Rethinking meniscal repair in patients over 40: Extending the boundaries of joint preservation

This article provides a comprehensive overview of current perspectives on meniscal repair, with a particular focus on the evolving situation for patients over 40. In the past, meniscectomy was the most common treatment for meniscal tears in this group due to presumptions about its poor capacity for healing. The paradigm has shifted in favor of meniscal preservation, thanks to recent developments in arthroscopic procedures, a deeper understanding of meniscal biology, and the crucial recognition of the role that meniscal tissue plays in long-term knee health. Results from important primary studies, meta-analyses, and recent systematic reviews are summarized in this article. We address the advantages of meniscal repair over meniscectomy in terms of long-term results and functional preservation, considering conflicting data and the significance of a patient's unique evaluation. In addition to the substantial influence of biologic augmentation methods like platelet-rich plasma and bone marrow aspirate concentrate in accelerating healing rates, the role of conservative management for degenerative tears is examined. Additionally, we compare all-inside and inside-out repair methods and look at the crucial elements of patient and tear selection, surgical methods, and technological advancements. Future research directions are paved by highlighting unresolved issues, such as the standardization of terminology and outcome definitions. Overall, the findings indicate that meniscal repair is no longer strictly contraindicated based solely on age, with careful patient selection and the strategic application of innovative techniques providing older patients with improved long-term outcomes and significant chondroprotective benefits.