Intrasubstance Mensicus Tear Specialist

Justin D. Saliman, MD -  - Orthopaedic Surgeon

Justin D. Saliman, MD

Orthopaedic Surgeon located in Beverly Grove, Los Angeles, CA

SAVE YOUR MENISCUS! Living with intrasubstance degeneration within your meniscus, or allowing a surgeon to remove the affected regions, increases your risk for arthritis and knee replacement. Don’t live with pain, don’t let someone “trim” your meniscus, and don’t temporarily mitigate your symptoms with cortisone, PRP or stem cell injections. Have your meniscus sewn together by the best! Justin D. Saliman, MD, invented the NovoStitch® Pro Meniscal Repair System, which received FDA approval in 2012 and a silver medal at the 2015 Edison Awards. The device passes Dr. Saliman’s patented Circumferential Stitch which is ideal for intrasubstance tears. Nobody has more experience passing this revolutionary stitch!

Intrasubstance Meniscus Tear Q & A

Why repair intrasubstance degeneration of the meniscus?
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 repair intrasubstance tears in every age range?  Because we can now sew using Circumferential Stitches. These stitches…

  • Evenly compress the intrasubstance region of the meniscus
  • Does not entrap the capsule during sewing which may allow more natural movement of the repaired meniscus
  • The needle used in NovoStitch device is tiny and it cuts in-line with the circumferential fibers of the meniscus.  Other techniques have left large holes which can propagate new tears
  • Passing the circumferential stitch 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?

Traditional techniques inadequately held the torn regions together, leading to poor healing. Surgeons often blame the blood supply even though there is excellent medical literature evidence that the avascular zones heal if adequately held together during the healing process. See the videos on this site for additional 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 intrasubstance degeneration of the meniscus?

Your menisci are two wedge-shaped pieces of cartilage that cushion your knee joints and act as shock absorbers every time you take a step. An intrasubstance meniscus tear (also called interstitial or degenerative) is essentially a painful blister that has formed within the substance of your meniscus due to the forces placed on it from the surrounding femur and tibia. These blisters can eventually break through the surface of the meniscus, at which point we call it a horizontal cleavage tear.

Intrasubstance tears, in particular, are perfect for Circumferential Stitch repair, which can compress and hold the blistered area together during the healing process.  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 meniscus tear may include one or more of the following:

  • Pain
  • Limited range of motion
  • Stiffness and swelling
  • Feeling as though your knee is catching
  • Locking or buckling
  • Instability in your knee

You will still be able to walk with an intrasubstance meniscal tear, and in fact, many athletes continue to play with a meniscal tear (to the detriment of the long term health of their knee).

How are intrasubstance meniscal tears treated?

Leaving a torn meniscus within 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” or “partial meniscectomy”) also results in significantly reduced effectiveness of your meniscus resulting in 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 meniscus tears. Unfortunately, the most common treatment for intrasubstance degeneration of the meniscus is to do nothing, leaving patients to live with their symptoms.  

Your best option is to have the intrasubstance degeneration of your meniscus sewn back together rather than doing nothing or having it removed.  This will give you pain relief and improved function in the near term and help prevent problems in the long term. However, traditional meniscus repair techniques only worked for a small fraction of the tear types, hence most orthopaedic surgeons have unfortunately embraced meniscus removal surgery.

But now there’s a new option – THE CIRCUMFERENTIAL STITCH! This stitch anatomically compresses the regions of intrasubstance degeneration and holds them together during the 6 weeks it takes for the meniscus to heal (like a cast holds a broken bone). This special stitch 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 then founded the start-up Ceterix® Orthopaedics in 2010 to develop the technology. The NovoStitch was approved by the FDA in 2012, received a Silver Award in the 2015 Edison Awards 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 regions of intrasubstance degeneration of the meniscus, which holds these regions together while they heal. 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 intrasubstance degeneration 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.


  • “This is a great honor for our founder, Dr. Justin Saliman, and our R&D team,” said John McCutcheon, president and CEO. “We are pleased to be included with the great innovators recognized by the Edison Awards.”

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    Justin Saliman, Founder and Chief Medical Officer at Ceterix said: “We are excited by the growth opportunities of the NovoStitch Pro at Smith & Nephew and are proud of the impact our technology has made in developing the meniscal repair market.”

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