Meniscal Repair, Enhancement of Healing Process

The meniscus is a crucial player in knee homeostasis, and its preservation is now considered necessary to obtain satisfactory clinical results, above all in the long-term follow-up to avoid the future onset of arthritis. Most of the current meniscal repair techniques are effective in the vascularized zone of the meniscus but fail to promote healing in the avascular zone. For this reason, aiming for improved healing of the meniscus, in addition to fixation techniques and devices, several biologic adjunctive methods have been proposed. They are focused on the delivery of “factors” or “agents” to promote the tissue healing, so that many more patients might benefit from the procedures for the preservation of the menisci. Beyond the most traditional augmentation techniques such as vascular access channel, trephination, abrasion, synovial flaps, and fibrin glue/clot, more recently growth factors, platelet-rich plasma (PRP), and mesenchymal stem cells (MSCs) have also gained attention due to their ability to improve tissue healing, especially in the avascular zone. In this chapter in vitro and clinical findings concerning these augmentation techniques are described and discussed