Post on 01-Aug-2020
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Meniscus Tears:Which Ones Need Repair?
Daniel E. Cooper, MDThe Carrell Clinic – Dallas
Head Team Physician – Dallas CowboysUS Consultant – Real Madrid CF
Goal: Prevent arthrosis
Restore Meniscal Function Avoid iatrogenic injury Avoid re-tear Avoid implant displacement
Meniscal Anatomy
Complex Fiber orientation
Not simple to restore
More complex to replace
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Meniscal Function
Medial and lateral are NOT alike!!
Attachments AP slide on tibia
during ROM (LM) Tear patterns are
different
Meniscal Blood Supply
Arnoczky, et al.
Lateral Compartment
Young athlete Huge problem Synovitis Arthrosis
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Medial Compartment
Young athlete Huge problem?
Not always Synovitis?
Not always Arthrosis?
Not always
No-Brainers – Do Not Repair
Complex tears Avascular flaps Avascular radial Degenerative soft tears Older patient (45 or 50+) Arthrosis in same compartment
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NFL Case Example:28 y/o WO – ACL+ BHMMT
NFL Case Example
Weigh desire to repair vs. technical feasibility and potential for long-term success
Keep in mind that you didn’t hurt the player
Don’t feel guilty for PMM Failed MMR – more likely to
impact career of ANY athlete (Generally more arthrosis)
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What Do You Need?
Good surgical assistant Surgical skill to do no harm (prioritize) Versatile single lumen I-O technique Versatile O-I technique (anterior horn) Good root guide and TOR technique Comfortable placing PM cannula for MM
rim rent tear repair All inside options - less critical and
expensive (Ceterex, Scorpion, implants)
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No-Brainers – Do Repair
Longitudinal peripheral tears Young patients Asso. Ligament surgery LM acute root avulsion w/ ACLT Really young kid – much more
aggressive – better healing, bigger problem long-term
Double longitudinal; big flaps; radial
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Meniscus Repair Decisions
Controversial Calls
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Controversial Calls
Chronic MM root avulsion w/ early extrusion
Horizontal tears thru rim (LM) Large PH LM flap tear w/ ACLT Complete LM radial tear
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Controversial Calls
Much higher failure rate Need good counselling w/ family Need good technique Imperative to avoid iatrogenic injury
(20 years of damage in 20 min) No matter what you do – future
surgery is likely (what type?) Really young + LMT = Push the limits
Dilemma
Most LM tears in athletes always lead to arthrosis - no matter what we do!
Repairs take the athlete out of sport for 3-4 months minimum
Arthrosis is often worse after failed MR than after PM
Instrumentation & implants are not benign - risk of iatrogenic chondral injury
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Summary
Be prepared - have good help and good instruments
Learn to be versatile with your MR techniques
Be aggressive with LMR in young pts Don’t feel guilty if you need to do a
partial mensicectomy Involve the patient in the decision Do no harm w/ your techniques!
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The Carrell Clinic
Thank You