The Meniscus (eBook)

151522_1_En_BookFrontmatter_OnlinePDF 1
151522_1_En_1_PartFrontmatter_OnlinePDF 14
151522_1_En_1_Chapter_OnlinePDF 15
1.1 15
Ontogeny-Phylogeny 15
Introduction 15
Meniscal Phylogeny 15
Meniscal Ontogeny 18
The Particular Case of Discoid Meniscus 19
Conclusion 20
References 21
151522_1_En_2_Chapter_OnlinePDF 22
1.2 22
Anatomy 22
Morphology 22
The Tibial Insertional Ligaments 24
The Intermeniscal Ligaments 24
The Meniscofemoral Ligaments 25
The Composition of Meniscal Tissue 25
The Fine Structure of Menisci 26
Blood Supply and Innervation 26
Meniscal Motion During Knee Flexion 27
Summary 28
References 28
151522_1_En_3_Chapter_OnlinePDF 30
1.3 30
Histology-Ultrastructure-Biology 30
Embryology 30
Chemical Composition and Organization of Normal Meniscal Tissue 30
Cellular Composition of Meniscal Tissue 31
Fibrochondrocyte 32
Fibroblast-Like Cells 32
Cells of the Superficial Zone 33
Healing Response in the Injured Meniscus 33
Model I: Transection of the Anterior Cruciate Ligament 33
Model II: Plug Model 34
Model III: Tear Model 34
Rationale for Meniscal Replacement 35
References 37
151522_1_En_4_Chapter_OnlinePDF 39
1.4 39
Biomechanics 39
Introduction 39
Material Properties of Meniscal Tissue 39
Tensile Material Properties 39
Compressive Material Properties 40
Functional Biomechanics of the Menisci 40
Biomechanics of the Meniscal Ligaments 43
Insertional Ligaments 43
The Deep Medial Collateral Ligament 43
The Anterior Intermeniscal Ligament 43
The Meniscofemoral Ligaments 44
The Consequences of Loss of Function of the Meniscus-Meniscal Ligament construct 44
Conclusions 45
References 45
151522_1_En_5_Chapter_OnlinePDF 48
1.5 48
Synthesis 48
Conclusion 49
References 50
151522_1_En_2_PartFrontmatter_OnlinePDF 51
151522_1_En_6_Chapter_OnlinePDF 52
2.1 52
Traumatic Lesions: Stable Knee, ACL Knee 52
Introduction 52
Classification of Meniscal Tears by Morphology: ISAKOS 52
Tear Length 52
Tear Depth 52
Location (Fig. .2.1.1a, b.) 52
Tear Pattern .[5,..6]. (Fig. .2.1.2.) 53
Longitudinal-Vertical Tear 53
Horizontal Tear 53
Radial Tear 53
Flap Tear 53
Complex Tear 53
Discoid Meniscus 54
Classification of Meniscal Tears by Symptomatology 54
Pathogenesis 54
Longitudinal Tears 54
Transverse, Radial, or Oblique Tears 54
Classification of Meniscal Tears by Reparability 55
Classification of Meniscal Tears by Type of Injury 55
References 56
151522_1_En_7_Chapter_OnlinePDF 57
2.2 57
Degenerative Lesions-Meniscal Cyst 57
Pathology 57
Frequency of Degenerative Meniscal Lesions 57
Arthroscopic Classification 58
MRI Classification 59
Correlation Between MRI and Histology 60
Correlation Between MRI and Arthroscopy 60
Clinical Aspects 60
Horizontal Cleavage Tear and Meniscal Cyst 61
Non-Traumatic Degenerative Tear of the Medial Meniscus or Type IV DML 61
Epidemiology 61
Age 61
Gender 61
Triggering Conditions 62
Clinical Symptoms 62
Radiological Evaluation 62
Treatment of Degenerative Meniscal Lesions 63
Meniscal Extrusion 64
Complex Meniscal Lesions (Type V) 65
Conclusion 65
References 65
151522_1_En_8_Chapter_OnlinePDF 67
2.3 67
Meniscus and Osteoarthritis 67
Introduction 67
Osteoarthritis 67
X-Rays 67
MRI 68
Cartilage Thickness 68
Bone Marrow Oedema 68
Arthroscopy 68
Degenerative Meniscal Lesions 68
Arthroscopic Classification 68
MRI Classification .(Fig. .2.3.2.) 68
Meniscus and OA 69
Conclusion 70
References 70
151522_1_En_9_Chapter_OnlinePDF 72
2.4 72
Synthesis 72
Traumatic Meniscal Lesions 72
Degenerative Meniscal Lesions 72
151522_1_En_3_PartFrontmatter_OnlinePDF 74
151522_1_En_10_Chapter_OnlinePDF 75
3.1 75
Clinical Examination: Standard X-Rays 75
Introduction 75
Physical Examination 75
Tests Commonly Used to Assess Meniscal Lesions 75
McMurray Test .[13] 75
Apley Test .[4] 76
Joint Line Palpation 76
Level of Evidence of Clinical Tests 76
Standard X-Rays 76
Conclusion 80
References 80
151522_1_En_11_Chapter_OnlinePDF 81
3.2 81
MRI, MR-arthrography and CT-arthrography 81
Introduction 81
Standard Radiography and Arthrography 81
CT and CT Arthrography 81
MR and MR Arthrography 82
Imaging Technique 83
Normal Meniscus Anatomy 84
Abnormal Meniscal Signals 84
Detection of Meniscal Lesions 85
Meniscal Lesions 85
Classification of Meniscal Tears 85
Longitudinal/Vertical Tears 85
Horizontal Tears 86
Radial Tears 86
Oblique Tears 87
Complex Tears 88
Meniscal Cysts 88
MR Imaging Pitfalls 88
Postoperative Imaging 89
MR Imaging of the Operated Meniscus 89
Imaging of the Sutured Meniscus 90
MR Imaging After Meniscus Transplantation 91
MR Imaging of the Artificial Meniscus 91
References 92
151522_1_En_12_Chapter_OnlinePDF 95
3.3 95
Bone Scan 95
Envelope of Function 96
Recommendations for Use of Bone Scans 97
References 99
151522_1_En_13_Chapter_OnlinePDF 100
3.4 100
Synthesis 100
History of Knee Injury 100
Physical Examination 100
Associated Lesions 100
Radiological Findings 101
History of Spontaneous Knee Pain 101
Conclusion 101
151522_1_En_4_PartFrontmatter_OnlinePDF 102
151522_1_En_14_Chapter_OnlinePDF 103
4.1 103
Meniscectomy: Medial-Lateral 103
Introduction 103
Treatment by Arthroscopic Meniscectomy 103
Introduction 103
Arthroscopic Medial Meniscectomy 103
Arthroscopic Lateral Meniscectomy 104
Specific Cases 105
Rehabilitation 105
Complications 105
Treatment by Open Meniscectomy 106
Introduction 106
Surgical Technique 106
Open Medial Meniscectomy 106
Open Lateral Meniscectomy 106
Conclusion 106
References 107
151522_1_En_15_Chapter_OnlinePDF 108
4.2 108
Meniscal Repair: Biomechanics 108
Introduction 108
Indications 108
Laboratory Testing of Meniscal Repair Techniques 109
Testing of the Initial Repair (Time-Zero Studies) 109
Testing Simulating the Early Healing Phase (0–12 Weeks) 111
Hydrolysis 111
Cyclic Loading 111
Shear Forces 112
Compression Forces 112
Testing Simulating the Late Healing Phase (.=.12 Weeks) 112
Forces Acting In Vivo 116
Conclusions 116
References 117
151522_1_En_16_Chapter_OnlinePDF 119
4.3 119
Meniscal Repair: Technique 119
Principles 119
Arthroscopic Set-Up 119
Debridement 120
Fixation 120
Technique 120
First Generation: Open Technique 120
Second Generation: Arthroscopically Assisted Inside-Out or Outside-In Technique 121
Third Generation: Devices 122
Fourth Generation: All-Inside Technique with Sutures 123
RapidLoc (Fig. .4.3.6.) 123
FasT-Fix (Fig. .4.3.7.) 124
Meniscal Cinch (Fig. .4.3.11.) 125
Specific Cases 126
Anterior Segment Tear (Fig. .4.3.12.) 126
Bucket-Handle Tear 127
Horizontal Cleavage Tear 127
Conclusion 128
References 128
151522_1_En_17_Chapter_OnlinePDF 129
4.4 129
Meniscal Repair: Enhancement of Healing Process 129
Introduction 129
Prerequisites of Meniscal Healing 129
Enhancement Techniques 130
Mechanical Trephination .(Fig. .4.4.1.) 130
Abrasion (Fig. .4.4.2.) 130
Synovial Flaps .(Fig. .4.4.3.) 130
High-Frequency Current .(Fig. .4.4.4.) 130
Gluing .(Fig. .4.4.5.) 131
Exogenous Fibrin Clot .(Fig. .4.4.6.) 131
Fascia Sheath Coverage and Fibrin Clot .(Fig. .4.4.7.) 131
Meniscus Wrap Technique .(Fig. .4.4.8.) 132
Unloading the Meniscus .(Fig. .4.4.9.) 133
Cell-Based Therapy and Gene Therapy 133
Conclusion 134
References 134
151522_1_En_18_Chapter_OnlinePDF 136
4.5 136
Meniscal Cysts 136
Introduction 136
Clinical Evaluation 136
History: Physical Examination 136
Diagnosis 137
Treatment Options 138
Conservative Treatment 138
Meniscal Tear Extending to the Joint (Grade 3) 138
Arthroscopic Meniscectomy Combined with Cyst Treatment 138
Technique 139
Results 140
Cyst Excision Combined with Meniscal Repair 140
Meniscal Tear Not Extending to the Articular Surface (Grade 2) 140
Technique 141
Results 141
Clinical and Surgical Algorithm for Treatment of Meniscal Cysts 141
Conclusion 142
References 143
151522_1_En_19_Chapter_OnlinePDF 145
4.6 145
Rehabilitation 145
Rehabilitation After Meniscectomy 145
Introduction 145
Rehabilitation Protocol 145
Early Postoperative Rehabilitation Phase 145
Second Phase 147
Third Phase 148
Rehabilitation After Meniscus Repair 148
Introduction 148
Healing of the Meniscus 148
Healing Rate After Meniscus Repair 148
Extrinsic Factors Influencing Meniscus Healing After Meniscus Repair 149
Immobilization 149
Weightbearing 149
Intrinsic Factors Influencing Meniscus Healing After Meniscus Repair 149
Protocol 149
Conventional Rehabilitation Protocol 149
Accelerated Rehabilitation Protocol 150
Individualized Rehabilitation Protocol 150
Conclusion 150
References 151
151522_1_En_20_Chapter_OnlinePDF 153
4.7 153
Synthesis 153
151522_1_En_5_PartFrontmatter_OnlinePDF 154
151522_1_En_21_Chapter_OnlinePDF 155
5.1 155
Functional and Objective Scores. Quality of Life 155
Summary of knee function/symptoms scoring systems 155
References 160
151522_1_En_22_Chapter_OnlinePDF 162
5.2 162
Postoperative Imaging: X-Rays, Arthro CT, Arthro MRI 162
Introduction 162
Current Concepts in Postoperative Imaging of the Meniscus 162
Postoperative Imaging After Meniscectomy 162
Radiography 162
Double-Contrast Arthrography 163
Magnetic Resonance Imaging 163
Arthro CT Scan (Fig. .5.2.3.) 164
Imaging of Cartilage After Meniscectomy 164
Postoperative Imaging After Meniscus Repair 164
Arthrography 164
Magnetic Resonance Imaging 165
Arthro MRI 166
Arthro CT Scan 166
Postoperative Imaging of Meniscus Allografts or Meniscal Substitutes 167
Radiography 167
MRI and Arthro MRI 167
When and Why to Perform Imaging After Meniscus Surgery? 167
After Meniscectomy 167
Meniscus Repair and Meniscus Transplantation 168
Conclusion 168
References 168
151522_1_En_6_PartFrontmatter_OnlinePDF 170
151522_1_En_23_Chapter_OnlinePDF 171
6.1 171
Meniscectomy: ...Global Results-Complications 171
History 171
Outcome Evaluation 172
Medial Meniscus 172
Lateral Meniscus 173
Subjective Results 173
Functional Results 174
Radiological Results 174
Meniscectomy in Stable Knees 173
Traumatic vs. Degenerative Tears 174
Meniscectomy in the ACL-Deficient Knee 175
Isolated Meniscectomy 175
Effect on Sports Level 175
Subjective Results 176
Functional Results 176
Radiological Results 176
Meniscectomy Associated with ACL Reconstruction 177
Subjective Results 177
Functional Results 178
Degenerative Changes 178
Complications 178
Short Term 179
Infections 179
Intraoperative Material Breakage 179
Ligament Injuries 179
Vascular Lesions 179
Neural Lesions 179
Synovial Fistula 180
Embolic Events 180
Medium Term 180
Early Chondrolysis 180
Conclusion 181
References 181
151522_1_En_24_Chapter_OnlinePDF 185
6.2 185
Meniscal Repair: Intra- and Postoperative Complications 185
Introduction 185
Neurovascular and Soft-Tissue Complications 185
Complications Related to Meniscal Devices and Implants 189
Nonspecific Complications 190
Conclusion 191
References 191
151522_1_En_25_Chapter_OnlinePDF 193
6.3 193
Meniscal Repair: Results 193
Introduction 193
Clinical Results 193
Subsequent Meniscectomy 193
Functional Results 194
Contributing Factors 194
ACL Status 194
Location of the Tear 195
Lateral/Medial Meniscus 195
Age 195
Time from Tear to Surgery 195
Anatomical Results 195
Assessment of Meniscal Healing Process 195
Healing Process and Clinical Outcomes 195
Meniscal Shortening 197
Secondary Arthritis 198
Conclusion 198
References 199
151522_1_En_7_PartFrontmatter_OnlinePDF 201
151522_1_En_26_Chapter_OnlinePDF 202
7.1 202
Traumatic Meniscal Lesions in a Stable Knee: Masterly Neglect, Meniscectomy, Repair 202
Introduction 202
Evaluation and Decision Making in the Treatment of a Traumatic Meniscus Tear 202
History 202
Physical Examination 203
Imaging 203
Arthroscopy 203
Indications for Treatment Options for Traumatic Tears in a Stable Knee 203
Conservative Treatment: Masterly neglect 203
Surgical Treatment 204
Meniscectomy 204
(Sub)Total or Partial Meniscectomy 204
Repair of Traumatic Tears 205
Suitability and Indications for Repair 205
Conclusion 206
References 206
151522_1_En_27_Chapter_OnlinePDF 208
7.2 208
Traumatic Lesions, ACL Knee: Masterly Neglect, Meniscectomy, Repair 208
Introduction 208
Does the Co-Existence of a Meniscal Lesion Influence the Indications for an ACL Reconstruction? 208
Indications for ACL Reconstruction in Case of a Co existent Meniscal Lesion and Modifications of the Procedure 208
Type of ACL Graft 209
Association of a Lateral Peripheral Tenodesis: Double-Bundle ACL Reconstruction 209
Rehabilitation After ACL Reconstruction 209
Secondary Meniscal Lesions in an Unstable Knee 209
Occurrence of Meniscal Lesions in an ACL-Reconstructed Knee 210
Does the Co-Existence of a Ligamentous Lesion Influence the Indications for Meniscal Surgery? 210
Isolated or Associated Meniscectomy 210
Meniscal Repair 210
Masterly Neglect 210
Meniscal Grafts and Substitutes 214
Conclusion 214
References 215
151522_1_En_28_Chapter_OnlinePDF 216
7.3 216
Degenerative Meniscal Lesions in a Stable Knee 216
Introduction 216
Evaluation and Decision Making in the Treatment of a Degenerative Meniscus Tear 216
History 217
Physical Examination 217
Imaging 217
Indications for Treatment Options for Degenerative Tears in a Stable Knee 218
Conservative Treatment- Masterly Neglect 218
Surgical Treatment 218
Meniscectomy 218
Repair 218
Horizontal Tears 219
Meniscal Cysts 220
Conclusion 220
References 220
151522_1_En_29_Chapter_OnlinePDF 222
7.4 222
Lavage, Debridement, and Osteoarthritis 222
Introduction 222
Diagnosis 222
Bone Marrow Edema 223
Effusion, Synovial Hypertrophy 223
Degenerative Meniscal Tear: Symptomatic or Not? 223
Medical Treatment 223
Manual Physical Therapy and Exercise 223
Hyaluronic Acid/Steroids 223
Lavage 224
Arthroscopic Lavage-Debridement-Meniscectomy-Chondroplasty 224
Debridement 224
Abrasion Arthroplasty 224
Level One Study 224
Other Studies: Review 225
Patient Selection for Arthroscopic Debridement 225
Grade of OA 225
Type and Location of Meniscal Tear, Mechanical Symptoms 225
Location of OA 225
Others Factors 225
Conclusion 225
References 226
151522_1_En_30_Chapter_OnlinePDF 228
7.5 228
Synthesis 228
Longitudinal Vertical Lesion in a Stable Knee 228
Traumatic Meniscal Lesion in an ACL-Deficient Knee 229
Meniscal Repair or Let the Meniscus Alone 229
“Primary” Degenerative Meniscal Lesion and Meniscal Lesion in an Osteoarthritic Knee (Meniscarthrosis) 229
151522_1_En_8_PartFrontmatter_OnlinePDF 232
151522_1_En_31_Chapter_OnlinePDF 233
8.1 233
Classification: Discoid Meniscus, Traumatic Lesions 233
Introduction 233
Traumatic Meniscal Lesions Without Congenital Abnormality 233
Meniscal Lesions with Congenital Meniscal Abnormality 234
Classification 234
Radiological Classifications 236
Correlation Between Type of Discoid Lateral Meniscus and Tear Pattern 237
References 237
151522_1_En_32_Chapter_OnlinePDF 239
8.2 239
Discoid Meniscus: Histology 239
References 241
151522_1_En_33_Chapter_OnlinePDF 242
8.3 242
Technique of Meniscoplasty and Meniscal Repair in Children 242
Introduction 242
Pre-Operative Planning 242
Patient Positioning, Equipment and Arthroscopic Portals 243
Discoid Meniscus 244
Introduction 244
Technical Considerations 245
Complications 248
Meniscal Lesions in Stable Knees 248
Introduction 248
Treatment of Horizontal Cleavage Tears with or Without Cyst 249
Meniscal Lesions Combined with ACL Tears 250
Post-Operative Management: Rehabilitation 250
Conclusion 250
References 251
151522_1_En_34_Chapter_OnlinePDF 252
8.4 252
Meniscus Lesions in Children-Indications and Results 252
Indications 252
Symptoms 252
Differential Diagnosis 252
Imaging Procedures 252
Surgical Findings 252
Treatment Options and Criteria for Repair 253
Results 255
References 257
151522_1_En_35_Chapter_OnlinePDF 259
8.5 259
Synthesis 259
References 262
151522_1_En_9_PartFrontmatter_OnlinePDF 263
151522_1_En_36_Chapter_OnlinePDF 264
9.1 264
Postoperative Osteonecrosis of the Condyle: Diagnosis and Management 264
Introduction 264
Epidemiology of ONPK 265
Etiology 267
Patient History, Physical Examination and Differential Diagnosis 267
Diagnosis of ONPK and Imaging Findings 268
Absence of Osteonecrosis on Preoperative Imaging 268
Temporal Association Between MRI Signal Changes Following Arthroscopy 268
Imaging Findings and Classification 269
Histologic Findings 272
Natural History and Prognostic Factors of ONPK 272
Treatment Options 274
Conclusion and Medicolegal Implications 274
References 275
151522_1_En_37_Chapter_OnlinePDF 277
9.2 277
Management of Early and Late Failure of Lateral Meniscus 277
Defining the Problem 277
Short and Medium-Term Complications 278
Long-Term Complications 278
Sec4_9.2 279
Tibial Varus Osteotomy 280
Choice of Osteotomy 280
Surgical Techniques 281
Tibial Varus Osteotomy .(Fig. .9.2.3.) 281
Femoral Varus Osteotomy 282
Conclusions 283
References 283
151522_1_En_38_Chapter_OnlinePDF 285
9.3 285
Synthesis 285
Early Complications 285
Late Complications 286
Conclusion 287
151522_1_En_10_PartFrontmatter_OnlinePDF 288
151522_1_En_39_Chapter_OnlinePDF 289
10.1 289
Basic Science 289
History of Meniscal Transplantation and Replacement 289
Animal Models 289
Type of Animal Models 289
Evaluation of Transplanted Meniscal Allografts in Animal Models 289
Macroscopic Assessment 289
Histological Assessment 290
Microangiography 290
Evaluation of Cartilage After Meniscal Transplantation 290
Macroscopic Assessment 290
Histological Assessment 291
Radiographic Evaluation 291
Effects of Nonanatomic Positioning and Incongruent Meniscal Transplants on Articular Cartilage 292
Effects of Intraoperative Pretensioning of Meniscal Transplants 292
Preservation Techniques 292
Biomechanical Studies 294
Biomechanical Evaluation of the Transplanted Meniscus in Animal Models 294
Biomechanical Testing of Cartilage 295
Contact Mechanics After Meniscal Allograft Transplantation 295
Effects of Positioning and Size Matching 295
Effects of Fixation 295
Conclusion 297
References 297
151522_1_En_40_Chapter_OnlinePDF 300
10.2 300
Organization: Type of Grafts, Conservation, Regulation 300
Introduction 300
Tissue Banking Organization 300
Donor Selection 300
Consent 300
Donor Selection 301
Harvesting 301
Risks and Recommendations 301
Graft Sizing 302
Types of Grafts 303
Data from Our Bank 304
References 305
151522_1_En_41_Chapter_OnlinePDF 307
10.3 307
Meniscal Allograft: French Organization 307
Standard Technique of Meniscal Grafting 307
Graft Selection, Removal and Preservation Procedure. Graft Distribution by French Tissue Banks 308
Donor Selection 308
Graft Removal 308
Preservation 309
Transplant Distribution and Preparation 309
Effectiveness of Meniscal Grafting: Indications 309
Material 309
Method 309
Conclusion 309
References 310
151522_1_En_42_Chapter_OnlinePDF 311
10.4 311
Open Technique 311
Preoperative Considerations 311
Surgical Technique 311
Introduction 311
Anaesthesia and Surgical Preparation 311
Allograft Preparation for the Open Procedure 312
Open Meniscal Allograft Transplantation 312
Alternative Soft Tissue-Bone Fixation 313
Special Note on Soft-Tissue vs. Bone-Block Fixation .[1, ..2, ..4–..6] 314
Rehabilitation 314
References 315
151522_1_En_43_Chapter_OnlinePDF 316
10.5 316
Arthroscopic Technique Without Plugs 316
Introduction 316
Surgical Technique 316
Medial Meniscal Transplantation 316
Lateral Meniscal Transplantation 319
Technical Pitfalls and Tips 321
Sub-Optimal Graft Size 321
Wrong-Sided Graft 322
Too Tight a Working Space 323
Posterior Graft Retraction 323
Results 323
Conclusion 323
References 324
151522_1_En_44_Chapter_OnlinePDF 325
10.6 325
Arthroscopic Technique with Bone Plugs 325
Introduction 325
Allograft Sizing and Selection 325
Techniques 325
Native Meniscus Preparation 325
Arthroscopically Assisted or Open Technique? 325
Meniscal Allograft Using Bone Block 326
Principles 326
Technique 326
Medial Meniscal Transplantation 327
Meniscal Allograft Using Bone Plugs 327
Principles 327
Lateral Meniscal Transplantation: Allograft Preparation 327
Surgical Exposure and Portals 327
Graft Introduction 328
Association with ACL Reconstruction 328
Medial Meniscal Transplantation 328
Rehabilitation 329
References 329
10.7 1
Results and Indications 1
Indications and Contraindications 1
Indications 1
Contraindications 1
Results 345
Subjective Assessment 345
Objective Clinical Scoring 345
Physical Examination 345
Radiological Examination (Table .10.7.5.) 345
MRI Analysis (Table .10.7.6.) 349
Second-Look Arthroscopy (Table .10.7.7.) 353
Failures and Survival Analysis 353
Conclusion 353
References 357
151522_1_En_11_PartFrontmatter_OnlinePDF 359
151522_1_En_46_Chapter_OnlinePDF 360
11.1 360
Menaflex (TM) Collagen Meniscus Implant: Basic Science 360
Rationale and Development 360
In Vitro Laboratory and In Vivo Animal Studies 360
Human Clinical Trials 362
References 364
151522_1_En_47_Chapter_OnlinePDF 365
11.2 365
Collagen Meniscus Implant: Technique and Results 365
Introduction 365
Surgical Procedure 365
Technical Points Specific to the Medial CMI 365
Patient Positioning 365
Establishing Portals 366
Preparing the Implant Bed 366
Suturing 366
Inside–Out Technique 366
All-Inside Technique 369
Technical Points Specific to the Lateral CMI 369
Patient Positioning 369
Arthroscopic Portals 370
Preparation and Delivery 370
Suturing 370
Inside–Out Technique 370
All-Inside Technique 370
Combined Surgeries 372
ACL Deficiency 372
Axial Malalignment 372
Chondral Treatment 372
Results 372
Summary 373
References 373
151522_1_En_48_Chapter_OnlinePDF 375
11.3 375
Actifit, Polyurethane meniscus implant: basic science 375
Introduction 375
Background 375
A New Synthetic Polymer 376
Degradation 376
Preclinical Biocompatibility and Animal Testing 377
Clinical Results 378
References 378
151522_1_En_49_Chapter_OnlinePDF 380
11.4 380
Polyurethane Meniscus Implant: Technique 380
Introduction 380
Indications for Use 380
Methods 381
Surgical Techniques 381
Medial Meniscal Implant 381
Lateral Meniscal Implant 383
Postoperative Procedures 384
Postoperative Care 384
Postoperative Rehabilitation 384
Clinical Outcome Following Surgery 384
Preliminary Clinical Results 385
Conclusions 385
References 385
151522_1_En_50_Chapter_OnlinePDF 386
11.5 386
Synthesis 386
151522_1_En_12_PartFrontmatter_OnlinePDF 388
151522_1_En_51_Chapter_OnlinePDF 389
12.1 389
The Future 389
References 390
151522_1_En_13_PartFrontmatter_OnlinePDF 391
151522_1_En_52_Chapter_OnlinePDF 392
13.1 392
General Conclusion 392
151522_1_En_BookBackmatter_OnlinePDF 394