Meniscectomy

To review the meniscus from a historical perspective especially on surgical management and general guidelines for arthroscopic meniscectomy procedures for various types of meniscal tears. We searched MEDLINE and PubMed for the years of 1980-2010 using the terms meniscus, meniscal repair, menisectomy, and arthroscopy. Orthopedic surgeons frequently encounter patients with pain or functional impairment of the knee joint and repair or resection of the injured meniscus is one of the most common orthopedic operative procedures. The object of meniscal surgery is to reduce pain, restore functional meniscus and prevent the development of degenerative osteoarthritis in the involved knee. Historically, total meniscectomy was a common procedure performed for meniscus tear symptoms. However, it has been reported that total meniscectomy has deleterious effects on the knee. In the past, the menisci were thought as a functionless remnant tissue. Currently, it is known that the meniscus is an important structure for knee joint function. Menisci provide several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint. It is widely accepted that the function of the meniscus can be preserved through minimal excision. An arthroscopic partial meniscectomy preserving more of the meniscus is preferred over total meniscectomy. In recent decades, this shift toward arthroscopic partial meniscectomy has led to the development of new surgical techniques.

Rehabilitation after Menisectomy in Elite Soccer Players

OBJECTIVE: To evaluate the effect of systemic and appropriate rehabilitation after menisectomy. METHOD: We reviewed the medical records of 13 patients who had been in rehabilitation program after menisectomy. We measured the range of motion of the knee joint, pain intensity by visual analogue scale (VAS) score, the difference of thigh circumference between normal and menisectomied legs, and strength of flexors and extensor of the knee and functional tests before and after rehabilitation. RESULTS: Range of motion, VAS score, thigh circumference, strength of flexors and extensors of the menisectomied knee were significantly different before and after rehabilitation. Knee flexion angle increased from 76.9degrees to 135degrees and knee extension angle increased from -10.8degrees to 0degrees. VAS score decreased from 4.3 to 0.9. The difference of thigh circumference decreased from 2.80 to 0.44 cm. The torque of flexors increased from 82.88 to 120.05 Nm and that of extensors increased from 97.83 to 149.77 Nm at 60 degrees/ sec. Twelve out of 13 players performed functional activities and returned to sports successfully after systemic rehabilitation. The average duration of rehabilitation was 16.6 weeks. CONCLUSION: We suggested that systemic and appropriate rehabilitation after the menisectomy was needed for successful return to sports.

Patellar Tendon Rupture associated with Rupture of Anterior Cruciate Ligament, Both Collateral Ligoments, and Lateral Meniscus: A Case Report / 대한정형외과학회잡지

Combined rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament is common. Since O Donoghue described this combined injury in 1950, it has been referred to as O Donoghue's triad. But the rupture of the patellar tendon is a relatively uncommon form of injury, particularly in a young, well-conditioned athlete. Baker (1980) presented a case of O' Donoghue' s triad with a rupture of the patellar tendon. We present an unusual case of patellar tendon rupture associated with rupture of anterior cruciate ligament, medial collateral ligament, lateral collateral ligament and lateral meniscus. This case differs from Baker's case and has not yet been reported in the literature. The senior author performed arthroscopic partial menisectomy, patellar tendon repair by Matava's method and arthroscopic anterior cruciate ligament reconstruction, using the autogenous bone-patellar tendon-bone graft from the controlateral knee. The clinical results were good, and as far as the authors have reviewed, no report has been published about this rare injury. So we report this case with a review of the literature.

The Use of Holmium: Yag laser in Partial Menisectomy / 대한정형외과학회잡지

Previous applications of laser bone and cartilage ablation have focused largely on the CO2 and the Nd:Yag lasers, using both the continuous wave and rapid superpulsed mode, which revealed severe thermal damage such as tissue necrosis and carbonization of the remaining tissue. In contrast, Excimer lases have provided better histologic results with minimal or no thermal damage, but the ablation rate and cutting efficiency have remained unsatisfactory. Though arthroscopic partial menisectomy has become the accepted technique for dealing with tears in menisci, division of the meniscus is sometimes difficult in the confined joint space of the knee and is associated with iatrogenic injury to the articular cartilage. The ability to quickly and safely divide or remove meniscal tissue would be a distinct advantage. The Holmium:Yag laser has many potential advantages over the CO2 laster, the Nd:Yag laser and the Excimer laser. Its principal advantages include minimal mechanical trauma to the articular cartilage, greater access to tight or restricted area of the knee joint, and its ability to function in a saline medium and to resect meniscus with minimal tissue necrosis. We have evaluated the effectiveness of the Holmium:Yag laser 74 partial menisectomies of 57 patients. Among 74 meniscal tears, there were 35 medial and 39 lateral meniscal tears. The average operation time was 33 minutes in the menisectomy and hospital stay was average 3 days. There was no significant carbonization on the surrounding tissue. Menisectomy of the posterior horn was safe and easy and there was minimal iatrogenic articular cartilage damage.

The Factors Affecting The Prognosis of Arthroscopic Meniscectomy / 대한정형외과학회잡지

Between May 1982 and October 1983, arthroscopic meniscectomy had been performed in 54 knees between ages of 11 and 70 years. There were 32 male patients and 22 female patients in this series. The mean follow-up was 20 months, ranging from 15 months to 33 months. Postoperative complications developed were retropatellar tenderness and effusion. No infection, thrombophlebitis or instability occurred postoperatively. The aim of this study was to evaluate the effect of the various possible prognostic factors upon the developtnent of the above mentioned complications. The factors included were 1) shape of tear, 2) ligamentous injury, 3) degenerative arthritia, 4) discoid lateral meniscus, 5) quadriceps atrophy, 6) sites of meniscus(medial or lateral) & extent of excision, 7) preoperative retropatellar tenderness and 8) method of rehabilitation. The findings were statistically analyzed by the Chi-square test (df-1) & Fisher's direct probability method. The results obtained were as follows; 1. The rate of development of postoperative effusion was significantly high in cases of quadriceps atrophy (P<0.01) and preoperative retropatellar tenderness(P<0.01). 2. The rate of deveopment of postoperative retropatellar tenderness was significantly high in case of discoid lateral meniscus (P <0.01). 3. There was no significant correlation between complications and other factors including shape of tear, preoperative degerative arthritis, site of meniscus & extent of excision and methods of rehabilitation.

Arthroscopic Total Meniscectomy of the Lateral Discoid Meniscus / 대한정형외과학회잡지

The technique of the arthroscopic total meniscectomy of discoid meniscus is very difficult. Ikeuchi(1982) reported a technique of arthroscopic total meniscectomy of the lateral discoid meniscus by removal of 2/3 of the anterior part of the meniscus first and then by morselization. The purpose of this paper is to report a technique of arthroscopic total meniscectomy of the lateral discoid meniscus as a whole. During the period from October 1982 to October 1984, we had 12 experiences of arthroscopic total meniscectomy of the discoid meniscus and found good results, that is, little postoperative pain, short period of hospitalization and early restoration of joint motion without physical therapy. Complications are 3 cases of symptomless slight lateral instability and 4 cases of hemarthrosis.