Meniscectomy

Background

 

Meniscectomy 

- resect 30%

- increases contact pressures 3.5 x

- shock absorbing capacity reduced to 20% normal

 

Results of partial & total meniscectomy are very poor in children

- meniscectomy in children is a last resort

- repair amenable tears

- treat others non-operatively

- only real indication for meniscectomy is locked knee not amenable to repair

 

Partial better than total

- less OA and less instability

- excision of unstable or loose meniscus with maximum preservation

 

Types

 

1.  Partial Meniscectomy

- excision unstable fragments that can be pulled into joint

- stable rim / menisco-capsular junction preserved

- smooth rim, but don't need perfectly smooth as remodels

 

2. Sub-total Meniscectomy

- excision of portion of rim usually posterior horn

 

3.  Total Meniscectomy

- required if completely detached and unrepairable

 

Results Meniscectomy

 

Total meniscectomy

 

40% OA at 15 years 

- compared with 6% in normal knee 

 

Meniscectomy Open

 

Partial Meniscectomy

 

1.  No chondral damage at arthroscopy

- 95% good results

 

Schimmer Arthroscopy 1998

- deterioration over time for partial meniscectomy

- 90% good or excellent at 4 years

- 80% good or excellent at 14 years

 

2.  Chondral damage at arthroscopy

- if obvious articular damage initially good or excellent 60% at 12 years

- if grade III or IV good or excellent 10%

 

Technique Excision Bucket Handle Tear

 

Indication

- long standing

- irreparable

 

Technique

1.  98% detachment posterior horn

- scissors / punch

2.  Complete detachment anterior horn 

- can use arthroscopic knife for this portion

- insert through anteromedial portal and cut down

3.  Grasp meniscus firmly with grasper

- roll meniscus several times then twist

- break flimsy posterior attachment

4.  Remove meniscus

- may need to enlarge anteromedial portal

5.  Smooth remaining meniscus with shaver

 

Lateral Meniscus Bucket HandleMensicus Division Posterior HornPost Removal Bucket Handle Meniscus