Foreword	6
	Foreword Surgery Meniscus Book	8
	Preface	10
	Contents	12
	Part I: Meniscus Basic Science	17
	1: Knee Meniscal Phylogeny and Ontogeny	18
	1.1 Introduction	18
	1.2 Knee and Meniscal Phylogeny	19
	1.3 Meniscal Ontogeny	25
	1.4 The Particular Case of Discoid Meniscus	27
	Conclusion	28
	References	28
	2: Anatomy and Vascularisation	30
	2.1 Medial Meniscus	30
	2.1.1 Overview	30
	2.1.2 Zone 1	31
	2.1.3 Zone 2	31
	2.1.4 Zone 3	32
	2.1.5 Zone 4	32
	2.1.6 Zone 5	32
	2.2 Connections Between the Medial and the Lateral Meniscus	33
	2.3 Lateral Meniscus	33
	2.3.1 Anterior Root	33
	2.3.2 Hiatus Popliteus	33
	2.3.3 Menisco-femoral Ligaments	35
	2.3.4 Posterior Root	35
	2.4 Vascularisation	35
	References	36
	3: Histology-Ultrastructure-Biology	37
	3.1 Introduction	37
	3.2 Overview of the Anatomy and Biomechanics	38
	3.3 Ultrastructure, Cells, and Extracellular Matrix	40
	3.4 Vascularity and Innervation	43
	3.5 From Biology to Repair and Replacement	44
	Conclusion	45
	References	45
	4: Physiology: Biomechanics	48
	4.1 Introduction	48
	4.2 Morphology	48
	4.3 Material Properties of Meniscal Tissue	51
	4.3.1 Tensile Material Properties	51
	4.3.2 Compressive Material Properties	51
	4.4 Ligaments	52
	4.4.1 Meniscotibial Ligaments	52
	4.4.2 Meniscofemoral Ligaments	53
	4.4.3 The Deep Medial Collateral Ligament (dMCL)	53
	4.4.4 The Anterior Inter-meniscal Ligament	53
	4.5 Functional Biomechanics of the Menisci	53
	4.5.1 Load Distribution	53
	4.5.2 Stability	55
	4.5.3 Meniscal Motion During Knee Flexion	55
	Conclusion	56
	References	56
	5: Physiopathology of the Meniscal Lesions	59
	5.1 Introduction	59
	5.2 Anatomy, Biology, and Biomechanics: Relevance on Meniscal Injuries	60
	5.3 Traumatic Meniscus Injuries in Younger Population	63
	5.4 Degenerative Meniscus Tears in Older Population	67
	5.5 Meniscal Tears in Children	68
	References	69
	6: Meniscus Basic Science: Synthesis	74
	Part II: Classification Meniscal Lesions	76
	7: Traumatic Meniscal Lesions	77
	7.1 Introduction: Traumatic Versus Degenerative Meniscal Tears	78
	7.2 Classification of the Meniscal Tears	78
	7.2.1 Radial Tears	78
	7.2.2 Flap or Parrot-Beak Tears	79
	7.2.3 Peripheral, Longitudinal Tears	79
	7.2.4 Bucket-Handle Tears	79
	7.2.5 Horizontal Cleavage Tears	79
	7.2.6 Complex, Degenerative Tears	81
	7.2.7 Meniscal Root Lesions (MRTs)	81
	7.3 International Classification of Meniscal Tears	83
	7.3.1 Tear Depth	83
	7.3.2 Rim Width	83
	7.3.3 Radial Location	83
	7.3.4 Tear Pattern and Treatment	84
	7.4 Traumatic Meniscal Lesion in ACL-Deficient Knee	84
	7.4.1 Symptomatic Anterior Laxity of the Knee (Functional Instability) in a High-Demand Sports-Active Person	84
	7.4.2 Anterior Laxity of the Knee Associated with Minor Symptoms in an Active Individual in Low-Demand Sports Activities	85
	7.4.3 Meniscal Repair or Leave the Meniscal Tear Alone Without Treatment	85
	References	87
	8: Degenerative Meniscus Lesions, Cartilage Degeneration, and Osteoarthritis of the Knee	89
	8.1 Etiology and Pathogenesis of Degenerative Meniscus Lesions	89
	8.2 The Definition of a  Degenerative Meniscal Lesion at Arthroscopy or Magnetic Resonance Imaging	90
	8.3 The Prevalence of Degenerative Meniscal Lesions	91
	8.4 Degenerative Meniscal Lesions and Knee Symptoms	92
	8.5 The Consequences in the Knee by a  Degenerative Meniscal Lesion	94
	8.6 Knee Osteoarthritis	94
	8.7 The Association Between Degenerative Meniscus Lesions and Osteoarthritis	95
	8.8 Imaging Assessment of the Degenerate (Osteoarthritis) Knee: Role of Knee Radiographs	95
	8.9 Imaging Assessment for the Degenerate Knee and Osteoarthritis: Role of Magnetic Resonance Imaging	96
	References	97
	9: Hidden Lesions and Root Tears	102
	9.1 Arthroscopic All-Inside Suture Repair of Medial Meniscus Lesion in Anterior Cruciate Ligament-Deficient Knees	102
	9.1.1 Introduction	102
	9.1.2 Classification	103
	9.1.3 Surgical Technique	103
	9.1.4 Authors’ Clinical Outcomes	107
	9.2 Arthroscopic All-Inside Repair for Lateral Meniscus Root Tear in Patients Undergoing Concomitant Anterior Cruciate Ligament Reconstruction	107
	9.2.1 Introduction	107
	9.2.2 Classification of the LMPH Root Tear	107
	9.2.3 Surgical Technique	107
	9.2.4 Authors’ Clinical Outcomes	108
	9.3 Arthroscopic Meniscus Root Re-fixation Technique Using a Modified Mason-Allen Stitch	110
	9.3.1 Introduction	110
	9.3.2 Surgical Technique	110
	References	113
	10: Meniscal Lesions in Children: Classification, Discoid Meniscus, Traumatic Lesions	115
	10.1 Introduction	115
	10.2 Tears and Normal Meniscus	116
	10.2.1 Generalities	116
	10.2.2 Description of the Tears	116
	10.2.2.1 According to the Vascularization of the Meniscus	116
	10.2.2.2 According to the Type of Tear	116
	10.2.2.3 According to the Stability of the Knee	118
	10.3 Meniscal Tears and  Morphological Meniscal Anomaly	119
	10.3.1 Discoid Meniscus	119
	10.3.2 Lateral Hypermobile Meniscus	123
	Conclusion	123
	References	124
	11: Discoid Meniscus: Histology	126
	References	128
	12: Classification of Meniscal Lesions: Synthesis	130
	Part III: Preoperative Clinical Examination and Imaging	132
	13: Clinical Examination, Standard X-Rays	133
	13.1 Introduction	133
	13.2 Clinical Examination	133
	13.2.1 Anamnesis	133
	13.2.2 General Clinical Examination of the Knee	134
	13.2.3 Tests Commonly Used to Assess Meniscal Lesions	134
	13.2.3.1 Joint Line Tenderness	134
	13.2.3.2 McMurray’s Test	134
	13.2.3.3 Apley’s Test	134
	13.2.3.4 Thessaly’s Test	134
	13.2.3.5 Steinmann I Test	139
	13.2.3.6 Ege’s Test	140
	13.2.3.7 Childress’ Sign (Squat Test)	140
	13.2.3.8 Payr’s Test	140
	13.2.3.9 Bohler’s Test	140
	13.2.3.10 Combination of Different Tests	140
	13.3 Standard X-Rays	142
	References	142
	14: Preoperative MR Imaging of the Meniscus	144
	14.1 Introduction	144
	14.2 Imaging Technique	144
	14.3 Meniscal Tears	145
	14.4 Imaging Pitfalls	145
	14.5 Classification of Meniscal Tears	146
	14.5.1 Longitudinal Tear	146
	14.5.2 Radial Tear	146
	14.5.3 Parrot-Beak Tear	147
	14.5.4 Horizontal Tear	147
	14.5.5 Bucket-Handle Tear	147
	14.5.6 Flipped Meniscal Tear	148
	14.5.7 Complex Tear	148
	14.5.8 Root Tear	148
	14.6 Meniscal Degeneration	150
	References	150
	15: Meniscus Ultrasound	152
	15.1 Introduction	152
	15.1.1 MRI Verses MSU	153
	15.2 Imaging Assessment Meniscus	153
	15.2.1 Radiographs	153
	15.2.2 Ultrasound	153
	15.2.3 Probes	153
	15.3 Knee Ultrasound Equipment and Setup	154
	15.3.1 Meniscus Scanning Positions	154
	15.4 History of Meniscus Ultrasound	155
	15.5 Normal Meniscus	155
	15.5.1 Lateral Meniscus Vascularization	156
	15.6 Conditions Suggesting Pathology	157
	15.6.1 Lateral Posterior Popliteal Recessus	157
	15.7 Meniscus Pathology	157
	15.7.1 Meniscus Tear	157
	15.7.2 Meniscus Flap Tear	157
	15.7.3 Anterior Horn Dislocation of the Medial Meniscus	158
	15.7.4 Meniscus Bucket Handle	158
	15.7.5 Hidden Lesions	158
	15.8 Meniscus Combined Lesions	158
	15.8.1 Meniscus and Anterior Cruciate Ligament Instability	158
	15.8.2 Meniscus Follow-Up in ACL-­Deficient Knees	159
	15.9 Meniscus Repair	159
	15.9.1 Ultrasound for Meniscal Repair	159
	15.9.2 Meniscus Spontaneous Healing	160
	15.9.3 Meniscus Reparability	162
	15.9.4 Meniscus Repair	162
	15.9.5 Acute Lesions	162
	15.10 Specific Conditions	163
	15.10.1 Meniscus Degeneration	163
	15.10.2 Meniscus Chondrocalcinosis	163
	15.10.3 Meniscus Extrusion	164
	15.10.4 Meniscus Cyst	164
	15.10.5 Discoid Meniscus	164
	15.11 Complications or Prolonged Symptoms After Surgery	165
	References	165
	16: SPECT/CT Imaging of the Meniscus and Cartilage: What Does It Offer?	167
	16.1 Introduction	167
	16.2 Basics about SPECT/CT Imaging	167
	16.3 Current and Potential Use of SPECT/CT	168
	16.3.1 Meniscus	169
	16.3.2 Cartilage	170
	16.3.3 OA	170
	Conclusion	170
	References	171
	17: Synthesis: Differences Between Traumatic and Degenerative Meniscal Lesions	173
	17.1 Introduction	173
	17.2 Clinical Examination	173
	17.3 MRI	174
	17.4 Relationship Between Clinical Symptoms and MRI	174
	17.5 Radiographs	175
	17.6 Histology	175
	Conclusion	175
	References	176
	18: Synthesis	177
	Part IV: Surgical Technique	178
	19: Arthroscopy of the Normal Meniscus	179
	19.1 Introduction	179
	19.2 Medial Meniscus	180
	19.2.1 Anterior Horn	180
	19.2.2 Distal Insertion of the ACL	180
	19.2.3 Body of the Meniscus	181
	19.2.4 Deep MCL: Meniscotibial and Meniscofemoral Ligaments	181
	19.2.5 Posterior Horn	182
	19.3 Intermeniscal Ligament	183
	19.4 Lateral Meniscus	183
	19.4.1 Anterior Horn	183
	19.4.2 Midbody of the Meniscus	184
	19.4.3 Popliteus Tendon	184
	19.4.4 Popliteomeniscal Fasciculi	184
	19.4.5 Meniscofemoral Ligaments: Humphrey and Wrisberg Ligaments	184
	19.5 Posterior Horn	185
	Conclusion	187
	References	187
	20: Meniscectomy Medial: Lateral	189
	20.1 Introduction	189
	20.2 Indication for Surgery	190
	20.3 Surgical Preparation and Patient Positioning	190
	20.4 Diagnostic Arthroscopy and Portal Placement	190
	20.5 Surgical Strategy During Medial Meniscectomy	192
	20.6 Pitfalls During Meniscectomy	194
	20.7 Specific Features to Lateral Meniscectomy	194
	20.7.1 Approaches	195
	20.7.2 Technical Features to Lateral Meniscectomies	195
	20.7.3 Treatment of Vertical Radial Lesions	196
	20.7.4 Treatment of a Lateral Meniscal Flap	196
	20.7.5 Treatment of Horizontal Cleavage	196
	20.7.6 Treatment of Meniscal Cyst	197
	20.7.7 Treatment of Discoid Meniscus	198
	20.7.8 Indications for Lateral Meniscectomy	198
	20.8 Termination of the Procedure	199
	20.9 Complications	199
	20.10 Postoperative Regimen and Rehabilitation	200
	Conclusion	200
	References	200
	21: Biomechanics of Meniscal Repair	202
	21.1 Introduction	202
	21.2 Meniscus Biomechanical Considerations	203
	21.3 Meniscus Repair: Results	203
	21.4 Sutures: Methods and Devices	205
	21.5 Biomechanical Testing	206
	21.6 Biomechanical Studies: Current Knowledge	207
	21.7 Biomechanical Studies: Limitations	208
	References	209
	22: Meniscus Repair: Updated Techniques (Open and Arthroscopic)	211
	22.1 Introduction	211
	22.2 Arthroscopic Assessment	212
	22.3 Debridement/Abrasion	213
	22.4 Suture Placement	213
	22.5 Fixation by All-Inside Devices	214
	22.6 Inside-Out Technique	216
	22.7 Outside-In Technique	216
	22.8 Posteromedial Sutures for Meniscocapsular Lesions of the Medial Meniscus	216
	22.8.1 General Principles	216
	22.8.2 Surgical Technique	217
	22.9 Open Meniscus Repair for Horizontal Cleavage in Young Patients	219
	22.9.1 General Principles	219
	22.9.2 Surgical Technique	219
	Conclusion	221
	References	222
	23: Meniscal Repair: Enhancement of Healing Process	224
	23.1 Introduction	224
	23.2 Vascular Access Channel, Trephination, and Abrasion	225
	23.3 Fibrin Glue and Fibrin Clot	226
	23.4 Growth Factors and Platelet-­Rich Plasma	228
	23.5 Synovial Flaps	230
	23.6 Mesenchymal Stem Cells	230
	Conclusion	231
	References	232
	24: Meniscal Cysts	235
	24.1 Introduction	235
	24.2 Etiology and Pathology of Meniscal Cysts	236
	24.3 Incidence of Meniscal Cysts	237
	24.4 Clinical Evaluation and Diagnostic	237
	24.5 Treatment of Meniscal Cysts	240
	24.5.1 Conservative Treatment	240
	24.5.2 Surgical Treatment	240
	24.6 Results	245
	Conclusion	246
	References	246
	25: Discoid Meniscus and Meniscoplasty in Children	249
	25.1 Introduction	249
	25.2 Novel MRI Classification	251
	25.3 Arthroscopic Partial Meniscectomy with Repair of the Peripheral Tear for Discoid Lateral Meniscus in Children	254
	25.3.1 Diagnostic Arthroscopic Examination	254
	25.3.2 Partial Central Meniscectomy	254
	25.3.3 Meniscus Suture Repair for Peripheral Tears	255
	25.3.4 The Modified Outside-In Technique for Tears from the Anterior Horn to the Posterolateral Corner	258
	25.3.5 The Modified All-Inside Technique for Posterior Horn Tears	259
	25.3.6 Postoperative Care	264
	References	266
	26: Repair in Children	268
	26.1 Introduction	268
	26.2 Diagnosis	269
	26.3 Indications for Repair	269
	26.3.1 Lesions Types	269
	26.3.2 Rationale for Repair	269
	26.3.2.1 Blood Supply	269
	26.3.2.2 Age of the Lesion	270
	26.4 Principles of Repair	270
	26.4.1 Inside-Out Sutures	270
	26.4.2 Outside-In Sutures	270
	26.4.3 All-Inside Sutures	270
	26.5 Repair Technique According to the Type of Lesion	271
	26.5.1 Vertical Tears	271
	26.5.2 Horizontal Tears and Meniscal Cysts	271
	26.5.3 Meniscal Horn Avulsion	272
	26.5.4 Radial Tears	272
	26.5.5 Meniscal Substitution (Actifit®)	272
	26.6 Postoperative Course	272
	26.7 Results	272
	Conclusion	274
	References	274
	27: Rehabilitation and Return to Sport	276
	27.1 Introduction	276
	27.2 Scientific Background (The State of Art in Meniscus Rehabilitation and Return to Sport)	277
	27.2.1 Progressive Knee Motion	277
	27.2.2 Progressive Weight-Bearing	278
	27.2.3 Return to Activity	278
	27.3 Rehabilitation Strategies	278
	27.3.1 Organizational Principles	278
	27.3.2 Clinical Principles	279
	27.4 First Step: Walking Without Crutches	279
	27.4.1 Criteria to Be Achieved	279
	27.4.2 Specific Interventions	279
	27.5 Second Step: When Running on a Treadmill	280
	27.5.1 Criteria to Be Achieved	280
	27.5.2 Specific Interventions	280
	27.6 Third Step: When Starting On-Field Rehabilitation	280
	27.6.1 Criteria to Be Achieved	280
	27.6.2 Specific Interventions	280
	27.7 Fourth Step: When Return to the Team	280
	27.7.1 Criteria to Be Achieved	280
	27.7.2 Specific Interventions	281
	27.8 Considerations and Precautions According to the Type of Surgery	281
	Conclusion	282
	References	282
	28: Partial Meniscectomy and Meniscal Suture: Graft Rehabilitation Guidelines	283
	28.1 Guidelines for Partial Meniscectomy	284
	28.2 Phase 1	285
	28.2.1 1–2 Postoperative Weeks	285
	28.2.1.1 Goals	285
	28.2.1.2 Precautions/Contraindications	285
	28.2.1.3 Exercise Program	285
	At Home	285
	Physiotherapy	285
	28.2.2 3–4 Postoperative Weeks	285
	28.2.2.1 Goals	285
	28.2.2.2 Precautions/Contraindications	286
	28.2.2.3 Exercise Program	286
	At Home	286
	Physiotherapy	286
	28.3 Phase 2	287
	28.3.1 5–6 Postoperative Weeks	287
	28.3.1.1 Goals	287
	28.3.1.2 Precautions/Contraindications	287
	28.3.1.3 Exercise Program	287
	At Home	287
	Physiotherapy	288
	28.3.2 7–8 Postoperative Weeks	288
	28.3.2.1 Goals	288
	28.3.2.2 Precautions/Contraindications	288
	28.3.2.3 Exercise Program	288
	At Home	288
	Physiotherapy	288
	28.4 Guideline for Meniscal Suture/Meniscal Graft	289
	28.5 Phase 3	290
	Conclusion	290
	References	290
	29: Synthesis	292
	29.1 Introduction	292
	29.2 Lesion Left In Situ	292
	29.3 Meniscus Repair	293
	29.4 Meniscectomy	293
	29.5 Meniscal Lesions in Children (Repair, Discoid Meniscus)	293
	29.6 Meniscal Cysts/Horizontal Cleavage of the Meniscus in the Young Athlete	294
	29.7 Rehabilitation	294
	Conclusion	294
	References	294
	Part V: Postoperative Evaluation	296
	30: Functional and Objective Scores: Quality of Life	297
	30.1 Chapter Structure	297
	References	300
	31: Postoperative Imaging of the Meniscus	301
	31.1 Introduction	301
	31.2 Partial Meniscectomy and Meniscal Repair	302
	31.3 Meniscus Allograft Transplantation	302
	References	304
	32: Synthesis	306
	Part VI: Results	308
	33: Posterior Horn Plus Pars Intermedia Bucket-Handle Tear Resection: Long-Term Outcome and Complications	309
	33.1 Introduction	309
	33.2 Bucket-Handle Tear	310
	33.3 Long-Term Outcome and Complications After Bucket-Handle Tear Resection (Posterior Horn Plus Pars Intermedia)	311
	33.3.1 Bucket-Handle Tears Resection: Surgical Technique	311
	33.3.2 Long-Term Outcome and Complications	312
	Conclusion	314
	References	314
	34: Results of Lateral Meniscectomy	318
	34.1 Introduction	318
	34.2 Effects of Meniscectomy	319
	34.3 Clinical and Radiographic Results of Arthroscopic Partial Lateral Meniscectomy	319
	34.3.1 Short- to Mid-Term Follow-Up	319
	34.3.2 Long-Term Follow-Up	320
	34.4 Failures	321
	Conclusion	321
	References	321
	35: Meniscal Repair: Intra- and Postoperative Complications	323
	35.1 Introduction	323
	35.2 Intraoperative Complications	324
	35.2.1 Neurologic Complications	324
	35.2.1.1 Saphenous Nerve Injuries	324
	35.2.1.2 Peroneal Nerve Injuries	325
	35.2.2 Vascular Complication	325
	35.2.3 Medial Collateral Ligament Sprain and Cartilage Lesion	326
	35.3 Postoperative Complications	326
	35.3.1 Nonspecific Complications	326
	35.3.1.1 Deep Venous Thrombosis (DVT)	326
	35.3.1.2 Arthrofibrosis and Type 1 Complex Regional Pain Syndrome	327
	35.3.1.3 Infection	327
	35.3.2 Specific Complication Related to the Meniscal Repair	327
	35.3.2.1 Mechanical Symptoms Related to the Fixation Devices	328
	35.3.2.2 Meniscal Cyst Formation	328
	35.3.2.3 Aseptic Synovitis	328
	35.3.2.4 Cartilage Damage	328
	35.4 Discussion	329
	Conclusion	329
	References	330
	36: Meniscal Repair: Results	332
	36.1 Meniscal Repair: Short-Term Results (Clinical Outcomes and Imaging)	332
	36.1.1 Introduction	332
	36.1.2 Meniscus Repair: Short-Term Clinical Outcomes	332
	36.1.2.1 Difference Between Techniques	333
	36.1.2.2 Medial Versus Lateral Meniscus	333
	36.1.2.3 Time from Injury to Surgery	333
	36.1.2.4 ACL Reconstruction	333
	36.1.2.5 High-Level Sports	333
	36.1.3 Failures	333
	36.1.4 Trends in Meniscal Repair Practice	335
	36.1.5 Short-Term Imaging	335
	36.1.5.1 Short-Term Imaging Features	335
	36.1.5.2 Short-Term Imaging Outcomes and Second-Look Arthroscopy	336
	36.1.6 Outcomes of Meniscal Repair of Horizontal Cleavage Tears	337
	36.1.7 Summary	338
	36.2 Meniscal Repair: Long-Term Results (Clinical Outcomes and Imaging)	338
	36.2.1 Introduction	338
	36.2.2 Meniscus Repair Long-Term Results	338
	36.2.3 Radiological Long-Term Results	339
	36.2.4 Meniscus Repair in the Elite Athlete	339
	36.2.5 Meniscus Repair and Concomitant ACL Reconstruction	340
	36.2.6 Summary	341
	References	341
	37: Discoid Meniscus. Meniscus Lesions in Children: Indications and Results	345
	37.1 Introduction	345
	37.2 Origin and Ultrastructure	345
	37.3 Diagnosis	346
	37.4 Treatment	347
	37.5 Results	348
	37.6 Summary	352
	References	352
	38: Synthesis	355
	Part VII: Indications: Adults	357
	39: Traumatic Lesions in a Stable Knee: Masterly Neglect - Meniscectomy - Repair	358
	39.1 Introduction	358
	39.2 Basic Science	358
	39.3 Patient History	359
	39.4 Physical Examination	359
	39.5 Imaging	360
	39.6 Arthroscopy	360
	39.7 Treatment Strategies	361
	39.7.1 Conservative Treatment	361
	39.7.2 Surgical Treatment	361
	39.7.2.1 Meniscectomy	361
	39.7.2.2 Repair	361
	39.7.2.3 Evaluation of the Lesion and Decision Making	362
	Conclusion	363
	References	363
	40: Meniscal Traumatic Lesions in ACL-Deficient Knee: Masterly Neglect, Repair, or Meniscectomy	365
	40.1 Introduction	365
	40.2 Masterly Neglect	366
	40.3 Meniscal Repair	368
	40.4 Meniscectomy	371
	40.5 Meniscus Replacement	373
	Conclusion	373
	References	374
	41: Degenerative Meniscal Lesions: Indications	378
	41.1 Classification	379
	41.2 Frequency	379
	41.3 Assessing a DML	379
	41.4 Treatment	380
	41.4.1 Functional Treatment or Arthroscopic Meniscectomy?	380
	41.4.2 Functional Treatment: What Does It Mean?	382
	41.4.3 Partial or Subtotal Meniscectomy: Which Outcomes?	382
	41.4.3.1 What Is the Risk of Osteoarthritis After APM?	382
	41.5 Algorithm	383
	Conclusion	385
	References	386
	42: Arthroscopic and Supplementation Therapy in Osteoarthritis of the Knee	388
	42.1 Introduction	388
	42.2 Arthroscopic Therapy	389
	42.2.1 Lavage	389
	42.2.2 Debridement	389
	42.3 Supplementation	391
	42.3.1 Intra-articular Viscosupplementation	392
	42.3.2 Oral Supplements and Medication	394
	Conclusion	395
	References	395
	43: Indications in Meniscus Surgery: Synthesis	398
	43.1 Traumatic Lesions	399
	43.2 Degenerative Meniscal Lesions	400
	References	401
	Part VIII: Post-meniscectomized Knee	403
	44: Postoperative Osteonecrosis of the Knee: Incidence, Diagnosis, Management and Results	404
	44.1 Introduction	404
	44.2 Incidence and Epidemiology in ONPK	405
	44.3 Physiopathology	406
	44.4 Patient History, Physical Examination and Differential Diagnosis	408
	44.5 Diagnosis of ONPK and Imaging Findings	409
	44.5.1 Absence of Osteonecrosis on Preoperative Imaging	409
	44.5.2 Timely Association Between MRI Signal Changes Following Arthroscopy	410
	44.5.3 Imaging Findings and Classification	412
	44.6 Histologic Findings	415
	44.7 Blood Markers	415
	44.8 Natural History and Prognostic Factors of ONPK	415
	44.9 Treatment Options	416
	Conclusion	416
	References	417
	45: Concepts in Managing the Patient with Post-meniscectomy Knee Pain	419
	45.1 Introduction	419
	45.2 Aim	420
	45.3 Patient Assessment	420
	45.4 Nonoperative Treatment	420
	45.5 ‘A la carte’ Surgical Approach	420
	45.5.1 Arthroscopy	421
	45.5.2 Alignment	421
	45.5.3 Stability	422
	45.5.4 Meniscus Deficiency	423
	45.5.5 Articular Cartilage Lesions	424
	45.6 Rehabilitation	425
	45.7 Decision Making: Putting It All Together	425
	45.8 Summary	427
	References	427
	Part IX: Meniscal Reconstruction: Allograft	429
	46: Basic Science on the Meniscus	430
	46.1 Embryology	430
	46.2 Chemical Composition and Organisation of Normal Meniscal Tissue	431
	46.3 Cellular Composition of Meniscal Tissue	433
	46.3.1 Fibrochondrocyte	434
	46.3.2 Fibroblast-Like Cells	434
	46.3.3 Cells of the Superficial Zone	434
	46.4 Healing Response in the Injured Meniscus	434
	46.4.1 Model I: Transection of the Anterior Cruciate	435
	46.4.2 Model II: Plug Model	435
	46.4.3 Model III: Tear Model	436
	46.5 Rationale for Meniscal Replacement	436
	46.6 Immunological Aspects of Meniscal Transplantation	438
	Conclusion	438
	References	439
	47: Organization: Type of Grafts, Conservation, Regulation	442
	47.1 Tissue Banks and Control	442
	47.2 Donor and Recipient Protection	443
	47.3 Harvesting	444
	47.4 Risk and Recommendations	445
	47.5 Regulation	445
	47.5.1 Development	445
	47.5.2 Ethics	446
	47.6 Types of Grafts	447
	47.6.1 Lyophilization	447
	47.6.2 Freezing	447
	47.6.3 Cryopreservation	448
	47.6.4 Fresh Allograft	448
	Conclusion	449
	References	450
	48: Meniscus Allograft: Organization and Regulation in Europe and USA	452
	48.1 Organization in Europe	452
	48.2 Organization in the USA	455
	48.3 Tissue Procurement Overview	456
	48.4 Comparison of Regulations, Standards, and Other Initiatives	457
	48.4.1 Europe	458
	48.4.2 USA	458
	48.4.3 Overview	459
	48.5 Activity	459
	48.6 Consent/Authorization	460
	48.7 Quality	462
	48.7.1 Donor Suitability	462
	48.7.1.1 Medical Records and Cause of Death	463
	48.7.1.2 Malignancy	463
	48.7.1.3 Age Criteria	464
	48.7.1.4 Physical Evaluation	464
	48.7.1.5 Donor Screening: Required Infectious Disease Testing	464
	48.7.1.6 Procurement Site and Time Limits for Recovery	465
	48.7.1.7 Testing the Tissue	465
	48.7.1.8 Tissue Processing	465
	Conclusion	466
	References	466
	49: Surgical Technique for Open Meniscal Allograft Transplantation	467
	49.1 Indication	467
	49.2 Clinical Examination and Preoperative Management	468
	49.3 Surgical Technique (Lateral Meniscus Allograft Transplantation)	469
	49.4 Postoperative Management	471
	Conclusion	472
	References	472
	50: Meniscus Allograft Transplantation with Bony Fixation	473
	50.1 Introduction	473
	50.2 Clinical Evaluation	474
	50.3 Surgical Indications	475
	50.4 Procedure	476
	50.5 Postoperative Course and Rehabilitation	481
	50.6 Complications	481
	50.7 Outcomes	481
	References	481
	51: Arthroscopic Meniscal Allograft Transplantation with Soft Tissue Fixation Through Bone Tunnels	483
	51.1 Introduction	483
	51.2 Soft Tissue Versus Bone Plug Fixation Techniques	483
	51.3 Surgical Technique	484
	51.3.1 Principles	484
	51.3.2 The Key Stages	484
	51.3.3 Technique Decision Options	484
	Conclusion	492
	References	492
	52: Arthroscopic Technique with One Bone Plug: Meniscal Transplantion – How I Do It	493
	52.1 Prerequisites	493
	52.2 Preoperative Workup	495
	52.3 Implantation of the Graft	495
	52.4 Postoperative Rehabilitation	496
	52.4.1 Week 0–3	496
	52.4.2 Week 4–6	497
	52.4.3 Week 7–9	497
	52.4.4 Week 10–12	497
	52.4.5 Week 13–18	497
	52.4.6 Week 19–24	497
	52.5 Follow-Up	497
	Conclusion	497
	References	498
	53: Meniscal Allograft Transplantation: Results and Indications	499
	53.1 Introduction	499
	53.2 Indications	500
	53.3 Patient-Reported Outcomes	500
	53.4 Return to Sports	500
	53.5 Radiological Outcomes	500
	53.6 Complications and Failures	501
	53.7 Discussion	501
	Conclusion	502
	References	502
	54: Synthesis	505
	54.1 Introduction	505
	54.2 Procurement and Preservation of Meniscal Allograft	506
	54.3 Surgical Technique	507
	Conclusion	507
	Part X: Meniscal Reconstruction: Substitutes	508
	55: Collagen Meniscus Implant: Basic Science, Technique and Results	509
	55.1 Introduction	509
	55.2 Basic Science	510
	55.2.1 Development of the Collagen Meniscus Implant (CMI)	510
	55.2.2 CMI Animal Studies	511
	55.3 CMI Surgical Technique	511
	55.3.1 Medial CMI Technique	511
	55.3.2 Lateral CMI Technique	513
	55.3.3 Combined Surgeries	514
	55.3.4 Rehabilitation Protocol	514
	55.4 CMI Results	515
	55.4.1 Medial CMI Clinical Results	515
	55.4.2 Lateral CMI Clinical Results	516
	55.4.3 Radiographic Results	516
	55.4.4 MRI Results	517
	55.4.5 Histological Results	517
	55.5 Summary	518
	References	518
	56: Actifit Polyurethane Meniscus Scaffold: Basic Science, Techniques, and Results	521
	56.1 Introduction	521
	56.2 Basic Science	521
	56.3 Indications/Requirements	522
	56.4 Surgical Technique and Postoperative Rehabilitation	523
	56.4.1 Surgical Technique	523
	56.4.2 Postoperative Rehabilitation	525
	56.5 Results	525
	56.5.1 Clinical Results	525
	56.5.2 MRI Results	525
	56.5.3 Complications	527
	Conclusion	528
	References	528
	57: Meniscal Substitutes Synthesis	530
	57.1 Introduction	530
	57.2 Scaffolds	530
	57.3 New Approaches	531
	Conclusion	531
	References	531
	Part XI: Substitutes and Future Technology	533
	58: Gene Therapy, Growth Factors, Mesenchymal Cells, New Trends and Future Perspectives	534
	58.1 Introduction	535
	58.2 Gene Therapy for Meniscal Repair	535
	58.2.1 Target Cells and Candidate Factors	535
	58.2.2 Gene Transfer Vectors	535
	58.2.3 Genetically Enhanced Tissue Engineering	536
	58.2.4 Strategies and Applications of Gene Therapy	536
	58.3 PRP and Future	538
	58.3.1 PRP and Meniscus: Are In Vitro Evidences Correlated with Clinical Benefit?	538
	58.3.2 PRP and Growth Factors: A Future in Meniscal Healing?	539
	58.4 Mesenchymal Stem Cells in Meniscal Repair	540
	58.4.1 Endogenous Mesenchymal Cell-Based Meniscal Repair	540
	58.4.2 Mesenchymal Cells for Enhanced Meniscal Tear Repair	540
	58.4.3 Mesenchymal Cells for Enhanced Meniscal Defect Repair	541
	58.5 New Trends and Future Perspectives	542
	58.5.1 Scaffolds: New Materials? New Methods? Patient Specific?	542
	58.5.2 Controlling Growth Factors	544
	58.5.3 Cell-Based Strategies and Bioreactors	545
	Conclusion	545
	References	547
	Index	551