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Ibañez M, Hoffmann F, Mouton C, Seil R. Horizontal Cleavage Meniscus Tear: "The Quad Tendon Augmentation Technique". Arthrosc Tech 2024; 13:102977. [PMID: 39036403 PMCID: PMC11258872 DOI: 10.1016/j.eats.2024.102977] [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: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
The management of medial meniscus horizontal cleavage tears can be challenging. Currently, several treatment options, including nonoperative and surgical options, have been proposed in the literature. Different repair techniques aiming to promote the healing process have been reported and have shown good outcomes. However, recurrent parameniscal cysts and decreased meniscal volume have also been reported. In this Technical Note, a novel surgical technique to repair a horizontal cleavage tear of the posterior horn of the medial meniscus is reported in young patients. The technique uses a strip of autologous quadriceps tendon to fill the void between the upper and lower meniscal leaflets followed by an all-inside compression suture. Both of these technical features aim to overcome the limitations of current repair techniques.
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Affiliation(s)
- Maximiliano Ibañez
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Hoffmann
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg
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Joshi A, Basukala B, Sharma R, Singh N, Bista R, Pradhan I. Semitendinosus Autograft Transplant for Medial Meniscus. Arthrosc Tech 2024; 13:102862. [PMID: 38435257 PMCID: PMC10907936 DOI: 10.1016/j.eats.2023.10.005] [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: 08/19/2023] [Accepted: 10/08/2023] [Indexed: 03/05/2024] Open
Abstract
Treatment of meniscal tears has evolved over the last few decades, and preservation has now become the gold standard of treatment. Advancements in repair technique have extended the indication of repair. However, meniscectomy has to be performed in some situations. In these situations, meniscal allograft transplantation is considered the gold standard. But allografts are not available in every part of the world. Collagen implants and synthetic polymers are also advocated. But again, its limited research, availability, and high cost have restricted its widespread use. Many authors have advocated autograft transplantation, but there are no long-term results, and there is a lack of uniform surgical techniques. There is a technique described for lateral meniscus, but a medial meniscus autograft transplant technique is not very well elaborated. In this report, we aimed to describe a medial meniscus replacement technique using a hamstring autograft.
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Affiliation(s)
- Amit Joshi
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
| | - Bibek Basukala
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
| | - Rajiv Sharma
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
| | - Nagmani Singh
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
| | - Rohit Bista
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
| | - Ishor Pradhan
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko Lalitpur, Nepal
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Uchio Y, Takuwa H, Wakatsuki T, Kuwata S. Meniscal Allograft Transplantation Concomitant With Cartilage Repair for Symptomatic Lateral Meniscus-Deficient Knees With Over Two Years of Follow-up. Cureus 2023; 15:e48774. [PMID: 38024091 PMCID: PMC10644150 DOI: 10.7759/cureus.48774] [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] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective The treatment for symptomatic meniscus-deficient knees with cartilage defects remains challenging on account of insufficient meniscal substitutes. One solution for this might involve combining meniscal allograft transplantation (MAT) and cartilage repair. In this study, we aimed to analyze the effectiveness and safety of MAT concomitant with cartilage repair for symptomatic lateral meniscus-deficient knees in a setting with limited availability of meniscal transplants in Japan. Methods Nine patients who underwent MAT concomitant with osteochondral transplantation (five) and/or autologous chondrocyte implantations (seven) were followed up for at least two years (mean: 51.2 months, range: 24-84 months). Their demographic data and other characteristics were as follows - mean age: 51.7 years, range: 36-67 years; men/women: 4/5; cause: trauma/discoid meniscus: 8/1; cartilage defect size: mean: 6.7 cm2/knee, range: 1.0-11.3. The effectiveness and safety were evaluated clinically by using the Lysholm Knee Scoring Scale (LKSS) and Japanese Orthopaedic Association (JOA) knee score, physical examination, X-rays, and MRI preoperatively and at one, 12, and 24 months after the implantation. Differences between the variables were analyzed using the Friedman test and Scheffe's multiple comparisons. Results The median LKSS and JOA scores significantly improved from 70 points (range: 21-80) and 35 (25-45) preoperatively to 86.5 (65-98) and 87.5 (80-95) at 24 months after surgery, respectively (p<0.001, p=0.0013). The range of motion (ROM), femorotibial angle, and the lateral joint space showed no significant changes. However, lateral meniscal extrusions (LMEs) increased by 3.0 mm (range: 0-6.3 mm) at one month postoperatively and remained unchanged until two years postoperatively. Treatment failure occurred in one case, which was revised by total knee arthroplasty (TKA) at 18 months postoperatively. Additional surgeries were needed in some cases: lateral meniscal tear (three cases), contracture (two cases), and patellar instability (one case). However, neither infection nor allergic reaction was observed in the blood exams. Conclusions Although MAT concomitant with cartilage repair showed good clinical outcomes, half of the cases needed additional surgeries. Based on our findings, this technique should be adopted only in select cases and performed by a handful of highly experienced surgeons.
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Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Hiroshi Takuwa
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Takuya Wakatsuki
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Suguru Kuwata
- Department of Orthopaedic Surgery, National Hospital Organization Hamada Medical Center, Hamada, JPN
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Yang L, Chiu CH, Hsu KY, Chuang CA, Chen ACY, Chan YS, Yang CP. Using Single Peroneal Longus Tendon Graft for Segmental Meniscus Transplantation and Revision Anterior Cruciate Ligament Combined Anterolateral Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1497. [PMID: 37629787 PMCID: PMC10456414 DOI: 10.3390/medicina59081497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency.
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Affiliation(s)
- Ling Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Keelung 204, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
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Sukopp M, Shemesh M, Pruech E, Linder-Ganz E, Hacker S, Condello V, Schwer J, Ignatius A, Dürselen L, Seitz AM. Free-floating medial meniscus implant kinematics do not change after simulation of medial open-wedge high tibial osteotomy and notchplasty. J Exp Orthop 2023; 10:13. [PMID: 36757624 PMCID: PMC9911568 DOI: 10.1186/s40634-023-00576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states. METHODS A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis. RESULTS The maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics. CONCLUSIONS The results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future.
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Affiliation(s)
- Matthias Sukopp
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Maoz Shemesh
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Elena Pruech
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Eran Linder-Ganz
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Scott Hacker
- Grossmont Orthopedic Medical Group, 5565 Grossmont Center Drive, Building 3, Suite 256, La Mesa, CA USA
| | - Vincenzo Condello
- grid.500617.5Humanitas Castelli Clinic, Via Mazzini, 11, Bergamo, Italy
| | - Jonas Schwer
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Anita Ignatius
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Lutz Dürselen
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081, Ulm, Germany.
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Autologous semitendinosus meniscus graft significantly improves knee joint kinematics and the tibiofemoral contact after complete lateral meniscectomy. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07300-z. [PMID: 36604322 DOI: 10.1007/s00167-022-07300-z] [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: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate the potential of a doubled semitendinosus (ST) and a single gracilis tendon (GT) lateral meniscus autograft to restore the knee joint kinematics and tibiofemoral contact after total lateral meniscectomy (LMM). METHODS Fourteen human knee joints were tested intact, after LMM and after ST and GT meniscus autograft treatment under an axial load of 200 N during full range of motion (0°-120°) and four randomised loading situations: without external moments, external rotation, valgus stress and a combination of external rotation and valgus stress using a knee joint simulator. Non-parametric statistical analyses were performed on joint kinematics and on the tibiofemoral contact mechanics. RESULTS LMM led to significant rotational instability of the knee joints (p < 0.02), which was significantly improved after ST autograft application (p < 0.04), except for knee joint flexions > 60°. The GT autograft failed to restore the joint kinematics. LMM significantly increased the tibiofemoral contact pressure (p < 0.03), while decreasing the contact area (p < 0.05). The ST autograft was able to restore the contact mechanics after LMM (p < 0.02), while the GT replacement displayed only an improvement trend. CONCLUSION The doubled ST lateral meniscus autograft improved the knee joint kinematics significantly and restored the tibiofemoral contact mechanics almost comparable to the native situation. Thus, from a biomechanical point of view, ST meniscus autografts might be a potential treatment alternative for patients who are indicated for meniscus allograft transplantation.
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Nishino K, Hashimoto Y, Nishida Y, Orita K, Takigami J, Nakamura H. Transplantation of Parathyroid Hormone-Treated Achilles Tendon Promotes Meniscal Regeneration in a Rat Meniscal Defect Model. Am J Sports Med 2022; 50:3102-3111. [PMID: 35914290 DOI: 10.1177/03635465221112954] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous tendon grafts are used for meniscal reconstruction of surgically removed knee joint meniscus. However, as meniscal reconstruction cannot prevent the progression of cartilage degeneration, additional procedures that confer meniscus-like histological properties to the transplanted tendon are required for improved outcomes. HYPOTHESES Parathyroid hormone (PTH)(1-34) induces cartilage formation in the rat tendon, and transplantation of PTH-treated tendon promotes meniscal regeneration. STUDY DESIGN Controlled laboratory study. METHODS Rat Achilles tendon-derived cells were cultured with or without PTH for 28 days and stained with Alcian blue to determine chondrogenic differentiation. After 14 and 28 days of incubation, gene expression was assessed using quantitative real-time polymerase chain reaction. In an in vivo study, rat Achilles tendon was injected with PTH and then transplanted onto a medial meniscal defect. Macroscopic and histological assessments of the regenerated meniscus and of cartilage degeneration in the tibial plateau were performed at 4 and 8 weeks after surgery. RESULTS In vitro, PTH-treated cells showed better staining with Alcian blue than the control (normal medium) group. PTH1R, Col2a1, Sox9, and RUNX2 were significantly upregulated in PTH-treated cells (P < .05). Macroscopically, the in vivo results revealed more prominent meniscal coverage and lesser progression of articular cartilage degeneration in the PTH group than in the phosphate-buffered saline-injected group. Histologically, toluidine blue staining revealed metachromasia in the PTH-injected tissue at 4 and 8 weeks. The PTH-treated regenerated meniscus showed positive immunostaining for type II collagen in the area exhibiting metachromasia. Moreover, PTH-treated tendon had an enhanced histological score compared with the untreated group at 4 and 8 weeks (P < .05). CONCLUSION PTH(1-34) induced cartilage formation in the rat tendon. Transplantation of PTH(1-34)-treated Achilles tendon in a rat meniscal defect model induced meniscal regeneration and preserved knee articular cartilage. Macroscopically, PTH groups showed a greater coverage of the regenerated meniscus. Histologically, the regenerated meniscus had higher cartilaginous matrix content in rats transplanted with PTH-treated tendons. PTH(1-34) stimulated tendon-derived cells to promote chondrogenic differentiation. CLINICAL RELEVANCE Meniscal transplantation using PTH-injected autologous tendon grafts might promote meniscal regeneration and prevent progression of cartilage degeneration by stimulating chondrogenic differentiation of tendon-derived cells.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kumi Orita
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Ozeki N, Koga H, Sekiya I. Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment. Life (Basel) 2022; 12:603. [PMID: 35455094 PMCID: PMC9032096 DOI: 10.3390/life12040603] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, 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;
| | - 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;
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