What does meniscal suture consist of?
The meniscal suture consists of repairing the meniscus, repairing meniscal tears that patients may present and avoid resecting this tissue and therefore lose the function of the meniscus. The meniscal suture techniques have become increasingly popular due to the good results they have and the possibility we have of maintaining the function of the meniscus, keeping the tissue in place and preserving the function of this fundamental element for the transmission of loads in the knee.
Why is it so important to repair the meniscus rather than to remove it?
The menisci are two crescent-shaped fibrocartilage structures located in the external and internal femorotibial compartments. They play a fundamental role in the transmission of loads through the knee joint. When the meniscus is removed, this load transmission is altered. This cushioning role of the meniscus is lost and this will lead to degeneration of the articular cartilage and therefore to osteoarthritis. The meniscus also plays a fundamental role in the stability of the knee. Patients who lose the meniscus will have worse knee stability and a worse functional result when we perform an anterior cruciate ligamentoplasty. That is why it is fundamental, especially in those young and active patients, especially in those who have had traumatic ruptures and especially in those who also have a torn anterior cruciate ligament. To maintain the meniscus, suture it, and therefore maintain the function, and to ensure an adequate evolution of the knee and a lower incidence of post-traumatic osteoarthritis.
What technique is used?
Today the vast majority of meniscal repairs can be done through the same portals that we use for simple arthroscopy, that is, two small holes in the anterior aspect of the knee, because we can do many of these repairs with what we call “all-inside” systems. That is, we can repair the meniscus without the need for accessory incisions. That would be the most frequently used technique but, depending on the location of the tear, we can also use “outside-in” techniques, that is to say, we introduce needles and different devices from the outside to the inside of the knee and also techniques that are called “inside-out” in which we pass different suture systems from the inside of the knee to the outside. In these cases we do need a small counter incision. But I have already said that in most cases we can make these repairs with “all-in” systems using only the small portals that we use to make a simple arthroscopy.
What care should be taken after the operation?
Postoperative treatment after meniscal suturing will depend on the type of repair and the type of tear we have had to repair. In those patients with a vertical-longitudinal meniscal tear, and they are the great majority of the tears that we are going to be able to repair, we allow them a partial load immediately after the surgery and that has been demonstrated that it can even be beneficial for the healing of the tear. You have to be careful not to carry weight with the knee above 90° of flexion under any circumstances. That is why we use knee braces with flexion-extension limitation for about 10-12 weeks. At the beginning we limit this flexion to about 30º or 40º, just enough so that the patient does not limp during normal walking, and then after 6 weeks we limit the flexion to 90º. After this period, the patient will be able to do gentle exercise and we allow the return to sporting activity around five months after surgery.