The evolution of the meniscus: Where surgical advancements meet translational research

Objective

To evaluate key historical developments in meniscal pathobiology research and surgical advancements to capture pivotal moments in the evolution towards contemporary meniscus treatment.

Design

We conducted a literature search in PubMed and Hollis, Harvard's online library database, to identify influential primary and secondary literature on meniscus form, function, and surgical techniques. Primary sources generally consisted of case reports or research investigations, while secondary sources included literature reviews. We used these sources to create a chronology of research findings, highlighting periods of controversy, shifts in opinion, and technological innovation.

Results

The meniscus was considered a functionless, vestigial structure for most of modern history until research in the mid-1940s identified significant degenerative changes among patients following total meniscectomy. Interest in the meniscus surged following this discovery, spurring investigations that broadened scientific understanding of the vasculature, neuroanatomy, and biochemical composition of the meniscus. In turn, these findings altered treatment practices in favor of meniscal preservation and stimulated research into the implications of altered hoop tension and meniscus vascularity.

Conclusions

The history and advancement of meniscal surgery has and continues to be shaped by translational research that has broadened scientific understanding of the form and function of the meniscus. We demonstrate that advancements in surgical techniques addressing meniscal tears were preceded by translational research that broadened understanding of the form and function of the meniscus. Future meniscal research should continue to utilize both translational and clinical findings to optimize meniscal tear treatment methodologies, while also minimizing risk of osteoarthritis.