The Meniscus

The Meniscus The management of meniscus lesions is an unbelievable story of so-called scient- cally based, controversial treatment, covering a time span of more than 120 years, including: • The time when a locked knee was manipulated in order to reduce a bucket-handle or a fap tear back into place to restore motion. • The time when famous surgeons excised the meniscus in thousands of patients and kept the resected specimens as trophies in large glass jars. • The time of animated discussions on whether either partial meniscectomy, only removing the ruptured parts, should be performed or total meniscectomy, as ad- cated by Smillie, because some meniscus-shaped semilunar tissue regeneration had been shown by Mandic after complete removal. • The time when the next milestone was reached as Trillat introduced intramural resection, which preserved the circular stabilizing fbrous rim with its menis- ligamento-capsular attachments to the tibia and femur, to maintain more rotational knee stability. Prior to these mainstream meniscal resection treatments, pioneering work had been done by Thomas Annandale in 1883 and Moritz Katzenstein in 1908, who sutured the menisci back into place, with the latter achieving a series of good results. In 1921, Eugen Bircher was the frst to perform a diagnostic knee arthroscopy for internal knee derangement, just using a standard Jacobaeus laparoscope! Nowadays, the fundamental importance of the menisci to normal knee function, e.g., motion, load distribution, and rotational stabilization, is scientifcally acknowledged.

This clinical guide provides a special focus on the normal meniscal mechanism, body and function. Meniscal pathology and therapy are depicted in detail, followed by the presentation of long-term experience of meniscal transplantation and a look into the future of meniscal surgery.

During the last few decades, as the management of meniscal trauma has evolved, and knowledge gained on meniscal function, the orthopaedic surgeon has attempted to preserve the meniscus whenever possible. Arthroscopic meniscal repair has become the treatment of choice when the tear is located in the peripheral rim. Partial meniscectomy has become limited to such an extent that the deleterious effect of total meniscectomy is avoided. Meniscal allograft replacement, which has been available for the last two decades, is used when the patient is confronted with a painful total meniscectomy. Future research and experiments may suggest that partial meniscal replacement might be indicated in the presence of a painful knee compartment after failed meniscal repair or partial meniscectomy.