Open and arthroscopic approaches for meniscus surgery

ABSTRACT: The meniscus is a fibrocartilaginous structure that functions both as a shock absorber and a secondary stabilizer of the knee. Meniscus tears or meniscus deficiency can lead to increased intra-articular contact pressures with subsequent accelerated joint degeneration. Surgical treatment options for meniscal pathology include meniscectomy, repair, or transplantation with both arthroscopic and open approaches. The medial and lateral menisci have distinct anatomic features that need to be taken into consideration in order to preserve the native anatomy during meniscus surgery. The medial meniscus is larger and is more tethered to the femur, tibia, and capsule whereas the lateral meniscus is more mobile. The vascular supply of the meniscus is limited to the periphery and influences the healing potential along the width of the meniscus. Arthroscopic and open treatment options can be implemented to address meniscal pathology. Variations of standard arthroscopic portals should be considered based on the tear’s location and treatment being employed. Additionally, accessory portals and supplementary techniques, such as medial collateral ligament fractional lengthening, can enhance visualization and access during arthroscopic surgery. Open approaches may be required for certain meniscus treatment options, such as inside-out repair and meniscus transplants. Knowledge of key anatomic landmarks is crucial to avoid complications during meniscus procedures.