A 13-year-old player presents after an innocuous twisting injury of his knee. He describes experiencing a popping sensation as he changed direction followed by severe pain, immediate swelling and an inability to weight bear. The pain was bad enough to take him to the hospital emergency department. On examination there was an effusion, tenderness about the lateral joint line and a restricted ROM (10-60 degrees).
An x-ray series of the knee was normal. MRI images show an extensive displaced tear of the lateral meniscus. The meniscus is deficient laterally and posteriorly with most of the meniscal tissue displaced anteriorly and centrally into the intercondylar region. It is unclear whether the injured meniscus has a discoid morphology. The medial meniscus and the articular cartilage are normal.
This player was managed with an arthroscopic lateral meniscal repair. Good reduction and a solid repair were achieved. At the time of surgery, the lateral meniscus was noted to be otherwise normal (not discoid).
Children and adolescents are known to have more vascular menisci. As a result, it is generally thought that meniscal tears in these groups are more likely to heal, and meniscal repairs are more likely to be successful. The literature contains very few studies that look at outcomes following isolated meniscal repairs. A recent review only identified two studies that evaluated outcomes following isolated meniscal tears in adolescents. Both studies reported achieving “clinical healing” in about 60% of cases. Whether this translates to a good outcome in the medium to long term is not known. The available data suggests that meniscal repairs are more likely to be successful when combined with an ACL reconstruction, when the repair involves the lateral (rather than medial meniscus) and when the patient has open physes (is younger). Simple tears and bucket handle tears appear more likely to heal than those with a more complex orientation.
Where possible patients with large meniscal tears should be offered a meniscal repair. This gives them the best chance of having a “normal knee” and will hopefully result in a lower risk of post traumatic osteoarthritis. They should be counselled about the possibility of a failed repair and the need for future surgery (most likely a partial meniscectomy).
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