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Liu X, Yang B, Liu C, Xin X. Factors associated with medial meniscal extrusion in non-osteoarthritic knees with medial meniscus tears: A cross-sectional study. PM R 2024. [PMID: 38511476 DOI: 10.1002/pmrj.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Medial meniscal extrusion (MME) plays an important role in the progression of knee osteoarthritis. Exploring the factors associated with MME in non-osteoarthritic knees may assist in the prevention of osteoarthritis. OBJECTIVE To identify the factors associated with pathologic MME in non-osteoarthritic knees with medial meniscus tears (MMTs). DESIGN A cross-sectional study. PARTICIPANTS One hundred fifty patients with non-osteoarthritic knees who underwent arthroscopic surgery for MMT. Patients were divided into a pathologic MME group (n = 54) and a control group (n = 96) based on whether a pathologic MME was present on magnetic resonance (MR) images. SETTING Tertiary medical institution. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The MME distance was measured on a coronal MR image obtained at the midpoint of the medial femoral condyle. An MME distance ≥3 mm was considered to indicate pathologic MME. Demographic and clinical data were collected as variables. Multivariable logistic regression analysis was performed to identify factors associated with pathologic MME. RESULTS After multivariable adjustment, body mass index (BMI) and the type of MMT were associated significantly with pathologic MME in the multivariable logistic regression model. Each unit higher in BMI was associated with a 13% higher risk of pathologic MME (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01-1.28, p = .04). The odds of pathologic MME were approximately four times and three times higher for radial tears (OR 4.34, 95% CI 1.25-15.03, p = .02) and complex tears (OR 3.07, 95% CI 1.17-8.05, p = .02) than for horizontal and longitudinal tears. CONCLUSIONS BMI and the type of MMT were independent factors associated with pathologic MME in non-osteoarthritic knees with MMT. A higher BMI, radial tears, and complex tears were predisposed to pathologic MME.
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Affiliation(s)
- Xinguang Liu
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Bin Yang
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Chen Liu
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Xing Xin
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
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Barreira F, Gomes E, Oliveira S, Valente C, Bastos R, Sánchez M, Andrade R, Espregueira-Mendes J. Meniscal extrusion in knees with and without osteoarticular pathology: A systematic review of normative values and cut-offs for diagnostic criteria. Knee 2023; 45:156-167. [PMID: 37925806 DOI: 10.1016/j.knee.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this systematic review was to compare diagnostic methods and summarize the data of medial and lateral meniscal extrusion in knees with and without osteoarticular pathology. METHODS This systematic review was conducted according to the PRISMA 2020 statement. Searches were conducted on PubMed, EMBASE and Cochrane databases to identify studies that measured meniscal extrusion using magnetic resonance imaging (MRI) or ultrasound (US). Meniscal extrusion data was summarized as weighted mean for medial and lateral meniscus, and stratified according to the method of measurement (MRI or US) and presence of knee osteoarticular pathology. RESULTS A total of 26 studies were included in this review. Weighted mean values of meniscal extrusion were always higher for the medial than the lateral meniscus, regardless of the method of measurement. The medial meniscus extrusion was always higher in knees with osteoarticular pathology than those without. For the lateral meniscus extrusion, the mean values were higher in those knees without osteoarticular pathology. When classifying pathological meniscal extrusion with pre-defined cut-off values, the higher the cut-off used, the lower the percentage of knees classified as pathological meniscal extrusion. CONCLUSIONS The medial meniscus presents on mean higher extrusion and extrusion is higher in knees with osteoarticular pathology. Based on summary data, the most suitable cut-offs for pathological meniscal extrusion for both MRI and US seem to fall within >2 and >3 mm.
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Affiliation(s)
| | - Eluana Gomes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
| | - Sofia Oliveira
- Center for MicroElectroMechanical Systems (CMEMS UMINHO), University of Minho, Azurém Campus, 4800-058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal
| | - Ricardo Bastos
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Mikel Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain; Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal
| | - João Espregueira-Mendes
- School of Medicine, University of Minho, Braga, Portugal; Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3B's Research Group Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal.
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Sekiya I, Katano H, Guermazi A, Miura Y, Okanouchi N, Tomita M, Masumoto J, Kitazume Y, Koga H, Ozeki N. Association of AI-determined Kellgren-Lawrence grade with medial meniscus extrusion and cartilage thickness by AI-based 3D MRI analysis in early knee osteoarthritis. Sci Rep 2023; 13:20093. [PMID: 37973855 PMCID: PMC10654518 DOI: 10.1038/s41598-023-46953-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
The associations among Kellgren-Lawrence (KL) grade, medial meniscus extrusion (MME), and cartilage thickness in knee osteoarthritis (OA) remain insufficiently understood. Our aim was to determine these associations in early to moderate medial tibiofemoral knee OA. We included 469 subjects with no lateral OA from the Kanagawa Knee Study. KL grade was assessed using artificial intelligence (AI) software. The MME was measured by MRI, and the cartilage thickness was evaluated in 18 subregions of the medial femorotibial joint by another AI system. The median MME width was 1.4 mm in KL0, 1.5 mm in KL1, 2.4 mm in KL2, and 6.0 mm in KL3. Cartilage thinning in the medial femur occurred in the anterior central subregion in KL1, expanded inwardly in KL2, and further expanded in KL3. Cartilage thinning in the medial tibia occurred in the anterior and middle external subregions in KL1, expanded into the anterior and middle central subregions in KL2, and further expanded in KL3. The absolute correlation coefficient between MME width and cartilage thickness increased as the KL grade increased in some subregions. This study provides novel insights into the early stages of knee OA and potentially has implications for the development of early intervention strategies.
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Affiliation(s)
- Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Yugo Miura
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriya Okanouchi
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Tomita
- School of Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan
| | | | - Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Pirri C, Stecco C, Güvener O, Mezian K, Ricci V, Jačisko J, Novotný T, Kara M, Chang KV, Dughbaj M, Jain NB, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee. Am J Phys Med Rehabil 2023; 102:e67-e72. [PMID: 36729007 DOI: 10.1097/phm.0000000000002173] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound examination of the knee is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of the daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
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Affiliation(s)
- Carmelo Pirri
- From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Department of Orthopaedics, University J.E. Purkinje, Masaryk Hospital, Usti nad Labem, Czech Republic (TN); Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey (MK, LÖ); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (K-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
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Dynamic response of medial meniscus extrusion to the lateral wedge insole is correlated with immediate pain reduction in knee osteoarthritis patients: real-time ultrasonographic study. J Med Ultrason (2001) 2022; 49:731-738. [PMID: 35790646 DOI: 10.1007/s10396-022-01234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the effect of lateral wedge insole (LWI) on medial meniscus extrusion (MME) observed during dynamic evaluation with ultrasound and its correlation with the alteration in knee pain in patients with knee osteoarthritis (OA). METHODS This cohort study included 25 participants with knee OA. The medial meniscus was imaged during walking in video mode using ultrasonography. The degree of increase in MME (ΔMME) was calculated as the difference in the value of the maximum and minimum MME. The intensity of knee pain was evaluated immediately after the walking trial using the visual analogue scale (VAS). These measurements were performed with and without the LWI. The participants were categorised into the responder group, which was identified by the constant reduction in the VAS, and the non-responder group. RESULTS MME, ΔMME, and knee pain during walking were significantly lower with the LWI than without the LWI (p < 0.01). The reduction in ΔMME with the LWI in the responder group was significantly higher than that in the non-responder group (p < 0.01). CONCLUSIONS Our findings showed that MME and knee pain during walking decreased with LWI use, especially in patients whose reduction in knee pain was characterised by inhibition in the increase in MME observed during dynamic evaluation with ultrasound.
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