Editorial Commentary: Repair of "Degenerative" Horizontal Cleavage Meniscus Tears Is Cost-effective, Is Chondroprotective, and Shows Healing Rates Similar to Other Meniscal Tear Patterns

Abstract

Over the past 15 years, there has been a shift toward meniscus preservation even for previously believed irreparable patterns like bucket handle, radial, meniscus root, vertical, and horizontal cleavage tears (HCTs). HCTs are a common tear pattern, especially as we age, and are estimated to occur in 23% to 32% of meniscus tears. They occur in both males and females, are more common on the medial than the lateral side, and most often occur with minor to normal trauma in an anterior cruciate ligament intact knee. HCTs were traditionally deemed irreparable and treated with subtotal or partial meniscectomy but with a high risk of chondral degeneration and subsequent arthritic changes thereafter. More recently, they have been increasingly treated with repair using open, inside-out, outside-in, or most commonly all-inside techniques, as the chondroprotective benefits of repair have been well documented in basic science studies. Removal of the white-white zone is often critical to appreciate the tear, after which the white-red and red-red zone can be repaired with multiple circumferential compression sutures. Sometimes percutaneous superficial medial collateral ligament release is necessary for visualization and instrumentation. Biologic augmentation with platelet-rich plasma, bone marrow venting, or trephination is recommended for improved healing of these tears. Recent outcomes have suggested reasonable failure and complication rates and possibly fewer degenerative changes compared to partial meniscectomy. The evidence is growing that meniscus repair and preservation of this type of tear pattern is a worthy endeavor.