What is the meniscal suture?
The meniscal suture is to repair the meniscus, repair of meniscal tears that may present patients and avoid drying the tissue and therefore lose the function of the meniscus. Techniques meniscal suture have been imposed given the good results they have and the possibility that we have to maintain the function of the meniscus, keep the fabric in place and preserve the function of that element as essential to the transmission of loads in the knee.
Why is it so important to repair the meniscus rather than remove it ?
The menisci are two structures of fibrocartilage, shaped like a crescent, which are located in the outer and inner tibiofemoral compartments. It has a fundamental role in the transmission of loads through the knee joint. When the meniscus is removed, the load transmission is altered. That role buffer having the meniscus is lost and that a degeneration of articular cartilage will result and therefore osteoarthritis. The meniscus also has a key role in the stability of the knee. Patients lose the meniscus will have a worse stability of the knee and a worse functional outcome when they make a ligamentoplasty anterior cruciate ligament. Therefore it is essential, especially in those young and active patients, especially in those who have had traumatic tears and especially in those that also have the torn anterior cruciate ligament. Keep the meniscus, suturing, and therefore maintain function, and ensure proper development of the knee and a lower incidence of post-traumatic osteoarthritis.
What technique is used?
Today the vast majority of meniscal repairs can make it through these portals we use for simple arthroscopy, ie two small holes in the front of the knee, because we can do many of these repairs with systems that call "all in". That is, we can repair the meniscus without accessory incisions. That would be the most frequently used but, depending on the location of the break can also use techniques of "outside inside" technique, ie introduce needles and different devices from outside to inside the knee and techniques that are called "inside to be "in which different systems we suture from inside the knee outwards. In these cases we do need a small contraincisión. But I say that in most cases we can make these repairs systems "all in" using only small portals we use to make a simple arthroscopy.
What care must be taken after surgery?
Postoperative treatment after a meniscal suture will depend on the type of repair and the kind of break we've had to repair. In patients with a-longitudinal vertical meniscus, and are the vast majority of the breaks that we will be able to repair broken, we allow a partial load immediately after surgery and that has been shown to be even beneficial for healing the break. We must be careful not bear weight with the knee above 90 degrees bending in any case. So we use kneepads with flexion and extension limitation for 10-12 weeks. At first we limit the bending to 30º or 40º, just enough so that the patient does not limp during normal driving, and then at 6 weeks limit flexion 90 °. After this period, the patient will be able to do gentle exercise and allow the return to sporting activity around five months after surgery.