标枪式半月板修复系统.pptVIP

Meniscal Anatomy Indications for Meniscal Repair Location: peripheral one-third “red-red- zone” and “red-white-zone”. Indications for Meniscal Repair Chronicity: both acute and chronic tears can be successfully repaired. Knee stability: Poor results in ACL-deficient knees. Patient age: Generally better results in younger patients. Patient compliance: Patient must understand importance of post-operative protection of healing meniscus “Ideal” meniscal tear: Acute longitudinal tear in vascular periphery in young patient with stable knee. Indications for Meniscal Repair Configuration: (best results with simple or single tears) vertical tears best horizontal tears often indicates meniscal degeneration, thus poor healing capacity deformed bucket-handle fragment not amenable to repair radial tears are difficult to repair What do we know about Meniscal Healing Meniscal repair tensile strenght reaches 80% by 8-12 weeks 50% of the lenght of the tear can be healed at 3 weeks (Zhang et al. 1995) Vascular zone tears can be healed completely by fibrovascular scar in 10 weeks. (Arnoczky Cabaugh) Repair strenght at 2 months is 33% normal and at 6 months 62% (Roddecker et al. 1994) 3 Basic Types of Arthroscopic Meniscal Repair Techniques Outside - In Technique(developed by R.F.Warren) Disadvantages neurovascular injuries may be caused lower healing rate in the posterior horn (van Trommel et al. 1998) difficulty suturing posteriorly Inside-Out Technique (developed by C.E. Henning) Advantages greater flexibility in repairing complex tears good primar stability All-Inside-Technique Advantages No secondary incisions Eliminates possible neurovascular injury Potentially decreases surgical time over other techniques Disadvantages Less knowledge of primary stability All-Inside Techniques Meniscal Arrows Meniscal Darts Meniscal Staple Suture Hook Technique T-Fix Suture Anchor Technique Meniscal Arrows Material: polylactide 3 Lenght 10, 13 and 16 mm T-headed Arrows may bra