Techniques to treat challenging meniscus tears

Introduction: Meniscus tears are one of the most common knee pathologies encountered. Although meniscus tears were initially treated with meniscectomy, numerous studies have described the effect of meniscectomy on accelerating degenerative changes of the knee. In addition, certain tear patterns that may have been traditionally underrecognized are now the subject of recent investigation on the merits of repair. Objectives: We review the existing literature on the biomechanical and clinical outcomes following treatment of radial, horizontal cleavage, and ramp meniscus tears. This article will also highlight meniscus repair strategies for these tear patterns. Methods: PubMed was searched. All levels of evidence (I-IV) pertaining to meniscus tears were analyzed and presented. Results: For radial tears, all-inside techniques are gaining popularity, with 2 emerging strategies: “tie-grip” sutures and transtibial approaches. For horizontal tears, circumferential sutures allow even compression of the superior and inferior leaflets of the tear. Multiple techniques have been described for repair of ramp lesions, which are best recognized with a systematic exploration of the posteromedial aspect of the knee. Conclusions: Increased awareness of certain meniscus tear types and their effect on knee kinematics and stability has led to investigation and evolution of repair techniques, with an increased emphasis on all-inside repairs.