26dkou09410.3205/26dkou094urn:nbn:de:0183-26dkou0941Meeting AbstractZone specific suspension and neurovascular histology of the human lateral meniscus: Implications for repairSelleSelleSebastianSInternational Center for Orthopedics, ATOS Hospital Heidelberg, Institute for Anatomy and Cell Biology, Ruprecht-Karls University, INF 307, Heidelberg, DeutschlandauthorSieboldSieboldRainerRInternational Center for Orthopedics, ATOS Hospital Heidelberg, Institute for Anatomy and Cell Biology, Ruprecht-Karls University, INF 307, Heidelberg, DeutschlandauthorKirschKirschJoachimJInternational Center for Orthopedics, ATOS Hospital Heidelberg, Institute for Anatomy and Cell Biology, Ruprecht-Karls University, INF 307, Heidelberg, DeutschlandauthorFeilFeilSvenSInternational Center for Orthopedics, ATOS Hospital Heidelberg, Heidelberg, DeutschlandauthorGerman Medical Science GMS Publishing House
Düsseldorf
61020261020englThis is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).M0659094Deutsche Gesellschaft für Orthopädie und UnfallchirurgieDeutsche Gesellschaft für Orthopädie und Orthopädische ChirurgieDeutsche Gesellschaft für UnfallchirurgieBerufsverband für Orthopädie und UnfallchirurgieDeutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2026)Abstracts | Knorpeltherapie und Osteochondrale LäsionenBerlin2026102020261023DKOU26_Abs_2178TextObjectives and questions: To quantify region-dependent variation in meniscosynovial suspension and synovial pouch (SP) architecture of the human lateral meniscus (LM), to map associated neurovascular patterns, and to translate these microanatomical findings into zone-adapted arthroscopic repair concepts (Table 1 ; Figure 1 ).Material and methods: Six fresh-frozen cadaveric knees (mean age 72 years, range 59–83) were examined in a basic science cadaveric laboratory study. A total of 139 histological section planes were analyzed across five predefined regions (A: anterior horn [AH]; Ba: anterior pars intermedia [aPI]; Bb: posterior pars intermedia [pPI]; C: popliteal hiatus [POH]; D: posterior horn [PH]). Hematoxylin–eosin–safran (HES) and Movat’s pentachrome staining were performed; whole-slide images were digitized; calibrated measurements quantified attachment proportion, vessels and nerve fibers were annotated per region.Results: Meniscal base height attached via meniscosynovial suspension (mean ± SD) was A 84 ± 3%, Ba 100 ± 0%, Bb 62 ± 11%, C 47 ± 21%, and D 96 ± 10%. Region A (loose connective tissue [LCT], shallow SP, central tract; pacinian corpuscles) supports supra- and/or inframeniscal outside-in repair with minimal intra-articular bulk. Region Ba (two dense connective tissue [DCT] bundles, deep SP, sub–mid-height neurovascularity in adipose tissue [AT]) favors hybrid fixation (inferior inside-out/outside-in; superior all-inside). Region Bb (inferior DCT insertion well below the tibial plateau [TP], deep SP, fewer vessels near the base, lateralized larger vessels in AT) suggests primarily inframeniscal base capture with cautious all-inside repair and capsular fixation only when necessary. Region C shows variable, often minimal attachment consistent with popliteomeniscal fascicle (PMF) tissue (inferior iPMF/superior sPMF) and sparse adjacent perimeniscal vascularity; therefore inframeniscal-only, non-bridging, popliteus tendon (PT)- preserving repair anchored to PMF is recommended. Region D (robust converging DCT bundles, small SP, diffuse vessels/nerves at the meniscocapsular transition) permits all-inside or inside-out repair supra- and/or inframeniscally while avoiding overtethering.Discussion and conclusions: Marked regional heterogeneity of LM suspension and neurovascular anatomy supports differentiated selection of suture level, technique, and material rather than uniform repair across the lateral meniscus. Specifically, suspension-dominant and mobile segments (A/Ba/D) warrant constructs that stabilize the base while minimizing long-term capsular tethering, whereas the POH (C) should be treated as a distinct entity with PMF-based, inframeniscal-only fixation to preserve popliteus-dependent kinematics and avoid bridging across the hiatus. A region-adapted algorithm informed by quantitative suspension metrics (Table 1 ) and integrated concepts (Figure 1 ) may improve anatomic restoration, reduce iatrogenic motion restriction, and better address extrusion-prone segments.