Sutura Meniscal en Niños. ¿En Qué Hemos Avanzado?

Abstract

The true incidence of meniscal injuries in children and adolescents remains unknown, though estimated to have increased during the last years. Clinical suspicion must remain high since physical examination and magnetic resonance imaging have reported less accuracy for meniscal tears in pediatric patients. Although literature is scarce in children and adolescents and the basis for managing these lesions is extrapolated from adult population, the current trend is meniscal preservation. Considering the greater healing potential and vascularization of the pediatric meniscus, indications for meniscal suture are extended to all those tears amenable to repair in spite of their size, tear pattern and time to repair. Literature has demonstrated good outcomes for meniscal repair in children, with healing rates above 70%, comparable to those reported for adults. To date, the all-inside technique is the most frequently used for meniscal repair thanks to its simplicity and shorter operative time. However, we must be especially careful to avoid iatrogenic neurovascular injury given the smaller size and proximity of the neurovascular package in the pediatric knee. Suture failure is the main complication, with rates comparable to adult population despite widespread indication of repair in children. Younger age, open physis, simple tear patterns and simultaneous anterior cruciate ligament reconstruction appear to benefit meniscal repair in children. This article summarizes the available literature regarding meniscal repair in children and adolescents, emphasizing the differences with adult population. We also present our experience in the treatment of these injuries and our preferred rehabilitation protocol.