Surgical decision on which meniscal tear to repair

The classical indication for meniscal repair is an acute longitudinal, unstable tear of >1cm in the periphery of the meniscus which is of traumatic (nondegenerative) etiology.

The knee should be stable or a concomitant ligament reconstruction should be performed. 

The reality is that quite often meniscal tears do not clearly fall into the above criteria and may be responsible for relatively lower meniscal repair rates in some centres. Age of the patient and chronicity of tear are not contraindications for meniscal repair. Incomplete stable tears do not require repair.

The intra-operative dilemma usually is whether the tear is peripheral enough. The commonest tears are in the posterior third of the medial or lateral meniscus and it is important to develop arthroscopy skills to visualise the ‘rim width’ in this area of the meniscus. The vascular zone has been shown to be present in the peripheral 4mm or up to 25-30% of meniscal periphery.

Adequate preparation of the tear edges using rasps/shavers, meniscal trephination and synovial abrasion can help increase success rates and extend indications for meniscal repair into white-white zones. The success of newer generation suture based all inside techniques along with the above augmentation techniques should help the surgeon increase repair rates and improve results.