28, 32, 35, 45 Additionally, preparing 2 transtibial tunnels to secure the meniscal root to its attachment site further increases the footprint of the repair, though … Transtibial pull-out repair is routinely performed to treat medial meniscal posterior root tear (MMPRT). The probability of healing is … *Meniscal root repair. Patient selection is key and repairs should be reserved for tears that have a good chance of healing. The preferred repair … Indications that are too difficult to reach with standard drilling approaches can easily be treated using the low profile FlipCutter® II drill, without creating unnecessary full bone tunnels. Because the meniscus must heal back together, recovery time for a repair is longer than for a meniscectomy. Meniscal Root Repair Using a Two-Tunnel Technique . Moreover, repair of degenerative meniscal root tears has also shown to provide favorable out-come [ 2 … Avoidance of Major Complications. The repair device is introduced from the anteromedial portal guided by a slotted cannula. Herein, we review meniscal root injuries and repairs with respect to their anatomy, … Meniscal root repair and transplantation are ideal for FlipCutter usage. Surgical treatment options will depend on the type of tear, location and extent of the tear. Indications for meniscal root repair are evolving as these tears are increasingly recognized. Contraindications to meniscus root repair … Our e-learning platform contains high resolution images and a certified CME of the Trans-tibial meniscal root repair using Smith and Nephew Firstpass mini surgical procedure. … Indications for surgical management of meniscal root tears include (1) isolated symptomatic MMRTs with minimal arthritis, (2) failure of nonsurgical management with continued activity-limiting pain, and (3) lateral meniscal root tears concomitant with an anterior cruciate ligament (ACL) tear. Options for meniscal tear management broadly fall into three categories: non-operative management, meniscal repair or meniscectomy. Meniscal Root Repair Partial Meniscectomy Osteoarthritis Treatment Knee Osteotomy Joint Preservation Surgery Knee Replacement Surgery Patellofemoral Treatment Lateral Patellotibial Ligament Reconstruction Trochleoplasty Tibial Tubrical Osteotomy Platelet Rich Plasma | PRP Stem Cell Therapy Patient Resources Press and Publications Patient Stories Contact Us. Factors that contribute to good healing potential and low failure rates have been well studied. The relative indications of meniscal repair are summarized in Table 1. 2. It has been … Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Indications for meniscal repair are increasing and can now be performed in older patients who are active, even if the tear is in the avascular zone. Meniscal root tears substantially affect meniscal hoop function and accelerate cartilage degeneration; therefore, meniscus root repair is necessary to prevent the progression of osteoarthritis change. Short- and midterm clinical results of meniscal root repair are promising, but long-term results are yet to be established. … As noted, root repair is generally contraindicated in the setting of advanced osteoarthritis or severe malalignment. Learn the Trans-tibial meniscal root repair using Smith and Nephew Firstpass mini surgical technique with step by step instructions on OrthOracle. Whether a tear can be successfully repaired depends upon the type of tear, as well as the overall condition of the injured meniscus. • The younger the patient, the more “aggressive” I am • Much of my philosophy is driven by my 20+ year experience with meniscal transplants (that is another story for another meeting) Philosophy on Technique I use an inside … LaPrade R.F. Arthroscopic meniscal root repair has been shown to restore more normal joint mechanics and is considered a treatment option in the appropriately indicated patient. Meniscal Repair and Transplantation: Indications, Techniques, Rehabilitation, and Clinical Outcome Timothy P. Heckmann, PT, ATC1 Sue D. Barber-Westin, BS2 Frank R. Noyes, MD3 The purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus repair and … Indications for repair in this setting are evolving and the optimal candidate has not yet been defined. In this report, we present a histological evaluation of the harvested specimen of a patient who underwent … (Reproduced with permission from Bhatia et al.2) Fig 2. tTKEY WORDS: meniscal root repair, meniscal root tear, root repair rehabilitation T he importance of the meniscal roots in maintaining normal knee joint mechanics, contact forces, and prevention of osteoarthritic changes, and the negative impact that meniscal root tears (MRTs) have on these factors, has only recently been reported in the literature.4,7,14,28,31,36,40 Meniscal root … Root avulsions should generally be repaired, when feasible, to mitigate the detrimental biomechanical consequences of root deficiency (1,8,34). With a greater understanding of the impor-tance of meniscal root injuries, more emphasis has been placed recently on the development of surgical techniques to repair meniscal root tears, to prevent long-term sequelae (9,15). Appropriate indications for root repair are key to obtain successful outcomes. This procedure is designed to limit catching the device on soft tissue. Meniscal root tears: Significance, diagnosis, and treatment. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). Meniscal root tears are an increasingly recognized injury leading to notable functional limitations, potential rapid cartilage deterioration of the affected compartment, and subsequent risk of total knee arthroplasty if left untreated. Arthroscopic Meniscal Root Repair • Anteroposterior, Rosenberg, sunrise, long-leg alignment, and lateral knee radiographs are obtained in all patients. Rehabilitation Guidelines for Meniscal Repair of Root and Complex Tears There are two types of cartilage in the knee; articular cartilage and meniscus cartilage. Retract the half pipe cannula sled from the joint space once the JuggerStitch Meniscal Repair Device has been successfully inserted into the joint space (Figure 4). repair Indications • Techniques University of Pittsburgh • Case examples My Philosophy on Indications • All meniscal tears are potentially repairable! Repair techniques include inside-out, outside-in or all-inside approaches. For symptomatic meniscus defects after meniscectomy, transplantation of allograft or collagen meniscus implant may be indicated, and acceptable clinical results have … Indications for surgery. Horizontal cleavage and Root Tears. Nonoperative treatment is rarely successful for treating meniscal tears in young athletes and repair of the torn menisci is often required Repair of a meniscal lesion should be strongly considered if the tear is peripheral and longitudinal, with concurrent Anterior Cruciate Ligament (ACL) reconstruction, and in younger patients. Surgery Meniscus Repair. doi: 10.1016/j.jos.2020.03.012 Published online April 10 , 2020 . The root is not attached posteriorly. Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. 2014; 42: 3016-3030. Meniscal repair is essential when the torn meniscus does not heal on its … (Reproduced with permission from Bhatia et al. Meniscus repair. However, data on the postoperative histological evaluation of the repaired medial meniscus posterior attachment after the procedure is scarce. Meniscal Injuries: Repair v. Removal • Extended Indications: Radial –Lateral/posterior root •Leave alone with ACL surgery (Shelbourne 2012, Marzo 2014) •Fix (Noyes , Arthroscopy 2000, LaPrade AJSM 2016) –Medial/posterior root •Leave alone - Degenerative radiographs, Obesity, >50 years •Fix – Traumatic injury, normal BMI, normal articular cartilage . Meniscal radial root tears can disrupt the load-bearing function of the meniscus and worsen instability in anterior cruciate ligament–deficient knees. An MRI-based suspension bridge sign can predict an arthroscopically favorable meniscal healing following the medial meniscus posterior root repair. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. (Fig. Ellman M.B. Close-up of partial … Bhatia S. LaPrade C.M. Treatment decision making for meniscal root tears. Using the needle, enter the surface of … The depth limiter for the device is set at 20 mm for a central entry point and 16 mm for a peripheral entry point in the … Indications Nontraumatic meniscal root tears without severe degenerative changes (Kellgren–Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament … Expanding Meniscus Repair Indications – Horizontal Cleavage Tears and Root Tears Peter R. Kurzweil, MD Memorial Orthopaedic Surgical Group Long Beach, CA. Photographs showing the relation of the 4 meniscal roots in a right knee (A) with menisci intact and both cruciate lig-aments to better illustrate the anatomical relation between the structures. Moreover, it also describes a literature review focused on the expected outcome and possible complications. JuggerStitch Meniscal Repair Device into the joint by sliding the sharp point against the half pipe cannula sled. 7) Fig. The main indications for meniscal repair include (7,8): Acute, traumatic root tears in patients who have yet to develop osteoarthritis, with the goal of preventing arthritic changes in the future; Chronic symptomatic root tears in young or middle-aged … Keywords All-inside Inside-out Meniscal tear classification Meniscal repair Outside-in This is a preview of subscription … The new adjustable Meniscal Root Marking Hook has several features that KNEE TECHNIQUE GUIDE 05486 V1 Two-Tunnel Meniscal Root Repair Technique Overview The meniscal roots are very important to overall joint health; however meniscal root tears are often underdiagnosed or misdiagnosed and, in my experience, represent from 10% to 21% of overall tears seen on MRI scans. Your surgeon may recommend surgery if the conservative treatment options fail to relieve your knee pain or if your knee continues to lock and is not healing. For lateral meniscal root repair with an all-inside meniscal repair device, the left knee is placed in a figure-of-4 position and viewed from the anterolateral portal. Establishing an accurate diagnosis and understanding indications for meniscal repair are essential to avoiding complications . With limited evidence directly comparing each of these options optimal … … Trans-osseous repair of the root maintains hoop stresses in the meniscus and prevents extrusion, thereby offering some protection from cartilage degeneration. This work aims to provide a comprehensive approach of the most frequent techniques and indications for meniscal repair. Crossref; PubMed; Scopus (196) Google Scholar) View Large Image Figure Viewer; … Repair of these tears is advised when articular cartilage remains intact because both medial and lateral meniscus root repairs have … Contraindications to meniscal root repair are (1) medial joint … Most meniscal … (Figs 3–6) (14), and the surgical indications for meniscal root repair can aid the radiologist in the reporting of meniscal root tears. The vascular supply of a meniscal tear is the most important intrinsic factor in healing. We review the complications of meniscal repair associated with preoperative, intraoperative, and postoperative errors. Indication for procedure. The transtibial meniscal root repair is emerging as the gold standard treatment due to its ability to restore a large footprint at the meniscal root's native attachment site and restore normal joint contact pressures. Appropriate indications for root repair are key to obtain suc-cessful outcomes. Repair Indications Although meniscal preservation is important, only certain types of tears are amenable to repair. J Orthop Sci. Am J Sports Med. Meniscal root repair has been demonstrated to have high satisfaction rates and superior outcomes than arthroscopic meniscectomy for root tears.6 10 11 44 51 52 Early referral of these patients for surgery had been demonstrated to significantly decrease the progression of knee OA and the requirement for TKA at mid-term follow-up.14 38 39 7 a and b – Arthroscopic photos of a posterior root lateral meniscal tear with meniscal extrusion in the setting of ACL rupture. Objective Anatomic repair of the torn meniscal root using transosseous sutures through the proximal tibia. Meniscal Injuries: Repair … Paracentral radial tears adjacent to the root (types 1, 2, and 4) repaired with a transtibial pullout suture technique can lead to over-medialization of the meniscal root and a high-tension nonanatomic repair.
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