Meniscal Repair: Enhancement of Healing Process

Abstract

The limited healing potential of meniscal tissue and the importance of preserving the meniscus in view of its important role in load transmission, force distribution, shock absorption, articular cartilage protection, joint lubrication and knee stabilization have led to multiple strategies for enhancing meniscal repair [23, 39, 40, 42]. Loss of meniscal tissue, especially in young patients, has detrimental consequences for the long-term prognosis of the knee joint because it increases point loading and leads to premature wear of the knee due to altered mechanical forces, which ultimately results in osteoarthritis [9, 31]. The healing potential of meniscus tears depends on different factors, such as configuration of the tear, time between injury and repair, age of the patient and location of the tear. An essential prerequisite for meniscus healing is vascular access, which unfortunately is limited in meniscal tissue. The vascular anatomy of the meniscus was described by Arnoczky and Warren, who distinguished the red–red, vascularized peripheral zone with the best healing potential from the intermediate red–white zone and the most central white–white zone [3]. The more central the lesion is located, the worse its healing potential is. A longitudinal red–red peripheral lesion repaired by meniscal suturing has the best chance of healing. Already in 1936, King stated that “for a meniscal tear to heal the torn meniscus must communicate with its peripheral blood supply” [21].