Complex Meniscus Tear Specialist

Why repair complex meniscus tears?
And why with the Circumferential Stitch?

Meniscus repair has been around a long time, but traditional techniques have had somewhat high failure rates and were only possible for a limited number of tear types. The meniscus spreads forces evenly within the knee joint, and, without its full function, the knee becomes arthritic.  

So why are we now able to sew every tear type in every age range?  Because we can now sew using Circumferential Stitches. These stitches…

• Align the tear edges perfectly to uniformly compress them together during healing
• Sew the top and bottom of the tear at the same time (traditional repair was only practical on the top side and surgeons typically ignored the bottom side which leads to partial healing and eventual re-tearing of the meniscus)
• Do not entrap capsule into the repair which may allow more natural movement of the repaired meniscus
• The needle used in NovoStitch device is very small and it cuts in-line with the circumferential fibers of the meniscus.  Other techniques have left large holes which can propagate new complex tears
• Meniscus repair has been associated with risk of injury to the vessels and nerves in the back of the knee.  Passing the circumferential stitch with the NovoStitch device does not require needle passes in the direction of the neurovascular structures
• There is no other device that can safely and reliably pass circumferential stitches in all zones of the meniscus and for all tear types

Am I too old to have my meniscus repaired? 

NO!  Studies have shown that patient age is not a factor, and that the meniscus can heal in patients of all ages provided the knee is not already arthritic

 I was told my tear was “degenerative” and could not heal because there was not a good enough blood supply? 

If you have a complex tear many surgeons will say that it cannot heal.  It is true that traditional techniques didn’t work well, but surgeons blamed the blood supply despite excellent medical literature evidence that the avascular zones heal if adequately held together during the healing process.  The reality is that older techniques inadequately approximated the torn edges. With anatomical reduction and uniform compression of the tear edges during healing, complex tears can heal quite well and repair should be considered in all knees that are not yet arthritic.  See the videos on this site for proof!

See the following article, The Circumferential Compression Stitch for Meniscus Repair, for a better understanding of why repair your meniscus and to see the various tear types

What is a complex meniscus tear?

Your menisci are two wedge-shaped pieces of cartilage that cushion your knee joints and act as shock absorbers.  A complex tear is one that tears in many different directions, and is often a combination of the different tear types all at once.  Your doctor might also call a complex tear a “degenerative tear”. These tear types render the meniscus significantly less functional and the torn fragments can cause fluid accumulation and pain.  Without the full function of your meniscus, your knee joint becomes arthritic. The only definitive treatment for an arthritic knee is total knee replacement – so, SAVE YOUR MENISCUS!

Symptoms of a complex meniscus tear may include one or more of the following:

• Pain
• Swelling
• Limited motion
• Catching
• Locking
• Buckling
• Giving way

You will probably still be able to walk with a complex meniscus tear and, in fact, many athletes continue to play with a meniscal tear (to the detriment of their knee).

How are meniscal tears treated?

Leaving a complex meniscus tear in your knee increases your risk of arthritis and the eventual need for knee replacement surgery. Similarly, removal of part of your meniscus (often called “trimming”, “cleaning up” or “partial meniscectomy”) also results in significantly reduced effectiveness of your meniscus causing arthritis and the possible eventual need for total knee replacement. Injecting the knee with cortisone, PRP or even stem cells, has not been shown to heal complex meniscus tears. There are simply too many knee forces on the meniscus tear constantly pulling it apart for it to heal well without stitches holding the tears in place to resist those forces during the 6 weeks that it takes for the meniscus to heal (similar to a cast for a broken bone).

Assuming your knee is not already arthritic, your best option is to have your complex tear sewn back together rather than removed. Unfortunately, most orthopaedic surgeons have embraced meniscus removal surgery. But now there’s a new option – THE CIRCUMFERENTIAL STITCH! This stitch anatomically aligns the tear edges and uniformly compresses complex tears together during the healing process in a way never before possible. This is the secret sauce that Dr. Saliman brought to the world.

What is the NovoStitch Pro Meniscal Repair System?

Dr. Saliman invented the NovoStitch Pro Meniscal Repair System in 2008 and founded the start-up Ceterix® Orthopaedics in 2010 to develop the technology. The NovoStitch was approved by the FDA in 2012, received an Edison Award in 2015 in the surgical tools category, and was recently purchased by a well known medical device company called Smith & Nephew.

Dr. Saliman uses his NovoStitch device to place circumferential compression stitches around complex and degenerative meniscus tears, which holds the torn edges together while it heals. There is no need for removal of the tissue, which has been shown to increase the risk of future knee problems. Nobody has more experience sewing meniscus tears back together with circumferential stitches than Dr. Saliman.

For the best care of your complex meniscus tear from the inventor of the procedure that sews your meniscus with Circumferential Stitches, call the office of Justin D. Saliman, MD, or request an appointment online today.