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Martinkėnienė VB, Austys D, Šaikus A, Brazaitis A, Bernotavičius G, Makulavičius A, Sveikata T, Verkauskas G. Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?-A Prospective Comparative Cohort Study. Clin Pract 2024; 14:602-613. [PMID: 38666805 PMCID: PMC11049170 DOI: 10.3390/clinpract14020047] [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: 02/25/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. METHODS A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. RESULTS MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. CONCLUSIONS To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.
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Affiliation(s)
- Viktorija Brogaitė Martinkėnienė
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania
| | - Donatas Austys
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Andrius Šaikus
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania
| | - Andrius Brazaitis
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Giedrius Bernotavičius
- Department of Children’s Orthopedics and Traumatology, Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania
- Clinic of Gastroenterology, Nefrourology and Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Aleksas Makulavičius
- Clinic of Rheumatology, Orthopaedics, Traumatology and Reconstructive Surgery, Faculty of Medicine Vilnius University, LT-03101 Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics, Traumatology and Reconstructive Surgery, Faculty of Medicine Vilnius University, LT-03101 Vilnius, Lithuania
| | - Gilvydas Verkauskas
- Clinic of Gastroenterology, Nefrourology and Surgery, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
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Chiba D, Yamamoto Y, Kimura Y, Sasaki E, Sasaki S, Tsuda E, Ishibashi Y. Association Between MRI Signal Intensity of the Repaired Lateral Meniscus and Residual Anterolateral Knee Laxity After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241241821. [PMID: 38628462 PMCID: PMC11020732 DOI: 10.1177/23259671241241821] [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] [Received: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 04/19/2024] Open
Abstract
Background Anterolateral knee laxity (ALLx) has been linked to tears of the lateral meniscus (LM) and anterior cruciate ligament (ACL) injury. Purpose To investigate the longitudinal relationship between the signal intensity (SI) of the repaired LM on magnetic resonance imaging (MRI) and residual ALLx after ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Included were 87 patients who underwent double-bundle ACLR and lateral meniscal repair (mean age, 23.5 years; body mass index, 23.7 kg/m2; 56 women) at a single institution between 2010 and 2019. Proton density-weighted (PDW) and T2-weighted (T2W) MRI was performed at 3, 6, and 12 months postoperatively, and the SI ratio (SIR) was calculated as (SI of the repaired LM)/(SI of the posterior cruciate ligament). At the 12-month follow-up, ALLx was evaluated using the pivot-shift test; an International Knee Documentation Committee grade ≥1 indicated residual ALLx. Results Overall, 12 patients (13.8%) exhibited ALLx at 12 months postoperatively. At 3 months postoperatively, the SIR on PDW images (SIR-PDW) was significantly higher in patients with ALLx versus those without ALLx (1.98 ± 0.77 vs 1.49 ± 0.52, respectively; P = .007); there was no difference in the SIR on T2W images between the groups. SIR-PDW at 3 months postoperatively was correlated negatively with patient age (r = -0.308, P = .004). When patients were stratified into a younger (≤22 years; n = 53; ALLx = 7 [13.2%]) and an older (>22 years; n = 34; ALLx = 5 [14.7%]) group, the area under the receiver operating characteristic curves (AUCs) for SIR-PDW in the younger group were statistically significant for predicting the prevalence of ALLx at all follow-up times (AUCs, 0.733-0.788) with optimal cutoff values of 2.00 at 3 months, 1.50 at 6 months, and 1.50 at 12 months. Logistic regression analysis revealed that if younger patients consistently had higher SIR-PDW values than the cutoff values, they were more likely to have residual ALLx (odds ratios, 10.24-23.57). Conclusion For younger patients who underwent both ACLR and lateral meniscal repair, higher MRI SI of the repaired LM was associated with a higher prevalence of residual ALLx.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Schwach M, Grange S, Klasan A, Putnis S, Philippot R, Neri T. MRI Criteria for Healing at 1 Year After Repair of a Traumatic Meniscal Tear. Am J Sports Med 2023; 51:3693-3700. [PMID: 37960860 DOI: 10.1177/03635465231207838] [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] [Indexed: 11/15/2023]
Abstract
BACKGROUND Meniscal repair for a traumatic meniscal tear is increasingly used to preserve the meniscus. Interpreting postoperative magnetic resonance imaging (MRI) scans remains challenging, especially in symptomatic patients. There is a lack of reliable MRI criteria to affirm the healed character of a traumatic meniscal injury repair. PURPOSE To identify relevant MRI criteria for meniscal healing after meniscal repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively included all patients with a traumatic meniscal injury who underwent either an isolated meniscal repair or a repair during a concomitant anterior cruciate ligament reconstruction. A standardized preoperative and postoperative clinical evaluation was performed, along with collection of functional scores-Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, Lysholm Score, and 36-Item Short Form Health Survey. An MRI scan was performed 1 year postoperatively and compared with the preoperative MRI scan. The following MRI aspects were analyzed: variation of morphology and fat-saturated (FS) T2 intensity signal and pre- and postoperative tear diastasis measurement. RESULTS Fifty patients (age, mean ± SD, 28.7 ± 8.5 years [range, 16-45 years]) who were 1 year postoperative were included. All patients were considered clinically healed had the same MRI characteristics. A signal change (FS T2) was observed from a high signal intensity fluid to a nonfluid moderate signal intensity. The morphology of the lesion was more complex: from the initial lesion, line ramifications appeared, creating the appearance of tree branches. The tear diastasis decreased (from 2.3 ± 0.5 mm [range, 1.3-3.5] to 1.1 ± 0.28 mm [range, 0.5-1.5]). CONCLUSION MRI criteria confirming meniscal healing after traumatic meniscal repair at 1 year were identified: a change in the intrameniscal signal becoming nonfluid and moderate in intensity; a reduction in tear diastasis to <1.5 mm; and a change in the signal morphology of the repaired meniscus.
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Affiliation(s)
- Maxime Schwach
- Orthopedic Surgery and Traumatology Department, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint Etienne, France
| | | | - Sven Putnis
- Avon Orthopedic Center, Southmead Hospital, Bristol, UK
| | - Rémi Philippot
- Orthopedic Surgery and Traumatology Department, University Hospital of Saint-Etienne, Saint Etienne, France
- Laboratory of Human Movement Biology, University of Lyon, University Jean Monnet, Saint Etienne, France
| | - Thomas Neri
- Orthopedic Surgery and Traumatology Department, University Hospital of Saint-Etienne, Saint Etienne, France
- Laboratory of Human Movement Biology, University of Lyon, University Jean Monnet, Saint Etienne, France
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Kim SH, Min K, Kim KI, Lee SH. Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size. Orthop J Sports Med 2023; 11:23259671231167535. [PMID: 37655242 PMCID: PMC10467388 DOI: 10.1177/23259671231167535] [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] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Arthroscopic repair of longitudinal tears in the medial meniscal posterior horn (MMPH) has been reported to result in high rates of meniscal healing when performed alongside anterior cruciate ligament reconstruction (ACLR). However, studies that have focused on longitudinal tears and their impact on clinical outcomes after arthroscopic repair are insufficient. Purpose To investigate the clinical outcome and healing status after concomitant arthroscopic ACLR and repair of MMPH peripheral longitudinal tears, with respect to the tear length. Study Design Cohort study; Level of evidence, 3. Methods A total of 263 patients who underwent concurrent arthroscopic suture repair of longitudinal tears of the MMPH and ACLR were enrolled. All patients had 2-year postoperative magnetic resonance imaging (MRI) evaluations, and 61% of patients underwent a second-look arthroscopy. The exclusion criteria were partial meniscectomies and multiligament injuries. Patients were assessed pre- and postoperatively for clinical scores, amount of anterior translation, grade of pivot shift, and presence of meniscal tear extension. According to the length of longitudinal tears, patients were classified into 2 groups: (1) patients with tears that were located in the posterior compartment and (2) patients with tears that extended to the midbody of the meniscus. Binary stepwise logistic regression analysis was used to evaluate the risk factors for unhealed menisci as identified by MRI. Results A total of 83 patients were included in this study-52 patients (group 1) had MMPH tears without tear extension and 31 patients (group 2) had MMPH tears with tear extension. There were no differences in outcomes between the groups, including the healing rate after meniscal repair (P > .05). Based on postoperative MRI scans, 67 patients (80.7%) were categorized as completely healed and 16 patients (19.3%) as unhealed. There were no significant differences between the completely healed and unhealed groups in outcomes or the rate of preoperative midbody tear extension. Higher body mass index and lower preoperative Lysholm scores were identified as risk factors for unhealed menisci. Conclusion Overall, the rate of complete healing of MMPH tears repaired concomitantly with ACLR was 80.7% (67/83), and midbody tear extension did not affect the healing rate of the repaired meniscus. Results indicate that suture repair for unstable MMPH tears should be considered regardless of tear size.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyeonguk Min
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Dai W, Leng X, Wang J, Hu X, Ao Y. Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211038289. [PMID: 34708138 PMCID: PMC8543730 DOI: 10.1177/23259671211038289] [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] [Received: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Evaluation of meniscal healing status after repair is important, as it allows
the surgeon to inform patients whether they can increase their activities or
return to sports. Purpose: To identify the healing rates after arthroscopic repair of meniscal tears via
second-look arthroscopic evaluation. Study Design: Systematic review; Level of evidence, 4. Methods: Searches of PubMed, Embase, Scopus, and the Cochrane databases were conducted
to identify relevant studies published before June 1, 2020. Studies were
eligible for this meta-analysis if they provided data regarding healing
status of the meniscus at second-look arthroscopy. Random-effects
meta-analyses were generated to provide pooled meniscal healing estimates.
We further performed subgroup analysis to investigate the healing rates of
the meniscus under different situations. Results: A total of 41 studies with 1908 individuals were included in the study. The
pooled analysis showed the complete healing rate was 74% (95% confidence
interval [CI], 67%-80%), the partial healing rate was 10% (95% CI, 6%-16%),
and the failure rate was 12% (95% CI, 10%-15%) for arthroscopic repair of
meniscal tears via second-look arthroscopic evaluation. Sensitivity analysis
demonstrated that no individual study affected the overall healing rate by
>1%. Subgroup analysis found higher meniscal healing rates in patients
with the following characteristics: age <40 years, male, body mass index
<26, red-red tear location, tear in posterior horn, vertical tear,
outside-in technique, repair concomitant with anterior cruciate ligament
reconstruction, weight-restricted rehabilitation, and time interval from
meniscal repair to second-look arthroscopy >12 months. Conclusion: In this systematic review, the complete healing rate was 74%, the partial
healing rate was 10%, and the failure rate was 12% for arthroscopic repair
of meniscal tears via second-look arthroscopic evaluation.
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Affiliation(s)
- Wenli Dai
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xi Leng
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Jian Wang
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, People's Republic of China
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Safaei M, Bolus NB, Whittingslow DC, Jeong HK, Erturk A, Inan OT. Vibration Stimulation as a Non-Invasive Approach to Monitor the Severity of Meniscus Tears. IEEE Trans Neural Syst Rehabil Eng 2021; 29:350-359. [PMID: 33428572 DOI: 10.1109/tnsre.2021.3050439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Musculoskeletal disorders and injuries are one of the most prevalent medical conditions across age groups. Due to a high load-bearing function, the knee is particularly susceptible to injuries such as meniscus tears. Imaging techniques are commonly used to assess meniscus injuries, though this approach suffers from limitations including high cost, need for skilled personnel, and confinement to laboratory or clinical settings. Vibration-based structural monitoring methods in the form of acoustic emission analysis and vibration stimulation have the potential to address the limits associated with current diagnostic technologies. In this study, an active vibration measurement technique is employed to investigate the presence and severity of meniscus tear in cadaver limbs. In a highly controlled ex vivo experimental design, a series of cadaver knees (n =6) were evaluated under an external vibration, and the frequency response of the joint was analyzed to differentiate the intact and affected samples. Four stages of knee integrity were considered: baseline, sham surgery, meniscus tear, and meniscectomy. Analyzing the frequency response of injured legs showed significant changes compared to the baseline and sham stages at selected frequency bandwidths. Furthermore, a qualitative analytical model of the knee was developed based on the Euler-Bernoulli beam theory representing the meniscus tear as a change in the local stiffness of the system. Similar trends in frequency response modulation were observed in the experimental results and analytical model. These findings serve as a foundation for further development of wearable devices for detection and grading of meniscus tear and for improving our understanding of the physiological effects of injuries on the vibration characteristics of the knee. Such systems can also aid in quantifying rehabilitation progress following reconstructive surgery and / or during physical therapy.
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