Abstract des Autors

In this review article the early and late complications, results and rehabilitation of arthroscopic meniscectomy and meniscal repair are analysed and discussed. Review of the literature shows that the early complication rate of partial meniscectomy is significantly lower compared to meniscal repair. Suturing procedures are accompanied by higher rates of infection and vascular or neurological damage. The duration of the rehabilitation period is significantly shorter in partial meniscectomy than in repair procedures. Both procedures are characterized by a high percentage of good/excellent short-term results. Unsuccessful partial meniscectomy, which requires a second operation, is rare. Symptomatic unsuccessful healing which require further surgery in meniscal repairs occurs in 4-24% of the patients. Although the success rate of meniscal repair of acute peripheral tears is relative high, spontaneous healing will occur in the majortiy of cases. In these cases the tears can be left alone and arthroscopic repair would be redundant. Roetgenological arthritic changes secondary to meniscal surgery are the most important complications. Development of arthritic changes is influenced by pre-existing chondral damage, femoral-tibial malalignment, knee instability and type of the tear. In most long-term follow-up studies minor attention is paid to these important factors, which makes mutual comparison of partial meniscectomy versus meniscal repair difficult. We conclude that in the acute situation only a locked knee presents an indication for acute surgery. In patients with a suspected meniscal lesion with a relative unrestricted range of movement (no locked knee) a six-week period of conservative treatment can be installed. When symptoms remain or return, a partial meniscectomy can be performed as an elective procedure. Suturing procedures are indicated when the lesion is located in red-red zones. When choosing this procedure, the patient has to be explained about the possibility of neurovascular complications, the long duration of rehabilitation and the relative high chance of rerupture. Concerning long-term outcome, meniscus suture is believed to prevent arthritic changes. There are no comparative findings to support this hypothesis, however. Verf.-Referat