Meniscal repositioning procedures
¨ For patients with persistent, loud or painful displacement, and where there appears to be a mechanical cause for the problem, it may be appropriate to reposition the disc surgically
¨ Preauricular approach, Howarth’s periosteal elevator is inserted into the upper joint space to delineate the space and search for adhesions
¨ Disc is mobilised and pulled back into position
¨ Disc is then tethered into position
¨ Carries a reasonably high rate of success in terms of pain relief, but clicking frequently returns
Meniscectomy
¨ Sometimes the disc is perforated, fragmented or so tightly tethered that it cannot be satisfactorily repositioned, consequently it must be removed
¨ If the disc is removed there is an increased risk of degenerative joint disease
¨ Disc Displacement Disorders
Meniscectomy
¨ An alloplastic material e.g. silastic may be placed instead of the disc but long term leads to multiple granulomas, however if a thin sheet is left, a layer of fibrous tissue forms around it, this has been considered as a reasonable replacement.
Other disc replacements include free grafts of dermis or temporalis fascia
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