Title : The meniscus, a useless remnant of evolution or an essential part of the knee joint and highly essential to prevent early osteoarthritis?
Abstract:
In the knees of the Eryops megalocephalus, who lived from 299 million to 251 million years ago, menisci were found. From that time until the present it has been known that all vertebrates, from chicken, crocodile and gorilla to humans, have menisci in the knees.
Structure: The meniscus is composed of a collagen network, vascularized from the outside, with well-oriented bundles, covered with cartilage.
Functions: The meniscus has many functions: distribution of pressure, shock absorption, guiding the condyles like “train rails” principle, adapting the contact area between, the femur condyles and tibia and more.
In 1897, Sutton, a surgeon, stated that the meniscus is “A functionless remains of leg muscle origins”.
This led to uninhibited removal of meniscus parts for many years, until research in the 1970s showed that removal of 16-34% of the meniscus increases the articular contact forces up to 350%! (3 – 4x) and removal of the total meniscus: increase up to 1000% (10x)!
In the late 1980s and 1990s, gradually awareness arose that repair of ruptured menisci could prevent early knee arthrosis, leading to a worldwide movement: “Save the meniscus” that was mentioned in many editorials and at conferences. Still, a failure rate was found between a failure rate of approximately 20% to 48%. If a finger tendon is severed and you wait more than 3 weeks before restyling, the surgeon will say "I can suture everything, but after more than 3 weeks it will grow less well or not even attach anymore!". The core of a meniscus is composed of tendon like tissue, so why waiting for more than 3 week to repair a ruptured meniscus?
One author mentions an improvement of failure rate from 48% if repair is performed later than 6 weeks, to 17% when repair was performed within 6 weeks. With this in mind, I repaired in one group of 91 patients, (group1) all the ruptures within 3 weeks after trauma and in group 2, 15 patients, by necessity, later than 3 weeks after the injury. The overall failure rate was significantly lower in patients who underwent meniscus repair within 3 weeks than in those who underwent repair at 3 weeks (or more) after the trauma. Thus, early repair of meniscus tears is beneficial, can prevent failure of meniscus repair surgery and so early, preventable, early arthrosis of that knee compartment and loss of a normal live.
Audience Take Away Notes:
- Consider to repair acute meniscus tears within 3 weeks to improve the outcome
- This procedure should be implemented in other hospitals as research object to prove its value
- According to the result of this research, early repair of meniscus tears is beneficial, can prevent failure of meniscus repair surgery and so early, preventable, early arthrosis of that knee compartment and loss of a normal live
