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The menisci: basic science and advances in treatment
  1. Ehud Rath,
  2. John C Richmond
  1. Department of Orthopaedic Surgery, Tufts University School of Medicine, New England Medical Center Hospital, Boston, MA, USA
  1. Correspondence to: Dr J C Richmond, 750 Washington Street, NEMC Box #189, Boston, MA 02043, USA email: jrichmond{at}lifespan.org

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Take home message

Meniscal tears are common in sports and non-sports related injuries. The long term protective effect of the menisci on the joint surfaces has been well documented. Meniscal preservation should be the goal of treatment. When surgery is indicated, minimally invasive arthroscopic techniques can adequately achieve this goal.

Introduction

Meniscal injury is a major cause of functional impairment of the knee. For many years the meniscus was treated with disrespect as an unnecessary appendage that could be sacrificed with the first hint of malfunction.1 In 1948 Fairbank2 described radiographic changes following total meniscectomy. As long term results after major meniscectomy were disappointing, a conservative clinical approach to the management of meniscal tears has developed over the past two decades.3–7 Meniscal preservation is emphasised, as the menisci play important roles in weight bearing, stabilisation, and energy absorption. In recent decades, a shift towards meniscal preservation has led to the development of new surgical techniques. This article will review the basic science of the semilunar cartilage and current approaches to diagnosis and treatment of meniscal injuries.

Anatomy of the human menisci

The semilunar cartilage gained its name from the C shape appearance reminiscent of the moon as the month begins. Arising from the tibia, the menisci serve to deepen the surface of the tibial plateau. The menisci are crescents roughly triangular in cross section, covering one half to two thirds of the articular surface of the corresponding tibial plateau. The outer rims of the menisci are convex and attached to the knee joint capsule. The inner edges are concave, thin, and free.

To understand meniscal pathology, it is important to know the basic embryological and vascular features of the meniscus. Both the medial and lateral meniscus assume their characteristic shapes early in prenatal development.8 The meniscus is identifiable about seven and …

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