• Restore meniscal function

• Peak force dissipation

• Increased congruity of articulating surfaces

• Increased nutrition to chondrocytes

• Increased knee stability

• Increased lubrication function in the knee

• Repair results in

• Decreased risk of chondral degeneration in the future

• Decreased discomfort from peak contact overload

• Decreased risk of increased knee instability

• Resection indicated

• Risk of failure of repair and need for repeat surgery outweighs potential for successful repair and its subsequent benefit

• Tear pattern

• Vertical longitudinal—ideal

• Horizontal cleavage—perhaps with newer techniques

• Radial—challenging, perhaps repair if tear propagates into peripheral third of meniscus

• Complex—perhaps, depending on location and status of unstable fragment and age of patient

• Condition of unstable fragment

• Intact and undamaged—ideal.

• The more the unstable fragment is damaged and compromised, the less desirable it is to repair, because the strength of the repair and the ultimate function of the meniscal fragment are questionable if it were salvaged.

• Location of tear²

• The more peripheral, the better. Repair site needs access to the vascularity along the periphery (meniscal-capsular junction).

• The more the tear involves the avascular central portion of the meniscus, the less healing potential it has unless combined with techniques such as vascular channeling or biologics to improve healing potential.

• Considered historically to be the strongest type of repair.

• Needle puncture into meniscus has less impact than all-inside devices and outside-in systems.

• Age

• Must consider the risk vs the benefit of attempting meniscal repair in older patient.

• The younger the patient, the greater the benefit of “saving the meniscus.”

• Younger patient also may have greater healing potential.

• Activity demands

• The higher the activity demands of the patient, the greater the benefit of saving the meniscus.

• Body mass index (BMI)⁴

• Likely does not have an effect on the success of a repair.

• Laxity

• Knee instability may increase the risk of repair failure and is considered by many to be a contraindication to repair unless corrected at time of repair or as a staged procedure.

• Chondral status

• The more severe the arthritis in the knee, the lower the risk/benefit ratio for the patient.

• Prior failed repair

• Repeat attempt at stabilizing a peripheral meniscal tear can be done, but often the unstable fragment is significantly damaged from the previous sutures or implants during the mechanism of the new injury, making the success and benefit of a repeat repair attempt less attractive.

• Smoking⁵

• Has been shown to increase risk of repair failure

• Zone-specific cannulas

• Retractors to protect neurovascular structures and aid in retrieval of needles

• Options include Army-Navy, a spoon, Henning retractor, bottom portion of a small or medium speculum

• Long flexible needles

• Suture: nonabsorbable typically preferred

• Rasp or shaver to abrade tear edges and synovium

• Standard arthroscopic equipment

• Standard open exposure tray

• Multiple hemostats to snap each individual suture pairs for tying

• Extra needle forceps for retrieval of meniscal needles

• Stool for surgical team member retrieving the needles

• Thigh tourniquet (inflate only if needed)

• Typically supine, using the surgeon’s preferred knee arthroscopy setup

• If using a thigh holder or lateral post, enough exposure of thigh above the knee should be ensured, as well as circumferential access to the knee for posterolateral or posteromedial incisions.

• A complete diagnostic arthroscopy should be performed before treatment of the meniscal pathology (Fig. 36-4; Video 36-1).