White on white meniscal tears to fix or not to fix?

The mechanical disadvantage to articular cartilage following meniscectomy has been well documented in the literature. Meniscal repair in the avascular (white on white) is controversial and would be deemed inappropriate by many. We have developed criteria for repair in all meniscal tears. These are:The meniscus1.must not be degenerated2.must be reducible, without a rolled edge3.the fixation must be considered sound.Between 1999 and 2008 our department prospectively collected data on meniscal repairs as part of a sports database. Four hundred and twenty three patients underwent repair during this time period. We identified 87 patients with no co existent ACL injury or instability. There were 73 males and 14 females with a mean age of 26 years (13–54). All tears were in the non peripheral (white on white) area. The criterion for failure was reoperation on the same meniscus requiring excision or re fixation. The mean follow up was 49 months (10–112). Twenty eight patients required further surgery on their repaired meniscus. There were eight re-repairs and 20 partial menisectomies. This represents a success rate of 68% (59/87). The mean pre operative Lysholm score was 61 (4–88) which rose to 75 (12–100) postoperatively, p = 0.002. The mean pre op Tegner score was 6 (3–10) and this did not change significantly post operatively, mean 6 (0–10) p = 0.4. Isolated white on white avascular meniscal tears can be successfully repaired in the majority of cases with a good clinical and functional result.