REPEATED

REGENERATION
DAVID
K.

OF
EVANS,
the Royal

A MENISCUS
ENGLAND
Sheffield

IN

THE

KNEE

SHEFFIELD,
Infirnzarv,

From,,

Experimental the knee joint can

regenerated cartilages

work

in animals after
human in the

(Walmsley surgical
knee joint

and
(Mandl

Bruce

1938) There
1929,

has have

shown been

that
Fisher

the

menisci

of

regenerate

removal.

several

reports
1936, Bruce

of

M#{246}ller 1930,

and Walmsley It is in general It is composed

capsule, thejoint fibrous which
A

1937). Smillie (1944) described the characteristics of the regenerated meniscus. appearance similar to the normal meniscus but is narrower, thinner and whiter. of fibrous tissue without cartilage cells. It has a dense attachment to the
is therefore less mobile rare, than and lax. are the normal invariably meniscus. Because with it projects less into

and

and
menisci renders

is more
are the joint

fixed,
therefore

the

regenerated

meniscus

is less vulnerable
associated

to injury.
ligamentous

Tears

of these damage, a is

abnormally

search
time,

of the
and the

literature
following

has
case,

failed the same

to reveal
a torn

a report
lateral

of regeneration
meniscus and two

of a meniscus
torn regenerated

second

in which

menisci thought

have

been

removed

from

knee

compartment

in the

course

of two

years,

to be unique.
CASE REPORT

professional immediately

footballer locked

aged and

sixteen rapidly

twisted became

his

right

knee The

when next day

playing the joint

in April was

1960. opened

The

joint

swollen.

FIG. I The three specimens. On the left is the complete lateral can just be seen. On the right are the two regenerated and have longitudinal

meniscus. The peripheral menisci : they are thinner tears.

haematoma and whiter

and and, of 748

a peripheral since it bore

tear

of

the

lateral on

meniscus its torn edge

was

found.

The

whole the

meniscus

was of the

removed, periphery

a haematoma

demonstrating

vascularity

the

cartilage,

it was

mounted

for

teaching

purposes.
THE JOURNAL OF BONE AND JOINT SURGERY

REPEATED

REGENERATION

OF

A MENISCUS

IN THE

KNEE

749 football six weeks a second twisting meniscus

again recovery

later. injury

The patient He played to the same

tear

made a satisfactory regularly every week knee.

was

recovery for nearly locked.

the lateral

and returned a year, but A week

compartment.

to first class he then suffered later a regenerated

Once

The
removed

joint

again
from

with
was

longitudinal

uneventful football
for

and within

the two

patient months. the

returned to professional He turned out regularly next season until in April A sudden twisting injury and pain localised to the a confident diagnosis.
regenerated removed
(Fig.

his club

throughout

1962 the story was repeated. followed by swelling, locking lateral compartment allowed
At

a third Two

arthrotomy tear later when was three played months and again There incidents

a second was every the no occasions. knee sudden

meniscus
1).

with football
ing

a longitudinal

he again

returned
week gave dramatic The until

to professional
pain, incident was swellas felt way instability gradually

and the

increased. on was some not third previous

subjectively acute
surprise

in the and limited

was and The

lateral
embarked not

compartment
upon with

and line.
interest.

tenderness A further
With we found

to the lateraljoint
a little of the disappointment,

exploration

the slightest
time.

sign
cause

of regeneration
symptoms

of the
was

meniscus
seen

a The articular

to be a

lesion

in the

articular

cartilage

(Fig.

2).
COMMENT

FIG. 2 damage seen arthrotomy.

at the

fourth

As stated earlier, a tear of a regenerated abnormally mobile. In this case the anterior Examination
experiments meniscus is not

meniscus can cruciate ligament description It is clear

reason why

occur was of that

this

only intact

in a joint which is but excessively lax. In reported regeneration

did not

of the
menisci the

menisci
never rule and

confirmed Smillies failed to regenerate.

there is no obvious

them. in man
patient

animal of the
a

regenerate

third

fibrous meniscus. Since regeneration the joint to near normal, leaving

performed.

of a meniscus replaces a structure with a definite function and returns it should be encouraged. To this end total excision of the meniscus fibrocartilage should be the practice when meniscectomy is

no

rim

of

avascular

SUMMARY

1.
2.

The
A

characteristics
case is reported

of the
in which

regenerated
a meniscus

knee
twice

meniscus
regenerated

are

reviewed.
and was twice torn.

This
this

patient
report.

was under

the care

of Mr F. W. Holdsworth,
REFERENCES

to whom

I am grateful

for permission

to publish

BRUCE, J., and WALMSLEY, R. (I 937): Replacement of the Semilunar Cartilages of the Knee After Operative Excision. British Journal of Surgers, 25, 17. FISHER, A. G. T. (1936): The Problem of Repair and Regeneration of the Semilunar Cartilages. Lancet, i, 1,351. MANDL, F. (1929): Regeneration des menschlichen Kniegelenkzwischenknorpels. Zentralblatt f#{252}r Chirurgie, 56, 3,265. MOLLER, W. (1930): Luxation eines nach Exstirpation neugebildeten Kniegelenksmeniscus. Zentralblatt f#{252}r Chirurgie, 57, 2,790. SMILLIE, I. S. (1944): Observations on the Regeneration of the Semilunar Cartilages in Man. British Journal ofSurgery, 31, 398. WALMSLEY, R., and BRUCE, J. (1938): The Early Stage of Replacement of the Semilunar Cartilages of the Knee Joint in Rabbits After Operative Excision. Journal of Anaton, 72, 260.
VOL.

45 B,

NO.

4,

NOVEMBER

1963