniversity of KentuckyBowling GreenUSA

Personalised recommendations