Arthroscopic Radial Meniscal Tears: Diagnosis and Repair Techniques

Radial tears of the meniscus are tears that extend from the inner margin in a perpendicular direction towards the outer peripheral margin of the meniscus. Complete radial tears transect the circumferential fibers of the meniscus affecting the ability of the meniscus to transmit hoop stresses. Biomechanically, a complete radial tear results in decreased joint contact area and increased joint contact pressures which over time lead to the development of osteoarthritis. Recognition of the biomechanical consequences of radial tears has led to greater efforts to repair these tears. Successful meniscal repair depends on solid fixation of the tear and stimulation of biological healing at the repair site. Currently, three surgical techniques are commonly used to repair radial tears: the inside-out, the all-inside, and the transtibial repair techniques. Complex suture repair techniques have been developed which increase the strength of the repair and decrease gapping at the repair site. These repair techniques have been developed as an alternative to partial meniscectomy and have produced good short-term outcomes, lower failure rates, and allowed tears that previously would have been treated with meniscectomy to be successfully repaired. The goals of this chapter are to review: the clinically relevant anatomy of the meniscus, the biomechanical consequences of radial tears, diagnostic imaging for radial tears, current treatment concepts and surgical repair techniques, and to discuss postoperative rehabilitation following repair of radial tears of the meniscus.