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From PREFACE. It is not long ago that every suspicion of a meniscal lesion eventually led to an open meniscectomy, which in most of the cases was total. This solution was widely proposed as it was considered to be a simple and effective procedure
followed by a speedy recovery. It was all the more recommended as the biomechanical role of the meniscus was thought to be of secondary importance. But reviewing patient at a long term follow up, it obviously appeared that many of these patients presented significant cartilaginous changes. Specially in two occurrences: lateral meniscectomy and/or non reconstructed ACL tear.
After the works of Smillie, Noble, Fairbank, Trillat, and many others, two truly revolutionary improvements were introduced in the 1970s and 1980s: arthroscopic surgery and subsequently magnetic resonance imaging (MRI). It
should be emphasized that arthroscopy was introduced into clinical practice before MRI and today’s chronological order (physical examination, MRI, arthroscopy) is of course different.
These technological advances contributed to a better understanding of meniscal pathology, diagnostic techniques and principles of treatment, and resulted in a lower complication rate. Like all technical innovations, they also entailed some disadvantages, such as the risk of resorting all too often to surgical treatment, particularly meniscectomy, as a result of the sensitivity of these methods.
However, the advantages prevailed over the drawbacks. From that time on, it was realized that the menisci play a prominent role in knee joint biomechanics, and that there is not just one but many different meniscal lesions and consequently not just one but various treatment methods, adapted to the type of lesion and its clinical context.
This has led to the concept of meniscal preservation or meniscal sparing, which is based on three pillars: meniscectomy as partial as possible, thanks to arthroscopy, meniscal repair and masterly neglect.
Thomas Annandale in 1883 and Moritz Katzenstein in 1908 were the promotors, who sutured the menisci back into place, with the latter surgeon achieving a series of good results. Now, the history repeats itself. The technique of meniscal repair has become more refined, proceeding from open meniscal suture to combined open and arthroscopic techniques and then to all-inside techniques, which are now in widespread use. The results have been evaluated and the indications have been clearly defined, particularly those concerning the choice between meniscectomy, surgical repair and masterly neglect.
This monography attempts to cover what concerns meniscus repair in terms of surgical anatomy, biomechanics, technique and its complications, results and indications.