***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Ten patients underwent meniscectomy using a medial collateral ligament-dividing approach . Ten r and omly chosen patients had a meniscectomy through the st and ard anteromedial approach  and served as  controls . The ligament-dividing approach allowed easy , complete removal of the medial meniscus under direct vision . However , postoperative studies showed statistically increased varusvalgus and anteroposterior instability with the ligament-dividing approach as compared with the controls . The patients operated on with the former approach also had more difficulty in attaining a full range of motion of the knee Abstract This study examined the effect of four different methods for treating intrasubstance meniscal lesions . Forty patients ( 21 men , ¶19 women ; age 30.4 years , range 16–50 ) with an isolated and symptomatic painful horizontal grade 2 meniscal lesion on the medial side ( documented with MRI ) were included . Patients were r and omly assigned by the birth date to one of four treatment groups : group A , conservative therapy ( n = 12 ) ; group B , arthroscopic suture repair with access channels ( n = 10 ) ; group C , arthroscopic minimal central resection , intrameniscal fibrin clot and suture repair ( n = 7 ) ; and group D , arthroscopic partial meniscectomy ¶(n = 11 ) . The average length of follow-up was 26.5 months ( range 12–38 months ) . Follow-up evaluation consisted of clinical examination with the findings recorded according to the IKDC protocol , radiographs , and control MRI . Group A had 75 % normal or nearly normal final evaluation at follow-up , group B 90 % , group C 43 % , and group D 100 % normal or nearly normal at follow-up . These short-term results indicate that intrasubstance meniscal lesions can be treated best by performing partial meniscectomy . To preserve the important function of the meniscus , arthroscopic suture repair with access channels might give even better medium- to long-term results . Conservative treatment is often not satisfactory . Additionally , our findings show that MRI examinations are not superior to accurate clinical examinations INTRODUCTION The theoretical advantages of the Ho-Yag laser make it the ideal instrument for current use in arthroscopic meniscectomy . Short term results showed less patient discomfort , rapid recovery and less post operative pain and swelling . The purpose of this single blind prospect i ve r and omized study was to compare the results of arthroscopic meniscectomy performed mechanically to those obtained with the Ho-Yag laser , with a minimum follow up of one year . MATERIAL S AND METHODS Eighty meniscectomies in 76 patients were included with a mean follow up of 19.5 months ( extremes 12 - 35 months ) . The mean age was 42.5 years ( extremes 18 - 65 years ) . The laser group included 39 patients while the mechanical group included 37 patients . In the Ho-Yag laser group , energy never exceeded 30 watts . During arthroscopic meniscectomy , no other surgical procedure was allowed i.e. chondroplasty , ligament surgery . Prior to arthroscopy , all patients underwent a clinical evaluation including : Pain and Lysholm score assessment . This was repeated in the post operative period at the 10th , 30th day and at last follow up . 37 patients also had a st and ard X ray at last follow up ( anterior-posterior , lateral , and schuss views ) . RESULTS No statistically significant difference was observed in global clinical results between both techniques . Even if mechanical meniscectomy showed better results , the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions . In degenerative medial meniscal tears with severe cartilaginous lesions , mechanical meniscectomy showed significantly better results ( p = 0.048 ) . X ray control was normal in 47 p. 100 of the laser group and in 80 p. 100 of the mechanical group . The difference was statistically significant ( p = 0.038 ) . Narrowing of the joint space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechanical group . Iterative arthroscopy was necessary in 4 cases ( 3 laser and 1 mechanical ) for residual pain . Severe chondrolysis was present in 2 cases following laser meniscectomy . In the 2 other cases a complement of meniscectomy for residual lesions allowed good results . No bony necrosis was observed after laser meniscectomy . CONCLUSION According to the results of this study and the high cost of the laser , we do not recommend the laser as a routine technique for arthroscopic meniscectomy Some authors have reported a few cases of paraarticular osteonecrosis following  arthroscopic knee surgery  in which laser was used to assist in the treatment of cartilage and meniscal pathology . We performed a prospect i ve r and omized clinical study to determine if osteonecrosis occurs after arthroscopic laser surgery .  Fifty-five patients with cartilage problems in their knee joints were r and omized into two groups : the  laser group included 30 patients and the conventionally instrumented group consisted of 25 patients . Power setting s for the Holmium : YAG laser were 0.5 to 1.5 joules per pulse and 5 and 25 Hertz . Total energy used for the procedures was 1 to 2 K joules . Magnetic resonance imaging was performed on all patients preoperatively and postoperatively ( in third , sixth , and thirteenth months ) . None of the patients had osteonecrosis following arthroscopic laser surgery . When the Holmium : YAG laser is used at an optimal dosage ( optimal joule and Hertz ) with an optimal technique ( keeping the h and piece at an appropriate angle and distance ) and for an optimal time ( avoiding overtreatment ) , it does not cause osteonecrosis A pattern of variability was noted in the rehabilitative progress of patients undergoing knee surgery . Forty- eight patients who underwent routine medial or lateral meniscectomy were studied in a controlled , r and om ized , prospect i ve investigation design ed to identify electromyographic ( EMG ) and functional deficits as sociated with using a pneumatic tourniquet in knee surgery . The control group ( 24 individuals ) underwent  knee surgery without the use of a tourniquet . Six weeks postoperatively all patients were studied by EMG and functionally by determining the single leg vertical leap of the affected leg and expressing this as a percentage of that accomplished by the sound leg . The results were : ( 1 ) 17 of 24 ( 71 % ) of the tourniquet group had EMG evidence of denervation and a func tional capacity of 39 % of the normal leg . ( 2 ) 7 of 24 ( 29 % ) of the tourniquet group had no evidence of denervation and a 71 % functional capacity . ( 3 ) The control group had no evidence of denervation and a functional capacity of 79 % . Of the patients on whom a tourniquet was used , total tourniquet time and pressure did not vary signifi cantly between those patients who demonstrated EMG findings and those who did not . Arthrotomy in the absence of a tourniquet required more attention to hemostasis , but did not present overwhelming dif ficulty . Operative time was slightly prolonged . This investigation suggests that the ideal of early return to functional activity after knee surgery can best be accomplished by avoiding use of a pneumatic tourni quet The adaptive bone remodeling in the proximal tibia following medial meniscectomy was measured quantitatively by dual photon absorptiometry . Thirty-three patients who had undergone a meniscectomy ( r and omized to either total [ n=19 ] or partial [ n=14 ] meniscectomy ) performed by open joint surgery approximately 12 years earlier were included in the study . Bone mineral density was measured in the previously injured legs and in the healthy contralateral legs in areas located medially and laterally in the cortical bone of the subchondral plates and below in the trabecular bone of the medial and lateral tibial condyles . The distribution of bone mineral within the proximal tibia showed a characteristic and significant pattern . In the trabecular bone of the healthy contralateral knees , bone mineral density was 15 % higher in the medial tibial condyles compared with the values laterally ; a total or partial meniscectomy increased this difference to 25 % . With regard to the cortical bone of the subchondral plates , the bone mineral density in the healthy knees was 24.8 - 29.4 % higher medially than laterally , whereas after total and partial meniscectomy the differences were , respectively , 37.7 and 41.4 % . No significant differences in the distribution of bone mineral density , at either cortical or trabecular measuring sites , were found between totally and partially meniscectomized knees Abstract In a prospect ively r and omized study including 68 patients , the results of inside-out horizontal meniscus suturing were compared to meniscus repair using the meniscus arrow . 96 % of the patients underwent re-arthroscopy after 3–4 months . Only lesions in the red/red or red/white areas were included . Patients were treated with a hinged brace for 9 weeks . 30 patients had an isolated bucket-h and le lesion . In 19 cases the repair was done in conjunction with an  ACL reconstruction  and in 19 cases the repair was performed in an ACL-insufficient knee . The two groups were comparable . Operating time in the arrow group was one half that of the suture group . Of 65 re-arthroscopies , 91 % of the patients had healed or partially healed in the arrow group compared to 75 % in the suture group ( P = 0.11 ) . In only 50 % of the non-healed cases was this clinical ly suspected prior to control arthroscopy . The difference between healing in ACL-reconstructed and ACL-insufficient knees was not significant . Two patients in the suture group had a deep infection . There were no serious neurovascular injuries . Five patients in the suture group and two patients in the arrow group had symptoms in the saphenous nerve area . All patients had some synovial irritation at control arthroscopy but no severe reactions to suture or arrows were seen . Short-term results with meniscus arrows , based on healing and evaluated by second-look arthroscopy , seem promising A prospect i ve trial has been carried out to determine the value of suction drainage in the operation of meniscectomy . One hundred operations were analysed , in half of which drains had been used . The use of the drain could not be shown to result in any sustained advantages . The dem and for analgesics after the operation was reduced but not to a statistically significant level . The size of the early effusion was significantly reduced , but this benefit was lost when the knee was mobilised . The return of power to the quadriceps and of movement to the knee were not hastened . The average volume of fluid drained was 134 millilitres and it has been shown that forty-eight hours is a suitable time for removal of the drain . The use of suction drainage is not advocated for the uncomplicated operation of meniscectomy Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total meniscectomy in a r and om manner . The results were compared at one year and at 6.3 to 9.8 years ( median 7.8 ) . After one year more patients with partial meniscectomy ( 90 % ) than with total meniscectomy ( 80 % ) had no complaints . At the later review these figures were 62 % and 52 % , respectively ( p = 0.18 ) . However , patients with partial meniscectomy had higher functional scores . The deterioration in function between the first review and the second showed no significant difference in the two treatment groups . The incidence of mediolateral instability rose from 8 % to 47 % and was more frequent after total than after partial meniscectomy . Between the two review s the radiological signs of knee degeneration increased with no difference between the two treatment groups Two hundred patients with a meniscus lesion were peroperatively allocated to partial or total meniscectomy . The results were compared at one year and at 6.3 - 9.8 years ( median 7.8 ) . After one year , more patients with  partial meniscectomy  ( 90 % ) than with  total meniscectomy  ( 80 % ) had no complaints ( p = 0.029 ) . At the late review these figures were 62 % and 52 % respectively ( p = 0.18 ) . However , patients with partial meniscectomy had the highest functional scores . In five percent knee joint function had improved and in 35 % deteriorated , in the latter group without detectable difference between partial and total meniscectomy . The incidence of lateral laxity rose from eight to 47 % , most frequently seen after total meniscectomy . During the observation period radiological signs of knee joint degeneration changed from solely joint line narrowing into additional ridge formation and flattening of the femoral condyle , but unrelated to whether partial or total meniscectomy had been performed . Following partial meniscectomy posterior horn lesions had the poorest functional outcome , but only if more than one third of the meniscal surface had been removed . The amount of meniscal tissue excised was inversely correlated to the level of knee joint function except in bucket h and le lesions treated with partial meniscectomy . These lesions had the largest areas of meniscal tissue removed , but higher functional scores than posterior horn lesions . Preservation of the peripheral rim of the meniscus following partial meniscectomy was essential for the functional outcome after surgery On the basis of animal studies , an arthroscopic surgical system and procedure of trephination plus suturing were design ed for clinical practice . The system consists of a treph 
    Output:
    
Partial meniscectomy may allow a slightly enhanced recovery rate as well as a potentially improved overall functional outcome including better knee stability in the long term .
It is probably associated with a shorter operating time with no apparent difference in early complications or re-operation between partial and total meniscectomy .
However it is likely that partial meniscectomy via arthroscopy is associated with shorter operating times and a quicker recovery .
REVIEW ER 'S CONCLUSIONS The lack of r and omised trials means that no conclusions can be drawn on the issue of surgical versus non-surgical treatment of meniscal injuries , nor meniscal tear repair versus excision .
In r and omised trials so far reported , there is no evidence of difference in radiological or long term clinical outcomes between arthroscopic and open meniscal surgery , or between total and partial meniscectomy .
Partial meniscectomy seems preferable to the total removal of the meniscus in terms of recovery and overall functional outcome in the short term