2017 AJSM

Meniscal repair procedures are increasingly performed because of an enhanced understanding of the long-term deleterious consequences of meniscectomy, the benefits of meniscal preservation, and the improved techniques and devices available for meniscal repair. While meniscal repair has demonstrated a higher reoperation rate than meniscectomy, recent studies have reported that meniscal repair results in improved long-term outcomes when compared with meniscectomy. If the anatomic meniscal shape is not restored, the chondroprotective function of the meniscus is disrupted, predisposing the joint to early degenerative changes and increased morbidity.

While the decision for meniscal repair or meniscectomy is typically determined based on the tear pattern and location, the ultimate surgical decision is based on the preference of the treating surgeon. When meniscal repair is indicated, several techniques can be utilized. Of these, the inside-out technique allows for versatility and improved surgical precision, avoids leaving prominent intra-articular structures that could damage the articular cartilage, and allows for a greater number of low-profile sutures that do not alter the meniscal structure. Further, most types of meniscal tears can be repaired with the inside-out technique. There are, however, potential complications associated with inside-out techniques that are minimized or eliminated with all-inside techniques.

Meniscal tears repaired at the time of anterior cruciate ligament (ACL) reconstruction have demonstrated improved outcomes when compared with those repaired in isolation.14,21,29 While the average failure rate was 23% in the overall population, Westermann et al reported a 14% failure rate at 6 years’ follow-up in 235 patients with ACL reconstruction. Similarly, Feng et al reported a 100% failure rate if the objective arthrometer-measured laxity was greater than 5 mm. It has been theorized that the reason behind these improved outcomes relates to a favorable healing environment created by biological augmentation of the repair from the intra-articular release of peptides, growth factors, and pluripotent cells from the bone marrow when drilling the ACL reconstruction tunnels. In an attempt to re-create this favorable healing response, bone marrow stimulation procedures, such as venting of the intercondylar notch, have been performed in conjunction with isolated meniscal repair procedures as a potential option to enhance healing of the repair. In this regard, several studies have reported that the introduction of bone marrow components has resulted in improved healing of meniscal tears.

The purpose of this study was to compare the meniscal repair outcomes and survivorship in 2 cohorts of patients: meniscal repair with biological augmentation from a marrow venting procedure (MVP) of the intercondylar notch, and meniscal repair with concurrent ACL reconstruction. We hypothesized that the clinical outcomes and survivorship of meniscal repair with concomitant ACL reconstruction would be superior to meniscal repair with biological augmentation.

Full Article: Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction

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