Basic Research

Histological features of meniscal injury

Vinesh Senan1, Jilsa Sucheendran2, Prasad3, Balagopal K4

www.kjoonline.org
Govt. Medical
College, Thrissur
Kerala, India

Abstract
Background: Meniscus tissue is highly susceptible to injury and tears. As these
are intrasynovial and lack cellularity, their healing potential is less. Any knowledge
to the factors affecting the meniscal healing can help surgeons in treating meniscal
1
injuries.
Asst. Professor of
Orthopaedics
Hypothesis: Patient age is a predictor of the healing of meniscus tissue.
Study Design: Prospective study.
2
Resident in
Methods: Gross and histologic evaluation of torn meniscus tissue from 30
Pathology
patients and 10 control menisci were performed. Histologic scoring system was used
to access the tissue healing
3
Addl. Professor
Results: Patients age had a significant effect on the healing intention of the
of Pathology
torn meniscus, with patients older than 40 years having significantly fewer meniscus
4
Assoc. Professor of
cells than did those younger than 40 years. Further studies are needed to define
Orthopaedics
the relative importance of the individual histologic findings in the clinical setting of
meniscus tear and repair.
Correspondence
Clinical Relevance: Our findings show that menisci from patients older than 40
should be sent to:
vineshsenan@yahoo.com years may be more vulnerable to degeneration and re tear after repair than are
menisci of younger patients.
Keywords: Meniscus, tear, healing, injury, age

Kerala Journal of
Orthopaedics
2011;24:30-36
Kerala Journal of
Orthopaedics

30

Introduction
The menisci of the knee are part
of a complex system designed to provide
load sharing support and stability
throughout the wide range of motion of
the knee joint. In turn, the normal
mechanical functioning of the meniscus
is dependent on its proper biochemical
composition, ultrastructural organisation
and macroanatomical forms.
The human meniscus functions as
a shock absorber for the normal
knee.[10,48,62] It has been observed
that
meniscectomy
results
in
osteoarthritis of the knee.[29,38] The
interdependence of the ACL and medial
meniscus on each other[50] have led
surgeons to find new methods to repair
torn meniscii.[4,5,41,59]
Injured tissues undergoes healing
through the stages of inflammation,

proliferation and remodelling,[3] which

result in scar formation. However the
meniscus
fails
to
heal
spontaneously[68]. Meniscus repair has
shown variable rates of meniscus
healing. Extraarticular tissues show a
better healing rate with failures less than
2%.[39] Clinical failure rates may not
estimate the healing rates in repaired
meniscus thus meniscus may have failed
to heal in as high as 45% of patients.[69]
Meniscus tissue being relatively
acellular is susceptible to nonhealing of
tears, [42,47,55,56] and it is thought
that the presence of viable cells in the
meniscus is important in the long-term
survival of the tissue.[55] Previous
investigators have reported patient
age,[14,66] time since injury,[14,64,70]
and instability [12,34,71] as risk factors
for poor clinical outcome of meniscus

Kerala Journal of Orthopaedics Volume 24 | Issue 1 | July 2011

Basic

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Vinesh et al.:Histological features of meniscal injury

repair. The cellularity of the meniscus will help the

healing of the meniscus. The factors affecting the
cellularity will increase the predictability of success
of repair process. Correlation of cellularity with one
of these risk factors could facilitate our
understanding of the pathophysiology and
predictability of meniscus repair failure.
In this study, our hypothesis was that patient
age will significantly affect the healing rate of the
meniscus. This will help the surgeon to predict the
chances of meniscus healing preoperatively and to
better understand the prognosis of the treatment.
Previous studies have shown that cellularity
and
healing
of
tissue
have
a
direct
corelation.[23,24,26,46,51].
Materials and methods
Thirty torn menisci were collected from patients
aged 26 to 70 years at the time of arthroscopic
meniscectomy. Ten cases following total knee
replacement were used as controls. Seven lateral
and twenty three medial torn menisci were included
in the study. Five of the menisci were torn at the
time of an ACL rupture. Patients with any other
history of ipsilateral knee injury were excluded.
The
torn
menisci
were
removed
arthroscopically using a punch and the meniscus
was balanced to remove the entire torn section
leaving a stable rim of meniscus tissue. Operative
notes were used to document the appearance of
the tear tissue as well as the status of the adjacent
cartilage at time of partial meniscectomy.
Tear Classification
Torn menisci were classified into 3 major zones
Zone 1 - outer most third
Zone 2 - middle third
Zone 3 - inner most third
Histologic sample preparation
The menisci were fixed in formalin for 3 days.
After fixation, specimens were embedded in paraffin

and 5m thick axial sections were cut and fixed on

glass slides. Representative sections from each
sample were stained with hematoxylin and eosin.
Histologic evaluation
Normal menisci contain two populations of
cells: spindle shaped fibroblastic cells on the
meniscal surface and rounder fibrochondrocytes in
the interior. All menisci were evaluated for overall
collagen organisation, presence of synovial layer,
measures of cell number density and cell type at
site of the meniscus tear. The mean cell number
density was calculated counting the total number
of cells present in twenty four 0.1-cm 2 fields
arranged in a radial direction and dividing by the
total area analysed.
Meniscus Histologic Scoring System
A total histologic score of 0 to 6 points was
assigned according to the scale published by Rodeo
et al. (56) For cellularity, the intrinsic cellularity was
assigned points as shown in table 1.
Fibroblasts and fibrochondrocytes were
identified when mean nuclear aspect ratio of intrinsic
cells was 2.0 or more and less than 2.0 respectively.
Histomorphometry
The torn menisci were evaluated in a radial
direction. Analysis in the radial direction was chosen
as it was anticipated from previous studies in
animals that synovial and vascular cell densities
would vary as a function of distance from the
peripheral rim. Similarly, in a previous study of intact
menisci, 1 higher cell densities were identified near
the anterior and posterior horns. All tears were
evaluated radially at 1, 2, 4, and 6 mm from the
inner edge
At each location, three 0.1-mm2 areas were
evaluated by determining the total cell number
density, the nuclear morphologic characteristics,
and the blood vessel density. Cellularity was
determined by dividing the area of analysis by the

Table 1. Meniscus histologic scoring system

Points

C ellualrity
C ells/mm2

Predominant cell

C ollagen

Matrix

organisation

morphology

>50

Mononucl e ar ce l l s

Di s organi s e d

50 -300

Fi brobl as t

We l l organi s e d

>300

Fi brochondrocyt e s

Kerala Journal Of Orthopaedics Volume 24 | Issue 1 | July 2011

Chondromyxoi d
de ge ne rat i on
Fi brous t i s s ue

31

Basic

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Vinesh et al.:Histological features of meniscal injury

total number of cells counted within that area. The

nuclear morphologic characteristics were classified
on the basis of the nuclear shape, with cells that
had nuclei with a ratio of length divided by width of
1 classified as spheroid, between 1 and 2 classified
as ovoid, and greater than 2 classified as fusiform
as shown in previous studies
Figure 1. Healing phase of meniscal injury.
Fibroblasts and are neovascularisation seen

lower in torn menisci retrieved at 36 weeks or more

after injury than in the control menisci [P < .02).
No significant correlation was found between
patient age and histologic score [Spearman
correlation coefficient = 0.01, P = .94).
Meniscus histology score [ranges from 0, which
is the worst score, to 6, which is the best score) as
a function of site of tear.
The patient factors of age had significant
effects on the histologic characteristics of the torn
meniscus. Patients older than 40 years had a
decreased intrinsic cellularity in the torn menisci
compared with patients younger than 40 years.
Decreasing histologic score of the meniscus tissue,
had an increasing prevalence of Outerbridge II
changes in the adjacent cartilage. Histologic score
was related to tear site ( P < .001), with worse
scores found in inner zone tear types compared
with controls (both P < .01).
Table 2. Histologic
changes.

Statistical Analysis was done to determine the

effect of patient age on the perimeniscal cellularity,
intrinsic cellularity, intrinsic cell nuclear shape, and
histologic score.[45] Descriptive statistics and x2
analysis were used to assess differences between
groups. Within each zone, Student t tests were
used to compare cell density between patients
younger than 40 years and those 40 years and
older.
Results
Quantitative Pathologic Characteristics:
Cell Density: 17 patients below the age of 40
years showed more cell density in the intact
meniscus in zone3 compared to 13 patients >40
years( 423 113 vs 12176 P>.001). The cell
number density in the zone 2 was also significantly
greater in patients younger than 40 years than in
patients older than 40 years (900 486 vs 522
243 cells/mm2, P = .013). In zone 1 the Intrinsic
cellularity was significantly higher in younger
patients than in those 40 years and older (1202
427 vs 746 305, P < .001).
Meniscal histologic score
Histologic score was related to tear site (P <
.001), with worse scores found in inner zone.
The meniscus histology score was significantly

32

criteria for grading degenerative

P oi nt s

Hi s t ol ogy

Homoge nous e os i nophi l i c

col l a ge n wi t h norma l
chondrocyt e s

Di s cre t e f oci of muci nous

hya l i ne or myxoi d de ge ne ra t i on
a nd re duct i on of chondrocyt e s

Ba nds of muci nous

de ge ne ra t i on wi t h hypoce l l ul a r
re gi ons

Muci nous de ge ne rra t i on wi t h

f i broca rt i l a gi nous s e pa ra t i on

Figure 2. Graph showing Meniscal Histologic Score

Discussion
Research in the past 20 years has further
defined and clarified the multifaceted role of the
meniscus. It has been shown to play an integral
part in force transmission from the lower femur to
the upper tibia[30,31,34].
These forces could be a partial explanation of
the degenerative changes that occur in articular
cartilage and subchondral bone after total

Kerala Journal of Orthopaedics Volume 24 | Issue 1 | July 2011

Figure 1

Basic

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Vinesh et al.:Histological features of meniscal injury

meniscectomy. The meniscuss role in shock

absorption and load transmission has also been
clearly demonstrated in several biomechanical
studies[13,14].
The effect of patient age:
Long term clinical outcomes have been poor in
patients above 40 years[14,66] but short term
results are good. 6 these patients have reportedly
lower rates of meniscus healing and higher longterm failure rates of repair. One reaason for higher
failure rates may be due to the decreased cellularity
in older patients.
Earlier studies in animals have shown that a
defect in the vascular zone heals successfully by
migration of synovial cells over the surface of the
meniscus. This establishes the connection between
rates of healing and the cellularity of the
meniscus.[9,25] Methods to enhance healing of
tears in the avascular zone including implantation
of synovium [11,20,31,36,61] and fibrin clot[5,46]
have therefore focused on stimulation of the
perimeniscal tissue growth toward the repair site.
Although intrinsic cell proliferation has been noted
in animal models of tears in the avascular zone
during the first few weeks after injury,[46,47,72]
no spontaneous closure of the untreated defects is
observed in these tears,[5,20,24,26,65,73] even
with suture repair.[30,52,61] These findings suggest
that the intrinsic cells contained within the meniscus
in the avascular zone may be incapable of mounting
a sufficient repair response and that it is the
perimeniscal growth that is more critical to
successful healing.[5] In the current study, the
factors of patient age and site of injury affects the
cellularity (which leads to higher risk of degeneration
and retear) and may contribute to increased failures
of meniscus repair in older patients.
Our study only shows that age influences the
way the meniscus responds to injury. Our study did
not show the formation of any tissue bridging the
tear ends. Further studies are required to study
the effect of repair in the healing of meniscus and
durability of these repair tissue to further injury,
and wear and tear. The other problem of this study
was that degenerated meniscus were used as
controls.
Summary
The human meniscus shows a response to

injury different from that seen in tissues that heal.

1. It does not show any proliferation of
macrophages or neutrophils.
2. It does not show any scar tissue between
the torn sites.
But it shows certain signs of healing like
a. Proliferation of fibroblasts and
fibrochodrocytes
b. Hypertrophy and increased cellularity of
the synovium
c. Modification of the cells to normal meniscal
cells
d. Neovascularisation in the peripheral zone.
These findings suggest that the synovium
plays an important role in the healing of meniscus
and any repair process requires the synovium to
be sutured to the tear to promote healing by
bringing neovascularisation, neutrophils and
macrophages to the site of injury. Further studies
are required to study the effect of repair in the
healing of meniscus. A deeper understanding of
the biologic response of the human meniscus to
injury is likely to not only help surgeons decide
which tears may be at high risk for repair failure
but may also lead to new approaches to facilitate
regeneration and repair of this important
musculoskeletal tissue.
References
1.

Adams ME, Billingham MEJ, Muir H. The

glycosaminoglycans in menisci in experimental
and natural osteoarthritis. Arthritis
Rheum.1983;26:69-76.

2.

Arnoczky SP, Adams ME, Mow V, et al. The

meniscus. In: Woo SL-Y,Buckwalter JA, eds.
Injury and Repair of Musculoskeletal Soft
Tissue. Park Ridge, Ill: American Academy of
Orthopaedic Surgeons;1988:487-537.

3.

Arnoczky SP, Torzilli PA, Warren RF, et al.

Biologic fixation of ligament prostheses and
augmentations: an evaluation of bone ingrowth
in thedog. Am J Sports Med. 1988;16:106-112.

4.

Ahluwalia S, Fehm M, Murray MM, Martin SD,

Spector M. Distribution of smooth muscle actincontaining cells in the human meniscus. J
Orthop Res. 2001;19:659664.

5.

Andersen RB, Gormsen J. Fibrin dissolution in

synovial fluid. Acta Rheumatol Scand.
1970;16:319333.

Kerala Journal Of Orthopaedics Volume 24 | Issue 1 | July 2011

33

Basic Research
Vinesh et al.:Histological features of meniscal injury

6.

7.

Andriacchi T, Sabiston P, DeHaven K. Ligament:

19.

Patient-relevant outcomes fourteen years after

eds. Injury and Repair of the Musculoskeletal

meniscectomy: influence of type of meniscal

Soft Tissues. Chicago, Ill: American Academy of

tear and size of resection. Rheumatology.

Orthopaedic Surgeons; 1988:103128.

2001;40:631639.

Arnoczky SP. Building a meniscus: biologic

20.

considerations. Clin Orthop Relat Res. 1999(367

ligament. J Orthop Res. 1983;1:179188.

Arnoczky SP, Warren RF, Spivak JM. Meniscal

21.

10.

Repair of meniscal tears with the absorbable

experimental study in dogs. J Bone Joint Surg

Clearfix screw: results after 13 years. Arch

Orthop Trauma Surg. 2005;125:585591.

Barrett GR, Field MH, Treacy SH, Ruff CG.

Experimental methods of repairing injured

menisci. J Bone Joint Surg Br. 1986;68:106

Bohnsack M, Borner C, Schmolke S, Moller H,

110.
23.

repair using the meniscus arrow in knees

biodegradable screws. Knee Surg Sports

undergoing concurrent anterior cruciate

Traumatol Arthrosc. 2003;11:379383.

ligament reconstruction. Arthroscopy.

Cabaud HE, Rodkey WG, Fitzwater JE. Medial

2002;18:569577.
24.

Ammenwerth J, Paessler HH. Arthroscopic

129134.

meniscal repair with an absorbable screw:

Casscells SW. The torn or degenerated

results and surgical technique. Knee Surg

Sports Traumatol Arthrosc. 2005;13:273279.
25.

Clin Orthop Relat Res. 1978;132:196200.

Cisa J, Basora J, Madarnas P, Ghibely A,

joints. J Clin Pathol. 1961;14:305308.

26.

flap transfer: healing of the avascular zone in

endothelial cell growth factor: an experimental

rabbits. Acta Orthop Scand. 1995;66:3840.

study in dogs. Am J Sports Med. 1992;20:537

DeHaven KE, Lohrer WA, Lovelock JE. Long-

541.
27.

Joint Surg Br. 1980;62:397402.

28.

Hede A, Svalastoga E, Reimann I. Repair of

Eggli S, Wegmuller H, Kosina J, Huckell C,

three-month-old experimental meniscal lesions

Jakob RP. Long-term results of arthroscopic

in rabbits. Clin Orthop Relat Res. 1991;266:

meniscal repair: an analysis of isolated tears.

Am J Sports Med. 1995;23:715720.

238243.
29.

Henning CE, Lynch MA, Yearout KM, Vequist SW,

Ellermann A, Siebold R, Buelow JU, Sabau C.

Stallbaumer RJ, Decker KA. Arthroscopic

Clinical evaluation of meniscus repair with a

meniscal repair using an exogenous fibrin clot.

bioabsorbable arrow: a 2- to 3-year follow-up

study. Knee Surg Sports Traumatol Arthrosc.
18.

Heatley FW. The meniscus: can it be repaired?

An experimental investigation in rabbits. J Bone

Eastwood DM. The failures of arthroscopic

partial meniscectomy. Injury. 1985;16:587590.

17.

Hashimoto J, Kurosaka M, Yoshiya S, Hirohata

K. Meniscal repair using fibrin sealant and

Sports Med. 1995;23:524530.

16.

Harrold AJ. The defect of blood coagulation in

Navarro-Quilis A. Meniscal repair by synovial

term results of open meniscal repair. Am J

15.

Hantes ME, Kotsovolos ES, Mastrokalos DS,

morphologic study. Am J Sports Med. 1981;9:

the weight-bearing areas of the femur and tibia.

14.

Gill SS, Diduch DR. Outcomes after meniscal

arthroscopic meniscal repair using

meniscus and its relationship to degeneration of

13.

Ghadially FN, Wedge JH, Lalonde JM.

years and older. Arthroscopy. 1998;14:8248

meniscus repairs: an experimental and

12.

22.

Clinical results of meniscus repair in patients 40

Wirth CJ, Ruhmann O. Clinical results of

11.

Frosch KH, Fuchs M, Losch A, Sturmer KM.

repair using an exogenous fibrin clot: an

Am. 1988;70:12091217.
9.

Frank C, Schachar N, Dittrich D. Natural history

of healing in the repaired medial collateral

suppl):S244S253.
8.

Englund M, Roos EM, Roos HP, Lohmander LS.

injury and repair. In: Woo SLY, Buckwalter J,

Clin Orthop Relat Res. 1990;252:6472.

30.

Hosmer DW, Lemeshow S. Applied Logistic

2002;10:289293.

Regression. 2nd ed. New York, NY: John Wiley;

Englund M. Meniscal tear: a feature of

2000.

osteoarthritis. Acta Orthop Scand Suppl.

2004;75:145, back cover.

31.

Hough AJ Jr, Webber RJ. Pathology of the

meniscus. Clin Orthop Relat Res. 1990;252:32
40.

34

Kerala Journal of Orthopaedics Volume 24 | Issue 1 | July 2011

Basic Research
Vinesh et al.:Histological features of meniscal injury

32.

Huang TL, Lin GT, OConnor S, Chen DY,

ligamentintact and anterior cruciate ligament

Barmada R. Healing potential of experimental

deficient knees. Am J Sports Med.

meniscal tears in the rabbit: preliminary results.

2004;32:14791483.

Clin Orthop Relat Res. 1991;267:299305.

33.

meniscectomy in patients over the age of fifty:

a six year follow-up study. Swiss Surg. 2002;8:

autograft: an experimental study in rabbits.

113119.
46.

DeLee JC. Meniscal repair: an experimental

Isolated arthroscopic meniscal repair: a long-

study in the goat. Am J Sports Med. 1995;23:

term outcome study (more than 10 years). Am

124128.
47.

Orthop Relat Res. 1989;243:286293.

37.
38.

2001.
48.

Kimura M, Shirakura K, Hasegawa A, Kobuna Y,

of an in-substance conduit with injection of a

blood clot on tears in the avascular region of

meniscal repair: factors affecting the healing

the meniscus. Acta Orthop Belg. 1991;57:242

rate. Clin Orthop Relat Res. 1995;314:185191.

246.

King D. The healing of semilunar cartilages. J

49.

Histological and biochemical changes of

Klompmaker J, Jansen HW, Veth RP, de Groot

experimental meniscus tear in the dog knee. J

JH, Nijenhuis AJ, Pennings AJ. Porous polymer

Orthop Sci. 2005;10:406413.

50.

Kotsovolos ES, Hantes ME, Mastrokalos DS,

1986;210:6268.
51.

Levidiotis C, Chronopoulos E, Sourlas J.

meniscal repair with the FasT-Fix meniscal

Isolated meniscal repair in the avascular area.

Krause WR, Pope MH, Johnson RJ, Wilder DG.

Acta Orthop Belg. 2003;69:341345.

52.

A, Woo SL, Fu FH. The biomechanical

meniscectomy. J Bone Joint Surg Am. 1976;58:

interdependence between the anterior cruciate

599604.

ligament replacement graft and the medial

Larsen LB, Madsen JE, Hoiness PR, Ovre S.

meniscus. Am J Sports Med. 2001;29:226231.

53.

Am J Pathol. 1961;38:495513.

prospective, randomized study with 3.8 years

follow-up. J Orthop Trauma. 2004;18:144149.

Peach R, Williams G, Chapman JA. A light and

electron optical study of regenerating tendon.

fractures be with or without reaming? A

54.

Peretti GM, Gill TJ, Xu JW, Randolph MA, Morse

Marsolais GS, Dvorak G, Conzemius MG. Effects

KR, Zaleske DJ. Cell-based therapy for

of postoperative rehabilitation on limb function

meniscal repair: a large animal study. Am J

Sports Med. 2004;32:146158.

after cranial cruciate ligament repair in dogs. J

Am Vet Med Assoc. 2002;220:13251330

55.

Petsche TS, Selesnick H, Rochman A.

McAndrews PT, Arnoczky SP. Meniscal repair

Arthroscopic meniscus repair with

enhancement techniques. Clin Sports Med.

bioabsorbable arrows. Arthroscopy.

2002;18:246253.

1996;15:499510.
44.

Papageorgiou CD, Gil JE, Kanamori A, Fenwick J

Mechanical changes in the knee after

Should insertion of intramedullary nails for tibial

43.

Papachristou G, Efstathopoulos N, Plessas S,

Lorbach O, Paessler HH. Results of all-inside

repair system. Arthroscopy. 2006;22:39.

42.

Noble J, Turner PG. The function, pathology, and

surgery of the meniscus. Clin Orthop Relat Res.

1991;12:810816.

41.

Nishida M, Higuchi H, Kobayashi Y, Takagishi K.

Bone Joint Surg. 1936;18:333342.

preliminary study in dogs. Biomaterials.

40.

Nakhostine M, Gershuni DH, Danzig LA. Effects

Niijima M. Second look arthroscopy after

implant for repair of meniscal lesions: a

39.

Montgomery DC. Design and Analysis of

Experiments. 5th ed. New York, NY: John Wiley;

Kawai Y, Fukubayashi T, Nishino J. Meniscal

suture: an experimental study in the dog. Clin

36.

Miller MD, Ritchie JR, Gomez BA, Royster RM,

Johnson MJ, Lucas GL, Dusek JK, Henning CE.

J Sports Med. 1999;27:4449.

35.

Menetrey J, Siegrist O, Fritschy D. Medial

enhanced by an interpositional free synovial

Arthroscopy. 1994;10:659666.
34.

45.

Jitsuiki J, Ochi M, Ikuta Y. Meniscal repair

Meister K, Indelicato PA, Spanier S, Franklin J,

56.

Rockborn P, Messner K. Long-term results of

Batts J. Histology of the torn meniscus: a

meniscus repair and meniscectomy: a 13-year

comparison of histologic differences in meniscal

functional and radiographic follow-up study.

tissue between tears in anterior cruciate

Kerala Journal Of Orthopaedics Volume 24 | Issue 1 | July 2011

35

Basic Research
Vinesh et al.:Histological features of meniscal injury

Knee Surg Sports Traumatol Arthrosc.

57.

67.

Itoh H, Iwata H. Histologic examination of

Rodeo SA. Meniscal allografts: where do we

meniscal repair in rabbits. Clin Orthop Relat

stand? Am J Sports Med. 2001;29:246261.

58.

Rodeo SA, Seneviratne A, Suzuki K, Felker K,

Res. 1997;338:253261.
68.

of meniscal repairs: factors that effect healing.

of human meniscal allografts: a preliminary

Am J Sports Med. 1994;22:797802.

69.

1082.
Roeddecker K, Muennich U, Nagelschmidt M.

bioabsorbable screw. Arthroscopy. 2004;20:

Meniscal healing: a biomechanical study. J Surg

586590.
70.

Results of rasping of meniscal tears with and

Guensche K. Meniscal healing: a histological

without anterior cruciate ligament injury as

study in rabbits. Knee Surg Sports Traumatol

evaluated by second-look arthroscopy.

Arthroscopy. 2003;19:463469.

Shelbourne KD, Carr DR. Meniscal repair

71.

Wickiewicz TL. Different regional healing rates

medial meniscal tears in anterior cruciate

with the outside-in technique for meniscal

Med. 2003;31:718723.

repair. Am J Sports Med. 1998;26:446452.

72.

Review of the clinical results of arthroscopic

partial meniscectomy versus meniscus repair

meniscal repair. Knee. 2001;8:129133.

73.

anterior cruciate ligament reconstructed knees.

65.

Shirakura K, Niijima M, Kobuna Y, Kizuki S. Free

Warren RF. Meniscectomy and repair in the

anterior cruciate ligamentdeficient patient. Clin

Arthroscopy. 2004; 20:581585.

64.

Venkatachalam S, Godsiff SP, Harding ML.

Shelbourne KD, Dersam MD. Comparison of

for bucket-handle lateral meniscus tears in

63.

Van Trommel MF, Simonian PT, Potter HG,

compared with meniscectomy for bucket-handle

ligamentreconstructed knees. Am J Sports
62.

Uchio Y, Ochi M, Adachi N, Kawasaki K, Iwasa J.

Roeddecker K, Nagelschmidt M, Koebke J,

Arthrosc. 1993;1:2833.
61.

Tsai AM, McAllister DR, Chow S, Young CR,

Hame SL. Results of meniscal repair using a

Res. 1994;56:2027.
60.

Tenuta JJ, Arciero RA. Arthroscopic evaluation

Wickiewicz TL, Warren RF. Histological analysis

report. J Bone Joint Surg Am. 2000;82:1071
59.

Takeuchi N, Suzuki Y, Sagehashi Y, Yamaguchi T,

2000;8:210.

Orthop Relat Res. 1990;252:5563.

74.

Zhang Z, Arnold JA, Williams T, McCann B.

synovium promotes meniscal healing:

Repairs by trephination and suturing of

synovium, muscle and synthetic mesh

longitudinal injuries in the avascular area of the

compared in dogs. Acta Orthop Scand.

meniscus in goats. Am J Sports Med.

1997;68:5154.

1995;23:3541.

Sommerlath K. The importance of the meniscus

75.

Zhang ZN, Tu KY, Xu YK, Zhang WM, Liu ZT, Ou

in unstable knees: a comparative study. Am J

SH. Treatment of longitudinal injuries in

Sports Med. 1989;17:773777.

avascular area of meniscus in dogs by

Spindler KP, McCarty EC, Warren TA, Devin C,

trephination. Arthroscopy. 1988;4:151159.

Connor JT. Prospective comparison of

arthroscopic medial meniscal repair technique:
inside-out suture versus entirely arthroscopic
arrows. Am J Sports Med. 2003; 31:929934.
66.

Stone RG, Frewin PR, Gonzales S. Long-term

assessment of arthroscopic meniscus repair: a
two- to six-year follow-up study. Arthroscopy.
1990;6:7378.

Source of funding: Grant from Kerala

Orthopaedic Association; Conflict of interest: Nil

Cite this article as:

Vinesh Senan,, Jilsa Sucheendran, Prasad, Balagopal K. Histological features of meniscal injury. Kerala
Journal of Orthopaedics. 2011;24:30:36

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Kerala Journal of Orthopaedics Volume 24 | Issue 1 | July 2011