Arthroscopic meniscal repair

Function of meniscus
Arthroscopic meniscal repair
Tears
Meniscal repair versus resection
Meniscal repair techniques

 Meniscus

Function of meniscus 

Shock absorption

Load transmission 

Knee stability

Lubrication

Joint congruency




Partial menisectomy

Functionally better results than total menisectomy

The ultimate outcome for partial menisectomy 

remains suboptimal

Arthroscopic meniscal repair

Only 10~15% of meniscal tears can be repaired

Usually associated with ACL injuries


Positive healing factors

Narrow peripheral meniscal rim (<4mm)

Repair within 8 weeks of injury

Length of tear (longer than 4cm : high failure rate)

Additional fibrin clot


Tears that can be definitely repaired

 Single vertical tears in red-red zone at the menisco-synovial junction

Age < 40 

 With stimulated by rasping, ACL reconstruction, fibrin clot




















*Higher scores associated with higher failure rates.

Outside-In

tears in the anterior horn or anterior half of the body of the meniscus 


Inside-Out 

allows reproducible, solid fixation of tears in the posterior and middle thirds of the meniscus


All-inside

tears in the posterior and middle thirds of the meniscus

Minimally invasive meniscal repair


Popular posts from this blog

Mirels’ Classification for pathologic fractures

Image
 Mirels’Classification Mirels H: Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 249:256–264, 1989. Mirels’Classification : Nature of lesion Mirels’Classification : Nature of lesion Orthopedic Radiology: A Practical Approach, Greenspan, Adam; Lippincott, 2000 Diagnosis of Bone and Joint Disorders, Resnick, Donald, W. B. Saunders Mirels’Classification : Nature of lesion Score of 8 or higher  consider prophylactic internal fixation Guideline aids in decision making, but does not serve as an absolute criterion Each patient should be evaluated individually, keeping two generally accepted principles in mind.  First, prophylactic internal fixation of an impending fracture is technically easier than fixation of an actual pathologic fracture. Second, patient morbidity is decreased with prophylactic fixation compared with fixation after the fracture. Prophylactic intramedullary fixation (↓pain and prevent subsequen...
Read more

Tibial spine fracture

Image
  Tibial spine fracture HyperExtension and femur external rotation during a fall Intercondyle eminence : Medial spine (ACL attachment) + Lateral spine ACL fiber -> tibial spine, inter-meniscal lig, MM attachment Classification Modified Meyers and McKeever classification Non-Operative management Type I, II (after C/R) Long leg cast, Slightly flexion (avoid ACL positional tension) Hemarthrosis evacuation Closed reduction (Physician’s preference for Type II) Surgical treatment Type II & III & IV Reduction method : Arthroscopic vs Open Fixation method : Suture vs Screw
Read more

Adrena incidentaloma: Diagnosis & Treatments

Epidemiology Adrenal incidentaloma is an adrenal mass lesion with a diameter of more than 1 cm incidentally detected by imaging. Adrenal incidentaloma is found in at least 2% of the population, and the prevalence increases with age. Adrenal incidentaolma is found in 1% of 40s and 7% of 70s. Most adrenal incidentalomas are endocrine-inactive adrenocortical adenomas that do not release hormones. The prevalence of endocrine-inactive adrenocortical adenoma is 60 to 85% of endocrine-active adrenocortical adenoma, endocrine-active adrenocortical adenoma is 5 to 10% of cortisol producing adenoma, aldosterone-producing adenoma is 2 to 5%, and pheochromocytoma is 5 to 10 %. 2 to 5% of the unilateral adrenal mass is a malignant adrenocortical carcinoma and 15% is metastatic cancer at other sites. Diagnosis Diagnostic evaluation should be performed in patients with adrenal masses greater than 1 cm. Two important factors must be considered. First, does the tumor secrete hormones that can harm...
Read more