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Aharonov A, Sofer S, Bruck H, Sarig U, Sharabi M. Unveiling the mechanical role of radial fibers in meniscal tissue: Toward structural biomimetics. Acta Biomater 2024; 187:199-211. [PMID: 39181178 DOI: 10.1016/j.actbio.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/01/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
The meniscus tissue is crucial for knee joint biomechanics and is frequently susceptible to injuries resulting in early-onset osteoarthritis. Consequently, the need for meniscal substitutes spurs ongoing development. The meniscus is a composite tissue reinforced with circumferential and radial collagenous fibers; the mechanical role of the latter has yet to be fully unveiled. Here, we investigated the role of radial fibers using a synergistic methodology combining meniscal tissue structure imaging, a computational knee joint model, and the fabrication of simple biomimetic composite laminates. These laminates mimic the basic structural units of the meniscus, utilizing longitudinal and transverse fibers equivalent to the circumferential and radial fibers in meniscal tissue. In the computational model, the absence of radial fibers resulted in stress concentration within the meniscus matrix and up to 800 % greater area at the same stress level. Furthermore, the contact pressure on the tibial cartilage increased drastically, affecting up to 322 % larger areas. Conversely, in models with radial fibers, we observed up to 25 % lower peak contact pressures and width changes of less than 0.1 %. Correspondingly, biomimetic composite laminates containing transverse fibers exhibited minor transverse deformations and smaller Poisson's ratios. They demonstrated structural shielding ability, maintaining their mechanical performance with the reduced amount of fibers in the loading direction, similar to the ability of the torn meniscus to carry and transfer loads to some extent. These results indicate that radial fibers are essential to distribute contact pressure and tensile stresses and prevent excessive deformations, suggesting the importance of incorporating them in novel designs of meniscal substitutes. STATEMENT OF SIGNIFICANCE: The organization of the collagen fibers in the meniscus tissue is crucial to its biomechanical function. Radially oriented fibers are an important structural element of the meniscus and greatly affect its mechanical behavior. However, despite their importance to the meniscus mechanical function, radially oriented fibers receive minor attention in meniscal substitute designs. Here, we used a synergistic methodology that combines imaging of the meniscal tissue structure, a structural computational model of the knee joint, and the fabrication of simplistic biomimetic composite laminates that mimic the basic structural units of the meniscus. Our findings highlight the importance of the radially oriented fibers, their mechanical role in the meniscus tissue, and their importance as a crucial element in engineering novel meniscal substitutes.
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Affiliation(s)
- Adi Aharonov
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 407000, Israel
| | - Shachar Sofer
- Dr. Miriam and Sheldon Adelson School of Medicine, Department of Morphological Sciences and Teratology, Ariel University, Ariel 407000, Israel
| | - Hod Bruck
- Dr. Miriam and Sheldon Adelson School of Medicine, Department of Morphological Sciences and Teratology, Ariel University, Ariel 407000, Israel
| | - Udi Sarig
- Dr. Miriam and Sheldon Adelson School of Medicine, Department of Morphological Sciences and Teratology, Ariel University, Ariel 407000, Israel; Department of Chemical Engineering, School of Engineering, Ariel University, Ariel 407000, Israel
| | - Mirit Sharabi
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 407000, Israel.
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Villagran M, Driban JB, Lu B, MacKay JW, McAlindon TE, Harkey MS. Radiomic features of the medial meniscus predicts incident destabilizing meniscal tears: Data from the osteoarthritis initiative. J Orthop Res 2024; 42:2080-2087. [PMID: 38747030 PMCID: PMC11336561 DOI: 10.1002/jor.25851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/02/2024] [Accepted: 03/30/2024] [Indexed: 08/02/2024]
Abstract
The objective of this study was to determine the optimal meniscal radiomic features to classify people who will develop an incident destabilizing medial meniscal tear. We used magnetic resonance (MR) images from an existing case-control study that includes images from the first 4 years of the Osteoarthritis Initiative (OAI). For this exploratory analysis (n = 215), we limited our study sample to people with (1) intact menisci at the OAI baseline visit, (2) 4-year meniscal status data, and (3) complete meniscal data from each region of interest. Incident destabilizing meniscal tear was defined as progressing from an intact meniscus to a destabilizing tear by the 48-month visit using intermediate-weighted fat-suppressed MR images. One reader manually segmented each participant's anterior and posterior horn of the medial menisci at the OAI baseline visit. Next, 61 different radiomic features were extracted from each medial meniscus horn. We performed a classification and regression tree (CART) analysis to determine the classification rules and important variables that predict incident destabilizing meniscal tear. The CART correctly classified 24 of the 34 cases and 172 out of 181 controls with a sensitivity of 70.6% and a specificity of 95.0%. The CART identified large zone high gray level emphasis (i.e., more coarse texture) from the posterior horn as the most important variable to classify who would develop an incident destabilizing medial meniscal tear. The use of radiomic features provides sensitive and quantitative measures of meniscal alterations, allowing us to intervene and prevent destabilizing meniscal tears.
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Affiliation(s)
- Michelle Villagran
- Department of Chemistry, Wellesley College, Wellesley, Massachusetts, USA
| | - Jeffrey B Driban
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Bing Lu
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - James W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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Rocheleau PJ, Robson A, Bird SD, Pickersgill MM, Holz KA. Short-term outcomes of 43 dogs treated with arthroscopic suturing for meniscal tears associated with cranial cruciate ligament disease. Vet Surg 2024; 53:881-892. [PMID: 38591745 DOI: 10.1111/vsu.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To describe short-term outcomes and complications in dogs receiving meniscal suturing and concurrent tibial plateau leveling osteotomy (TPLO) with or without augmentation with an extracapsular suture. STUDY DESIGN Retrospective case series. ANIMALS Forty-three client-owned dogs submitted for cruciate ligament disease. METHODS Dogs were included if meniscal suturing was performed during or after a TPLO procedure. Criteria included an unstable medial meniscus without evidence of a tear, a caudal vertical longitudinal tear with or without displacement, or if a bucket-handle tear was debrided and the remaining rim was unstable. Stifle stabilization was performed by either a standard TPLO or an augmented TPLO (TPLO + internal brace [IB]). Outcome measures included physical examination findings, radiographs, subjective gait examination, Liverpool Osteoarthritis in Dogs (LOAD) scores, and second-look arthroscopy. RESULTS Forty-four meniscal repairs were performed in 43 dogs. Five types of meniscal tears were treated employing eight suture materials. Complications were documented in 15 cases (34%). The stabilization technique had a significant impact on the outcome (p = .049): TPLO + IB had a 93.3% success rate and the success rate was 71.4% in the TPLO-only group. CONCLUSION Five types of meniscal pathology were addressed successfully in the study, indicating that currently accepted criteria for meniscal suturing in dogs may be overly conservative. The majority of complications were not related to the meniscal suturing itself and did not compromise the outcome. The stifle stabilization technique had an impact on outcome. CLINICAL SIGNIFICANCE The authors found arthroscopic meniscal suturing to be practical and successful in this patient population. Postoperative stifle stability had an impact on successful treatment.
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Affiliation(s)
- Patrick J Rocheleau
- Espanola Animal Hospital, Greater Sudbury, Ontario, Canada
- Arthrex Vet Systems, Naples, Florida, USA
| | | | - Sarah D Bird
- Espanola Animal Hospital, Greater Sudbury, Ontario, Canada
| | | | - Kali A Holz
- Espanola Animal Hospital, Greater Sudbury, Ontario, Canada
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Bartolo MK, Newman S, Dandridge O, Halewood C, Accardi MA, Dini D, Amis AA. An ovine knee simulator: description and proof of concept. Front Bioeng Biotechnol 2024; 12:1410053. [PMID: 38994124 PMCID: PMC11237960 DOI: 10.3389/fbioe.2024.1410053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Aims The ovine stifle is an established model for evaluation of knee treatments, such as meniscus replacement. This study introduces a novel ovine gait simulator for pre-testing of surgical treatments prior to in vivo animal trials. Furthermore, we describe a pilot study that assessed gait kinematics and contact pressures of native ovine stifle joints and those implanted with a novel fiber-matrix reinforced polyvinyl alcohol-polyethylene glycol (PVA-PEG) hydrogel meniscus to illustrate the efficacy of the simulator. Methods The gait simulator controlled femoral flexion-extension and applied a 980N axial contact force to the distal tibia, whose movement was guided by the natural ligaments. Five right ovine stifle joints were implanted with a PVA-PEG total medial meniscus replacement, fixed to the tibia via transosseous tunnels and interference screws. Six intact and five implanted right ovine stifle joints were tested for 500 k gait cycles at 1.55 Hz. Implanted stifle joint contact pressures and kinematics in the simulator were compared to the intact group. Contact pressures were measured at 55° flexion using pressure sensitive film inserted sub-meniscally. 3D kinematics were measured optically across two 30-s captures. Results Peak contact pressures in intact stifles were 3.6 ± 1.0 MPa and 6.0 ± 2.1 MPa in the medial and lateral condyles (p < 0.05) and did not differ significantly from previous studies (p > 0.4). Medial peak implanted pressures were 4.3 ± 2.2 MPa (p > 0.4 versus intact), while lateral peak pressures (9.4 ± 0.8 MPa) were raised post medial compartment implantation (p < 0.01). The range of motion for intact joints was flexion/extension 37° ± 1°, varus/valgus 1° ± 1°, external/internal rotation 5° ± 3°, lateral/medial translation 2 ± 1 mm, anterior/posterior translation 3 ± 1 mm and distraction/compression 1 ± 1 mm. Ovine joint kinematics in the simulator did not differ significantly from published in vivo data for the intact group, and the intact and implanted groups were comparable (p > 0.01), except for in distraction-compression (p < 0.01). Conclusion These findings show correspondence of the ovine simulator kinematics with in vivo gait parameters. The efficacy of the simulator to evaluate novel treatments was demonstrated by implanting a PVA-PEG hydrogel medial meniscal replacement, which restored the medial peak contact pressures but not lateral. This novel simulator may enable future work on the development of surgical procedures, derisking subsequent work in live animals.
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Affiliation(s)
- Maria Kristina Bartolo
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, United Kingdom
- Orthonika Ltd, London, United Kingdom
| | - Simon Newman
- Department of Surgery and Cancer, Imperial College London School of Medicine, London, United Kingdom
| | - Oliver Dandridge
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, United Kingdom
- Orthonika Ltd, London, United Kingdom
| | - Camilla Halewood
- Department of Surgery and Cancer, Imperial College London School of Medicine, London, United Kingdom
| | | | - Daniele Dini
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, United Kingdom
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, United Kingdom
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Nlandu A, Giurazza G, Lahsika M, An JS, Jacome-Pacheco D, Venzo L, Patel K, Vieira TD, Sonnery-Cottet B. How To Avoid Suture Damage in Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Posterior Root Reinsertion With the Transtibial Pullout Technique: A Technical Note. Arthrosc Tech 2024; 13:102849. [PMID: 38435243 PMCID: PMC10907902 DOI: 10.1016/j.eats.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/24/2023] [Indexed: 03/05/2024] Open
Abstract
Lateral meniscus posterior root tears (LMPRTs) are estimated to occur in 7% to 12% of anterior cruciate ligament (ACL)-injured knees. This topic is of great interest because of their biomechanical consequences in terms of interruption of hoop stress distribution. If left unrepaired, the corresponding compartment is exposed to unfavorable contact dynamics, similar to those resulting from a total meniscectomy. This Technical Note describes a transtibial LMPRT repair using a Knee Scorpion and an 18-gauge spinal needle. It is a reproducible arthroscopic LMPR reinsertion technique combined with concomitant standard ACL + anterolateral ligament reconstruction with hamstring tendons and it describes how to safely avoid damage to root traction sutures during the ACL independent tibial tunnel drilling.
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Affiliation(s)
- Alice Nlandu
- Pied Cheville Nantes Atlantique, Clinique Brétéché, Nantes
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Giancarlo Giurazza
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Mohammed Lahsika
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Jae-Sung An
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Dunio Jacome-Pacheco
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Leonardo Venzo
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Kaushal Patel
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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Liu H, Gong H, Chen P, Zhang L, Cen H, Fan Y. Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint. Med Biol Eng Comput 2023; 61:3087-3101. [PMID: 37624535 DOI: 10.1007/s11517-023-02906-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.
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Affiliation(s)
- Haibo Liu
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China.
| | - Peng Chen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Le Zhang
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Haipeng Cen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
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Yang J, Wang H, Zhou Y, Duan L, Schneider KH, Zheng Z, Han F, Wang X, Li G. Silk Fibroin/Wool Keratin Composite Scaffold with Hierarchical Fibrous and Porous Structure. Macromol Biosci 2023; 23:e2300105. [PMID: 37247409 DOI: 10.1002/mabi.202300105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Indexed: 05/31/2023]
Abstract
The present study describes a silk microfiber reinforced meniscus scaffold (SMRMS) with hierarchical fibrous and porous structure made from silk fibroin (SF) and wool keratin (WK) using electrospinning and freeze-drying technology. This study focuses on the morphology, secondary structure, mechanical properties, and water absorption properties of the scaffold. The cytotoxicity and biocompatibility of SMRMS are assessed in vivo and in vitro. The scaffold shows hierarchical fibrous and porous structure, hierarchical pore size distribution (ranges from 50 to 650 µm), robust mechanical properties (compression strength can reach at 2.8 MPa), and stable biodegradability. A positive growth condition revealed by in vitro cytotoxicity testing indicates that the scaffold is not hazardous to cells. In vivo assessments of biocompatibility reveal that only a mild inflammatory reaction is present in implanted rat tissue. Meniscal scaffold made of SF/WK composite shows a potential application prospect in the meniscal repair engineering field with its development.
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Affiliation(s)
- Jie Yang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huan Wang
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yuhang Zhou
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lirong Duan
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Karl H Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Waehringer Gurtel 18-20, Vienna, 1090, Austria
| | - Zhaozhu Zheng
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Fengxuan Han
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Gang Li
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
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Simkheada T, Orozco GA, Korhonen RK, Tanska P, Mononen ME. Comparison of constitutive models for meniscus and their effect on the knee joint biomechanics during gait. Comput Methods Biomech Biomed Engin 2023; 26:2008-2021. [PMID: 36645841 DOI: 10.1080/10255842.2022.2163587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/25/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023]
Abstract
Mechanical behavior of meniscus can be modeled using constitutive material models of varying complexity, such as isotropic elastic or fibril reinforced poroelastic (FRPE). However, the FRPE material is complex to implement, computationally demanding in 3D geometries, and simulation is time-consuming. Hence, we aimed to quantify the most suitable and efficient constitutive model of meniscus for simulation of cartilage responses in the knee joint during walking. We showed that simpler constitutive material models can reproduce similar cartilage responses to a knee model with the FRPE meniscus, but only knee models that consider orthotropic elastic meniscus can also reproduce meniscus responses adequately.
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Affiliation(s)
- Tulashi Simkheada
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Gustavo A Orozco
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Oladeji LO, Reynolds G, Nuelle CW, DeFroda SF. Securing the Root: Meniscus Root Repair with Rip Stop and Cannulated Drilling. Arthrosc Tech 2023; 12:e1665-e1672. [PMID: 37942109 PMCID: PMC10627872 DOI: 10.1016/j.eats.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion of meniscal root. These injuries are important to recognize because they contribute to impaired joint mechanics and rapid articular cartilage degeneration. Given this, there remains significant interest in identifying novel surgical techniques that may facilitate better surgical repair and enhance patient outcomes. The purpose of this technical note is to describe a surgical technique for a medial meniscus root ripstop repair with cannulated drilling. This technique is simple and reproducible, while also allowing for the augmentation of potentially poor tissue quality.
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Affiliation(s)
- Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
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10
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Chen H, Liu L, Zhang Y. Finite element analysis of the knee joint stress after partial meniscectomy for meniscus horizontal cleavage tears. BMC Musculoskelet Disord 2023; 24:744. [PMID: 37726679 PMCID: PMC10508030 DOI: 10.1186/s12891-023-06868-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/10/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To establish a finite element model of meniscus horizontal cleavage and partial resection, to simulate the mechanical changes of knee joint under 4 flexion angles, and to explore what is the optimal surgical plan. METHODS We used Mimics Research, Geomagic Wrap, and SolidWorks computer software to reconstruct the 3D model of the knee joint, and then produced the horizontal cleavage tears model of the internal and lateral meniscus, the suture model, and the partial meniscectomy model. These models were assembled into a complete knee joint in SolidWorks software, and corresponding loads and boundary constraints were added to these models in ANSYS software to simulate the changing trend of pressure and shear force on femoral condylar cartilage, meniscus, and tibial cartilage under the flexion angles of 0°, 10°, 20°, 30° and 40° of the knee joint. At the same time, the difference of force area between medial interventricular and lateral interventricular of knee joint under four states of bending the knee was compared, to explore the different effects of different surgical methods on knee joint after horizontal meniscus tear. RESULTS Within the four medial meniscus injury models, the lowest peak internal pressure and shear force of the knee joint was observed in the meniscal suture model; the highest values were found in the bilateral leaflet resection model and the inferior leaflet resection model; the changes of pressure, shear force and stress area in the superior leaflet resection model were the most similar to the changes of the knee model with the meniscal suture model. CONCLUSION Suture repair is the best way to maintain the force relationship in the knee joint. However, resection of the superior leaflet of the meniscus is also a reliable choice when suture repair is difficult.
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Affiliation(s)
- Hao Chen
- Department of Sport Medicine, Beijing DCN Orthopedic Hospital, No.19 Fushi Road, Beijing, 100143 China
| | - Lantao Liu
- Department of Spinal Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, No.5 Donghai Zhong Road, Qingdao, 266000 China
| | - Youlei Zhang
- Department of Sport Medicine, Beijing DCN Orthopedic Hospital, No.19 Fushi Road, Beijing, 100143 China
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Meadows KD, Peloquin JM, Markhali MI, Zgonis MH, Schaer TP, Mauck RL, Elliott DM. Acute Repair of Meniscus Root Tear Partially Restores Joint Displacements as Measured With Magnetic Resonance Images and Loading in a Cadaveric Porcine Knee. J Biomech Eng 2023; 145:081002. [PMID: 37255448 PMCID: PMC10259466 DOI: 10.1115/1.4062524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
The meniscus serves important load-bearing functions and protects the underlying articular cartilage. Unfortunately, meniscus tears are common and impair the ability of the meniscus to distribute loads, increasing the risk of developing osteoarthritis. Therefore, surgical repair of the meniscus is a frequently performed procedure; however, repair does not always prevent osteoarthritis. This is hypothesized to be due to altered joint loading post-injury and repair, where the functional deficit of the meniscus prevents it from performing its role of distributing forces. The objective of this study was to quantify joint kinematics in an intact joint, after a meniscus root tear, and after suture repair in cadaveric porcine knees, a frequently used in vivo model. We utilized an magnetic resonance images-compatible loading device and novel use of a T1 vibe sequence to measure meniscus and femur displacements under physiological axial loads. We found that anterior root tear led to large meniscus displacements under physiological axial loading and that suture anchor repair reduced these displacements but did not fully restore intact joint kinematics. After tear and repair, the anterior region of the meniscus moved posteriorly and medially as it was forced out of the joint space under loading, while the posterior region had small displacements as the posterior attachment acted as a hinge about which the meniscus pivoted in the axial plane. Methods from this study can be applied to assess altered joint kinematics following human knee injuries and evaluate repair strategies aimed to restore joint kinematics.
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Affiliation(s)
- Kyle D. Meadows
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - John M. Peloquin
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Miltiadis H. Zgonis
- Department of Orthopaedic Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104; Translational Musculoskeletal Research Center, CMC VA Medical Center, Philadelphia, PA 19104
| | - Dawn M. Elliott
- Biomedical Engineering, University of Delaware, 201 STAR Health Sciences Center, Newark, DE 19716
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12
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Xue A, Mao Z, Zhu X, Yang Q, Wang P, Mao Z, Du M, Ma X, Jiang D, Fan Y, Zhao F. Biomechanical effects of the medial meniscus horizontal tear and the resection strategy on the rabbit knee joint under resting state: finite element analysis. Front Bioeng Biotechnol 2023; 11:1164922. [PMID: 37425368 PMCID: PMC10324406 DOI: 10.3389/fbioe.2023.1164922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
The biomechanical changes following meniscal tears and surgery could lead to or accelerate the occurrence of osteoarthritis. The aim of this study was to investigate the biomechanical effects of horizontal meniscal tears and different resection strategies on a rabbit knee joint by finite element analysis and to provide reference for animal experiments and clinical research. Magnetic resonance images of a male rabbit knee joint were used to establish a finite element model with intact menisci under resting state. A medial meniscal horizontal tear was set involving 2/3 width of a meniscus. Seven models were finally established, including intact medial meniscus (IMM), horizontal tear of the medial meniscus (HTMM), superior leaf partial meniscectomy (SLPM), inferior leaf partial meniscectomy (ILPM), double-leaf partial meniscectomy (DLPM), subtotal meniscectomy (STM), and total meniscectomy (TTM). The axial load transmitted from femoral cartilage to menisci and tibial cartilage, the maximum von Mises stress and the maximum contact pressure on the menisci and cartilages, the contact area between cartilage to menisci and cartilage to cartilage, and absolute value of the meniscal displacement were analyzed and evaluated. The results showed that the HTMM had little effect on the medial tibial cartilage. After the HTMM, the axial load, maximum von Mises stress and maximum contact pressure on the medial tibial cartilage increased 1.6%, 1.2%, and 1.4%, compared with the IMM. Among different meniscectomy strategies, the axial load and the maximum von Mises stress on the medial menisci varied greatly. After the HTMM, SLPM, ILPM, DLPM, and STM, the axial load on medial menisci decreased 11.4%, 42.2%, 35.4% 48.7%, and 97.0%, respectively; the maximum von Mises stress on medial menisci increased 53.9%, 62.6%, 156.5%, and 65.5%, respectively, and the STM decreased 57.8%, compared to IMM. The radial displacement of the middle body of the medial meniscal was larger than any other part in all the models. The HTMM led to few biomechanical changes in the rabbit knee joint. The SLPM showed minimal effect on joint stress among all resection strategies. It is recommended to preserve the posterior root and the remaining peripheral edge of the meniscus during surgery for an HTMM.
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Affiliation(s)
- Anqi Xue
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Institute of Medical Device Testing, Beijing, China
| | - Zuming Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyu Zhu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Qiang Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peichen Wang
- Beijing Institute of Medical Device Testing, Beijing, China
| | - Zimu Mao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Mingze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xu Ma
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Feng Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Nakanishi Y, Matsushita T, Nagai K, Araki D, Hoshino Y, Kuroda R. Fibrin clot and Leukocyte-rich platelet-rich fibrin show similar release kinetics and amount of growth factors: a pilot study. J Orthop Surg Res 2023; 18:238. [PMID: 36964579 PMCID: PMC10039559 DOI: 10.1186/s13018-023-03709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In knee arthroscopic surgery, fibrin clot (FC) and leukocyte-rich platelet-rich fibrin (L-PRF) may be used in augmentation for meniscal repair. Studies have investigated growth factors released from FC and L-PRF; however, it is difficult to compare FC and L-PRF between different studies. Direct comparison of growth factors that may support meniscal healing released from FC and L-PRF may be beneficial in deciding whether to use FC or L-PRF. If no significant difference is seen, the surgeon may decide to use FC which is easier to prepare compared to L-PRF. The purpose of this pilot study is to investigate the release amount and pattern of basic fibroblast growth factor (bFGF), platelet-derived growth factor AB (PDGF-AB), transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF), and stromal cell-derived factor 1 (SDF-1) from FC and L-PRF. METHOD Twenty milliliters (ml) of whole blood was collected from each of the four volunteers. Ten milliliters of whole blood was allocated for preparation of FC and 10 ml for L-PRF. FC and L-PRF were separately placed in 5 ml of culture media. Five milliliters of the culture media was sampled and refilled at 15 min, 1 day, 3 days, 1 week and 2 weeks. The collected culture was used to quantify bFGF, PDGF-AB, TGF-β1, VEGF, and SDF-1 release by Enzyme-linked immune-sorbent assay (ELISA). Mann-Whitney U test was performed to assess significance of differences in amount of each growth factor released between FC and L-PRF. Significance was accepted at P value less than 0.05. RESULTS At two weeks, the cumulative release of TGF-β1 was the highest among all the growth factors in both FC and L-PRF (FC:19,738.21 pg/ml, L-PRF: 16,229.79 pg/ml). PDGF-AB (FC: 2328 pg/ml, L-PRF 1513.57 pg/ml) had the second largest amount, followed by VEGF (FC: 702.06 pg/ml, L-PRF 595.99 pg/ml) and bFGF (FC: 23.48 pg/ml, L-PRF 18.2 pg/ml), which order was also common in both FC and L-PRF. No significant difference in final release amount and pattern was seen between FC and L-PRF. CONCLUSION The current pilot study showed that cumulative release amount and release pattern of PDGF-AB, VEGF, TGF-β1, and bFGF did not significantly differ between FC and L-PRF during the two weeks of observation.
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Affiliation(s)
- Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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14
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Editorial Commentary: High Tibial Osteotomy May Not Be Required With Medial Meniscus Root Repair. Arthroscopy 2023; 39:647-649. [PMID: 36740287 DOI: 10.1016/j.arthro.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 02/07/2023]
Abstract
Meniscal root tears are defined as tears within 10 mm of their attachment and are more commonly observed in middle-aged patients. They have been named the silent epidemic and are equivalent to a total meniscectomy. Basic science studies have shown that posterior meniscus root repairs restore both contact area and pressure to its native state. The role of an additional high tibial osteotomy is not clear yet. High tibial osteotomies are commonly used to correct varus malalignment, a condition that is often observed with these tears. However, an additional osteotomy does not seem to offer any additional clinical benefits with regards to clinical and radiologic outcomes. It also has no effect with regards to contact pressure and contact area and is not related to the degree of deformity correction.
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15
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Meadows KD, Peloquin JM, Markhali MI, Zgonis MH, Schaer TP, Mauck RL, Elliott DM. Acute repair of meniscus root tear partially restores joint displacements as measured with MRI and loading in a porcine knee. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.01.526670. [PMID: 36778395 PMCID: PMC9915670 DOI: 10.1101/2023.02.01.526670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The meniscus serves important load-bearing functions and protects the underlying articular cartilage. Unfortunately, meniscus tears are common and impair the ability of the meniscus to distribute loads, greatly increasing the risk for developing osteoarthritis. Therefore, surgical repair of the meniscus is a frequently performed procedure; however, this repair does not always prevent osteoarthritis. This is hypothesized to be due to altered joint loading post injury and repair, where the functional deficit of the meniscus prevents it from performing its role of distributing forces. However, many studies of meniscus function required opening the joint, which alters kinematics. The objective of this study was to use novel MRI methods to image the intact joint under axial load and measure the acute meniscus and femur displacements in an intact joint, after a meniscus root tear, and after suture repair in the porcine knee, a frequently used in vivo model. We found that anterior root tear led to large meniscus and femur displacements under physiological axial loading, and that suture anchor repair reduced these displacements, but did not fully restore intact joint kinematics. After tear and repair, the anterior region of the meniscus moved posteriorly and medially as it was forced out of the joint space under loading, while the posterior region had small displacements as the posterior attachment acted as a hinge about which the meniscus rotated in the axial plane. This technique can be applied to evaluate the effect of knee injuries and to develop improved repair strategies to restore joint kinematics.
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16
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Bradley PX, Thomas KN, Kratzer AL, Robinson AC, Wittstein JR, DeFrate LE, McNulty AL. The Interplay of Biomechanical and Biological Changes Following Meniscus Injury. Curr Rheumatol Rep 2023; 25:35-46. [PMID: 36479669 PMCID: PMC10267895 DOI: 10.1007/s11926-022-01093-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.
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Affiliation(s)
- Patrick X Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Karl N Thomas
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Avery L Kratzer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Allison C Robinson
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Louis E DeFrate
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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17
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Yuwen P, Sun W, Guo J, Chang W, Wei N, Wang H, Ding K, Chen W, Zhang Y. Femoral-tibial contact stresses on fixed rotational femur models. Front Surg 2023; 9:1016707. [PMID: 36684303 PMCID: PMC9852333 DOI: 10.3389/fsurg.2022.1016707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/28/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives This study aims to quantitatively evaluate the femoral-tibial contact pressure on the knee under certain malrotaional degrees. Methods Femoral-tibial contact pressure was carried out on 14 fixed rotational knee models under 200/400/600 N vertical load using ultra-low-pressure sensitive film technology, rotation angles including neutral position (0°, anatomically reduced), 5°, 10°, and 15° internally and externally. Data were collected and analyzed with SPSS software. Results There are significant statistical differences between the medial contact pressure among rotational deformities (including neutral position) (P < 0.01), the increase in the degree of fixed internal malrotation of the femur resulted in a linear increase in the medial femoral-tibial contact pressures (P < 0.05) under 200/400/600 N vertical load, while increase in the degree of fixed external malrotation resulted in a linear decrease (P < 0.05). Except the 200 N compression, we can't find significant differences in lateral contact pressures (P > 0.05). In the comparison of medial to lateral contact pressures, no statistically significant differences were found in neutral and 5° internal rotation under 200/400 N, neutral, 5° internal rotation, and 15° external rotation under 600 N. In contrast, medial contact pressures were higher than lateral at other angles (P < 0.05). Conclusion Obvious contact pressure changes were observed in rotatory femur. Doctors should detect rotational deformity as much as possible during operation and perform anatomical reduction. For patients with residual rotational deformities, indication of osteotomy should not be too broad.
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Affiliation(s)
- Peizhi Yuwen
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Weiyi Sun
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jialiang Guo
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Wenli Chang
- Department of Hand Surgery, Cangzhou Hospital of Integrated TCM-WM of Hebei, Cangzhou, China
| | - Ning Wei
- Department of Orthopedic Surgery, Chinese People's Liberation Army Joint Security Force 980th Hospital, Shijiazhuang, China
| | - Haicheng Wang
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Kai Ding
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Wei Chen
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopeadic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopeadic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Correspondence: Yingze Zhang
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Chastain K, Wach A, Pekmezian A, Wimmer MA, Warren RF, Torzilli PA, Chen T, Maher SA. ACL transection results in a posterior shift and increased velocity of contact on the medial tibial plateau. J Biomech 2022; 144:111335. [DOI: 10.1016/j.jbiomech.2022.111335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 10/31/2022]
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19
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Shu L, Abe N, Li S, Sugita N. Importance of posterior tibial slope in joint kinematics with an anterior cruciate ligament-deficient knee. Bone Joint Res 2022; 11:739-750. [PMID: 36226477 PMCID: PMC9582864 DOI: 10.1302/2046-3758.1110.bjr-2022-0039.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle. Methods In this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle. Results The ACL tensile force in the intact knee was significantly affected with increasing PTS angle. Considerable differences were observed in kinematics and initial posterior femoral translation between the intact and ACLD joints as the PTS angles increased by more than 2.5° (beyond 11.4°). Additionally, a higher contact stress was detected in the peripheral posterior horn areas of the menisci with increasing PTS angle during the gait cycle. The maximum tensile force on the horn of the medial meniscus increased from 73.9 N to 172.4 N in the ACLD joint with increasing PTS angles. Conclusion Knee joint instability and larger loading on the medial meniscus were found on the ACLD knee even at a 2.5° increase in PTS angle (larger than 11.4°). Our biomechanical findings support recent clinical evidence of a high risk of failure of ACL reconstruction with steeper PTS and the necessity of ACL reconstruction, which would prevent meniscus tear and thus the development or progression of osteoarthritis. Cite this article: Bone Joint Res 2022;11(10):739–750.
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Affiliation(s)
- Liming Shu
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Nobuhiro Abe
- Department of Orthopaedic Surgery and Sport Medicine, General Medical Center, Kawasaki Medical School, Okayama, Japan, Nobuhiro Abe. E-mail:
| | - Shihao Li
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Naohiko Sugita
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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20
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Wang S, Hase K, Kita S, Ogaya S. Biomechanical effects of medial meniscus radial tears on the knee joint during gait: A concurrent finite element musculoskeletal framework investigation. Front Bioeng Biotechnol 2022; 10:957435. [PMID: 36299291 PMCID: PMC9589217 DOI: 10.3389/fbioe.2022.957435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
The biomechanical variation in the knee during walking that accompanies medial meniscal radial tears stemming from knee osteoarthritis (OA) has not been explored. This study introduced a finite element musculoskeletal model using concurrent lower limb musculoskeletal dynamics and knee joint finite element analysis in a single framework and expanded the models to include knees with medial meniscal radial tears and total medial meniscectomy. The radial tears involved three locations: anterior horn, midbody, and posterior horn with grades of 33%, 50%, and 83% of the meniscus width. The shear and hoop stresses of the tear meniscus and tibial cartilage contact load, accompanying tears, and postmeniscectomy were evaluated during the stance phase of the gait cycle using the models. In the 83% width midbody tear group, shear stress at the end of the tear was significantly greater than in the intact meniscus and other tear groups, and the maximum shear stress was increased by 310% compared to the intact meniscus. A medial meniscus radial tear has a much smaller effect on the tibial cartilage load (even though in the 83% width tear, the cartilage/total load ratio increased by only 9%). However, the contact force on the tibial cartilage with total postmeniscectomy was increased by 178.93% compared with a healthy intact meniscus, and the peak contact pressure after meniscectomy increased from 11.94 to 12.45 MPa to 17.64 and 13.76 MPa, at the maximum weight acceptance and push-off, respectively. Our study shows that radial tears with larger medial meniscus widths are prone to high stress concentrations at the end of the tears, leading to the potential risk of complete meniscal rupture. Furthermore, although the tears did not change the cartilage load distribution, they disrupted the circumferential stress-transmitting function of the meniscus, thus greatly increasing the likelihood of the onset of knee OA. The significant increase in the tibial cartilage load with total postmeniscectomy indicates a potential risk of OA flare-ups. This study contributes to a better understanding of meniscal tear-induced OA biomechanical changes during human activities and offers some potential directions for surgical guidance of meniscectomies and the prophylaxis and treatment of OA.
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Affiliation(s)
- Sentong Wang
- Human-Mechanical System Laboratory, Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Kazunori Hase
- Human-Mechanical System Laboratory, Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Shunsuke Kita
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Graduate Course of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
- Department of Rehabilitation, Soka Orthopedics Internal Medicine, Saitama, Japan
| | - Shinya Ogaya
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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21
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Knee adduction moment is correlated with the increase in medial meniscus extrusion by dynamic ultrasound in knee osteoarthritis. Knee 2022; 38:82-90. [PMID: 35930897 DOI: 10.1016/j.knee.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND An increase in medial meniscus extrusion (MME) due to abnormal biomechanical stress leads to knee osteoarthritis (OA) progression. MME evaluation during walking is a key method of detecting dynamic changes in the meniscus, and in combination with motion analysis, can provide a deeper understanding of the mechanisms involved in the increase of MME. OBJECTIVE To validate the feasibility of MME dynamic evaluation in combination with a motion analysis system based on the correlation between the increase in MME and biomechanical factors. METHODS Twenty-three knees from 23 patients with mild to moderate knee OA were analysed in this study. The medial meniscus during walking was evaluated by ultrasound. The increase in MME was calculated as the difference between the minimum and maximum MME during walking. A three-dimensional motion analysis system was synchronised with the ultrasound and then, biomechanical factors such as knee moment and ground reaction force were evaluated. RESULTS The wave patterns of the mediolateral and vertical components of ground reaction forces and knee adduction moment were similar to those in the MME based on a high cross-correlation coefficient (>0.8). The increase in MME was significantly correlated with the peak value of the knee adduction moment (r = 0.54, P = 0.0073) but not with the mediolateral and vertical components of the ground reaction force. CONCLUSION The findings show that knee adduction moment is correlated with an increase in MME during walking and indicates the validity and feasibility of the dynamic evaluation of MME in combination with a motion analysis system.
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Aso K, Walsh DA, Wada H, Izumi M, Tomitori H, Fujii K, Ikeuchi M. Time course and localization of nerve growth factor expression and sensory nerve growth during progression of knee osteoarthritis in rats. Osteoarthritis Cartilage 2022; 30:1344-1355. [PMID: 35843479 DOI: 10.1016/j.joca.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Nerve growth factor (NGF) and sensory nerves are key factors in established osteoarthritis (OA) knee pain. We investigated the time course of NGF expression and sensory nerve growth across early and late stages of OA progression in rat knees. DESIGN Knee OA was induced by medial meniscectomy in rats. OA histopathology, NGF expression, and calcitonin gene-related peptide immunoreactive (CGRP-IR) nerves were quantified pre-surgery and post-surgery at weeks 1, 2, 4 and 6. Pain-related behavior was evaluated using dynamic weight distribution and mechanical sensitivity of the hind paw. RESULTS NGF expression in chondrocytes increased from week 1 and remained elevated until the advanced stage. In synovium, NGF expression increased only in early stages, whereas in osteochondral channels and bone marrow, NGF expression increased in the later stages of OA progression. CGRP-IR nerve density in suprapatellar pouch peaked at week 4 and decreased at week 6, whereas in osteochondral channels and bone marrow, CGRP-IR innervation increased through week 6. Percent ipsilateral weight-bearing decreased throughout the OA time course, whereas reduced paw withdrawal thresholds were observed only in later stages. CONCLUSION During progression of knee OA, time-dependent alterations of NGF expression and CGRP-IR sensory innervation are knee tissue specific. NGF expression increased in early stages and decreased in advanced stage in the synovium but continued to increase in osteochondral channels and bone marrow. Increases in CGRP- IR sensory innervation followed increases in NGF expression, implicating that NGF is a key driver of articular nerve growth associated with OA pain.
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Affiliation(s)
- K Aso
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku 783-8505, Japan.
| | - D A Walsh
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, UK
| | - H Wada
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku 783-8505, Japan
| | - M Izumi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku 783-8505, Japan
| | - H Tomitori
- Pfizer Japan Inc., 7-22-3 Yoyogi Shibuya-ku Tokyo, Japan
| | - K Fujii
- Pfizer Japan Inc., 7-22-3 Yoyogi Shibuya-ku Tokyo, Japan
| | - M Ikeuchi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku 783-8505, Japan
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23
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van Minnen BS, van der Veen AJ, van de Groes SAW, Verdonschot NJJ, van Tienen TG. An anatomically shaped medial meniscus prosthesis is able to partially restore the contact mechanics of the meniscectomized knee joint. J Exp Orthop 2022; 9:91. [PMID: 36071256 PMCID: PMC9452619 DOI: 10.1186/s40634-022-00531-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether a flexible medial meniscus prosthesis is more capable of sharing loads with the direct tibiofemoral cartilage contact than the stiffer first-generation prosthesis. Additionally, the effect of the prosthesis on the tibial pressure distribution after total meniscectomy was investigated. METHODS In an artificial knee joint, the relative amounts of load transferred through both meniscus prostheses and the direct tibiofemoral contact were assessed with pressure-sensitive sensors. Additionally, six cadaveric knee joints were loaded in a physiological environment. Tibial contact pressures were measured with an intact native meniscus, after total meniscectomy and after implantation of the second-generation meniscus prosthesis. RESULTS Whereas the first generation of the meniscus prosthesis transferred virtually all the load from femur to tibia, the second-generation prosthesis allowed for load sharing with the direct tibiofemoral contact. No differences in load sharing were found between the native meniscus and the second-generation meniscus prosthesis. The prosthesis decreased peak and mean pressures on the medial tibial cartilage compared to meniscectomy. No significant differences in pressure were found between the native meniscus and the meniscus prosthesis. CONCLUSIONS The second-generation meniscus prosthesis presented in this study can share loads with the direct tibiofemoral contact, a characteristic that the first-generation prosthesis did not have. The flexible meniscus prosthesis significantly reduces the contact pressures on the medial tibial plateau after total meniscectomy. Although the biomechanical performance of the native meniscus could not be reproduced completely, the meniscus prosthesis may have the potential to relieve post-meniscectomy pain symptoms.
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Affiliation(s)
- Branco S van Minnen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands.
| | - Albert J van der Veen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands
| | - Sebastiaan A W van de Groes
- Department of Orthopaedics, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nico J J Verdonschot
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Tony G van Tienen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands
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Mameri ES, Dasari SP, Fortier LM, Verdejo FG, Gursoy S, Yanke AB, Chahla J. Review of Meniscus Anatomy and Biomechanics. Curr Rev Musculoskelet Med 2022; 15:323-335. [PMID: 35947336 DOI: 10.1007/s12178-022-09768-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Anatomic repair of meniscal pathology is critical for restoring native joint biomechanics and kinematics for patients who suffer from meniscal tears. The purpose of this review was to summarize the pertinent anatomy, biomechanics, and kinematics of the meniscus to guide surgeons during meniscal repair procedures. RECENT FINDINGS Over the past decade, there has been a growing trend to save the meniscus whenever possible. The goal of repair should be to recreate native anatomy as close as possible to recapitulate normal mechanics. Studies describing the quantitative and qualitative relationship of the meniscus roots, ligaments, and attachments are key in guiding any meniscus repair. This review summarizes these relationships, with particular emphasis on meniscal roots and other key attachments to the meniscus. The composition, embryology, vascularization, biomechanics, in vivo kinetics, and in vivo kinematics of the meniscus are also discussed in this review. Meniscal tears can cause profound functional, biomechanical, and kinematic derangements within the knee joint leading to accelerated degeneration of the articular cartilage. A strong understanding of the quantitative and qualitative relationships of the meniscus and its attachments with key arthroscopic landmarks will allow a surgeon to anatomically repair meniscal pathology in order to restore native joint biomechanics.
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Affiliation(s)
- Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.,Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.,Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Fernando Gómez Verdejo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.
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Oosten J, Yoder R, DiBartola A, Bowler J, Sparks A, Duerr R, Magnussen R, Kaeding C, Flanigan D. Several Techniques Exist With Favorable Biomechanical Outcomes in Radial Meniscus Tear Repair-A Systematic Review. Arthroscopy 2022; 38:2557-2578.e4. [PMID: 35189305 DOI: 10.1016/j.arthro.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare biomechanical properties of various radial tear repair techniques in the medial and lateral menisci. METHODS A search was performed for key words regarding mechanical properties of repair of radial meniscal tears in PubMed, Embase, CINAHL, Scopus, and Cochrane databases, yielding 1791 articles. Articles were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines against inclusion criteria and underwent Methodological Index for Non-Randomized Studies (MINORS) methodologic quality assessment. Repair constructs evaluated were classified based on repair technique, use of a transtibial augmentation, and the number, orientation, and pattern of stitches. Results published across different studies were compared but not subjected to meta-analysis due to variability in testing procedures and heterogeneity of repair methods. RESULTS We identified 20 studies that performed mechanical testing on 21 different radial meniscal tear repair techniques. The greatest reported mean load-to-failure (LtF) were the transtibial 2-tunnel + 4 horizontal inside-out sutures (191.2 N ± 17.3, cadaver) and all-inside double vertical repair (146.3 N ± 36.2, porcine). The transtibial technique improved LtF and displacement of an inside-out (IO) horizontal repair. All-inside vertical repairs demonstrated greater LtF, stiffness, and displacement compared with IO horizontal repairs in 2 studies. Compared with IO double horizontal repairs, all-inside double vertical or IO double horizontal repairs with reinforcing stitches parallel to the tear exhibited greater LtF in 3 studies and stiffness in 2 studies. Two studies reported that parallel reinforcing stitches significantly reduced suture tear-through compared with similar, nonreinforced repairs. Mean MINORS score for all studies analyzed was 19.88 ± 1.47 points. CONCLUSIONS A systematic review demonstrated that there may be alternatives to traditional IO horizontal repairs for radial meniscus tears. Less-invasive all-inside vertical techniques reinforced with suture parallel to the tear instead of standard IO horizontal sutures may improve strength of repair. In addition, transtibial 2-tunnel augmentation may also increase strength of radial meniscus tear repairs. CLINICAL RELEVANCE There may be alternatives to IO horizontal repairs for radial meniscus tears.
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Affiliation(s)
- James Oosten
- College of Medicine, Ohio State University, Columbus, Ohio, U.S.A
| | - Robert Yoder
- College of Medicine, Ohio State University, Columbus, Ohio, U.S.A
| | - Alex DiBartola
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A
| | - Josh Bowler
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A
| | - Alex Sparks
- College of Medicine, Ohio State University, Columbus, Ohio, U.S.A
| | - Robert Duerr
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A
| | - Robert Magnussen
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A
| | - Christopher Kaeding
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A
| | - David Flanigan
- Department of Orthopedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, U.S.A..
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Huddleston HP, Polce EM, Gilat R, Mehta N, Alzein M, Dandu N, Parvaresh KC, Cole BJ, Yanke AB. Time to Achieving Clinically Significant Outcomes After Meniscal Allograft Transplantation. Cartilage 2022; 13:19476035221102568. [PMID: 35864782 PMCID: PMC9310214 DOI: 10.1177/19476035221102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the time to achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient-reported outcome (PRO) measures and risk factors affecting achievement of clinically significant outcomes in patients undergoing meniscal allograft transplantation (MAT). METHODS A prospectively maintained MAT registry was retrospectively reviewed from April 2014 to May 2019. Patients who underwent revision MAT or did not complete preoperative PROs or one post operative time point were excluded. Patients who underwent concomitant procedures were included in the analysis. PROs were administered preoperatively and at 6 months, 1 year, and 2 years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months). RESULTS Eighty patients (age: 28.35 ± 9.76, 50% male) who completed preoperative, 6-month (n = 69, 86% compliance), and 1-year (n = 76, 95% compliance) PROs were included. The majority of patients (>50%) achieved MCID and PASS on most included PROs. Workers' compensation status was found to significantly delay achievement of MCID and PASS on all PROs except for PASS on Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL). Higher body mass index (BMI) significantly delayed time to achieving MCID on KOOS Pain and activities of daily living (ADL), as well as PASS on KOOS Symptoms and KOOS QoL. CONCLUSION This study suggests that the majority of patients have clinically significant improvements in pain and function after MAT, with more than 50% of patients experiencing clinically significant improvement within the first postoperative year. Workers' compensation status and high BMI may prolong time to achievement of MCID and PASS after MAT.
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Affiliation(s)
| | | | - Ron Gilat
- Rush University Medical Center, Chicago, IL, USA
| | - Nabil Mehta
- Rush University Medical Center, Chicago, IL, USA
| | | | - Navya Dandu
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Adam B. Yanke
- Rush University Medical Center, Chicago, IL, USA,Adam B. Yanke, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL 60612, USA.
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Meniscus surface texture is associated with degenerative changes in biological and biomechanical properties. Sci Rep 2022; 12:11977. [PMID: 35831482 PMCID: PMC9279509 DOI: 10.1038/s41598-022-16206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022] Open
Abstract
Meniscal degeneration is defined by semi-quantitative assessment of multiple histological findings and has been implicated in biomechanical dysfunction, yet little is known about its relationship with biological properties. This paper aimed to quantitatively evaluate degenerative findings in human meniscus to examine their relationship with gene expression and biomechanical properties, and to extract histological findings that reflect biological properties like gene expression and cytokine secretion. This study included lateral menisci of 29 patients who underwent total knee arthroplasty. The menisci were divided into six samples. For each sample, Pauli's histological evaluation and corresponding quantitative assessment (surface roughness, DNA content, collagen orientation, and GAG content) were performed, with surface roughness showing the highest correlation with the histological evaluation in a single correlation analysis (r = 0.66, p < 0.0001) and multivariate analysis (p < 0.0001). Furthermore, surface roughness was associated with gene expression related to meniscal degeneration and with tangent modulus which decreases with increasing degeneration (r = - 0.49, p = 0.0002). When meniscal tissue was classified by surface integrity, inflammatory cytokine secretion tended to be higher in severe degenerated menisci. These results suggest that the evaluation of meniscal surface texture could predict the degree of degeneration and inflammatory cytokine secretion.
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Santana DC, Oak SR, Jin Y, Rothy A, Lee LL, Katz JN, Winalski CS, Duryea J, Jones MH. Increased Joint Space Narrowing After Arthroscopic Partial Meniscectomy: Data From the Osteoarthritis Initiative. Am J Sports Med 2022; 50:2075-2082. [PMID: 35604336 DOI: 10.1177/03635465221096790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy (APM) is widely performed and remains an important therapeutic option for patients with a meniscal tear. However, it is debated whether or not APM accelerates the progression of osteoarthritis (OA) in the long term. PURPOSE/HYPOTHESIS The purpose was to compare the progression of OA measured by the change in tibiofemoral joint space width (JSW)-a quantitative measure of OA radiographic severity-across 3 groups with a midterm follow-up: (1) patients undergoing APM; (2) those with a meniscal tear treated nonoperatively; and (3) those without a tear. We hypothesized that the reduction in JSW would be greatest in patients undergoing APM and least in those patients without a tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Using the Osteoarthritis Initiative cohort, a total of 144 patients were identified that underwent APM with at least 12 months of follow up and without previous knee surgery. Those with a meniscal tear who did not have APM (n = 144) and those without a tear (n = 144) were matched to patients who had APM by sex, age, Kellgren-Lawrence (KL) grade, and follow up time. Participants underwent magnetic resonance imaging at baseline. Knee radiographs to assess JSW were collected annually or biannually. The change in minimum medial compartment JSW was calculated using a validated automated method. A piecewise linear mixed effects model was constructed to examine the relationship between JSW decline over time and treatment group-adjusting for age, body mass index, smoking status, KL grade, and baseline JSW. RESULTS All groups had comparable baseline JSW-ranging from 4.33 mm to 4.38 mm. The APM group had a rate of JSW decline of -0.083 mm/mo in the first 12 months and -0.014 mm/mo between 12 and 72 months. The rate of JSW decline in the APM group was approximately 27 times greater in the first 12 months than that in the nonsurgical group (-0.003 mm/mo) and 5 times greater than that in the no tear group (-0.015 mm/mo); however, there was no significant difference between groups for 12 to 72 months (nonsurgical group: -0.009 mm/mo; no tear group: -0.010 mm/mo). The adjusted JSW in the APM group was 4.38 mm at baseline and decreased to 2.57 mm at 72 months; the JSW in the nonsurgical group declined from 4.31 mm to 3.73 mm, and in the no tear group it declined from 4.33 mm to 3.54 mm. There was a statistically significant difference in JSW change between baseline and 72 months for the APM group compared with the other groups (P < .001), but not between the nonsurgical and no tear groups (P = .12). CONCLUSION In the first postoperative year, APM results in a faster rate of joint space narrowing compared with knees undergoing nonsurgical management of meniscal tears. Thereafter, there are comparable rates of OA progression regardless of the chosen management. APM results in a persistent decrease in JSW over at least 72 months. An untreated meniscal tear does not contribute to radiographic progression-assessed by JSW-as compared with an intact meniscus.
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Affiliation(s)
- Daniel C Santana
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sameer R Oak
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Ling-Ling Lee
- Cleveland Clinic Family Medicine Residency, Lakewood, Ohio, USA
| | - Jeffrey N Katz
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl S Winalski
- Department of Radiology and Biomedical Engineering, Program of Advanced Musculoskeletal Imaging, Lerner Research Institute, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeff Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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McHugh C, Opare-Addo M, Collins J, Jones M, Selzer F, Losina E, Katz J. Treatment of the syndrome of knee pain and meniscal tear in middle-aged and older persons: A narrative review. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4. [PMID: 35991623 PMCID: PMC9384701 DOI: 10.1016/j.ocarto.2022.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: Design: Results: Conclusion:
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Kim H, Kim JM, Bin SI, Lee BS. Radial tears in the anterior third of the lateral meniscus are frequently combined with horizontal tears. Orthop Traumatol Surg Res 2022; 108:103223. [PMID: 35104626 DOI: 10.1016/j.otsr.2022.103223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Radial tears of the lateral meniscus are often located in the junction of the middle and posterior third or posterior tibial attachment. However, we observed that a few cases of radial tears occurred in the anterior third of the lateral meniscus, and in many cases, they were accompanied by horizontal tears. HYPOTHESIS Radial tears are more frequently accompanied by horizontal tears in the anterior third of the lateral meniscus than in other regions. MATERIAL AND METHODS From July 2006 to May 2019, patients who underwent arthroscopic surgery for radial tears of the lateral meniscus were included. Patients with radial tears in the anterior third of the lateral meniscus were classified into the anterior group and those with radial tears in the middle and posterior third were classified into the comparison group. Magnetic resonance imaging and arthroscopic findings were reviewed to evaluate whether radial tears were accompanied by other types of tears, especially horizontal tears. The incidence of complex tears between the two groups was compared. RESULTS Eighty knees in 79 patients were included. The mean age at the time of surgery was 44.1±16.9 years. The anterior group included 30 knees, and 19 (63.3%) of those also had horizontal tears. In the anterior group, all complex tears were accompanied by horizontal tears, and no other types of accompanying tears were observed. The comparison group included 50 knees, and 16 (32%) of those also had other types of tears. Of the 16 complex tears, 14 had horizontal tears and 2 had longitudinal tears. The incidence of complex tear was significantly higher in the anterior group than in the comparison group (p<.001). CONCLUSION Radial tears occurring at the anterior third of the lateral meniscus are frequently accompanied by a horizontal tear. It is important to be aware and predict the occurrence of such characteristic tears and to do proper surgical procedures. LEVEL OF PROOF IV; Cross-sectional study.
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Affiliation(s)
- Hanwook Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
| | - Seong-Il Bin
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
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Chen T, Pekmezian A, Leatherman ER, Santner TJ, Maher SA. Tekscan analysis programs (TAP) for quantifying dynamic contact mechanics. J Biomech 2022; 136:111074. [PMID: 35413514 PMCID: PMC10150386 DOI: 10.1016/j.jbiomech.2022.111074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
This short communication provides details on customized Tekscan Analysis Programs (TAP) which extract comprehensive contact mechanics metrics from piezoelectric sensors in articulating joints across repeated loading cycles. The code provides functionality to identify regions of interest (ROI), compute contact mechanic metrics, and compare contact mechanics across multiple test conditions or knees. Further, the variability of identifying ROIs was quantified between seven different users and compared to an expert. Overall, the contribution of four variables were studied: two knee specimens; two points in the gait cycle; two averaging methods; and seven observers, to determine if variations in these values played a role in accurately quantifying the ROI. The relative error between the force ratio from each observer's ROI and the expert ROI was calculated as the output of interest. A multivariate linear mixed effects model was fit to the four variables for the relative error with an observer- and knee-specific random intercept. Results from the fitted model showed a statistically significant difference at the 0.05 level in the mean relative errors at the two gait points. Additionally, variability in the relative errors attributed to the observer, knee, and random errors was quantified. To reduce variability amongst users, by ensuring low inter-observer variability and increasing segmentation accuracy of knee contact mechanics, a training module and manual have been included as supplemental material. By sharing this code and training manual, we envisage that it can be used and modified to analyze outputs from a range of sensors, joints, and test conditions.
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Affiliation(s)
- Tony Chen
- Department of Biomechanics and Hospital for Special Surgery, New York, NY 10021 USA; Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021 USA.
| | - Ashley Pekmezian
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021 USA
| | - Erin R Leatherman
- Department of Mathematics and Statistics, Kenyon College, Gambier, OH 43022 USA
| | - Thomas J Santner
- Department of Statistics, The Ohio State University, Columbus, OH 43210 USA
| | - Suzanne A Maher
- Department of Biomechanics and Hospital for Special Surgery, New York, NY 10021 USA; Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021 USA
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Marigi EM, Till SE, Wasserburger JN, Reinholz AK, Krych AJ, Stuart MJ. Inside-Out Approach to Meniscus Repair: Still the Gold Standard? Curr Rev Musculoskelet Med 2022; 15:244-251. [PMID: 35489016 PMCID: PMC9276857 DOI: 10.1007/s12178-022-09764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date summary on the current literature and trends regarding use of the inside-out approach to meniscus repair. Additionally, the paper describes the authors preferred techniques for inside-out meniscus repair utilizing posteromedial and posterolateral exposures. RECENT FINDINGS There has been a substantial increase in recent publications regarding meniscus repair. However, comparisons regarding the optimal repair technique have not been conclusive. Despite the recent increase in use of all-inside devices, multiple investigations with short-to-mid-term follow-up have demonstrated similar rates of meniscus healing between inside-out and all-inside repair techniques. Similarly, current literature describes comparable failure rates of around 20%. There are variations in the profile of complications, with all-inside devices having more implant-related complications and inside-out techniques with higher neurovascular injuries. Inside-out meniscus repair is a versatile, cost-effective technique that remains the gold standard for management of most meniscus tear patterns. Through a thoughtful approach, efficient suture retrieval and repair can be performed while protecting critical neurovascular structures. All-inside meniscus repair devices have increased in popularity and surgeon access, but this technique is not without limitations and comparisons to inside-out meniscus repair demonstrates equivocal outcomes.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Jory N. Wasserburger
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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TRAN DATTRONG, JUANG YUNCHING, TSAI LIREN. Shock Response of Porcine Meniscus along with Axial and Radial Directions. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The meniscus is a multifunctional fibrocartilage tissue in the knee joint which stables joint movement, bears load and absorbs impact. Improper collisions will cause damage to meniscus tissue and lose its original functionality. However, it is difficult to fully evaluate the mechanical properties of the meniscus based on static test results alone. In this study, Split Hopkinson Pressure Bar (SHPB) and hydraulic material testing system (MTS) were utilized to examine the quasi-static and dynamic properties of the porcine meniscus along with two different orientations. The results showed that the meniscus is a strain rate sensitive material and its mechanical properties mainly depend on the orientation of collagen fiber bundles in the peripheral direction. The meniscus tissue did not show obvious yield characteristics under quasi-static test conditions. However, the meniscus showed clear yield behavior under dynamic loading. When the strain rate increased, the elastic modulus of the radial meniscus remained around 35 MPa while the elastic modulus of the axial meniscus increased from 30 MPa to 80 MPa. This study demonstrates that the meniscus is sensitive to strain rate at both dynamic and quasi-static conditions, and the meniscus is an anisotropic biological tissue.
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Affiliation(s)
- DAT TRONG TRAN
- Department of Mechanical Engineering, National Kaohsiung University of Science and Technology, 415 Jiangong Rd., Sanmin District, Kaohsiung City 807618, Taiwan, ROC
- School of Transportation Engineering, Hanoi University of Science and Technology, 1 Dai Co Viet Rd., Hai Ba Trung District, Hanoi City 11615, Vietnam
| | - YUN-CHING JUANG
- Department of Mechanical Engineering, National Kaohsiung University of Science and Technology, 415 Jiangong Rd., Sanmin District, Kaohsiung City 807618, Taiwan, ROC
| | - LIREN TSAI
- Department of Mechanical Engineering, National Kaohsiung University of Science and Technology, 415 Jiangong Rd., Sanmin District, Kaohsiung City 807618, Taiwan, ROC
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Srimongkolpitak S, Chernchujit B. Current concepts on meniscal repairs. J Clin Orthop Trauma 2022; 27:101810. [PMID: 35282657 PMCID: PMC8904242 DOI: 10.1016/j.jcot.2022.101810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
The specific meniscus injury pattern were divided into many patterns. Nowadays, the meniscus root injury, radial tear meniscus, bucket handle tear meniscus and Ramp lesion were particularly focused on many way to manage and still controversial a lot of issues. Meniscus root tears (MRTs) and Ramp lesion are the most ignored, or misdiagnosed causes of chronic knee pain. Most patients delayed seeking treatment, consequently resulting in cartilage loss, and leading to the condition progressing to osteoarthritis knee. This has resulted in the rate of MR and Ramp repair increase significantly. The bucket handle meniscus tear trend to strong saving the anatomical meniscus and avoid to menisectomy. This article, on the other hand, will reveal you how to save and secure a nearly native meniscus fixation. In case of the radial meniscus, the partial meniscectomy is still used to treat this type of injury today, but it does not prevent degenerative changes from occurring, which can lead to unfavorable outcomes. Meniscal repair is a popular procedure for treating radial tears as an alternative to surgery. However, this pattern of meniscus tear can be difficult to repair and has a high failure rate, the arthroscopic meniscus repair techniques are published.
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Affiliation(s)
- Surasak Srimongkolpitak
- Department of Orthopedic, Faculty of Medicine, Queen Savang Vadhana Memorial Hospital, 209 Jermjormpol Road, Si Racha District, Chon Buri Province, 20110, Thailand,Corresponding author.
| | - Bancha Chernchujit
- Department of Orthopedic, Faculty of Medicine, Thammasat University, Thailand
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Sukopp M, Schall F, Hacker SP, Ignatius A, Dürselen L, Seitz AM. Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review. Front Bioeng Biotechnol 2021; 9:765596. [PMID: 34926419 PMCID: PMC8681859 DOI: 10.3389/fbioe.2021.765596] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states. Methods: This review was conducted in accordance with the PRISMA guidelines. Studies were identified through a systematic literature search in Cochrane, PubMed and Web of Science databases. Literature was searched through pre-defined keywords and medical subject headings. Results: This review indicates a significant increase of up to 235% in peak CP when comparing healthy joints and intact menisci with impaired knee joints, injured or resected menisci. In addition, different test setups were indicated to have major influences on CP: The variety of test setups ranged from standard material testing machines, including customized setups via horizontal and vertical knee joint simulators, through to robotic systems. Differences in applied axial knee joint loads ranged from 0 N up to 2,700 N and resulted unsurprisingly in significantly different peak CPs of between 0.1 and 12.06 MPa. Conclusion: It was shown that untreated traumatic meniscal tears result in an increased CP. Surgical repair intervention were able to restore the CP comparable to the healthy, native condition. Test setup differences and particularly axial joint loading variability also led to major CP differences. In conclusion, when focusing on CP measurements in the knee joint, transparent and traceable in vitro testing conditions are essential to allow researchers to make a direct comparison between future biomechanical investigations.
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Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
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36
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Daszkiewicz K, Łuczkiewicz P. Biomechanics of the medial meniscus in the osteoarthritic knee joint. PeerJ 2021; 9:e12509. [PMID: 34900428 PMCID: PMC8627128 DOI: 10.7717/peerj.12509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Increased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus. Methods The finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone. Results The maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model. Conclusions Higher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.
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Affiliation(s)
- Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Department of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdańsk, Gdańsk, Poland
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Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models. Appl Bionics Biomech 2021; 2021:4931092. [PMID: 34777573 PMCID: PMC8580689 DOI: 10.1155/2021/4931092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
The assessment of the distribution of contact pressure on the meniscus is important in the elucidation of kinematics, etiology of joint diseases, and establishment of treatment methods. Compared with sensors widely used in recent years, pressure-sensitive conductive rubber sensors are easy to mold, flexible, durable, and resistant to shearing forces. This study is aimed at developing a rubber sensor for meniscal research and evaluating the pressure distribution after meniscal injury using porcine models. After confirming the reliability of the rubber sensor, contact pressure was obtained from the rubber sensor using the medial meniscus and femur of the porcine knee. Three test conditions of intact meniscus, radial tear, and meniscectomy were prepared, and a compressive load of 100 N was applied. After confirming the high reliability of the rubber sensor, the intact meniscus had the most uniform pressure distribution map, while the pressure in the meniscectomy model was concentrated in the resection region. The high-pressure region was significantly smaller in the intact group than in the radial tear models after 80 and 100 N (P < 0.05). The rubber sensor captured the pressure concentration specific to each examination group and was useful for evaluating the relationship between the pattern of meniscal injury and changes in the biomechanical condition of the knee.
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38
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Bansal S, Meadows KD, Miller LM, Saleh KS, Patel JM, Stoeckl BD, Lemmon EA, Hast MW, Zgonis MH, Scanzello CR, Elliott DM, Mauck RL. Six-Month Outcomes of Clinically Relevant Meniscal Injury in a Large-Animal Model. Orthop J Sports Med 2021; 9:23259671211035444. [PMID: 34796238 PMCID: PMC8593308 DOI: 10.1177/23259671211035444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The corrective procedures for meniscal injury are dependent on tear type, severity, and location. Vertical longitudinal tears are common in young and active individuals, but their natural progression and impact on osteoarthritis (OA) development are not known. Root tears are challenging and they often indicate poor outcomes, although the timing and mechanisms of initiation of joint dysfunction are poorly understood, particularly in large-animal and human models. PURPOSE/HYPOTHESIS In this study, vertical longitudinal and root tears were made in a large-animal model to determine the progression of joint-wide dysfunction. We hypothesized that OA onset and progression would depend on the extent of injury-based load disruption in the tissue, such that root tears would cause earlier and more severe changes to the joint. STUDY DESIGN Controlled laboratory study. METHODS Sham surgeries and procedures to create either vertical longitudinal or root tears were performed in juvenile Yucatan mini pigs through randomized and bilateral arthroscopic procedures. Animals were sacrificed at 1, 3, or 6 months after injury and assessed at the joint and tissue level for evidence of OA. Functional measures of joint load transfer, cartilage indentation mechanics, and meniscal tensile properties were performed, as well as histological evaluation of the cartilage, meniscus, and synovium. RESULTS Outcomes suggested a progressive and sustained degeneration of the knee joint and meniscus after root tear, as evidenced by histological analysis of the cartilage and meniscus. This occurred in spite of spontaneous reattachment of the root, suggesting that this reattachment did not fully restore the function of the native attachment. In contrast, the vertical longitudinal tear did not cause significant changes to the joint, with only mild differences compared with sham surgery at the 6-month time point. CONCLUSION Given that the root tear, which severs circumferential connectivity and load transfer, caused more intense OA compared with the circumferentially stable vertical longitudinal tear, our findings suggest that without timely and mechanically competent fixation, root tears may cause irreversible joint damage. CLINICAL RELEVANCE More generally, this new model can serve as a test bed for experimental surgical, scaffold-based, and small molecule-driven interventions after injury to prevent OA progression.
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Affiliation(s)
- Sonia Bansal
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle D. Meadows
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Liane M. Miller
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Kamiel S. Saleh
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Brendan D. Stoeckl
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Elisabeth A. Lemmon
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Michael W. Hast
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miltiadis H. Zgonis
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Carla R. Scanzello
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dawn M. Elliott
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Robert L. Mauck, PhD, Department of Orthopedic Surgery, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA 19104, USA () (Twitter: @MauckLab)
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Walczak BE, Miller K, Behun MA, Sienkiewicz L, Hartwig Stokes H, McCabe R, Baer GS. Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears. PLoS One 2021; 16:e0259678. [PMID: 34758053 PMCID: PMC8580232 DOI: 10.1371/journal.pone.0259678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022] Open
Abstract
Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.
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Affiliation(s)
- Brian E. Walczak
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kyle Miller
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Michael A. Behun
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Lisa Sienkiewicz
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Heather Hartwig Stokes
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Ron McCabe
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
| | - Geoffrey S. Baer
- Department of Orthopedics & Rehabilitation, Advancement of Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Wisconsin Institute of Medical Research (WIMR), University of Wisconsin-Madison, Madison, WI, United States of America
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40
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Shu L, Yamamoto K, Yoshizaki R, Yao J, Sato T, Sugita N. Multiscale finite element musculoskeletal model for intact knee dynamics. Comput Biol Med 2021; 141:105023. [PMID: 34772508 DOI: 10.1016/j.compbiomed.2021.105023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The dynamic characteristics of the intact knee joint are valuable for treating knee osteoarthritis and designing knee prostheses. However, it remains a challenge to elucidate the detailed dynamics of the knee due to its complexity of anatomical structure and complex interaction with body dynamics. METHODS In this study, a unique subject-specific musculoskeletal model with a concurrent high-accuracy intact finite element knee model was created and used to simultaneously evaluate the kinematics and mechanics of an intact knee joint during the gait cycle. RESULTS A medial pivot motion with external rotation, and a large parallel anterior translation were observed in the stance and swing phases, respectively, which is consistent with the in vivo fluoroscopy measurements. The maximum axial contact force on the knee joint, observed at 45% of the gait cycle, is approximately 2.89 times the body weight. The medial cartilage bears 65.7% of the total axial contact force. The results demonstrate that the cartilage-cartilage contact bears most of the joint load (62.5%) compared to the cartilage-meniscus-cartilage contact (37.5%). Regarding contact mechanics, the maximum contact pressure on both sides of the tibial cartilage (8.2 MPa) is almost similar to the first axial loading peak (14%) of the gait cycle. Additionally, the maximum contact pressure (6.01 MPa) was observed during the stance phase of the gait cycle on the patellofemoral joint. CONCLUSIONS The predicted results on the tibiofemoral and patellofemoral joints provide a theoretical basis for the treatment of knee joint diseases and knee prosthesis design. Moreover, this approach presents a comprehensive tool to evaluate the mechanics at both the body and tissue levels. Therefore, it has a high potential for application in human biomechanics.
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Affiliation(s)
- Liming Shu
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan.
| | - Ko Yamamoto
- Department of Mechano-Informatics, The University of Tokyo, Tokyo, Japan
| | - Reina Yoshizaki
- Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
| | - Jiang Yao
- Dassault Systemes Simulia Corp., Johnston, RI, USA
| | | | - Naohiko Sugita
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan; Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan
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41
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Kim-Wang SY, Holt AG, McGowan AM, Danyluk ST, Goode AP, Lau BC, Toth AP, Wittstein JR, DeFrate LE, Yi JS, McNulty AL. Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries. Arthritis Res Ther 2021; 23:280. [PMID: 34736523 PMCID: PMC8567695 DOI: 10.1186/s13075-021-02661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Abigail G Holt
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alyssa M McGowan
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA. .,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA. .,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
| | - John S Yi
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Department of Pathology, Duke University School of Medicine, Durham, NC, USA
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42
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Floyd ER, Rodriguez AN, Falaas KL, Carlson GB, Chahla J, Geeslin AG, LaPrade RF. The Natural History of Medial Meniscal Root Tears: A Biomechanical and Clinical Case Perspective. Front Bioeng Biotechnol 2021; 9:744065. [PMID: 34631684 PMCID: PMC8495066 DOI: 10.3389/fbioe.2021.744065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/09/2021] [Indexed: 01/21/2023] Open
Abstract
Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of degenerative disease. These injuries lead to an increase in average contact pressure in the medial compartment, along with increases in peak contact pressure and a decrease in contact area relative to the intact state. Loss of the root attachment impairs the function of the entire meniscus and leads to meniscal extrusion, thus impairing the force-dissipating role of the meniscus. Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repairs have been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA. In this study, the authors will describe the biomechanical basis of the natural history of medial meniscal root tears and will support the biomechanical studies with a case series including patients that either underwent non-operative treatment (5 patients) or non-anatomic repair of their medial meniscal root tears (6 patients). Using measurements derived from axial MRI, the authors will detail the distance from native root attachment center of the non-anatomic tunnels and discuss the ongoing symptoms of those patients. Imaging and OA progression among patients who were treated nonoperatively before presentation to the authors will be discussed as well. The case series thus presented will illustrate the natural history of meniscal root tears, the consequences of non-anatomic repair, and the findings of symptomatic meniscal extrusion associated with a non-anatomic repair position of the meniscus.
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Affiliation(s)
- Edward R Floyd
- University of North Dakota School of Medicine and Health Sciences/Sanford Orthopedics & Sports Medicine, Fargo, ND, United States
| | - Ariel N Rodriguez
- Twin Cities Orthopedics, Edina-Crosstown Surgery Center, Minneapolis, MN, United States.,Georgetown University School of Medicine, Washington, D.C., DC, United States
| | - Kari L Falaas
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - Gregory B Carlson
- Twin Cities Orthopedics, Edina-Crosstown Surgery Center, Minneapolis, MN, United States
| | - Jorge Chahla
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, IL, United States
| | - Andrew G Geeslin
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Robert F LaPrade
- Twin Cities Orthopedics, Edina-Crosstown Surgery Center, Minneapolis, MN, United States
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43
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Usefulness of ultrasonography for dynamic evaluation of medial meniscus hoop function in early knee osteoarthritis. Sci Rep 2021; 11:20091. [PMID: 34635735 PMCID: PMC8505604 DOI: 10.1038/s41598-021-99576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/23/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the dynamics of the medial meniscus during knee flexion–extension by ultrasonography and compare them with MRI findings to confirm the usefulness of ultrasonography for evaluating early knee osteoarthritis (KOA). In total, 100 patients were diagnosed with early KOA using clinical and radiographical findings. Dynamic ultrasonographic evaluation and MRI were performed in all patients. Medial meniscal extrusion (MME) and medial meniscal tears were evaluated via ultrasonography and MRI. Abnormal MME was defined as MME > 2 mm on ultrasonography during knee extension. Patients with abnormal MME were divided into two groups: a decrease group (group D) and a non-decrease group (group N). Age, sex, absence or type of meniscus tear, and MME were compared between the two groups. Of the 100 patients, 75 demonstrated MME > 2 mm at knee extension. MME at all assessment positions using ultrasonography and MRI were significantly greater in group N (n = 34) than that in group D (n = 41). Medial meniscus posterior root tears or radial tears were observed in most cases in group N. A lack of decrease in MME from 0° to 90° of flexion on ultrasonography was a characteristic finding in patients with a loss of meniscal hoop function.
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44
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Zhang S, Li H, Li H, Hua Y. Bone bridge fixation has superior biomechanics on posterior knees to bone plug fixation after lateral meniscal allograft transplantation - A biomechanical study simulating partial weight-bearing conditions. Knee 2021; 32:64-71. [PMID: 34419690 DOI: 10.1016/j.knee.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND It remains unknown how biomechanics change in posterior lateral knee using different fixation techniques in lateral meniscal allograft transplantation (MAT)during simulated toe-touch partial weight-bearing. This study aimed tocompare the biomechanical effects on posterior knee between bridgeand bone plug fixation in lateral MAT. METHODS Intact knee, bone bridge fixation, and bone plug fixation were tested with 500 N of axial load during knee flexion at 0°, 30°, and 60°, which simulated toe-touch partial weight-bearing. Contact area and peak pressure were assessed on posterior knee and the shift of peak pressure position were measured. RESULTS On the posterior lateral compartment, the contact mechanics of bone bridge fixation were similar to those of the intact knee (allP-values > 0.05), but its peak pressure was higher than that of intact knee at 60° (P = 0.002). For bone plug fixation, the contact area of the posterior lateral knee was significantly lower than those of intact knee and bone bridge fixation at 30° and 60° (allP-values < 0.05). The peak pressure of the posterior lateral knee was higher than that of the intact knee at all flexions and higher than that of bone bridge fixation at 30° and 60° (allP-values < 0.05). The peak pressure position of bone plug fixation shifted more laterally and posteriorly compared with intact knee and bone bridge fixation during knee flexion. CONCLUSION Bone bridges could maintain posterior knee biomechanics better than bone plug fixation during knee bending during partial weight-bearing.
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Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China.
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45
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Haber DB, Douglass BW, Arner JW, Miles JW, Peebles LA, Dornan GJ, Vidal AF, Provencher CMT. Biomechanical Analysis of Segmental Medial Meniscal Transplantation in a Human Cadaveric Model. Am J Sports Med 2021; 49:3279-3286. [PMID: 34494894 DOI: 10.1177/03635465211036441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation. PURPOSE To evaluate the effectiveness of segmental medial meniscal allograft transplantation in the setting of partial medial meniscectomy in restoring native knee loading characteristics. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human cadaveric knees underwent central midbody medial meniscectomy and subsequent segmental medial meniscal allograft transplantation. Knees were loaded in a dynamic tensile testing machine to 1000 N for 20 seconds at 0°, 30°, 60°, and 90° of flexion. Four conditions were tested: (1) intact medial meniscus, (2) deficient medial meniscus, (3) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures, and (4) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures and 1 suture fixed through 2 bone tunnels. Submeniscal medial and lateral pressure-mapping sensors assessed mean contact pressure, peak contact pressure, mean contact area, and pressure mapping. Two-factor random-intercepts linear mixed effects models compared pressure and contact area measurements among experimental conditions. RESULTS The meniscal-deficient state demonstrated a significantly higher mean contact pressure than all other testing conditions (mean difference, ≥0.35 MPa; P < .001 for all comparisons) and a significantly smaller total contact area as compared with all other testing conditions (mean difference, ≤140 mm2; P < .001 for all comparisons). There were no significant differences in mean contact pressure or total contact area among the intact, transplant, or transplant-with-tunnel groups or in any outcome measure across all comparisons in the lateral compartment. No significant differences existed in center of pressure and relative pressure distribution across testing conditions. CONCLUSION Segmental medial meniscal allograft transplantation restored the medial compartment mean contact pressure and mean contact area to values measured in the intact medial compartment. CLINICAL RELEVANCE Segmental medial meniscal transplantation may provide an alternative to full meniscal transplantation by addressing only the deficient portion of the meniscus with transplanted tissue. Additional work is required to validate long-term fixation strength and biologic integration.
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Affiliation(s)
- Daniel B Haber
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Justin W Arner
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Armando F Vidal
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Capt Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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46
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Chen T, Brial C, McCarthy M, Warren RF, Maher SA. Synthetic PVA Osteochondral Implants for the Knee Joint: Mechanical Characteristics During Simulated Gait. Am J Sports Med 2021; 49:2933-2941. [PMID: 34347534 PMCID: PMC9092221 DOI: 10.1177/03635465211028566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although polyvinyl alcohol (PVA) implants have been developed and used for the treatment of femoral osteochondral defects, their effect on joint contact mechanics during gait has not been assessed. PURPOSE/HYPOTHESIS The purpose was to quantify the contact mechanics during simulated gait of focal osteochondral femoral defects and synthetic PVA implants (10% and 20% by volume of PVA), with and without porous titanium (pTi) bases. It was hypothesized that PVA implants with a higher polymer content (and thus a higher modulus) combined with a pTi base would significantly improve defect-related knee joint contact mechanics. STUDY DESIGN Controlled laboratory study. METHODS Four cylindrical implants were manufactured: 10% PVA, 20% PVA, and 10% and 20% PVA disks mounted on a pTi base. Devices were implanted into 8 mm-diameter osteochondral defects created on the medial femoral condyles of 7 human cadaveric knees. Knees underwent simulated gait and contact stresses across the tibial plateau were recorded. Contact area, peak contact stress, the sum of stress in 3 regions of interest across the tibial plateau, and the distribution of stresses, as quantified by tracking the weighted center of contact stress throughout gait, were computed for all conditions. RESULTS An osteochondral defect caused a redistribution of contact stress across the plateau during simulated gait. Solid PVA implants did not improve contact mechanics, while the addition of a porous metal base led to significantly improved joint contact mechanics. Implants consisting of a 20% PVA disk mounted on a pTi base significantly improved the majority of contact mechanics parameters relative to the empty defect condition. CONCLUSION The information obtained using our cadaveric test system demonstrated the mechanical consequences of femoral focal osteochondral defects and provides biomechanical support to further pursue the efficacy of high-polymer-content PVA disks attached to a pTi base to improve contact mechanics. CLINICAL RELEVANCE As a range of solutions are explored for the treatment of osteochondral defects, our preclinical cadaveric testing model provides unique biomechanical evidence for the continued investigation of novel solutions for osteochondral defects.
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Affiliation(s)
- Tony Chen
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Caroline Brial
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Moira McCarthy
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Russell F. Warren
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Suzanne A. Maher
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
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Abstract
Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time. Surgical advances in operative techniques, modern instrumentation and biological enhancements collectively improve healing rates of meniscal repair. However, failed repair is not without consequences and can negative impact patient outcomes. Therefore, it is imperative for surgeons to have a thorough understanding of the vascular zones and biomechanical classifications of meniscal tears in order to best determine the most appropriate treatment.
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48
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Meniscus Repair Techniques. Sports Med Arthrosc Rev 2021; 29:e34-e43. [PMID: 34398120 DOI: 10.1097/jsa.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.
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Abstract
The meniscus has an important role in stabilizing the knee joint and protecting the articular cartilage from shear forces. Meniscus tears are common injuries and can disrupt these protective properties, leading to an increased risk of articular cartilage damage and eventual osteoarthritis. Certain tear patterns are often treated with arthroscopic partial meniscectomy, which can effectively relieve symptoms. However, removal of meniscal tissue can also diminish the ability of the meniscus to dissipate hoop stresses, resulting in altered biomechanics of the knee joint including increased contact pressures. This makes meniscal repair an important treatment consideration whenever possible. Understanding the incidence and mechanism of osteoarthritis development after arthroscopic partial meniscectomy as it relates to different tear morphologies and other treatment alternatives (ie, meniscus repair) is important to appropriately treat meniscus tears.
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50
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Kawata K, Koga H, Tsuji K, Miyatake K, Nakagawa Y, Yokota T, Sekiya I, Katagiri H. Extracellular vesicles derived from mesenchymal stromal cells mediate endogenous cell growth and migration via the CXCL5 and CXCL6/CXCR2 axes and repair menisci. Stem Cell Res Ther 2021; 12:414. [PMID: 34294118 PMCID: PMC8296733 DOI: 10.1186/s13287-021-02481-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) are promising candidates for tissue regeneration therapy. However, the therapeutic efficacy of MSC-EVs for meniscus regeneration is uncertain, and the mechanisms underlying MSC-EV-mediated tissue regeneration have not been fully elucidated. The aims of this study were to evaluate the therapeutic efficacy of intra-articular MSC-EV injection in a meniscus defect model and elucidate the mechanism underlying MSC-EV-mediated tissue regeneration via combined bioinformatic analyses. Methods MSC-EVs were isolated from human synovial MSC culture supernatants via ultrafiltration. To evaluate the meniscus regeneration ability, MSC-EVs were injected intra-articularly in the mouse meniscus defect model immediately after meniscus resection and weekly thereafter. After 1 and 3 weeks, their knees were excised for histological and immunohistochemical evaluations. To investigate the mechanisms through which MSC-EVs accelerate meniscus regeneration, cell growth, migration, and chondrogenesis assays were performed using treated and untreated chondrocytes and synovial MSCs with or without MSC-EVs. RNA sequencing assessed the gene expression profile of chondrocytes stimulated by MSC-EVs. Antagonists of the human chemokine CXCR2 receptor (SB265610) were used to determine the role of CXCR2 on chondrocyte cell growth and migration induced by MSC-EVs. Results In the meniscus defect model, MSC-EV injection accelerated meniscus regeneration and normalized the morphology and composition of the repaired tissue. MSC-EVs stimulated chondrocyte and synovial MSC cell growth and migration. RNA sequencing revealed that MSC-EVs induced 168 differentially expressed genes in the chondrocytes and significantly upregulated CXCL5 and CXCL6 in chondrocytes and synovial MSCs. Suppression of CXCL5 and CXCL6 and antagonism of the CXCR2 receptor binding CXCL5 and CXCL6 negated the influence of MSC-EVs on chondrocyte cell growth and migration. Conclusions Intra-articular MSC-EV administration repaired meniscus defects and augmented chondrocyte and synovial MSC cell growth and migration. Comprehensive transcriptome/RNA sequencing data confirmed that MSC-EVs upregulated CXCL5 and CXCL6 in chondrocytes and mediated the cell growth and migration of these cells via the CXCR2 axis. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02481-9.
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Affiliation(s)
- Kazumasa Kawata
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kunikazu Tsuji
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Orthopedics, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
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