The Meniscus

This guide focuses on the normal meniscal mechanism, body and function. Meniscal pathology and therapy are depicted in detail, followed by a presentation of long-term experience of meniscal transplantation and a look into the future of meniscal surgery.

The Meniscus The management of meniscus lesions is an unbelievable story of so-called scient- cally based, controversial treatment, covering a time span of more than 120 years, including: * The time when a locked knee was manipulated in order to reduce a bucket-handle or a fap tear back into place to restore motion. * The time when famous surgeons excised the meniscus in thousands of patients and kept the resected specimens as trophies in large glass jars. * The time of animated discussions on whether either partial meniscectomy, only removing the ruptured parts, should be performed or total meniscectomy, as ad- cated by Smillie, because some meniscus-shaped semilunar tissue regeneration had been shown by Mandic after complete removal. * The time when the next milestone was reached as Trillat introduced intramural resection, which preserved the circular stabilizing fbrous rim with its menis- ligamento-capsular attachments to the tibia and femur, to maintain more rotational knee stability. Prior to these mainstream meniscal resection treatments, pioneering work had been done by Thomas Annandale in 1883 and Moritz Katzenstein in 1908, who sutured the menisci back into place, with the latter achieving a series of good results. In 1921, Eugen Bircher was the frst to perform a diagnostic knee arthroscopy for internal knee derangement, just using a standard Jacobaeus laparoscope! Nowadays, the fundamental importance of the menisci to normal knee function, e.g., motion, load distribution, and rotational stabilization, is scientifcally acknowledged.