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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAn examination of the current and future states of the basic and clinical science of meniscal repair was presented by 2 United States researchers. This article discusses the future of the basic science of meniscal repair.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESports Medicine\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESports Medicine\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAn examination of the current and future states of the basic and clinical science of meniscal repair was presented by 2 US researchers. Steven P. Arnoczky, DVM, Michigan State University, Lansing, Michigan, USA, opened the session by discussing what the future may hold in the basic science of meniscal repair.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EEven a small amount of meniscus resection changes the function of the meniscus in terms of load transmission, which can overload the articular cartilage, leading to degeneration. The basic concept of successful meniscus repair has remained the same since the late 1970s, requiring healthy meniscal tissue, access to reparative cells, access to bioactive factors (a robust blood supply), and a favorable healing environment (a stable and noncatabolic knee). Although there are well-known factors that represent the \u201cideal\u201d candidate for meniscal repair (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E), anywhere from 69% of medial and 88% of lateral meniscal tears may be deemed unrepairable, even in patients with stable knees [Fetzer GB et al. \u003Cem\u003EJ Knee Surg\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14879\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14879\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14879\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EIdeal Candidate for Meniscal Repair\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EA study that assessed nearly 1500 patients (mean age, 46 years; 69% men, 31% women) with isolated meniscal tears in otherwise stable knees (73% medial, 19% lateral, and 8% both) revealed a poor success rate of repair, with only 7.3% of medial tears and 12.7% of lateral tears being repairable [Metcalf MH, Barrett GR. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2004]. This may have occurred because of damage to the meniscus, as many patients had complex or horizontal degenerative lesions that increased as they grew older.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDr. Arnoczky then discussed new strategies to treat the \u201cbiologically challenged\u201d patient with a damaged meniscus. Such patients include those patients aged \u0026gt; 40 years with (1) meniscal tears in the white-white zone, (2) chronic meniscal tears, or (3) complex tears. Three particularly innovative and potentially valuable meniscal repair strategies that may reduce repair failure in these challenging patients (and all patients) have been devised, which Dr. Arnoczky summarized as all-biologic repair, advanced repair, and scaffold replacement.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EBiologic repair, which can eliminate the need for sutures of implants, is one strategy for repairing bucket handle and longitudinal tears in the vascular region of the menisci. Advanced repair\u2014which uses the addition of cells, bioactive factors, or both to optimize the healing environment\u2014might be successfully utilized to repair formerly irreparable bucket handle and longitudinal tears in the avascular zone or even horizontal cleavage lesions. Vascular enhancement techniques include creating vascular access by means of channels, trephine-created cores, or slits; stimulating enhancement through deliberate abrasion of the synovium; adding bioactive factors, such as fibrin clot, platelet-rich plasma, and the injection of recombinant proteins; and performing bone marrow stimulation techniques. One promising targeted therapy is the injection of mesenchymal stem cells (MSCs) into the knee joint rather than having the patient undergo surgery [Pak J et al. \u003Cem\u003EBiomed Res Int\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EScaffold replacement utilizes bioinductive scaffolds or meniscal prostheses to regenerate chondroprotection function. This is a potential repair strategy for patients with irreparable complex, oblique, radial, or horizontal tears. MSCs may also have potential value as the basis of meniscal regeneration, with recent published data suggesting that up to 24% of patients who received an intra-articular injection of allogeneic MSCs 7 to 10 days after meniscectomy achieved a \u2265 15% increase in meniscal volume over meniscectomy controls at 12 months [Vangsness CT Jr et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2014]. Natural scaffolding in the form of allografts and xenografts, synthetic materials (eg, Actifit, Menaflex, MeniscoFix), and prostheses (eg, NUsurface) have potential merit for the repair of complex, oblique, and degenerative tears. In the future, custom-designed meniscal implants based on baseline magnetic resonance imaging may also be available. Dr. Arnoczky closed his session with a reminder that despite an array of new tools and techniques, the goal of meniscal surgery is, first and foremost, chondroprotection.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EKurt P. Spindler, MD, Cleveland Clinic, Cleveland, Ohio, USA, then reviewed the present and future clinical aspects of meniscal repair.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe 3 primary options for meniscus tears are excision, repair, or no treatment. The decision that proves best for the patient requires clinical consensus of the severity of the meniscal injury [Anderson AF et al. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2011; Dunn WR et al. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2004]. A clear understanding of what constitutes successful meniscal repair is crucial. The traditional view of success is no further surgery; follow-up studies have reported appreciable failure rates (14% to 27%) for this approach [Nepple JJ et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2012]. Patient-reported outcomes for aspects including pain and activities of daily living\u2014such as the International Knee Documentation Committee subjective knee evaluation score, Knee injury and Osteoarthritis Outcome Score, and the Marx sports activity scale\u2014are reportedly useful, particularly for medial meniscus repair [Cox CL et al. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2014; Barenius B et al. \u003Cem\u003EKnee Surg Sports Traumatol Arthrosc\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn contrast, a lateral meniscus repair was shown by patient-reported outcomes to be as good as the normal lateral meniscus [Cox CL et al. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2014]. The study reported in a 6-year follow-up of 1307 of 1512 (86%) patients (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14777\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14777\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14777\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EPredictors of Outcome Following ACL Reconstructive Surgery at 6 Years (p Values)\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EMore recently, visualization of articular cartilage changes using specialized radiography views and magnetic resonance imaging has been adopted. A caveat with these visualization approaches is that repair is based mainly on the type of tear and the vascularity of the site of injury; a decision to excise is based on the arthroscopic appearance and the relationship to the blood supply\u2014thus, excision versus repair is not interchangeable. A degenerative meniscus tear from lack of blood supply usually eliminates the option of subsequent repair.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EFrom a clinical standpoint, the future for meniscal repair has 3 main challenges, according to Dr. Spindler. The first is a more complete understanding of the unique roles of the medial versus lateral meniscus, which can affect clinical outcome. Second, there is a need for longer-term data from prospective cohorts to drive improved healing following medial meniscus surgery and to identify replacements for lost medial meniscus. Third, improvements in the evaluation of meniscus repair are necessary. Improvements should include validated patient-reported outcomes and assessments of the performance and appearance of the repaired cartilage.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/23\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoxde\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzoxde\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}