What are the recommendations for a lateral meniscectomy procedure?

Lateral Meniscectomy Recommendations

Arthroscopic partial meniscectomy should be performed for lateral meniscal tears only when repair is not possible, as lateral meniscectomy has a 40% rate of joint space narrowing at 13 years compared to 28% for medial meniscectomy. 1

Indications for Lateral Meniscectomy

Lateral meniscectomy is indicated in the following situations:

• Complex or horizontal cleavage tears that are symptomatic in stable knees 1
• Tears in the avascular zone (non-repairable) 1
• Deep horizontal cleavage or complex tears that are symptomatic 1
• Discoid meniscus with complete tear (should be treated with meniscoplasty rather than total meniscectomy) 1, 2
• Lateral meniscal cysts associated with horizontal cleavage tears 3

Surgical Technique Considerations

Approach Selection

• All-inside technique: Preferred for posterior horn tears with limited surgical access 3

  • Advantages: Shorter operating time, reduced morbidity
  • Disadvantages: Higher cost, technical challenges

• Inside-out technique: Gold standard for posterior horn and mid-body tears 3

• Outside-in technique: Better for anterior horn tears 3

Procedural Recommendations

1. Perform arthroscopic partial meniscectomy, preserving as much meniscal tissue as possible 1
2. For discoid meniscus, perform meniscoplasty to reshape the meniscus to a more anatomic form rather than total meniscectomy 1, 4
3. For meniscal cysts, address with arthroscopic meniscectomy reaching the meniscosynovial junction at the level of the cyst 1

Meniscal Repair vs. Meniscectomy

Meniscal repair is strongly preferred over meniscectomy when possible due to:

• Better long-term patient outcomes
• Improved activity levels
• Lower rates of osteoarthritis development 3

Criteria for Repair (When to Avoid Meniscectomy)

• Tears in peripheral/vascular "red zone" or "red-white zone" (outer 1/3 to middle 1/3) 3
• Vertical peripheral longitudinal lesions 1
• Horizontal cleavage tears in young athletes (if purely intrameniscal) 1

Post-Operative Care

1. For partial meniscectomy:

   • Physical therapy focusing on quadriceps strengthening 3
   • Clinical assessment at 2 weeks for wound check 3
   • Physical therapy for 6-8 weeks 3
   • Athletes with isolated longitudinal tears can return to sports in approximately 41 days 5
   • Athletes with complex tears or associated cartilage lesions may require 64-78 days to return to sports 5

2. For meniscal repair:

   • Splint protection in the first month 1
   • Exclusion from sports with knee torsion for 6 months 1
   • Long-term monitoring for progression of patellofemoral chondrosis 3

Outcomes and Prognosis

• Partial lateral meniscectomy in athletes shows 85% excellent/good results with 98% return to full sports activities 5
• Prognosis depends on:
  1. Type of meniscal tear (isolated longitudinal tears have best outcomes) 5
  2. Presence/absence of articular cartilage lesions (presence worsens outcomes) 5

Complications and Long-term Considerations

• Joint space narrowing after lateral meniscectomy (40% at 13 years) is higher than after medial meniscectomy (28%) 1
• Post-lateral meniscectomy syndrome may develop, requiring:
  • Viscosupplementation
  • Osteotomy (if lower limb axis is normal or in valgus)
  • Meniscal allograft in young patients with early arthritis (75% survival at 7 years) 1

Common Pitfalls to Avoid

1. Performing total meniscectomy when partial meniscectomy would suffice
2. Failing to recognize a discoid meniscus that requires meniscoplasty rather than meniscectomy
3. Missing associated cartilage lesions that may affect outcomes
4. Inadequate meniscectomy requiring revision surgery
5. Delaying surgical intervention beyond 3 months from initial injury, increasing risk of additional cartilage and meniscal injury 3

Early diagnosis with MRI and appropriate treatment selection between abstention, meniscectomy, or repair is crucial for optimal outcomes in lateral meniscal tears.