Clean Run - February 2012 - 32

the image to be seen on a large viewing screen (Figures 10 through 12). The surgeon uses these images to visualize the operative field and perform the resection or repair. Saline is pumped into the knee to expand the joint and make visualization and removal of debris easier. An appropriately placed accessory portal (or portals) is created for the introduction of resection or repair instruments. Resection of a tear is accomplished by surgically recreating the inner curve of the meniscus. A variety of cutting tools can be used to carve the new curve. The tear is incorporated into the resected portion of the meniscus, eliminating the torn element (Figures 13 and 14). After surgery, almost all patients can begin walking with the aid of crutches, which are usually abandoned within a day or two. Recovery progresses rapidly, especially when supported by postoperative physical therapy. In the appropriate patient, repair of the meniscus tear may be indicated. Tear type (for example, longitudinal tears), proxim-

ity to the vascular supply of the meniscus, and ligament status influence the treatment choice. Unstable knees should have their ligament injuries reconstructed if meniscus repair is considered. If repair is determined to be appropriate, sutures or other fixation devices can be introduced through small accessory wounds or needle holes and used to hold the tear in place while the meniscus heals. Many surgeons will limit weight bearing after repair surgery. Physical therapy to recover weakened muscles usually follows. Substitution of the meniscus with a cadaver (allograft) meniscus may be indicated in young, athletic, patients (with ligament stable knees and minimal surface cartilage injury) where substantial meniscus loss has occurred. In this procedure an entire meniscus with bone block attachments is surgically fixed to the tibial plateau. While the concept of meniscus replacement in the appropriate patient is extremely attractive, the longterm results are still being evaluated.

In Conclusion
As with my knee, the vast majority of people recover quickly from surgery for simple meniscus tears. However, the severity and complexity of the injury can significantly alter the outcome. Degenerative change, surface injury and associated ligament tears can influence recovery and the ultimate result. Importantly, not every knee is pain free. I cannot overemphasize that each patient is different. Tear types, the condition of the joint cartilage, concomitant ligament injury, the age of the patient, and lifestyle demands all contribute to the decision process that determines the best treatment option. All of those factors will ultimately influence outcome. Understanding your injury and your treatment choices can help you work with your orthopaedist to determine the appropriate course of management for you. D

I. Martin Levy, MD, lives in Ardsley, New York, and is a human sports medicine orthopaedist, who directs an orthopaedic surgical residency at Albert Einstein College of Medicine/Montefiore Medical Center. His areas of interest include meniscus and anterior cruciate ligament injury, biomechanics, and sports epidemiology. He uses that experience to evaluate obstacle safety and dog and handler injury patterns in canine agility. He has three Border Collies that participate in agility and Frisbee. Contact him at Frzbdog2@gmail.com.

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Clean Run - February 2012

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