Healing Potential of Experimental
Meniscal Tears in the Rabbit
Preliminary Results
TENGLIANGHUANG,M.D., GAUTYAN LIN, M.D., SCOTTOCONNOR,M.D.,
DERYIEN CHEN,M.D., AND RIADBARMADA,M.D.
This study assessed the healing potential of longi-
tudinal or transverse incisions in the peripheral,
central, and inner rim regions of rabbit medial me-
nisci. Longitudinal and transverse incisions were
made in 48 male New Zealand white rabbits. The
incisions were either repaired with sutures or left
open. The effect of joint motion on repair was also
evaluated. In one group, longitudinal incisions
were made in the peripheral, central, and inner rim
regions of the meniscus. Some of these incisions
were sutured, whereas others were not repaired. In
another group, transverse incisions were made in
the meniscus, extending from the inner rim to the
middle of the meniscus or to the peripheral attach-
ment (radial tear). Again, the lesions were left
open or repaired. The effect of joint motion on heal-
ing was assessed by immobilizing several knees
from each group with Kirschner wires temporarily
for ten weeks. Suture of the meniscus incision did
not substantially affect the rate of healing. When
the healing rates of menisci at the periphery, body,
and rim were compared, incisions at the periphery
healed significantly better than incisions at the me-
niscal body and central rim regions. K-wire immo-
bilization did not substantially affect the rate of
healing. The difference in healing with regard to
the type of incision, either longitudinal or trans-
verse, was not statistically significant.
The surgical management ofmeniscus inju-
ries has been a controversial issue among sur-
geons. Early studies by I(lng13 showed that
Reprint requests to T. L. Huang, M.D., Associate Pro-
fessor of Surgery, University of Illinois College of Medi-
cine, 901 S. Wolcott St., M/C 844, Chicago, IL 60612.
Received: April 7, 1989.
299
tears within the substance of the canine me-
niscus did not heal unless the tear extended
through the peripheral attachment to the sy-
novial membrane. Meniscal defects generally
heal by the proliferation of fibrous tissue into
the defect. Arnoczky and Warren,4 Cabaud et
aL6 Heatley," and Veth et al.24confirmed
that healing of a peripheral meniscal tear can
occur.
The evolution of meniscal surgery has
gone through many stages. It has been shown
paradoxically that leaving a torn meniscus in
place or removing it will precipitate more
rapid degenerative changes in the knee
The repair of a torn meniscus
through arthrotomy and arthroscopy was re-
ported recently, but relatively little has been
mentioned about the effect of mobilization,
immobilization, or location with regard to
the healing potential of the torn menis-
cus.6,22,23This study will assess the healing
potential of either longitudinal or transverse
incisions in the peripheral, central, and inner
rim regions of rabbit medial menisci.
MATERIALS AND METHODS
Experimental meniscal incisions were made in
48 male New Zealand white rabbits weighing 2.5
kg. Anesthesia was achieved by intravenously ad-
ministering 30 mg/kg of pentobarbitol into an ear
vein. Using sterile techniques, the skin was pre-
pared, and the left knee joint was entered through
a midpatellar skin incision and a medial capsular
incision. The patella was gently dislocated to the

300 Huang et al.
\PERIPHERAL
FIG. 1. Types of longitudinal meniscal incisions
made at rim, body, and peripheral locations in ex-
perimental rabbits.
lateral side. Great care was taken not to injure the
collateral ligaments, articular cartilage, cruciate lig-
aments, or peripheral attachments of the menis-
cus. Under the operative microscope (magnifica-
tion, X 6-12), longitudinal or transverse incisions
were made with the aid of an arthroscopic eye
blade. The medial rather than lateral meniscus
was chosen because of better accessibility.
The rabbits were divided into four groups. In
Group I , 3-mm longitudinal incisions were made
in the peripheral, central, and inner rim regions of
the meniscus to simulate a longitudinal tear (Fig.
1). In two of the rabbits used, the lesions were left
open, whereas in two others the lesions were re-
paired with No. 8-0 absorbable sutures. In Group
2, transverse incisions were made in the inner rim,
extending from the inner rim to the middle of the
meniscus or to the peripheral attachment to simu-
late a radial tear. Again, the lesions were left open
in two rabbits and were repaired in another two. In
Group 3, the same procedure was done as in
Group 1, but the knee joint was immobilized by
inserting a Kirschner wire between the tibia and
femur, with the knee joint in gentle flexion. The
K-wire was drilled from the anterior distal femur
and passed through the posterior upper tibia. The
ends of the wire were bent and cut below the skin.
In Group 4, the same procedure was done as in
Group 2, and the knee joints were immobilized as
in Group 3. Following the procedure, the joint
capsule was approximated with interrupted No.
3-0 absorbable sutures. Postoperatively, the rab-
bits were housed in individual indoor runs where
they were allowed exercise at will. Postoperatively,
penicillin (700,000 units per day) was injected in-
tramuscularly for seven days. Two rabbits died
postoperatively, and all remaining animals were
killed after ten weeks.
The hindlimbs were disarticulated at the hip,
and the specimens were fixed in 10%buffered for-
malin for three days. The meniscus and adjacent
perimeniscal tissue were dissected out en bloc, em-
bedded in paraffin, and processed for histologic
examination.
Clinical Orthopaedics
and Related Research
RESULTS
Forty-six rabbits were killed at the end of
ten weeks. Complete histologic healing was
demonstrated by proliferation of new fibrous
tissue into the wound along the cut edges of
the meniscus. Figure 2 shows a completely
healed lesion in which fibrous tissue has pro-
liferated into the wound. A meniscus was
classified as incompletely healed when the le-
sion was not entirely closed off by fibrous tis-
sue and as unhealed when there was no evi-
dence for fibroblastic proliferation (Fig. 3).
In Group 1,in which animals were mobile,
two menisci healed completely in cases with-
out suture in the peripheral region. One me-
niscus partially healed and one did not heal
in the body region, and two menisci in the
rim region did not heal. Among the sutured
cases, two menisci completely healed in the
peripheral region and two did not heal in the
body and rim regions (Table 1). In Group 2,
in which animals were mobile, complete heal-
ing occurred in one case each in the periph-
eral and body regions, one partial healing oc-
curred in the peripheral region, and one case
did not heal in each of the body and rim re-
gions. In the sutured cases, one case com-
pletely healed and one partially healed in the
peripheral region, and no healing occurred in
the body and rim regions. In Group 3 (immo-
bilization group), one of six rabbits that had
an incision in the periphery without sutures
showed signs of complete healing. In the su-
tured cases, the only menisci that healed
were the ones that had an incision in the pe-
riphery.
In Group 4, in which animals were immo-
bilized, one of the five rabbits without sutures
healed, and this was the only one that had an
incision in the periphery. In the sutured
cases, all rabbits that had incisions in the pe-
riphery and body regions healed completely,
whereas the other rabbits with incisions in
the rim area showed no signs of healing. Su-
ture of the meniscal incision did not substan-
tially affect the rate of healing (p = 0.7671).
Among the animals with incisions at the pe-
 FIGS.2A AND 2B. (A) A repaired longitudinal peripheral incision without postoperative immobiliza-
tion. Arrow shows complete healing at ten weeks. (B) Arrow shows formation ofgranulation tissue, which
is indicative of healing. (Stain, hematoxylin and eosin; original magnification, X230.)
 FIGS.3A AND 3B. (A) A repaired longitudinal incision of the meniscal body without postoperative
immobilization. Arrow shows good approximation of the cut edges at ten weeks. (B) Arrow shows no
healing, clustering of chondrocytes, and necrosis. (Stain, hematoxylin and eosin; original magnification,
X230.)
Number 267
June, 1991
TABLE 1. Histologic Grade of Healing in Individual Rabbit Knee Joint Medial Menisci
Group Type oflesion
Fully mobile joints
Group 1 Longitudinal, unsutured
Longitudinal, sutured
Group 2 Transverse, unsutured
Transverse, sutured
Subtotal
Joints immobilized in flexion
Group 3 Longitudinal, unsutured
Longitudinal, sutured
Group 4 Transverse, unsutured
Transverse, sutured
Subtotal
Total
* Each number listed represents the score for a rabbit.
0, lesion did not heal; I , lesion partially healed; 2, lesion completely healed.
riphery of the meniscus, 12 healed com-
pletely, whereas only two partially healed. Of
the 16 animals with incisions at the body of
the meniscus, three healed completely and
one healed partially. No healing was ob-
served in the 15 animals with incisions at the
rim area. When the healing rates of menisci
at the periphery, body, and rim were com-
pared, incisions at the periphery healed signif-
icantly better (p = 0.00 1) than incisions at the
meniscal body and central rim regions.
In the immobilized groups, degenerative
changes of the joint cartilage and meniscus,
deformation of the condyle, and massive ad-
hesions and pannus formation were noticed.
Healing of the menisci in this group was due
to ingrowth ofsynovial tissue. In contrast, the
healed tissue between the gaps of the mobi-
lized groups was whitish and translucent. Of
the 23 mobilized animals, seven showed
complete healing, whereas three showed par-
tial healing. Of the same number of animals
in the immobilized group, eight completely
healed by synovial tissue ingrowth. K-wire
immobilization did not substantially affect
the rate of healing (p = 0.82383). Among the
24 animals with longitudinal incisions of the
Healing of Rabbit Meniscal Tears 303
Locution of Lesion
Periphery (2)* Body (2) Rim (2)
meniscus, seven completely healed and one
partially healed. On the other hand, of the 22
animals with radial tears created by trans-
verse incisions, eight completely healed and
two partially healed. All showed healing of
the outer rim of the meniscus at the periph-
ery. None of the repaired menisci had healing
on the inner rim. The difference in healing
with regard to the type of incision, either lon-
gitudinal or transverse, was not statistically
significant (p = 0.5848). The only difference
was that the margins of the latter had re-
tracted, and therefore a larger volume of re-
pair tissue had formed in the expanded
wound.
DISCUSSION
The blood supply to the meniscus has been
well d o c ~ m e n t e d ~and
. ~ is
~ primarily
~ ~ , ~ ~ lim-
ited to the horns and outer one third of the
meniscus. Scapinelli2' reported that the
blood supply of the human meniscus is pri-
manly limited to the outer one third of the
meniscus and is derived from capsular anas-
tamoses. Arnoczky and Warren4,5investi-
gated the meniscal blood supply in humans

304 Huang et al.
and dogs and confirmed that the outer 10%-
25% is vascular and the inner three fourths is
avascular. KingI3 first described the impor-
tance of the synovial membrane to meniscal
healing in the dog and found that longitu-
dinal tears did not heal unless they communi-
cated with the synovial membrane and cap-
sule. Arnoczky and Warrens showed that
healing in dogs originated from the periph-
eral synovial tissues and could be expected to
take place by ten weeks. Tears in the avascu-
lar body that did not communicate with the
synovium did not heal. Ghadially et al. lo dem-
onstrated that no healing had occurred after
six months in the sutured and unsutured
wounds and that the meniscus was incapable
of significant intrinsic repair. Others have
stressed the importance of synovial invasion
for meniscal healing.6.7'10,1
The results of this study also revealed no
intrinsic repair reaction in the midsubstance
of the meniscus in the rabbit model. This has
been studied by previous workers in dog, pig,
and sheep menisci.s.10,11-'3 Incisions seldom if
ever heal with fibrocartilage. The width of
the rim did have a marked effect on healing
because more peripheral tears healed at a sig-
nificantly higher rate than did those in the
less vascular segments of the meniscus.
In human subjects, meniscus repair seems
to be strong enough to resist recurrence, but
animal experiments to date seem to suggest
otherwise. Several specimens in this study
showed gross evidence of healing by reducing
the defect of the cut edges of the meniscus but
were not healed histologically. This raises the
question of the validity of the postoperative
evaluation of repaired menisci in human
subject studies. Several studies have evalu-
ated the result of meniscal repair using ar-
thrography, arthroscopy, or both.7,'8,22,23
When sutures are used in large meniscal inci-
sions, it provides stability and reduces the
size of the gap with less scarring." However,
the sutures cause a n increase of fibrocartilage
cell death in the less vascular segments of the
meniscus. In this study with a 3-mm incision,
more peripheral tears healed at significantly
Clinical Orthopaedics
and Related Research
higher rates than those in the less vascular
segments, whether sutures were used or not.
Recently, early motion in the management
of extremity injuries has been emphasized,"
but those studies need to be justified dini-
cally and experimentally. Immobilization
causes cartilage d e g e n e r a t i ~ n , ' ~ pannus
,~'
formation,I4 and weakening of the ligament
s t r ~ c t u r e . 'Other
~ periarticular tissues re-
spond similarly to chemical and mechanical
changes. Decreases in water's2 and in glycos-
a r n i n o g l y ~ a nresult
~ ~ ~in
~ closer
' ~ ~ ~contact
~ be-
tween collagen fibrils, thus impairing their
normal gliding interaction. Amiel et dem-
onstrated that early immobilization is asso-
ciated with increased synthesis of collagen
and collagen crosslinks. After prolonged pe-
riods of immobilization, degradation of col-
lagen mass occurs as atrophy becomes
marked. In this study, rigid internal pin fixa-
tion did not affect the rate of meniscal heal-
ing but produced degenerative changes of the
joint cartilage and meniscus, with massive in-
traarticular adhesions and pannus forma-
tion.
In conclusion, meniscal suture did not af-
fect the rate of healing in the rabbit model.
Peripheral meniscal incisions healed signifi-
cantly better than incisions in the body. Nei-
ther direction of incision (longitudinal or
transverse) or immobilization substantially
affected the rate of healing.
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June, 1991
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