Speaker: First shot is the best shot for meniscal tears

Issue: January 2017

LAHAINA, Hawaii — Meniscal tears are a common knee problem that offer an opportunity to better define the indications for repair, according to a speaker, here.

At Orthopedics Today Hawaii 2017, Nicholas A. Sgaglione, MD, said studies have found that 1.5 million arthroscopies are performed per year. In 2016, Parker and colleagues published a study that showed 1 million are performed for meniscal pathology, which is a 37% increase in repairs from 2004 to 2012.

Nicholas A. Sgaglione

“I think that is compelling. We are beginning to learn that we have to preserve the meniscus, but we are defining what those indications are. We have to begin by considering the first shot is your best shot,” Sgaglione said. “I could talk about this with meniscal allografting and meniscal scaffolding. A 16-year-old who has an ACL tear with a bucket [handle tear] is an opportunity to make a difference.”

He said five technical pearls in meniscal repair are: defining which meniscus tears should be repaired, what should be resected and what should be left alone; preparation; the importance of sutures, especially vertical mattress and high strength sutures; the importance of stimulating healing; and defining rehabilitation protocols.

In deciding which meniscal tears to resect or repair, Sgaglione said orthopedic surgeons need to consider symptoms, site, size and tear pattern, stability, tissue viability, alignment and chondral/ACL status. However, the goals of the patient are probably most important, he said. – by Kristine Houck, MA, ELS

Reference:

Sgaglione NA. Meniscal pathology: What to do and what not to do. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.

Disclosure: Sgaglione reports he is on the board, is a trustee and committee member for Arthroscopy and the Arthroscopy Association of North America, and receives royalties from Zimmer Biomet Sports Medicine and Wolters Kluwer Health.