دانلود رایگان مقاله تعمیر داخل و خارج برای اشک های منیسک شعاعی

Abstract

Understanding of meniscal function through basic science, natural history, and biomechanics has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics. Tears that may alter these biomechanics can contribute to the progressive nature of degenerative joint disease in the knee. Radial tears result in the disruption of the circumferential fibers causing inability of the native meniscus to resist normal hoop stresses, thereby leading to increased focal areas of pressure that cause complications such as early onset arthrosis. In this technical note, we describe our preferred operative technique to repair radial meniscal tears using an arthroscopic inside-out approach with satisfactory clinical outcomes and healing response. The authors report the following potential conflict of interest or source of funding: B.A.L. receives support from Clinical Orthopaedics and Related Research, Arthrex, NIH, and VOT Solutions. M.J.S. receives support from Arthrex, Stryker, and USA Hockey Foundation. A.J.K. receives research support from Arthrex, Arthritis Foundation, and Histogenics.

Discussion

The menisci play many functions that maintain the overall health of the knee, including improved joint congruity, proprioception, shock absorption, lubrication, and nutrition of the articular cartilage. Meniscal tears can be a source of pain, swelling, and activity limitation. A full-thickness radial tear of the meniscus results in complete loss of hoop stress resistance that is biomechanically comparable with a complete meniscectomy.2,3 Reliable repair methods for radial tears of the meniscus can restore contact pressures in the knee joint and minimize the risk of future complications such as early arthrosis. All-inside repair techniques have become the technique of choice for many types of meniscal repairs. They often have shorter surgical times, are less invasive, and provide less risk for neurovascular damage.7,8 In addition, a study has recently shown a new all-inside technique using the vertical suture configuration to have lower displacement, higher load to failure, and grater stiffness compared with inside-out repairs of radial meniscal tears. Still, human studies have not reached a definitive conclusion.14 All-inside repairs also have potential disadvantages; these include increased local irritation because of extra-articular implants, implant migration, and failure.7 All-inside repairs also have larger-diameter insertion needles compared with an inside-out technique, and this increases the risk for iatrogenic meniscal and chondral damage, an important consideration in complex meniscal tear repairs.8,9,15 Although modern all-inside implants have been shown to have similar fixation strength and clinical results as an inside-out technique, all-inside repairs lack long-term outcome data, especially with regard to new techniques in human patients.6,7