Treatment, Return to Play, and Performance Following Meniscus Surgery

Meniscus Injuries in Soccer

Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players.

Comparison of Functional Outcomes after Anterior Cruciate Ligament Reconstruction with Meniscal Repair for Unstable versus Stable Meniscal Tears

This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears.

Optimized Allogenic Decellularized Meniscal Scaffold Modified by Collagen Affinity Stromal Cell-Derived Factor SDF1α for Meniscal Regeneration: A 6- and 12-Week Animal Study in a Rabbit Model

BACKGROUND

Total meniscectomy for treating massive meniscal tears may lead to joint instability, cartilage degeneration, and even progressive osteoarthritis. The meniscal substitution strategies for advancing reconstruction of the meniscus deserve further investigation.

HYPOTHESIS

A decellularized meniscal scaffold (DMS) modified with collagen affinity stromal cell-derived factor (C-SDF1α) may facilitate meniscal regeneration and protect cartilage from abrasion.

STUDY DESIGN

Controlled laboratory study.

METHODS

The authors first modified DMS with C-SDF1α to fabricate a new meniscal graft (DMS-CBD [collagen-binding domain]). Second, they performed in vitro studies to evaluate the release dynamics, biocompatibility, and differentiation inducibility (osteogenic, chondrogenic, and tenogenic differentiation) on human bone marrow mesenchymal stem cells. Using in vivo studies, they subjected rabbits that received medial meniscectomy to a transplantation procedure to implement their meniscal graft. At postoperative weeks 6 and 12, the meniscal regeneration outcomes and chondroprotective efficacy of the new meniscal graft were evaluated by macroscopic observation, histology, micromechanics, and immunohistochemistry tests.

RESULTS

In in vitro studies, the optimized DMS-CBD graft showed notable biocompatibility, releasing efficiency, and chondrogenic inducibility. In in vivo studies, the implanted DMS-CBD graft after total meniscectomy promoted the migration of cells and extracellular matrix deposition in transplantation and further facilitated meniscal regeneration and protected articular cartilage from degeneration.

CONCLUSION

The new meniscal graft (DMS-CBD) accelerated extracellular matrix deposition and meniscal regeneration and protected articular cartilage from degeneration.

CLINICAL RELEVANCE

The results demonstrate that the DMS-CBD graft can serve as a potential meniscal substitution after meniscectomy.

A bibliometric and visualized analysis of meniscus suture based on the WOS core collection from 2010 to 2022: A review

Meniscus suture is an important treatment method for meniscus injury and contributes to the preservation of proprioception, restoration of knee biomechanics and alleviation of progressive osteoarthritis. However, there are few visualized analyses concerning the present studies of meniscus suture. This paper aims to evaluate the global trends, highlights and frontiers of meniscus suture. A bibliometric analysis was conducted based on the results of studies related to meniscus suture from web of science core collection. VOSviewer, GraphPad Prism, Microsoft Excel and R-bibliometrix were utilized for the bibliometric analysis of country and institution distribution, chronological distribution, source journals analysis, prolific authors and institutions analysis, keywords analysis, and reference co-citation analysis. A total of 950 publications on meniscus suture from 177 different sources were retrieved over the set time span. These publications were completed by 3177 authors from 1112 institutions in 54 countries. The United States was the most prolific country with 7960 citations and 348 publications (36.63%). Furumatsu Takayuki acted as the most prolific author (51 publications), while Robert F LaPrade with 1398 citations was the most-cited author. And more papers were published in the core journals, including American Journal of Sports Medicine, Arthroscopy-The Journal of Arthroscopic and Related Surgery, Knee Surgery Sports Traumatology Arthroscopy and Arthroscopy Techniques. Furthermore, "meniscus healing," "meniscus root tear" seem to be the emerging research hotspots. Notably, the publication trend concerning the all-inside suture technique has been rising during the past decade. The number of research publications on meniscus suture has been continuously risen since 2010. The authors, publications and institutions from the United States and East Asia were still the mainstays in this field. And the all-inside suture may become the mainstream surgical technique in the future, with meniscus healing and meniscus root tears being research highlights recently.