{"title":"Editorial Commentary: Repair of Radial Meniscus Tears.","authors":"Jelle P van der List, David C Flanigan","doi":"10.1016/j.arthro.2024.08.041","DOIUrl":null,"url":null,"abstract":"<p><p>Treatment of meniscus injuries have evolved from open to arthroscopic, from total to partial meniscectomy, and towards meniscus preservation. In theory, almost all tear types can be repaired, including root tears, (oblique) radial tears, horizontal cleavage tears, vertical tears, and even complex tears, as a result of improved surgical techniques and tools. Meniscus repair outcomes literature may be confounded by lack of inclusion of control groups, as well as concomitant anterior cruciate ligament injury and reconstruction, augmentation with fibrin clot or platelet-rich plasma or other biologics, suture configuration, and timing of repair. Radial tears represent a most difficult pattern due to limited fixation strength suturing circumferential fibers, and technical challenge. However, successful meniscus repair outcomes can be obtained in this difficult tear pattern. The key to success for any radial repair, regardless of technique, is to create a tensionless repair, and one of the key components is anatomic reduction of the meniscus. Using all inside suture devices to place a traction stitch can assist in reducing the meniscus. Then, AI or IO techniques may be used to repair the meniscus to the capsule in anatomic position (vertical mattress), with rip stop sutures to create horizontal or oblique sutures across the tear. With the meniscus reduced anatomically, mismatch from intra- to extra-capsular distance is prevented.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2024.08.041","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Treatment of meniscus injuries have evolved from open to arthroscopic, from total to partial meniscectomy, and towards meniscus preservation. In theory, almost all tear types can be repaired, including root tears, (oblique) radial tears, horizontal cleavage tears, vertical tears, and even complex tears, as a result of improved surgical techniques and tools. Meniscus repair outcomes literature may be confounded by lack of inclusion of control groups, as well as concomitant anterior cruciate ligament injury and reconstruction, augmentation with fibrin clot or platelet-rich plasma or other biologics, suture configuration, and timing of repair. Radial tears represent a most difficult pattern due to limited fixation strength suturing circumferential fibers, and technical challenge. However, successful meniscus repair outcomes can be obtained in this difficult tear pattern. The key to success for any radial repair, regardless of technique, is to create a tensionless repair, and one of the key components is anatomic reduction of the meniscus. Using all inside suture devices to place a traction stitch can assist in reducing the meniscus. Then, AI or IO techniques may be used to repair the meniscus to the capsule in anatomic position (vertical mattress), with rip stop sutures to create horizontal or oblique sutures across the tear. With the meniscus reduced anatomically, mismatch from intra- to extra-capsular distance is prevented.
半月板损伤的治疗方法已从开放式发展到关节镜式,从半月板全切除术发展到半月板部分切除术,并逐渐发展到半月板保留术。理论上,由于手术技术和工具的改进,几乎所有类型的撕裂都可以修复,包括根部撕裂、(斜)径向撕裂、水平裂口撕裂、垂直撕裂,甚至复杂撕裂。半月板修复结果的文献可能因未纳入对照组、同时存在的前十字韧带损伤和重建、纤维蛋白凝块或富血小板血浆或其他生物制剂的增强、缝合结构和修复时机而受到混淆。径向撕裂是最困难的模式,因为缝合周缘纤维的固定强度有限,而且技术难度大。然而,在这种困难的撕裂模式下,半月板修复也能取得成功。无论采用哪种技术,半月板径向修复成功的关键在于实现无张力修复,而其中一个关键要素就是半月板的解剖缩小。使用所有内部缝合设备进行牵引缝合有助于缩小半月板。然后,可使用 AI 或 IO 技术将半月板修复到解剖位置的囊上(垂直床垫),并使用止裂缝合线在撕裂处进行水平或斜向缝合。随着半月板解剖位置的缩小,可避免囊内与囊外距离的不匹配。
期刊介绍:
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.