1
|
Iglesias-Chamorro P, Pérez-Bellmunt A, Ortiz-Miguel S, Möller I, Blasi J, Ortiz-Sagristà J, Martinoli C, Sanjuan X, Miguel-Pérez M. What Is New about the Semimembranosus Distal Tendon? Ultrasound, Anatomical, and Histological Study with Clinical and Therapeutic Application. Life (Basel) 2024; 14:631. [PMID: 38792649 PMCID: PMC11122743 DOI: 10.3390/life14050631] [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: 04/17/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
The semimembranosus muscle inserts into several tendons that are associated with some pathologies. Although ultrasound is useful for studying, diagnosing, and managing these pathologies, the correct interpretation of any images requires a clear knowledge of the related anatomical structures and the inter-related functions. We studied 38 cryopreserved non-paired knees from adult anatomical specimens and 4 non-paired knees from 29 to 38-week-old fetuses. The semimembranosus muscle and its tendons were located, observed, and injected under ultrasound guidance. The macroscopic anatomy was studied using dissection and anatomical cuts and the tendons were analyzed histologically. Measurements of muscle were taken 10 cm from the medial epicondyle and just before the tendon divided. The ultrasound facilitated the identification of the different divisions of the tendon of semimembranosus muscle and the rotation of the muscle and tendon from medial to posterior. An anatomical study confirmed this rotation and revealed an average width, thickness, and diameter of 38.29 mm, 14.36 mm, and 112.64 mm, respectively. Important relationships were observed between the divisions of the main tendons and the medial collateral ligament, the posterior side of the knee and popliteus muscle. This information can help to explain knee pathologies and facilitate rehabilitation after surgery.
Collapse
Affiliation(s)
- Pere Iglesias-Chamorro
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (P.I.-C.); (I.M.)
| | - Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08190 Barcelona, Spain; (A.P.-B.); (S.O.-M.)
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08190 Barcelona, Spain
| | - Sara Ortiz-Miguel
- Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08190 Barcelona, Spain; (A.P.-B.); (S.O.-M.)
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08190 Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Surgery and Medical-Surgical Specialities, Faculty of Medicine and Health Sciences (Clinic Campus), University of Barcelona, 08036 Barcelona, Spain
| | - Ingrid Möller
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (P.I.-C.); (I.M.)
| | - Juan Blasi
- Unity of Histology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Barcelona, Spain;
| | | | - Carlo Martinoli
- Department of Health Sciences, Università di Genova, Via Antonio Pastore 1, 16132 Genova, Italy;
| | - Xavier Sanjuan
- Unit of Pathological Anatomy, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Barcelona, Spain;
| | - Maribel Miguel-Pérez
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (P.I.-C.); (I.M.)
| |
Collapse
|
2
|
Gunadham U, Woratanarat P. Effect of knee bracing on clinical outcomes following anterior cruciate ligament reconstruction: A prospective randomised controlled study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:18-23. [PMID: 38406661 PMCID: PMC10891282 DOI: 10.1016/j.asmart.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives While there is a consensus against bracing after anterior cruciate ligament (ACL) reconstruction, the question of its potential benefits, especially in cases involving meniscus repair, as well as its routine use by the majority of clinicians, remains a topic of debate. This study aims to assess the effectiveness of bracing in relation to clinical scores after ACL reconstruction, regardless of meniscus surgery. Methods This randomised controlled study involved patients aged 15-55 years who underwent arthroscopic ACL reconstruction surgery. All eligible patients were assigned into two groups: one group received an adjustable frame with a four-point fixation knee brace for a four-week period, while the other did not.A single experienced surgeon performed standard anatomical single-bundle ACL reconstruction. All patients, irrespective of whether they underwent meniscus repair, followed the same rehabilitation protocol. Knee functional questionnaires, including the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner Activity Scale, Visual Analogue Scale (VAS), and examinations, were collected preoperatively, at six months, one year, and two years postoperatively. The study employed an intention-to-treat analysis and multilevel mixed-effects generalised linear models to compare continuous outcomes between the groups, adjusting for the times of follow-up. Results A total of 84 patients (42 patients per group) comprised of 75 males (89 %) and average age of 30 ± 9.4 years old. Patient-reported function, physical examination findings, and surgical characteristics were comparable between the two groups. (P-value >0.05) Both groups demonstrated significant improvement in IKDC and Lysholm scores at the end of the two-year follow-up period. (P-value <0.0001) In multivariate analysis, bracing was significantly associated with lower Tegner activity scale than the non-brace group after adjustment for VAS and time (coefficient -0.49, 95 % confidence interval -0.87, -0.10, P-value = 0.013). None of the graft ruptures were reported, and there was no significant difference of return to sports between the groups at the end of the follow-up. Conclusion The study suggests that knee bracing after ACL reconstruction, regardless of any additional meniscus procedures, fails to enhance subjective or objective outcomes and could potentially have a negative impact on the Tegner activity scale, although the difference is not clinically significant. The routine use of a postoperative brace should be discontinued. Level of evidence Level I, Randomised controlled trial with no negative criteria.
Collapse
Affiliation(s)
- Ukris Gunadham
- Department of Orthopaedics, Trang Regional Hospital, Trang, 92000, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Bangkok, 10400, Thailand
| |
Collapse
|
3
|
Cong T, Reddy RP, Hall AJ, Ernazarov A, Gladstone J. Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine. Orthop J Sports Med 2024; 12:23259671231226134. [PMID: 38639001 PMCID: PMC11025434 DOI: 10.1177/23259671231226134] [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: 05/25/2023] [Accepted: 07/31/2023] [Indexed: 04/20/2024] Open
Abstract
Background There is no consensus among sports medicine surgeons in North America on postoperative rehabilitation strategy after meniscus repair. Various meniscal tear types may necessitate a unique range of motion (ROM) and weightbearing rehabilitation protocol. Purpose To assess the current landscape of how sports medicine practitioners in the American Orthopedic Society for Sports Medicine (AOSSM) rehabilitate patients after the repair of varying meniscal tears. Study Design Cross-sectional study. Methods A survey was distributed to 2973 AOSSM members by email. Participants reviewed arthroscopic images and brief patient history from 6 deidentified cases of meniscus repair-in cases 1 to 3, the tears retained hoop integrity (more stable repair), and in cases 4 to 6, the tear patterns represented a loss of hoop integrity. Cases were shuffled before the presentation. For each case, providers were asked at what postoperative time point they would permit (1) partial weightbearing (PWB), (2) full weightbearing (FWB), (3) full ROM, and (4) ROM allowed immediately after surgery. Results In total, 451 surveys were completed (15.2% response). The times to PWB and FWB in cases 1 to 3 (median, 0 and 4 weeks, respectively) were significantly lower than those in cases 4 to 6 (median, 4 and 6 weeks, respectively) (P < .001). In tears with retained hoop integrity, the median time to PWB was immediately after surgery, whereas in tears without hoop integrity, the median time to PWB was at 4 weeks postoperatively. Similarly, the median time to FWB in each tear with retained hoop integrity was 4 weeks after surgery, while it was 6 weeks in each tear without hoop integrity. However, regardless of tear type, most providers (67.1%) allowed 0° to 90° of ROM immediately after surgery and allowed full ROM at 6 weeks. Most providers (83.3%) braced the knee after repair regardless of hoop integrity and utilized synovial rasping/trephination with notch microfracture-a much lower proportion of providers utilized biologic augmentation (9%). Conclusion Sports medicine practitioners in the AOSSM rehabilitated meniscal tears differently based on hoop integrity, with loss of hoop stresses triggering a more conservative approach. A majority braced and utilized in situ adjuncts for biological healing, while a minority added extrinsic biologics.
Collapse
Affiliation(s)
- Ting Cong
- Mount Sinai Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, USA
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P. Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arielle J. Hall
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Akhmad Ernazarov
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - James Gladstone
- Mount Sinai Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
4
|
Wang L, Chen X, Deng Q, You M, Xu Y, Liu D, Lin Y, Li P, Li J. Effectiveness of a digital rehabilitation program based on computer vision and augmented reality for isolated meniscus injury: protocol for a prospective randomized controlled trial. J Orthop Surg Res 2023; 18:936. [PMID: 38057846 DOI: 10.1186/s13018-023-04367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The lack of access to physical therapists in developing countries and rural areas poses a significant challenge in supervising postsurgical rehabilitation, potentially impeding desirable outcomes following surgical interventions. For this reason, this study aims to evaluate the feasibility, safety, and effectiveness of utilizing a digital rehabilitation program based on computer vision and augmented reality in comparison with traditional care for patients who will undergo isolated meniscus repair, since to date, there is no literature on this topic. METHODS This study intends to enroll two groups of participants, each to be provided with informed consent before undergoing randomization into either the experimental or control group. The experimental group will undergo a digital rehabilitation program utilizing computer vision and augmented reality (AR) technology following their surgical procedure, while the control group will receive conventional care, involving in-clinic physical therapy sessions weekly. Both groups will adhere to a standardized rehabilitation protocol over a six-month duration. Follow-up assessments will be conducted at various intervals, including preoperatively, and at 2 weeks, 6 weeks, 12 weeks, and 24 weeks postoperatively. Imaging assessments and return-to-play evaluations will be conducted during the final follow-up. Clinical functionality will be assessed based on improvements in International Knee Documentation Committee (IKDC) and Visual Analog Scale (VAS) scores. REGISTRATION NUMBER ChiCTR2300070582.
Collapse
Affiliation(s)
- Li Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Chen
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qian Deng
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - MingKe You
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Xu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Di Liu
- Jiakang Zhongzhi Technology Company, Beijing, People's Republic of China
| | - Ye Lin
- University of Chicago, Chicago, USA
| | - PengCheng Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
- China School of Nursing, Sichuan University, Chengdu, People's Republic of China.
| | - Jian Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| |
Collapse
|
5
|
Schwach M, Dergham R, Klasan A, Putnis S, Farizon F, Philippot R, Rambaud A, Neri T. Return-to-sport criteria after isolated meniscus suture: Scoping review of the literature. Orthop Traumatol Surg Res 2023; 109:103604. [PMID: 36940904 DOI: 10.1016/j.otsr.2023.103604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 03/22/2023]
Abstract
BACKGROUND Follow-up care including rehabilitation therapy after isolated meniscal repair remains to be standardized. Thus, no standard criteria are available for the return-to-running (RTR) or return-to-sport (RTS). The objective of this study was to identify criteria for RTR and RTS after isolated meniscal repair, based on a review of the literature. HYPOTHESIS Return-to-sport criteria after isolated meniscal repair have been published. METHODS We performed a scoping review of the literature using the methodology developed by Arksey and O'Malley. The terms "menisc*" and "repair" and "return-to-sport" or "return to play" or "return to run" or "rehabilitation" were used to search the PubMed database on 1st March 2021. All relevant studies were included. All RTR and RTS criteria were identified, analyzed, and classified. RESULTS We included 20 studies. Mean RTR and RTS times were 12.9 and 20 weeks, respectively. Clinical, strength, and performance criteria were identified. The clinical criteria included full range-of-motion recovery with no pain, quadriceps wasting, or joint effusion. Strength criteria were a quadriceps and hamstring deficit, no greater than 30% and 15% for RTR and RTS, respectively, compared to the normal side. Performance criteria were successful completion of proprioception, balance, and neuromuscular tests. RTS rates ranged from 80.4% to 100%. CONCLUSION Patients must meet clinical, strength, and performance criteria before resuming running and sports. The level of evidence is low, due to the heterogeneity and generally arbitrary choice of criteria. Further large-scale studies are therefore needed to validate and standardize RTR and RTS criteria. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Maxime Schwach
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France.
| | - Rayan Dergham
- EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Antonio Klasan
- Kepler University Hospital, Linz, Austria; Johanne-Kepler University, Linz, Austria
| | - Sven Putnis
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Frédéric Farizon
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Alexandre Rambaud
- EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| |
Collapse
|
6
|
Kaarre J, Herman ZJ, Persson F, Wållgren JO, Alentorn-Geli E, Senorski EH, Musahl V, Samuelsson K. Differences in postoperative knee function based on concomitant treatment of lateral meniscal injury in the setting of primary ACL reconstruction. BMC Musculoskelet Disord 2023; 24:737. [PMID: 37715148 PMCID: PMC10503181 DOI: 10.1186/s12891-023-06867-z] [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: 05/02/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Concomitant lateral meniscal (LM) injuries are common in acute anterior cruciate ligament (ACL) ruptures. However, the effect of addressing these injuries with various treatment methods during primary ACL reconstruction (ACLR) on patient-reported outcomes (PROs) is unknown. Therefore, the purpose of this study was to compare postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) at 2-, 5-, and 10-years after isolated primary ACLR to primary ACLR with various treatment methods to address concomitant LM injury. METHODS This study was based on data from the Swedish National Knee Ligament Registry. Patients ≥ 15 years with data on postoperative KOOS who underwent primary ACLR between the years 2005 and 2018 were included in this study. The study population was divided into five groups: 1) Isolated ACLR, 2) ACLR + LM repair, 3) ACLR + LM resection, 4) ACLR + LM injury left in situ, and 5) ACLR + LM repair + LM resection. Patients with concomitant medial meniscal or other surgically treated ligament injuries were excluded. RESULTS Of 31,819 included patients, 24% had LM injury. After post hoc comparisons, significantly lower scores were found for the KOOS Symptoms subscale in ACLR + LM repair group compared to isolated ACLR (76.0 vs 78.3, p = 0.0097) and ACLR + LM injury left in situ groups (76.0 vs 78.3, p = 0.041) at 2-year follow-up. However, at 10-year follow-up, no differences were found between ACLR + LM repair and isolated ACLR, but ACLR + LM resection resulted in significantly lower KOOS Symptoms scores compared to isolated ACLR (80.4 vs 82.3, p = 0.041). CONCLUSION The results of this study suggest that LM injury during ACLR is associated with lower KOOS scores, particularly in the Symptoms subscale, at short- and long-term follow-up. However, this finding falls below minimal clinical important difference and therefore may not be clinically relevant. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fabian Persson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Jonas Olsson Wållgren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, the NU Hospital Group, Trollhättan, Sweden
| | - Eduard Alentorn-Geli
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Catalana, Barcelona, Spain
- Fundación García Cugat, Barcelona, Spain
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
7
|
Weaver AP, Walaszek MC, Roman DP, Harkey MS, Kuenze C. The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:2357-2365. [PMID: 37272684 PMCID: PMC10865339 DOI: 10.1177/03635465231177626] [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: 06/06/2023]
Abstract
BACKGROUND Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. HYPOTHESIS Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. RESULTS An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type (P = .61) or meniscal procedure at the time of ACLR (P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type (P = .38) or meniscal procedure at the time of ACLR (P = .40). CONCLUSION Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.
Collapse
Affiliation(s)
- Adam P. Weaver
- Address correspondence to Adam P. Weaver, PT, DPT, Sports Physical Therapy, Connecticut Children’s, 399 Farmington Ave, Farmington, CT 06032, USA () (Twitter: @adampweaver)
| | | | | | | | | |
Collapse
|
8
|
Perez-Mozas M, Payo-Ollero J, Montiel V, Valenti-Nin JR, Valenti-Azcarate A. Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft. J Knee Surg 2023; 36:79-86. [PMID: 33932951 DOI: 10.1055/s-0041-1729553] [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] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.
Collapse
Affiliation(s)
- Maria Perez-Mozas
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jesus Payo-Ollero
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Veronica Montiel
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Juan Ramon Valenti-Nin
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Andres Valenti-Azcarate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| |
Collapse
|
9
|
Standardized Rehabilitation or Individual Approach?—A Retrospective Analysis of Early Rehabilitation Protocols after Isolated Posterior Cruciate Ligament Reconstruction. J Pers Med 2022; 12:jpm12081299. [PMID: 36013248 PMCID: PMC9409670 DOI: 10.3390/jpm12081299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Isolated posterior cruciate ligament (PCL) tears represent a severe type of injury. In hospitals, PCL reconstruction (PCL-R) is less frequently performed than other types of knee surgery. It is unclear whether there is consensus among surgeons on how to perform rehabilitation after PCL-R or if there are different, more individual approaches in daily routines. (2) Methods: Rehabilitation protocols and their main criteria (the progression of weight bearing and range of motion, the use of knee braces, rehabilitation training, and sports-specific training) were retrospectively analyzed after PCL-R. (3) Results: Only 33 of 120 (27.5%) analyzed institutes use rehabilitation protocols after PCL-R. The applied protocols showed vast differences between the individual rehabilitation criteria, especially with regard to the progression of weight bearing and the range of motion. The only standardized recommendations were the obligatory use of knee braces and the general restriction of weight bearing and range of motion immediately post-surgery. Therefore, because of the lack of a consensus about a standardized rehabilitation protocol after PCL-R, no recommendation can be made on one particular protocol. (4) Conclusion: There is no acknowledged standardized rehabilitation protocol after PCL-R. In clinical practice, recommendations are influenced by, i.a., surgeons’ opinions and experience. The lack of scientific evidence on a particular standardized rehabilitation protocol after PCL-R suggests that rehabilitation protocols need to be tailored to the individual patient.
Collapse
|
10
|
Memmel C, Krutsch W, Szymski D, Pfeifer C, Henssler L, Frankewycz B, Angele P, Alt V, Koch M. Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries-Differentiation Based on Tendon Graft and Concomitant Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074060. [PMID: 35409745 PMCID: PMC8997891 DOI: 10.3390/ijerph19074060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
Background: Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons’ choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods: Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone−patellar tendon−bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results: Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing (p = 0.01), ROM (p = 0.05) and the utilization of braces (p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing (p = 0.002) and ROM (p < 0.001) was found. Conclusions: Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.
Collapse
Affiliation(s)
- Clemens Memmel
- Department of Paediatric Surgery and Orthopaedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Paediatric University Medical Centre and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Werner Krutsch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- SportDocs Franken, 90455 Nuremberg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Christian Pfeifer
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Trauma Surgery, InnKlinikum Altoetting, 84503 Altoetting, Germany
| | - Leopold Henssler
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Borys Frankewycz
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Peter Angele
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Volker Alt
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Matthias Koch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, 4101 Basel, Switzerland
| |
Collapse
|
11
|
Wong CK, Man GCW, He X, Ng JP, Ng AWH, Ong MTY, Yung PSH. Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2022; 23:247. [PMID: 35287650 PMCID: PMC8922830 DOI: 10.1186/s12891-022-05174-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meniscus root tear is an uncommon but detrimental injury of the knee. Hoop stress is lost during meniscus root tear, which can lead to excessive tibiofemoral contact pressure and early development of osteoarthritis. Posterolateral meniscus root tears (PLRT) are more commonly associated with anterior cruciate ligament (ACL) tears. As the lateral compartment is less congruent than the medial compartment, it is more susceptible to a shearing force, which is increased in the ACL-deficient knee. In accordance with the compressive axial load, the increase in the tibial slope would generate a greater shearing force. The additional lateral compartment mobility caused by ACL tear should be reduced after ACL reconstruction (ACLR). However, there is a lack of evidence to conclude that ACLR can sufficiently limit the effect of large tibial slope (LTS) on the healing after PLRT repair. This study aimed to evaluate whether a steep LTS would be a risk factor for poorer clinical outcomes after PLRT repair concomitant with ACLR. METHODS In this retrospective study, a chart review was conducted to identify patients with concomitant unilateral primary ACLR and PLRT repair. Patients with a partial tear or healed tear were excluded. Postoperative MRI and clinical assessments were performed at a mean follow up of 35 months. MRI data was used to measure the LTS, medial tibial slope (MTS), coronal tibial slope (CTS), the lateral-to-medial slope difference (LTS-MTS) and meniscus healing and extrusion. Functional outcomes were evaluated by patient-reported outcomes (International Knee Documentation Committee [IKDC], Lysholm and Tegner scores) and KT-1000 arthrometer assessment. Interobserver reproducibility was assessed by two reviewers. RESULTS Twenty-five patients were identified for the analysis. Patients with larger LTS and larger LTS-MTS differences were shown to be correlated with poorer IKDC scores after surgery (R = -0.472, p = 0.017 and R = -0.429, p = 0.032, respectively). Herein, patients with LTS ≥ 6° or LTS-MTS ≥ 3° demonstrated poorer IKDC scores. CONCLUSION A large LTS (≥ 6°) and a large difference of LTS-MTS (≥ 3°) were shown to be risk factors for poorer functional and radiological outcomes for PLRT repair in patients after ACLR. Clinically, closer monitoring and a more stringent rehabilitation plan for patients with LTS ≥ 6° or LTS-MTS ≥ 3° would be recommended.
Collapse
Affiliation(s)
- Cham Kit Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Gene Chi Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Alex Wing Hung Ng
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Michael Tim Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Patrick Shu Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
12
|
Patel JM. Impediments to Meniscal Repair: Factors at Play Beyond Vascularity. Front Bioeng Biotechnol 2022; 10:843166. [PMID: 35299635 PMCID: PMC8921501 DOI: 10.3389/fbioe.2022.843166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jay M. Patel
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Medical Center, Department of Veterans Affairs, Decatur, GA, United States
- *Correspondence: Jay M. Patel,
| |
Collapse
|
13
|
Pihl K, Englund M, Christensen R, Lohmander LS, Jørgensen U, Viberg B, Fristed JV, Thorlund JB. Less improvement following meniscal repair compared with arthroscopic partial meniscectomy: a prospective cohort study of patient-reported outcomes in 150 young adults at 1- and 5-years' follow-up. Acta Orthop 2021; 92:589-596. [PMID: 33929284 PMCID: PMC8519526 DOI: 10.1080/17453674.2021.1917826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery.Patients and methods - We included 150 patients aged 18-40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life-KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4-6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint.Results - 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference -12, [95% CI -19 to -4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar.Interpretation - Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.
Collapse
Affiliation(s)
- Kenneth Pihl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden;
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; ,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark;
| | - L Stefan Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
| | - Uffe Jørgensen
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark;
| | - Bjarke Viberg
- Department of Orthopedics, Lillebaelt Hospital, Kolding, Denmark;
| | | | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; ,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Correspondence:
| |
Collapse
|
14
|
Clinical presentation, MRI and clinical outcome scores do not accurately predict an important meniscal tear in a symptomatic discoid meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:3133-3138. [PMID: 33386884 DOI: 10.1007/s00167-020-06375-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Discoid menisci can be symptomatic from instability or a tear. A torn discoid meniscus is likely to require repair to preserve meniscal function and should not be missed. This is the first study to evaluate a range of pre-operative methods to predict the likelihood of a torn discoid meniscus. METHODS A retrospective analysis of prospectively collected data was performed. Clinical, radiographic and operative data were reviewed. Patients were grouped based on the presence of a tear or not during surgery. All patients underwent MRI scans pre-operatively which were validated with arthroscopy findings to calculate sensitivity. All patients completed Pedi-KOOS and Pedi-IKDC pre-operative scores. RESULTS There were 32 discoid menisci in 27 patients. Mean age at surgery was 10.4 years (6-16). Nineteen patients were female. Seventeen menisci were identified as torn at time of arthroscopy (53%), 15 were unstable but not torn. Clinical findings did not differentiate between the torn or unstable menisci. MRI was only 75% sensitive and 50% specific at identifying a torn discoid meniscus. There was no statistical difference between KOOS-child (n.s.) and Pedi-IKDC (n.s.) scores between the groups. CONCLUSION MRI is neither sensitive nor specific at identifying tears in discoid menisci. There is no difference in pre-operative outcome scores for patients with a torn or unstable discoid meniscus; pre-operative PROMs are a poor predictor of a meniscal tear. This study emphasises that pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear and the operating surgeon should be vigilant in identifying and repairing tears at the time of surgery. Pre-operative findings poorly correlate to arthroscopic findings and potential surgical interventions required. Patients and parents/carers should, therefore, be appropriately counselled prior to surgery that post-operative measures are dependent on intra-operative findings and not pre-operative findings in patients. LEVEL OF EVIDENCE III.
Collapse
|
15
|
Abstract
Injuries to the meniscus, particularly tears, can have significant negative impacts on pain, function, and quality of life. Preservation of the meniscus is favorable, especially in the athletic and active populations. While first line treatment is often nonoperative in nature, recalcitrant, and more complex tears, typically require surgery. Meniscus repair rates have increased significantly during the last 2 decades as surgical techniques and postoperative outcomes have improved. Longer postoperative timeframes are to be expected when compared with menisectomy, however, accelerated programs have demonstrated favorable outcomes. Rehabilitation and return to play guidelines should reflect the intricacies of the tear type and repair procedure. Close communication with the surgeon is a vital component to optimize patient outcomes. Further, the patient's goals and expected level of return to function, or sport, must be taken into account for a rehabilitation program to be fully successful.
Collapse
|
16
|
Carder SL, Messamore WG, Scheffer DR, Giusti NE, Schroeppel JP, Mullen S, Vopat BG. Publicly Available Rehabilitation Protocols Designated for Meniscal Repairs Are Highly Variable. Arthrosc Sports Med Rehabil 2021; 3:e411-e419. [PMID: 34027449 PMCID: PMC8129055 DOI: 10.1016/j.asmr.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare publicly available rehabilitation protocols designated for meniscal repairs published online to determine the variability in meniscus repair protocols including different types of tears (radial vs nonradial repairs). Methods From the Fellowship and Residency Electronic Interactive Database Access System (FREIDA), a list of publicly available academic residency programs and orthopaedic sports medicine fellowships was obtained. With this list, an electronic search using Google was performed looking for meniscal repair rehabilitation protocols. In addition to academic institutions, private practice organizations with published meniscus repair rehabilitation protocols found during the search also were examined. Results Of 189 academic institutions, a total of 30 academic institutions had protocols that were included. Another 29 private practice programs were subsequently found and included. In total, 59 rehabilitation protocols fit the inclusion criteria. Six of the 59 specified radial repair and 53 did not. For return to full range of motion, nonradial protocols averaged 6.7 weeks and radial protocols averaged 7.3 weeks. For return to full weight-bearing, nonradial protocols averaged 6.2 weeks and radial protocols averaged 7.5 weeks. For return to sport, nonradial protocols averaged 17.8 weeks and radial protocols averaged 23.3 weeks. For time spent in a brace, nonradial protocols averaged 5.7 weeks and radial protocols averaged 6.7 weeks. Conclusions Of publicly available meniscal repair rehabilitation protocols, a small percentage (10.2%) changed their protocol in relation to tear type and there was a wide range of timeframes for each rehabilitation component. Protocols for radial tears tended to brace patients longer, limit their range of motion longer, delay full weight-bearing, and delay return to sport. However, it is recognized that some surgeons could be modifying their protocols in relation to tear type without publishing that information online. Clinical Relevance As stated in the purpose, the point of this study was to access only the protocols that would be available to the public. If anything, awareness should be raised for surgeons to look at their existing protocols and update them if they are truly incomplete and outdated. More research needs to be done to structure a rehabilitation protocol that is specific to the meniscal tear type, as the current protocols have a wide range of variance.
Collapse
Affiliation(s)
- Seth L Carder
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | | | | | - Nick E Giusti
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | | | - Scott Mullen
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Bryan G Vopat
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| |
Collapse
|
17
|
McGibbon CA, Brandon S, Bishop EL, Cowper-Smith C, Biden EN. Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 8:604860. [PMID: 33585409 PMCID: PMC7876241 DOI: 10.3389/fbioe.2020.604860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel "tricompartment unloader" (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint. Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models. Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30-50%) across all structures, at knee flexion angles >~30 degrees during DKB. Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.
Collapse
Affiliation(s)
- Chris A McGibbon
- Faculty of Kinesiology and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Scott Brandon
- School of Engineering, University of Guelph, Guelph, ON, Canada
| | - Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
| | | | - Edmund N Biden
- Department of Mechanical Engineering and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| |
Collapse
|
18
|
Haris A, Beng Chye Tan V. Stress response envelopes of intact tibiofemoral joint and knee osteoarthritis. Proc Inst Mech Eng H 2020; 234:1151-1161. [DOI: 10.1177/0954411920944078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine stress envelopes for an intact tibiofemoral joint and to study how they vary with knee loading, external–internal rotation, varus–valgus rotation and cartilage degradation (osteoarthritis) using the finite element method. The envelopes were presented in terms of knee flexion angle. The maximum von Mises stress for all tibiofemoral joint components increased with increasing the axial compressive force magnitude. Menisci exhibited the highest magnitude of maximum von Mises stress as compared to the femoral and tibial cartilages. In a range of flexion angles between 0° and 100°, the medial meniscus exhibited the highest maximum von Mises stress than the lateral meniscus and the stress in medial meniscus tended to increase with increasing the flexion angle. External–internal and varus–valgus rotations changed the stress distribution: higher stress on lateral compartment but lower stress on medial compartment, and conversely. The internal rotation provided more extreme effect than the external rotation. For the knee osteoarthritis, cartilage degradation (early stage) caused maximum von Mises stress to increase on the intact menisci revealing that knee osteoarthritis could also cause meniscal tear. The late osteoarthritis caused the maximum von Mises stress to increase on the calcified cartilage and subchondral bone.
Collapse
Affiliation(s)
- Andi Haris
- Department of Mechanical Engineering, National University of Singapore, Singapore
| | | |
Collapse
|
19
|
Massey PA, Miller BC, Perry K, McClary K, Chauvin B, Barton RS. Bucket-Handle Meniscus Repair in a Below-Knee Amputee: A Case Report. JBJS Case Connect 2020; 10:e1900564. [PMID: 32910618 DOI: 10.2106/jbjs.cc.19.00564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of a right knee lateral bucket-handle meniscal tear repair in a 25-year-old woman bilateral below-knee amputee. At the 4-year follow-up, the patient was ambulatory in a prosthesis with a successful outcome. CONCLUSION Meniscus repair in below-knee amputees requires careful evaluation and surgical management. Specific consideration should be given to evaluating limb alignment, maintaining the stump integrity, surgical technique, modified bracing, and rehabilitation. This case report demonstrates that bucket-handle meniscus repair can be successful in a below-knee amputee.
Collapse
Affiliation(s)
- Patrick A Massey
- 1Department of Orthopaedic Surgery, Louisiana State University Health, Shreveport, Louisiana 2School of Medicine, Louisiana State University Health, Shreveport, Louisiana
| | | | | | | | | | | |
Collapse
|
20
|
Li Y, Chen M, Zhou W, Gao S, Luo X, Peng L, Yan J, Wang P, Li Q, Zheng Y, Liu S, Cheng Y, Guo Q. Cell-free 3D wet-electrospun PCL/silk fibroin/Sr 2+ scaffold promotes successful total meniscus regeneration in a rabbit model. Acta Biomater 2020; 113:196-209. [PMID: 32561472 DOI: 10.1016/j.actbio.2020.06.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 01/09/2023]
Abstract
Considering the intrinsic poor self-healing capacity of meniscus, tissue engineering has become a new direction for the treatment of meniscus lesions. However, disturbed by mechanical stability and biocompatibility, most meniscus implants fail to relieve symptoms and prevent the development of osteoarthritis. The goal of this study was to develop a potential meniscal substitute for clinical application. Here, silk fibroin with good mechanical performance and biocompatibility, and strontium ion acting as bioactive factor, were incorporated with Ɛ-Polycaprolactone to fabricate a meniscus scaffold (SP-Sr). By the wet-electrospun method, the 3D SP-Sr provided suitable pore size (100-200 μm) and enough mechanical support (61.6 ± 2.9 MPa for tensile modulus and 0.11 ± 0.03 MPa for compressive modulus). Moreover, after addition of Sr2+, the SP-Sr seeded by rabbit adipose tissue-derived stromal cells (rADSCs) showed the highest secretion with 2.61- and 2.98-fold increase in collagen and aggrecan, respectively, compared with SF/PCL group. And the extracellular matrix related genes expression in SP-Sr also showed upregulation results. Particularly, the expression of the collagen II gene, which played a crucial role in the formation of meniscal inner avascular region, showed a 9-fold increase in SP-Sr compared with pure PCL group. Furthermore, the MRI results of SP-Sr implanted in rabbits with total meniscectomy for 6 months demonstrated effective prevention of meniscus extrusion and relieving joint space narrowing compared with meniscectomy group. And the effects of cartilage protection and delaying osteoarthritis development were confirmed by Pathological examination. Especially, after 6-month implantation, the neo-menisci showed similar structural constituent and mechanical performance. STATEMENT OF SIGNIFICANCE: Meniscus regeneration faces great challenge due to the meniscus having limited healing potential owing to its anisotropic structure, its hypocellularity and hypovascularity. The present tissue engineering solutions have failed to maintain the biological function for meniscus reconstruction in vivo because of fragile and poor biocompatible materials, leading to long-term joint degeneration. The goal of this study was to develop a meniscal substitute potential for clinical application. Here, silk fibroin and strontium were incorporated with Ɛ-Polycaprolactone by wet-electrospinning method to fabricate a meniscus scaffold (SP-Sr). The 6-month implantation results revealed that SP-Sr scaffold was effective in preventing meniscus extrusion, cartilage protection and delaying osteoarthritis development, and the regenerated menisci showed similar structural constituent and mechanical performance.
Collapse
Affiliation(s)
- Yangyang Li
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China
| | - Mingxue Chen
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wenhao Zhou
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China
| | - Shuang Gao
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China
| | - Xujiang Luo
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Liqing Peng
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianglong Yan
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China
| | - Pei Wang
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China
| | - Qiyao Li
- Department of Biomedical Engineering, Materials Research Institute, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Shuyun Liu
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| | - Yan Cheng
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Haidian District Chengfu Road No.205, Beijing 100871, China.
| | - Quanyi Guo
- Institute of Orthopedics, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Lab of Musculoskeletal Trauma & War Injuries in PLA, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
21
|
Rebar Repair of Radial Meniscus Tears: A Reinforced Suture Technique. Arthrosc Tech 2020; 9:e953-e957. [PMID: 32714804 PMCID: PMC7372502 DOI: 10.1016/j.eats.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/14/2020] [Indexed: 02/03/2023] Open
Abstract
The purpose of this paper is to describe the rebar repair as a technique for repair of radial meniscus tears and compare the rebar technique with current techniques used for meniscus repairs. This technique consists of 4 sutures placed with the inside-out technique. First, the vertical mattress reinforcement sutures are placed anteriorly and posteriorly to the tear. Then, 2 parallel horizontal sutures are placed directly in juxtaposition to the vertical sutures, ensuring the needles pass on the side of the reinforcing stitch away from the tear. This technique is less technically challenging than other meniscus repair techniques that require drilling of a transtibial tunnel. Overall, the rebar technique offers a more optimal way for stabilizing the meniscus by using 2 reinforcement sutures that run with the circumferential fibers to help restore the natural hoop stress of the meniscus. Also, the placement of the vertical mattress sutures in the rebar technique offers more direct reinforcement to the horizontal mattress sutures as compared with other techniques, which reduces the risk of pull-out tears.
Collapse
|
22
|
Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date? Rehabil Res Pract 2020; 2020:3989535. [PMID: 32292602 PMCID: PMC7146095 DOI: 10.1155/2020/3989535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Meniscus therapy is a challenging process. Besides the respective surgical procedure such as partial meniscectomy, meniscus repair, or meniscus replacement, early postoperative rehabilitation is important for meniscus regeneration and return to sport and work as well as long-term outcome. Various recommendations are available. However, the current literature lacks information concerning the actual early rehabilitation in daily routine recommended by orthopedic surgeons. Thus, the purpose of this study was to investigate currently used standard early rehabilitation protocols in the daily routine of orthopedic surgeons. This study investigated the recommendations and concepts for early rehabilitation after meniscus therapy given by German, Austrian, and Swiss orthopedic institutions. Standardized criteria such as weight bearing, range of motion, use of an orthosis, and rehabilitation training were analyzed according to the conducted surgical procedure: partial meniscectomy, meniscus repair, or meniscus replacement. The analysis of standard rehabilitation concepts for partial meniscectomy (n = 15), meniscus repair (n = 54), and meniscus replacement (n = 7) showed significantly earlier functional rehabilitation in all criteria after partial meniscectomy in contrast to meniscus repair techniques (p < 0.001). In addition, significant restrictions were found in full weight bearing, full range of motion, and the use of braces. In summary, a wide range of recommendations for weight bearing, ROM, brace therapy, and mobilization is available, particularly after meniscus repair and meniscus replacement. Most concepts are in accordance with those described in the current literature. Further research is necessary to enhance the scientific evidence on currently used early rehabilitation concepts after meniscus therapy.
Collapse
|
23
|
|
24
|
Budarick AR, MacKeil BE, Fitzgerald S, Cowper-Smith CD. Design Evaluation of a Novel Multicompartment Unloader Knee Brace. J Biomech Eng 2020; 142:014502. [PMID: 31523751 DOI: 10.1115/1.4044818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/08/2022]
Abstract
Knee osteoarthritis (OA) is a significant problem in the aging population, causing pain, impaired mobility, and decreased quality of life. Conservative treatment methods are necessary to reduce rapidly increasing rates of knee joint surgery. Recommended strategies include weight loss and knee bracing to unload knee joint forces. Although weight loss can be beneficial for joint unloading, knee OA patients often find it difficult to lose weight or begin exercise due to knee pain, and not all patients are overweight. Unicompartment offloader knee braces can redistribute joint forces away from one tibiofemoral (TF) compartment; however, <5% of patients have unicompartmental tibiofemoral osteoarthritis (TFOA), while patients with isolated patellofemoral or multicompartmental OA are much more common. By absorbing body weight (BW) and assisting the knee extension moment using a spring-loaded hinge, sufficiently powerful knee-extension-assist (KEA) braces could be useful for unloading the whole knee. This paper (1) describes the design of a spring-loaded tricompartment unloader (TCU) knee brace intended to provide unloading in all three compartments of the knee while weight-bearing, (2) measures and compares the force output of the TCU against the only published and commercially available KEA brace, and (3) calculates the static unloading capacity of each device. The TCU and KEA braces delivered maximum assistive moments equivalent to reducing BW by approximately 45 and 6 lbs, respectively. The paper concludes that sufficiently powerful spring-loaded knee braces show promise in a new class of multicompartment unloader knee orthoses, capable of providing a clinically meaningful unloading effect across all three knee compartments.
Collapse
Affiliation(s)
- Aleksandra R Budarick
- Spring Loaded Technology Inc., 50 Raddall Avenue, Unit 8, Burnside, NS B3B 1T2, Canada
| | - Bradley E MacKeil
- Spring Loaded Technology Inc., 50 Raddall Avenue, Unit 8, Burnside, NS B3B 1T2, Canada
| | - Stephen Fitzgerald
- Spring Loaded Technology Inc., 50 Raddall Avenue, Unit 8, Burnside, NS B3B 1T2, Canada
| | | |
Collapse
|
25
|
Schwartz O, Bulis S, Olsen CH, Glasberg E, Dudkiewicz I. The Association Between History of an Ankle Sprain and Traumatic Meniscal Injury Among Infantry Combat Soldiers in the Israeli Defense Forces: A Historical Cohort Study. Mil Med 2019; 185:e748-e754. [DOI: 10.1093/milmed/usz393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/26/2019] [Indexed: 12/26/2022] Open
Abstract
Abstract
Introduction
The high frequency and number of ankle inversion injuries and meniscal injuries in military populations is an area of concern due to the debilitating effects and cumulative consequences of these particular injuries on the soldiers sustaining injury and the consequences on the operational effectiveness of the Israeli Defense Force (IDF). This study examines the possible relationship between ankle inversion injury and potential for subsequent meniscal injury in infantry soldiers in the IDF.
Material and Methods
All 89,069 infantry combat soldiers (including special units), recruited to the IDF between 2007 and 2017 were included in this study. A historical cohort study was conducted. The cohort was divided into two groups: The exposure group included all participants that had suffered at least one ankle sprain in the past and the unexposed group that included all participants who did not suffer an ankle sprain in the past. A Cox proportional-hazards model (COX) model was used in order to obtain the adjusted to confounders association between exposure and outcome expressed in hazard ratio (HR).
Results
The crude association between ankle sprain in the past and the development of meniscal injury in this study was 0.87 (Relative risk = 0.87, P = 0.007). After adjusting for unit type, Body Mass Index (BMI), previous fracture of the lower limb, and the use of eyeglasses, using a COX model, the adjusted association between ankle sprain in the past and the development of meniscal injury was 0.8 (HR = 0.8, P = 0.001, confidence interval (95%) 0.74, 0.88).
Conclusion
The results of this study indicate ankle sprains to be a protective factor for meniscal injury. Our main conclusion from the results of this study is that the assumption that those with previous leg injuries are at a greater risk for further leg injuries is questionable and cannot be generalized. Hence, the association between different types of injuries should be investigated separately.
Collapse
Affiliation(s)
- Oren Schwartz
- Department of Day Care and Pain Unit, Reuth Rehabilitation Center, 2 Hachail Ave., Tel – Aviv, Israel 6772829
| | - Shir Bulis
- IDF Medical Forces headquarters, 1 Aharon Kazir st., Ramat-Gan, Israel 5262000
| | - Cara H Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20895, USA
| | - Elon Glasberg
- IDF Medical Forces headquarters, 1 Aharon Kazir st., Ramat-Gan, Israel 5262000
| | - Israel Dudkiewicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Department of Rehabilitation, Sheba Medical center, 2 Sheba road, Tel Hashomer, Ramat Gan, Israel 5262100
| |
Collapse
|
26
|
Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Evaluation of Midterm Clinical and Radiographic Outcomes of Arthroscopically Repaired Vertical Longitudinal and Bucket-Handle Lateral Meniscal Tears. Orthop J Sports Med 2019; 7:2325967119843203. [PMID: 31157282 PMCID: PMC6512156 DOI: 10.1177/2325967119843203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Lateral meniscal tears in the stable knee are rare. There are few comparative
studies evaluating functional and radiological outcomes of vertical
longitudinal and bucket-handle lateral meniscal tears. Purpose: To evaluate the midterm clinical and radiological outcomes of
arthroscopically repaired traumatic vertical longitudinal and bucket-handle
lateral meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 43 full-thickness lateral meniscal repairs, including 22 (51.2%)
for vertical longitudinal tears and 21 (48.8%) for bucket-handle tears, were
evaluated. A clinical assessment was performed according to the Barrett
criteria, and patient outcomes were measured with the Lysholm knee score,
Tegner activity scale, and overall satisfaction scale. Magnetic resonance
imaging was used as the radiological re-examination method preoperatively
and at final follow-up. A subgroup analysis examining isolated repair versus
repair with concurrent anterior cruciate ligament (ACL) reconstruction was
performed. Results: The mean follow-up period was 63.2 months (range, 24-86 months). Based on
clinical and radiological outcomes, 38 of the 43 repairs (88.3%) were
successful, and the remaining 5 (11.6%) cases were considered to be
failures. Overall, the combined results for both groups demonstrated an
improvement in the Lysholm score, Tegner score, and patient satisfaction.
There was no significant difference in the postoperative Lysholm score (91.4
vs 87.0, respectively; P = .223), Tegner score (5.4 vs 5.5,
respectively; P = .872), or patient satisfaction (7.2 vs
7.4, respectively; P = .624) between bucket-handle repair
and vertical longitudinal repair. The subgroup analysis demonstrated no
difference in outcome scores for isolated repair versus repair with
concurrent ACL reconstruction. Smoking was identified as a risk factor for
repair failure. Conclusion: Comparable clinical and radiological outcomes were obtained after vertical
longitudinal and bucket-handle lateral meniscal repairs using the all-inside
or hybrid suture technique with different suture configurations, regardless
of whether ACL reconstruction was performed. Smoking was identified as a
risk factor for failure.
Collapse
Affiliation(s)
- Erdal Uzun
- Department of Orthopaedics and Traumatology, Ordu University School of Medicine, Ordu, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Soner Akkurt
- Department of Sports Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
| |
Collapse
|
27
|
Effect of Physical Therapy Visits on Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction With and Without Concurrent Meniscal Repair. J Sport Rehabil 2019; 28:24-32. [PMID: 28787223 DOI: 10.1123/jsr.2017-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/18/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health care payment reform has increased employers and health insurance companies' incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair. OBJECTIVE To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation. STUDY DESIGN Retrospective cohort. LEVEL OF EVIDENCE 2b. METHODS Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database. RESULTS Patients with more PT visits had higher knee outcome survey-activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair. CONCLUSIONS Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery. CLINICAL RELEVANCE These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.
Collapse
|
28
|
Svantesson E, Cristiani R, Hamrin Senorski E, Forssblad M, Samuelsson K, Stålman A. Meniscal repair results in inferior short-term outcomes compared with meniscal resection: a cohort study of 6398 patients with primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2251-2258. [PMID: 29134251 PMCID: PMC6061769 DOI: 10.1007/s00167-017-4793-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/06/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare patient reported outcome measures (PROMs) during the first postoperative year between isolated anterior cruciate ligament (ACL) reconstruction and ACL reconstruction with concomitant meniscal intervention. METHODS Patients who underwent primary ACL reconstruction at Capio Artro Clinic, Stockholm, Sweden, between 1st Jan 2001 and 31st Dec 2014 without concomitant injuries others than meniscal and/or cartilage lesions were included. Five groups of meniscal treatment simultaneously to ACL reconstruction were established; medial meniscal (MM) resection, MM repair, lateral meniscal (LM) resection, LM repair, and MM + LM resection. Patients treated with isolated ACL reconstruction formed a separate group. Preoperative, 6-month and 1-year Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm knee score and Tegner Activity scale were collected. Differences in the change over time were analyzed with an ANOVA for repeated measurements with age at surgery, gender, and cartilage injury as covariates. A univariate ANOVA was applied to analyze PROMs between groups at the final follow-up. RESULTS A total of 6398 patients were included (56.8% males, mean age 28.5 ± 10.2 years). The KOOS improved across all subscales for all treatment groups. The mean change over time differed significantly between groups for the subscales symptoms (p = 0.017) and activities in daily living (ADL) (p < 0.001). Symptoms was least improved in the MM repair group, while the MM + LM resection group showed the largest improvement. For the ADL subscale, the isolated ACL reconstruction group showed the least improvement and the MM + LM resection group showed the major improvement. At 1-year follow-up, a significant difference between the groups was found for the subscale symptoms (p = 0.019), where the MM repair group reported the lowest score [mean 78.4 (95% CI 76.3-80.5)]. No significant differences were found between groups in change of the Lysholm score over time; however, at 6 months, the difference between groups was significant (p = 0.006) with the meniscal repair groups reporting the lowest scores. CONCLUSION Patients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively. However, patients with meniscal repair may have slightly worse subjective knee function at both 6- and 12-month follow-up. These findings could help clinicians to set realistic short-term expectations for patients undergoing ACL reconstruction with simultaneous meniscal intervention. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Valhallavägen, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
29
|
Lee KI, Olmer M, Baek J, D'Lima DD, Lotz MK. Platelet-derived growth factor-coated decellularized meniscus scaffold for integrative healing of meniscus tears. Acta Biomater 2018; 76:126-134. [PMID: 29908335 DOI: 10.1016/j.actbio.2018.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
Abstract
The aim of this study was to examine the potential of platelet-derived growth factor (PDGF)-coated decellularized meniscus scaffold in mediating integrative healing of meniscus tears by inducing endogenous cell migration. Fresh bovine meniscus was chemically decellularized and covalently conjugated with heparin and PDGF-BB. In vitro PDGF release kinetics was measured. The scaffold was transplanted into experimental tears in avascular bovine meniscus explants and cultured for 2 and 4 weeks. The number migrating and proliferating cells at the borderline between the scaffold and injured explant and PDGF receptor-β (PDGFRβ) expressing cells were counted. The alignment of the newly produced ECM and collagen was analyzed by Safranin-O, picrosirius red staining, and differential interference contrast (DIC). Tensile testing of the explants was performed after culture for 2 and 4 weeks. Heparin conjugated scaffold showed immobilization of high levels of PDGF-BB, with sustained release over 2 weeks. Insertion of the PDGF-BB treated scaffold in defects in avascular meniscus led to increased PDGFRβ expression, cell migration and proliferation into the defect zone. Safranin-O, picrosirius red staining and DIC showed tissue integration between the scaffold and injured explants. Tensile properties of injured explants treated with PDGF-BB coated scaffold were significantly higher than in the scaffold without PDGF. In conclusion, PDGF-BB-coated scaffold increased PDGFRβ expression and promoted migration of endogenous meniscus cells to the defect area. New matrix was formed that bridged the space between the native meniscus and the scaffold and this was associated with improved biomechanical properties. The PDGF-BB-coated scaffold will be promising for clinical translation to healing of meniscus tears. STATEMENT OF SIGNIFICANCE Meniscus tears are the most common injury of the knee joint. The most prevalent forms that occur in the inner third typically do not spontaneously heal and represent a major risk factor for the development of knee osteoarthritis. The goal of this project was to develop an approach that is readily applicable for clinical use. We selected a natural and readily available decellularized meniscus scaffold and conjugated it with PDGF, which we had previously found to have strong chemotactic activity for chondrocytes and progenitor cells. The present results show that insertion of the PDGF-conjugated scaffold in defects in avascular meniscus led to endogenous cell migration and proliferation into the defect zone with tissue integration between the scaffold and injured explants and improved tensile properties. This PDGF-conjugated scaffold will be promising for a translational approach to healing of meniscus tears.
Collapse
Affiliation(s)
- Kwang Il Lee
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Merissa Olmer
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jihye Baek
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
| | - Darryl D D'Lima
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
| | - Martin K Lotz
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA.
| |
Collapse
|
30
|
Demographics and rates of surgical arthroscopy and postoperative rehabilitative preferences of arthroscopists from the Arthroscopy Association of North America (AANA). J Orthop 2018; 15:591-595. [PMID: 29881200 DOI: 10.1016/j.jor.2018.05.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/06/2018] [Indexed: 11/21/2022] Open
Abstract
Survey of 869 arthroscopists regarding joint-specific arthroscopic procedures and postoperative rehabilitative preferences revealed comparable support for use of supervised physical therapy (SPT) and home exercise programs (HEPs) but stronger preference for joint-specific HEP applications (wrist, knee). Among respondents utilizing HEPs, modality of delivery (verbal/handout/web-based) didn't differ by joint, yet only 2.9% utilized web-based HEPs. This is the first known study to identify postoperative rehabilitation preferences. With 1.77 million estimated arthroscopic procedures annually (mean: 325.4 procedures/respondent), this study highlights under-utilization of web-based HEPs. Reliable, web-based HEPs can improve post-arthroscopic outcomes for patients, arthroscopic surgeons, and rehabilitative specialists while being cost efficient.
Collapse
|
31
|
Spang Iii RC, Nasr MC, Mohamadi A, DeAngelis JP, Nazarian A, Ramappa AJ. Rehabilitation following meniscal repair: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000212. [PMID: 29682310 PMCID: PMC5905745 DOI: 10.1136/bmjsem-2016-000212] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 02/01/2023] Open
Abstract
Objective To review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery. Methods and data sources Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies. Results Seventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair. Conclusions There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.
Collapse
Affiliation(s)
- Robert C Spang Iii
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Nasr
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
32
|
Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines. J Orthop Sports Phys Ther 2018; 48:162-173. [PMID: 29308697 DOI: 10.2519/jospt.2018.7459] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background The inclusion of specific exercises in rehabilitation after knee injury is currently expert based, as a thorough description of the knee contact forces during different exercises is lacking. Objective To quantify knee loading during frequently used activities such as squats, lunges, single-leg hops, walking stairs, standing up, and gait, and to grade knee joint loading during these activities. Methods Three-dimensional motion-analysis data of 15 healthy adults were acquired during 9 standardized activities used in rehabilitation. Experimental motion data were processed using musculoskeletal modeling to calculate contact and shear forces on the different knee compartments (tibiofemoral and patellofemoral). Using repeated-measures analyses of variance, contact and shear forces were compared between compartments and exercises, whereas muscle and average maximum femoral forces were compared only between exercises. Results With the exception of squats, all therapeutic exercises imposed higher forces to the tibiofemoral joint compared to gait. Likewise, patellofemoral forces were greater during all exercises when compared to gait. Greater compartmental contact forces were accompanied by greater compartmental shear forces. Furthermore, force distribution over the medial and lateral compartments varied between exercises. With increased knee flexion, more force was imposed on the posterior portion of the condyles. Conclusion These results suggest that with careful selection of exercises, forces on an injured zone of the joint can be reduced, as the force distribution differs strongly between exercises. Based on the results, a graded exercise program for progressive knee joint loading during rehabilitation can be conceptualized. J Orthop Sports Phys Ther 2018;48(3):162-173. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7459.
Collapse
|
33
|
Abstract
Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing.
Collapse
Affiliation(s)
- Shantanu Sudhakar Patil
- Department of Translational Medicine and Research, SRM Medical College and Hospitals, SRM University, Chennai, Tamil Nadu, India
| | - Anshu Shekhar
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | | |
Collapse
|
34
|
|
35
|
Feehan J, Macfarlane C, Vaughan B. Conservative management of a traumatic meniscal injury utilising osteopathy and exercise rehabilitation: A case report. Complement Ther Med 2017; 33:27-31. [PMID: 28735822 DOI: 10.1016/j.ctim.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 12/17/2022] Open
Abstract
Meniscal injury is one of the most common knee soft tissue injuries, commonly affecting young athletes and an older, degenerative population. Treatment largely depends on the type and extent of the injury with arthroscopic repair or meniscectomy being mainstays. Although non-surgical approaches have been described, there is no published literature regarding a combination of indirect osteopathic techniques and rehabilitation in the management of these injuries. The current case report follows a 20-year-old male presenting with a 5-day history of acute knee pain, following trauma during an Australian Rules Football (AFL) match. An 8-week management plan of indirect osteopathic techniques and a tailored rehabilitation program was implemented. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Lower Extremity Functional Scale (LEFS) questionnaires were utilised to measure outcomes. After the 8-week treatment and rehabilitation program, the patient had exceeded the minimum detectable change score for all outcome measures. This case report suggests that osteopathic manipulative treatment and rehabilitation may be an alternative, non-surgical approach in the management of post-traumatic meniscal injuries.
Collapse
Affiliation(s)
- Jack Feehan
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Chris Macfarlane
- College of Health & Biomedicine, Victoria University, Melbourne, Australia
| | - Brett Vaughan
- College of Health & Biomedicine, Victoria University, Melbourne, Australia; Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia.
| |
Collapse
|
36
|
Abstract
There is a growing body of evidence surrounding the pathology and treatment of meniscal root tears. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Little information has been published regarding specific rehabilitation parameters for meniscal root repairs through all phases of rehabilitation. The goal of this commentary is to describe a rehabilitation program for meniscal root repairs that is founded on anatomical, physiological, and biomechanical principles with criteria-based progressions.
Collapse
|
37
|
Lutz C, Dalmay F, Ehkirch FP, Cucurulo T, Laporte C, Le Henaff G, Potel JF, Pujol N, Rochcongar G, Salledechou E, Seil R, Gunepin FX, Sonnery-Cottet B. Meniscectomy versus meniscal repair: 10 years radiological and clinical results in vertical lesions in stable knee. Orthop Traumatol Surg Res 2015; 101:S327-31. [PMID: 26439421 DOI: 10.1016/j.otsr.2015.09.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy. PATIENTS AND METHOD A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10-13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45±12.3 years (range, 9-47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. RESULTS Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98±4.69 versus 77.38±21.97 for symptoms (P=0.0043), 96.89±7.20 versus 78.57±18.9 for pain (P=0.0052), 99.89±0.33 versus 80.88±19.6 for daily life activities (P=0.0002), 96.11±9.83 versus 54.05±32.85 for sport and leisure (P=0.0005), but 91±16.87 versus 68.15±37.7 for quality of life (P=0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22±0.44) in-group R and 2 (mean, 2.19±0.98) in group M (P<0.0001). DISCUSSION At more than 10year's follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- C Lutz
- Clinique du Diaconat, 50, avenue des Vosges, 67000 Strabourg, France.
| | - F Dalmay
- 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France
| | - T Cucurulo
- 118, rue Jean-Mermoz, 13008 Marseille, France
| | - C Laporte
- CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | | | - J F Potel
- Medipôle, 45, rue de Gironis, 31036 Toulouse cedex 1, France
| | - N Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Rochcongar
- Département d'orthopédie traumatologie, CHRU de Caen-Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - E Salledechou
- Département d'orthopédie traumatologie, CHRU de Caen-Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - R Seil
- Centre hospitalier de Luxembourg, 78, rue d'Eich, 1460 Luxembourg, Luxembourg
| | - F-X Gunepin
- Clinique Mutualiste, 3, rue Robert-de-la-Croix, 56324 Lorient cedex, France
| | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | | |
Collapse
|
38
|
Menta R, Howitt S. Meniscal allograft transplant in a 16-year-old male soccer player: A case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:436-443. [PMID: 25550669 PMCID: PMC4262797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Meniscal allograft transplantation (MAT) is a relatively new procedure that has gained popularity in the last couple of decades as a possible alternative to a meniscectomy to provide significant pain relief, improve function, and prevent the early onset of degenerative joint disease (DJD). As of present, evidence is limited and conflicting on the success of such procedures. In this case, a 16-year old male athlete underwent numerous surgical procedures to correct a left anterior cruciate ligament (ACL) rupture with associated medial and lateral meniscal damage that occurred as a result of a non-contact mechanism of injury. Following multiple procedures, including repair of both menisci and follow-up partial meniscectomy of the lateral meniscus, the patient continued to experience symptoms on the left lateral knee, making him a candidate for MAT. This case is used to highlight what a MAT is, what makes someone a candidate for this type of procedure, the current evidence surrounding the success of this intervention, and some rehabilitation considerations following surgery. The role of chiropractors and primary clinicians is to ensure that young athletes undergo early intervention to offset any degenerative changes that would be associated with sustained meniscal lesions.
Collapse
Affiliation(s)
- Roger Menta
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada
| | - Scott Howitt
- Associate Professor, Faculty of Clinical Education Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada
| |
Collapse
|
39
|
|
40
|
Oravitan M, Avram C. The effectiveness of electromyographic biofeedback as part of a meniscal repair rehabilitation programme. J Sports Sci Med 2013; 12:526-532. [PMID: 24149161 PMCID: PMC3772598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/05/2013] [Indexed: 06/02/2023]
Abstract
The objective of the study was to assess the effectiveness of using electromyographic biofeedback in the early stages of rehabilitation after meniscal repair. In this randomised, controlled, parallel group study, the evolution of patients with meniscal lesions treated by meniscal suture who received (study group, n = 33) or did not receive (control group, n = 31) electromyographic biofeedback as part of their early rehabilitation programme has been compared. A total of 64 patients with previous meniscal repair participated in the study. The patients received a baseline assessment (after 1 postoperative week) and a follow-up (after 8 postoperative weeks) consisting of surface electromyography, dynamometry of thigh muscles and the assessment of the Knee injury and Osteoarthritis Outcome Score (KOOS). The electrical potential in contraction and the speed for contraction and relaxation for all monitored muscles increased significantly in the study group (p < 0.05). The difference between groups in the assessed score was significant for sport and recreational function (p < 0.05). The strength of the thigh muscles was not significantly influenced by the introduction of electromyographic biofeedback (EMG- BFB) in the rehabilitation programme. Electromyographic biofeedback helped patients to control their muscles after meniscal repair to accomplish physical activities that require better neuromuscular coordination and control. For these reasons, one may consider electromyographic biofeedback as an important component of rehabilitation after meniscal repair. Key PointsExercises during the early phases of rehabilitation after meniscal repair are difficult to perform because of pain, oedema, and possibly a disruption in normal joint receptor activity.Electromyographic biofeedback is a painless, non-invasive method that can be used in muscle recovery after meniscal repair and enhances the rehabilitation process, especially related to muscular function.The rehabilitation programme that includes electromyographic biofeedback after meniscal repair increased the speed of muscle response to acoustic stimulation in both the initiation of contraction (onset time) and relaxation (offset time) and, also, the capacity of performing some specific physical acti-vities after 8 weeks of rehabilitation (according to KOOS values).Electromyographic biofeedback is not responsible for the decrease in pain, swelling or other postoperative symptoms but it is important in order to help the patient to conduct the activities which require neuromuscular coordination and muscle control.
Collapse
Affiliation(s)
- Mihaela Oravitan
- West University of Timisoara , Physical Education and Sport Faculty, Physical Therapy and Special Motricity Department, Timisoara, Romania
| | | |
Collapse
|
41
|
Morelli V, Braxton TM. Meniscal, Plica, Patellar, and Patellofemoral Injuries of the Knee. Prim Care 2013; 40:357-82. [DOI: 10.1016/j.pop.2013.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|