Current status of meniscus salvage.

The direct repair of meniscus tears with rasp preparation of all tear surfaces, stable suture fixation, and exogenous clot injection is effective for single longitudinal tears with peripheral white rims of 4 mm and less. Radial split and flap tears at the posterior horn of the lateral meniscus can be directly repaired as well. Single longitudinal tears typically in chronic knees with peripheral white rims of 5 mm and greater may have better reliability with use of the fascia sheath. The sheath is indicated in complex tears including flaps and radial splits. A structured rehabilitation program is necessary for improved reliability of meniscus healing. Tears out in the white substance are significantly more sensitive to rapid return to weight bearing than the peripheral tears or the ligament-reconstruction portions of the procedure. Contraindications to meniscus repair would include short tears (less than 10 mm), stable partial thickness tears with less than 50% of the vertical height of the meniscus torn, and shallow radial tears of 3 mm depth or less. A posterior incision and use of the popliteal retractor at all times are necessary for protection of the popliteal neurovascular structures.