Berzolla Emily, Sundaram Vishal, Strauss Eric
Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th Street, New York, NY, USA.
Curr Rev Musculoskelet Med. 2025 Apr 16. doi: 10.1007/s12178-025-09968-5.
Meniscus repair is preferred over meniscectomy when possible due to its ability to preserve meniscal tissue and reduce long-term joint degeneration. However, meniscus repair has a risk of failure, resulting in an increasing number of patients presenting with symptoms following a failed repair. Revision meniscus repair remains an option for symptomatic patients, yet guidance on indications, surgical techniques, and expected outcomes is limited. The purpose of this review is to summarize indications, surgical approaches, and outcomes associated with revision meniscus repair.
Patient-specific factors such as age, activity level, and modifiable risk factors influence revision repair success. Younger, highly active individuals may be at higher risk of retear due to increased mechanical stress. Tissue quality and vascularity are critical, as degenerative changes and poor perfusion increase failure rates. The gold-standard inside-out technique is often favored for revision repairs due to its superior biomechanical stability. However, all-inside and outside-in techniques remain viable options in specific cases. Biological augmentation, including platelet-rich plasma (PRP) and marrow venting, may enhance healing potential but requires further investigation. Revision meniscus repair demonstrates comparable failure rates and functional outcomes to primary repair, with reported failure rates ranging from 21-33% at mid-term follow-up. Many patients successfully return to high levels of activity following revision repair. Although younger age and high activity levels may predispose to failure, revision meniscus repair remains a viable option for preserving meniscal integrity and optimizing long-term joint health.
在可能的情况下，半月板修复优于半月板切除术，因为它能够保留半月板组织并减少长期关节退变。然而，半月板修复存在失败的风险，导致越来越多的患者在修复失败后出现症状。翻修半月板修复仍是有症状患者的一种选择，但关于适应证、手术技术和预期结果的指导有限。本综述的目的是总结与翻修半月板修复相关的适应证、手术方法和结果。
患者特异性因素，如年龄、活动水平和可改变的危险因素，会影响翻修修复的成功率。年轻、活动量大的个体由于机械应力增加，再撕裂的风险可能更高。组织质量和血管供应至关重要，因为退行性改变和灌注不良会增加失败率。金标准的由内向外技术由于其优越的生物力学稳定性，在翻修修复中常受青睐。然而，全内和由外向内技术在特定情况下仍是可行的选择。生物增强，包括富血小板血浆（PRP）和骨髓减压，可能会增强愈合潜力，但需要进一步研究。翻修半月板修复的失败率和功能结果与初次修复相当，中期随访报告的失败率为21%-33%。许多患者在翻修修复后成功恢复到高水平活动。虽然年轻和高活动水平可能易导致失败，但翻修半月板修复仍是保留半月板完整性和优化长期关节健康的可行选择。
