Types of Meniscus Tears That Can Be Repaired
Traumatic tears in the peripheral vascular zone of the meniscus are the most suitable candidates for repair, with longitudinal vertical tears in the peripheral third considered the "gold standard" indication for meniscal repair. 1
Repairable Meniscus Tear Types
- Longitudinal vertical tears in the peripheral third (red-red or red-white zones) have the best healing potential due to better blood supply 1
- Unstable peripheral detachments that occur in the vascularized zone of the meniscus 2
- Bucket handle tears that extend into the vascularized zone can be successfully repaired 3
- Meniscal root tears should be repaired to prevent progression of osteoarthritis and preserve meniscal hoop function 1
- Radial tears, despite being technically challenging, can be repaired with success rates of approximately 86% at 5-year follow-up 4
Factors Affecting Repairability
- Location: Tears in the peripheral vascular zone (red-red or red-white zones) have better healing potential than those in the avascular (white-white) zone 1
- Tear pattern: Vertical longitudinal tears heal better than horizontal or complex tears 1
- Timing: Acute tears generally have better outcomes than chronic tears 1
- Patient age: Younger patients typically have better healing potential 4
- Knee stability: Stable knees show better repair outcomes (8% failure rate) compared to anterior cruciate ligament-deficient knees (13% failure rate) 2
Repair Techniques
- Inside-out technique: Traditional method using sutures passed from inside the joint to outside 2
- Outside-in technique: Sutures passed from outside the joint to inside 2
- All-inside technique: Uses specialized devices that allow repair without additional incisions 5
- Hybrid approaches: Combination of techniques for complex tears 5
Clinical Outcomes of Meniscal Repair
- Long-term follow-up of meniscal repair demonstrates better clinical outcomes and less severe degenerative changes compared to partial meniscectomy 1
- Reoperation rates are higher after meniscal repair compared to arthroscopic partial meniscectomy 1
- For radial tears of the lateral meniscus in stable knees, repair has shown a functional healing rate of 86% at a mean follow-up of 5 years 4
Common Pitfalls to Avoid
- Attempting meniscus repair in the setting of advanced osteoarthritis is unlikely to be successful and may delay appropriate definitive treatment 6
- Rushing to arthroscopic procedures without adequate trial of conservative management in patients with degenerative meniscal tears should be avoided 7
- Assuming all mechanical symptoms require surgical intervention is incorrect 7
- Failing to address concomitant knee instability (especially ACL deficiency) may lead to higher failure rates of meniscal repairs 2
Emerging Approaches
- Advancements in biological augmentation such as bone marrow stimulation, fibrin clot, platelet-rich plasma, and stem cell therapy have expanded the indications for meniscus repair 1
- Centralisation techniques have been developed to reduce meniscus extrusion by suturing the meniscus-capsule complex to the edge of the tibial plateau 1
- For symptomatic meniscus defects after meniscectomy, transplantation of allograft or collagen meniscus implant may be indicated 1
In summary, while the evidence base for meniscal repair is still developing, the current literature supports repairing traumatic tears in the vascular zones of the meniscus, with longitudinal vertical tears having the best outcomes. The surgical approach should prioritize meniscal preservation whenever possible to prevent long-term joint degeneration.