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Kishiro S, Uehara K, Minakawa N, Ono M, Kudo T, Kotani T, Kumai T, Onuma H, Akazawa T, Niki H. Subchondral insufficiency fractures of the medial tibial condyle are associated with medial meniscus extrusion: A retrospective observational study. J Orthop Sci 2024:S0949-2658(24)00091-5. [PMID: 38777662 DOI: 10.1016/j.jos.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To the best of our knowledge, no prior studies have identified any risk factors for subchondral insufficiency fractures of the medial tibial condyle. This study aimed to explain relationships between subchondral insufficiency fractures of the medial tibial condyle and the meniscus status, lower extremity alignment, or osteoporosis. METHODS This retrospective study included 325 consecutive patients whose chief complaint is knee joint pain and who had visited one institution between April 2016 and March 2021, of which 70 patients (8 men and 62 women) who had suspected subchondral insufficiency fractures of the medial tibial condyle had undergone magnetic resonance imaging and radiographic examination. These patients were divided into two groups based on the results of their magnetic resonance imaging: the insufficiency fracture group included 46 patients who had subchondral insufficiency fractures of the medial tibial condyle and the nonfracture group included 24 patients without fractures. The meniscus injury and medial meniscus extrusion (MME) were evaluated by using magnetic resonance imaging. The Kellgren-Lawrence grade, the femorotibial angle, and the percent mechanical axis (%MA) were evaluated with the use of knee radiographs. T-scores were also measured by using dual-energy X-ray absorptiometry with a bone densitometer. RESULTS MME were significantly larger and the %MA was significantly smaller in the insufficiency fracture group than that in the nonfracture group. The prevalence of medial meniscus injuries and pathological MME were higher in the insufficiency fracture group than those in the nonfracture group. The prevalence of varus knee and osteoporosis did not vary remarkably different between the two groups. CONCLUSION The patients who had insufficiency fractures of the medial tibial condyle tended to have medial meniscus extrusion.
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Affiliation(s)
- Satoshi Kishiro
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Kenji Uehara
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Naoki Minakawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Mahiro Ono
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Takaaki Kudo
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Takashi Kotani
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Takanori Kumai
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Hiroyuki Onuma
- Department of Orthopaedic Surgery, Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, 2-16-1 Syukugawara, Tama-ku, Kawasaki, Kanagawa 214-8525, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
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Ishii Y, Okamoto S, Okinaka R, Hashizume T, Xu C, Zhu K, Nakashima Y, Okada K, Takagi K, Adachi N, Takahashi M. Temporary meniscus extrusion is caused by cumulative stress from uphill and downhill tasks in healthy volunteers. Front Sports Act Living 2024; 6:1271987. [PMID: 38650839 PMCID: PMC11033369 DOI: 10.3389/fspor.2024.1271987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose Excessive mechanical stress accumulates and causes knee injury. Meniscal extrusion is a key factor in detecting the reaction to cumulative mechanical stress. The accumulation of stress strongly depends on environmental conditions such as flat ground or uphill/downhill, and accumulates in knee compartments; only a few studies have reported the effects of different environments on lateral and medial meniscus extrusion. This study aimed to investigate the effects of cumulative uphill/downhill stress on the meniscal extrusion in each compartment. Methods A total of 30 healthy volunteers with 30 affected knees were involved in this cohort study (mean age, 22.0 ± 1.1 years; men, n = 14). The participants were divided into flat-walking, uphill/downhill-walking, and uphill/downhill-jogging groups and their numbers of steps taken were recorded during the effort. Moreover, medial and lateral meniscal extrusions during walking were evaluated using ultrasound three times, before and after efforts (T1) and (T2), and one day after efforts (T3), respectively. Results In the flat-walking group, no significant differences were observed between the follow-up periods. Conversely, in the uphill/downhill-walking and jogging groups, the medial meniscus extrusion at T2 was significantly higher than that at T1. Conversely, the medial meniscus extrusion at T3 was significantly lower than that at T2. By contrast, the lateral meniscus did not show any difference between the follow-up periods in any group. Conclusion Temporary extrusion of the meniscus occurred after uphill/downhill tasks in healthy volunteers, and its reaction was observed only in the medial meniscus.
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Affiliation(s)
- Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Riko Okinaka
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Chen Xu
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kexin Zhu
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakashima
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Okada
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc., Tokyo, Japan
| | - Kazuya Takagi
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc., Tokyo, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Liu X, Yang B, Liu C, Xin X. Factors associated with medial meniscal extrusion in non-osteoarthritic knees with medial meniscus tears: A cross-sectional study. PM R 2024. [PMID: 38511476 DOI: 10.1002/pmrj.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Medial meniscal extrusion (MME) plays an important role in the progression of knee osteoarthritis. Exploring the factors associated with MME in non-osteoarthritic knees may assist in the prevention of osteoarthritis. OBJECTIVE To identify the factors associated with pathologic MME in non-osteoarthritic knees with medial meniscus tears (MMTs). DESIGN A cross-sectional study. PARTICIPANTS One hundred fifty patients with non-osteoarthritic knees who underwent arthroscopic surgery for MMT. Patients were divided into a pathologic MME group (n = 54) and a control group (n = 96) based on whether a pathologic MME was present on magnetic resonance (MR) images. SETTING Tertiary medical institution. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The MME distance was measured on a coronal MR image obtained at the midpoint of the medial femoral condyle. An MME distance ≥3 mm was considered to indicate pathologic MME. Demographic and clinical data were collected as variables. Multivariable logistic regression analysis was performed to identify factors associated with pathologic MME. RESULTS After multivariable adjustment, body mass index (BMI) and the type of MMT were associated significantly with pathologic MME in the multivariable logistic regression model. Each unit higher in BMI was associated with a 13% higher risk of pathologic MME (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01-1.28, p = .04). The odds of pathologic MME were approximately four times and three times higher for radial tears (OR 4.34, 95% CI 1.25-15.03, p = .02) and complex tears (OR 3.07, 95% CI 1.17-8.05, p = .02) than for horizontal and longitudinal tears. CONCLUSIONS BMI and the type of MMT were independent factors associated with pathologic MME in non-osteoarthritic knees with MMT. A higher BMI, radial tears, and complex tears were predisposed to pathologic MME.
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Affiliation(s)
- Xinguang Liu
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Bin Yang
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Chen Liu
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
| | - Xing Xin
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
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Kawada K, Furumatsu T, Tamura M, Higashihara N, Yokoyama Y, Ozaki T. Longitudinal changes in medial knee joint space narrowing after medial meniscus posterior root repair: A 2-year follow-up study. Knee 2024; 47:92-101. [PMID: 38310818 DOI: 10.1016/j.knee.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Despite good clinical results, repair of medial meniscus (MM) posterior root tears (MMPRTs) may not completely prevent knee osteoarthritis progression. This study evaluated changes in the medial joint space (MJS) during the first and second years after repair, compared to narrowing in the contralateral knee, using fixed-flexion view (FFV) radiographs. METHODS Fifty-four patients who underwent pull-out repair for a unilateral MMPRT were included. FFV radiographs were obtained pre-operatively and at the 1- and 2-year post-repair timepoints to evaluate changes in the MJS and Kellgren-Lawrence grade bilaterally. Clinical outcomes were also evaluated. RESULTS The change in the MJS was greater in MMPRT knees than in contralateral knees during the first year (0.48 ± 0.80 mm vs. 0.09 ± 0.49 mm, p < 0.001), but this difference lessened in the second year (0.09 ± 0.36 mm vs. 0.07 ± 0.38 mm, p = 0.285). Kellgren-Lawrence grade progression in MMPRT knees was less in the second year. Clinical outcomes significantly improved at both 1 and 2 years post-repair than the pre-operative values (p < 0.001), with continued improvement in clinical outcomes in the second year. There was no significant correlation between patient characteristics and the change in the MJS from preoperatively to 2 years postoperatively. CONCLUSION Pull-out repair for MMPRTs did not completely prevent MJS narrowing, but the rate of narrowing decreased in the second year (mean, 0.09 mm) compared to that in the first year (mean, 0.48 mm). MJS narrowing in the second year after MM posterior root repair was comparable to that of the contralateral knee. Clinical outcomes further improved over the second year after repair. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan.
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Fukui D, Nishiyama D, Yamanaka M, Tamai H, Nishio N, Kawakami M, Yamada H. Development of a Novel Rat Knee Osteoarthritis Model Induced by Medial Meniscus Extrusion. Cartilage 2023:19476035231205680. [PMID: 37837194 DOI: 10.1177/19476035231205680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The medial meniscus extrusion (MME) is associated with increased stress on the knee joint, which leads to cartilage degeneration. To evaluate the etiology of knee osteoarthritis, it is extremely important to create animal models of the disease that more closely resemble actual clinical conditions in terms of symptomatology, molecular biology, and histology. This study aimed to create a clinically relevant model of MME in rats. DESIGN Behavioral, molecular biological, and histological changes in the newly developed rat MME model were compared with those in sham and medial meniscus transection and medial collateral ligament transection (MMT) models to examine the characteristics of this model. RESULTS In the MME rat model, behavioral evaluation shows abnormalities in gait compared with the other 2 groups, and molecular biological evaluation of the infrapatellar synovia of rats shows that gene expression of inflammatory cytokines, matrix-degrading enzymes, and pain-related nerve growth factor was increased compared with the sham group. Furthermore, histological evaluation reveals that cartilage degeneration was the most severe in the MME group. CONCLUSIONS The newly developed MME model reproduced the characteristic pathology of MME in clinical practice, such as severe pain, inflammation, and rapid progression of osteoarthritis. The MME model, which might more closely mimic human knee osteoarthritis (OA), could be a useful model for elucidating the pathophysiology and considering therapeutic management for knee OA.
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Affiliation(s)
- Daisuke Fukui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Yamanaka
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hidenobu Tamai
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoko Nishio
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mamoru Kawakami
- Department of Orthopedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Hashizume T, Ishii Y, Nakashima Y, Okamoto S, Iwamoto Y, Okada K, Takagi K, Adachi N, Takahashi M. Evaluation of meniscus extrusion during stair ambulation in healthy volunteers using dynamic ultrasonography: a feasibility study. J Med Ultrason (2001) 2023; 50:541-549. [PMID: 37566159 PMCID: PMC10912121 DOI: 10.1007/s10396-023-01348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This study aimed to investigate the feasibility of evaluating medial meniscus extrusion (MME) during stair ambulation. METHODS Twenty healthy young participants (mean age, 22.4 ± 0.9 years) were recruited for this cross-sectional study. Synchronization between the three-dimensional motion system and ultrasonography was used to quantify the extent of meniscal extrusion and knee angles during different tasks, including gait, stair ascent, and stair descent. In particular, ultrasonography was used to record the movements of both the middle and posterior segments of the meniscus to obtain detailed information about these movements in relation to the knee angle. The difference between the maximum MME and the MME at the initial contact (ΔMME) was evaluated during each task in the stance phase. RESULTS Visualization of the meniscus in the middle segment was limited with increasing knee flexion angle, whereas the posterior segments were visible during all tasks. ΔMME of the posterior segment during stair ascent and descent was higher than that during gait (gait: 0.68 ± 0.20 mm, ascent: 1.00 ± 0.39 mm, descent: 0.90 ± 0.27 mm, gait-ascent: p = 0.009, gait-descent: p = 0.004). CONCLUSIONS Evaluation that includes the posterior segment enables visualization of the medial meniscus and detection of its specific behavior during stair ambulation. These findings demonstrate the feasibility of evaluating meniscus dynamics during stair ambulation, and could contribute to a better understanding of these dynamics.
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Affiliation(s)
- Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Yuko Nakashima
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yoshitaka Iwamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Kaoru Okada
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc, Tokyo, Japan
| | - Kazuya Takagi
- Ultrasound Business Operations, Healthcare Business Headquarters, Konica Minolta, Inc, Tokyo, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Kothurkar R, Lekurwale R, Gad M, Rathod CM. Finite element analysis of a healthy knee joint at deep squatting for the study of tibiofemoral and patellofemoral contact. J Orthop 2023; 40:7-16. [PMID: 37143926 PMCID: PMC10151221 DOI: 10.1016/j.jor.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
Background In non-western countries, deep squatting is a daily activity, and prolonged deep squatting is common among occupational squatters. Household tasks, taking a bath, socializing, using toilets, and performing religious acts are among the activities frequently carried out while squatting by the Asian population. High knee loading is responsible for a knee injury and osteoarthritis. Finite element analysis is an effective tool to determine stresses on the knee joint. Methods Magnetic Resonance Imaging (MRI) and Computed Tomographic (CT) images were acquired of one adult without knee injuries. The CT images were acquired at the fully extended knee and one more set of images was acquired with the knee at a deeply flexed knee position. The MRI was acquired with the fully extended knee. 3-Dimensional models of bones were created using CT and soft tissue using MRI with the help of 3D Slicer software. Kinematics and finite element analysis of the knee was performed for standing and deep squatting posture using Ansys Workbench 2022. Results High peak stresses were observed at deep squatting compared to standing along with the reduction in the contact area. Peak von Mises stresses on femoral cartilage, tibial cartilage, patellar cartilage, and meniscus were increased from 3.3 MPa to 19.9 MPa, 2.9 MPa to 12.4 MPa, 1.5 MPa to 16.7 MPa and 15.8 MPa to 32.8 MPa respectively during deep squatting. Posterior translation of 7.01 mm, and 12.58 mm was observed for medial and lateral femoral condyle respectively from full extension to 153° knee flexion. Conclusions Increased stresses in the knee joint at deep squat posture may cause cartilage damage. A sustained deep squat posture should be avoided for healthy knee joints. More posterior translations of the medial femoral condyle at higher knee flexion angle warrant further investigation.
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Affiliation(s)
- Rohan Kothurkar
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Ramesh Lekurwale
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Mayuri Gad
- St. Xavier's Gait Lab, Xavier Institute of Engineering, Mumbai, India
| | - Chasanal M. Rathod
- St. Xavier's Gait Lab, Xavier Institute of Engineering, Mumbai, India
- Department of Orthopaedics, SRCC Children's Hospital, Haji Ali, Mumbai, India
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Dirim Mete B, Cilengir AH, Gursoy M, Dag F, Bulut T. Meniscal extrusion, cartilage, bone, and ligament lesions associated with medial meniscus posterior root tear gap. Eur J Radiol 2023; 162:110801. [PMID: 36996720 DOI: 10.1016/j.ejrad.2023.110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To determine the relationship between the severity of the tear gap resulting from medial meniscus posterior root (MMPR) tear and medial meniscal extrusion, cartilage, bone, and ligament lesions on MRI. METHODS A total of 133 patients with MMPR tear were retrospectively evaluated. The patients were divided into two groups according to the tear gap width as minor (≤ 4 mm) and widely (4 mm<) displaced. Medial meniscal extrusion and medial compartmental chondromalacia, bone and ligament lesions were analyzed. RESULTS There were 61 patients (56 women and 5 men) in the minor displaced group (mean age: 56.3 years, range: 29-82 years) and 72 patients (59 women, 13 men) in the widely displaced group (mean age: 53.2 years, range: 20-86 years). There was no significant difference in terms of age and sex (p = 0.31 and p = 0.09, respectively). The mean absolute extrusion was 3.51 mm (range: 1.5-5 mm) in the minor displaced group and 4.52 mm (range: 2.4-7.2 mm) in the widely displaced group (p < 0.001). High-grade medial femoral condylar chondromalacia was more common in the widely displaced group (p = 0.002). Osteophyte, bone marrow edema, and subchondral cyst in the medial compartment, and ligament injury were higher in the widely displaced group, but were not statistically significant (p > 0.05). CONCLUSION The amount of medial meniscal extrusion and the prevalence of high-grade medial femoral condylar chondromalacia were found to be significantly more in patients with wider tear gap. Determining the amount of tear gap in the evaluation of root ligament tears on MRI is important to predict knee joint internal derangement.
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Affiliation(s)
- Berna Dirim Mete
- Izmir Democracy University Faculty of Medicine Department of Radiology, 35140 Guzelyali Konak, Izmir, Turkey
| | - Atilla Hikmet Cilengir
- Izmir Democracy University Faculty of Medicine Department of Radiology, 35140 Guzelyali Konak, Izmir, Turkey.
| | - Merve Gursoy
- Izmir Katip Celebi University Faculty of Medicine Department of Radiology, 35360 Basin Sitesi Karabaglar, Izmir, Turkey
| | - Fatih Dag
- Manisa Turgutlu State Hospital, 45400 Turgutlu, Manisa, Turkey
| | - Tugrul Bulut
- Izmir Katip Celebi University Faculty of Medicine Department of Orthopedics, 35360 Basin Sitesi Karabaglar, Izmir, Turkey
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Hiranaka T, Furumatsu T, Okazaki Y, Kintaka K, Yamawaki T, Ozaki T. A newly-developed guide can create tibial tunnel at an optimal position during medial meniscus posterior root repairs. J Orthop Sci 2022; 27:815-820. [PMID: 34039522 DOI: 10.1016/j.jos.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND During transtibial pullout repair of medial meniscus (MM) posterior root tears (MMPRTs), accurate tibial tunnel creation within the anatomic MM posterior root attachment seems critical. This study aimed to evaluate the tibial tunnel position created by a newly-developed Precision guide during pullout repair of MMPRTs. METHODS In 40 patients who underwent transtibial pullout repairs, the tibial tunnel was created using the Unicorn Meniscal Root (UMR) (n = 20) or Precision guide (n = 20). Three-dimensional computed tomography images of the tibial surface were evaluated postoperatively, using Tsukada's measurement method. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines corresponding to anatomic bony landmarks. The expected anatomic center (AC) and the tibial tunnel center (TC) were evaluated using the percentage-based posterolateral location on the tibial surface. The difference in the mediolateral and anteroposterior percentage distance between the AC and TC was calculated, as was the absolute distance between the AC and TC. RESULTS The mean AC was located 77.4% posterior and 40.1% lateral. The mean TC was similar in the UMR and Precision guide groups. There was no significant difference in the mediolateral percentage distance (UMR 3.9% vs. Precision 3.6%, p = 0.405), but a significant difference was observed in the anteroposterior percentage distance (UMR 3.5% vs. Precision 2.6%, p = 0.031). The mean absolute distance between the AC and TC was 3.9 mm and 3.5 mm (UMR and Precision guide groups, respectively) (p = 0.364). CONCLUSIONS The new Precision guide can create tibial tunnel in an optimal and stable position during pullout repair of MMPRTs.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Kosei Hospital, 3-8-35 Koseicho, Kitaku, Okayama 700-0985, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Kozaki T, Fukui D, Yamamoto E, Nishiyama D, Yamanaka M, Murata A, Yamada H. Medial meniscus extrusion and varus tilt of joint line convergence angle increase stress in the medial compartment of the knee joint in the knee extension position -finite element analysis. J Exp Orthop 2022; 9:49. [PMID: 35622195 PMCID: PMC9142723 DOI: 10.1186/s40634-022-00490-y] [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: 02/26/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Although it has been recognized that the medial meniscus extrusion (MME) leads to progressive cartilage loss and osteoarthritis (OA), about 20% of cases with MME had minor symptoms and poor progression of knee OA. However, it is still unclear which patients will have minimal symptoms or will not progress to degeneration. The purpose of this study is to compare the effect of the relationship between the MME and Joint line convergence angle (JLCA) on knee stress with the finite element (FE) analysis method. METHODS The 65 year-old female was taken computer tomography (CT) from thigh to ankle. A 3-dimentional nonlinear FE model was constructed from the patient's DICOM data. We made the six models, which was different from JLCA and MME. Contact stresses on the surfaces between femoral and tibial cartilages and both side of meniscus are analyzed. RESULTS As the JLCA or MME increased, the stress load on the medial compartment increased. The effect of MME was stronger on the femoral side, while the effect of JLCA was stronger for the tibia and meniscus. If the JLCA was tilted valgus, the stress in the medial compartment did not increase even in the presence of MME. CONCLUSIONS This study revealed that the MME is associated with increased a stress loading on medial compartment structures. Furthermore, this change was enhanced by the varus tilt of the JLCA. In the case of valgus alignment, the contact pressure of the medial compartment did not increase so much even if with the MME. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Fukui
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Ei Yamamoto
- Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai University, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Yamanaka
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan
| | - Akimasa Murata
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthppaedics Surgery, Wakayama Medical University, Wakayama, Japan
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Guo Y, Guo W. Study and numerical analysis of Von Mises stress of a new tumor-type distal femoral prosthesis comprising a peek composite reinforced with carbon fibers: finite element analysis. Comput Methods Biomech Biomed Engin 2022; 25:1663-1677. [PMID: 35094629 DOI: 10.1080/10255842.2022.2032681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Research on carbon-fiber-reinforced polyetheretherketone (CF-PEEK/CFR-PEEK) as a bone tumor joint prosthesis remains limited. Herein we numerically determine the feasibility of CF-PEEK material containing 30% Wt carbon fiber (CF30-PEEK) as a material for the dual-action tumor-type distal femoral prosthesis. Use CT scan method to build a complete finite element model of the knee joint. Simulate the resection of the distal femoral tumor, and then reconstruct it with the dual-action tumor-type distal femoral prosthesis. The femoral condyle and extension rod components were simulated with cobalt chromium molybdenum (CoCrMo), PEEK and CF30-PEEK materials respectively. When simulating the standing state, a vertical stress of 700 N is applied to the femoral head. When simulating the squatting state, a vertical stress of 2800 N is applied to the femoral head. The displacement and rotation angle of each node of the distal tibia are fully restrained in three directions (X-axis, Y-axis, Z-axis). We examined the stress magnitude, stress distribution, and stability of the prosthesis and each of its components by means of finite element analysis (FE analysis). The FE analysis results show: after replacing the distal femur and the extension rod with CF30-PEEK material, the stress is still evenly distributed, and the average stress is significantly reduced. In addition, the stability is similar to CoCrMo material. Therefore, CF30-PEEK is an appropriate material for this type of prosthesis.
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Affiliation(s)
- Yu Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China.,Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China.,Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, People's Republic of China
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12
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Biomechanical Strengthening Design for Limb Articulation Based on Reconstructed Skeleton Kinesthetics. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00645-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hiranaka T, Furumatsu T, Miyazawa S, Okazaki Y, Kintaka K, Kodama Y, Kamatsuki Y, Ozaki T. Transtibial pullout repair techniques using two simple stitches for medial meniscus posterior root tear can prevent the progression of medial meniscus extrusion and obtain successful outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:795-802. [PMID: 34137941 DOI: 10.1007/s00590-021-03035-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Transtibial pullout repairs using two simple stitches (TSS) and a combination of TSS with posteromedial pullout repair (TSS + PMP) using an all-inside meniscal repair device have been reported previously for the treatment of medial meniscus (MM) posterior root tears. This study aimed to investigate the postoperative clinical outcomes of these techniques including MM extrusion (MME). METHODS Fifty-two patients who underwent transtibial pullout repair were investigated and divided into TSS (n = 27) and TSS + PMP (n = 25) groups. The clinical outcomes were assessed using the Lysholm knee score and Knee Injury and Osteoarthritis Outcome Score 1 year postoperatively and compared between two groups. MME was measured using magnetic resonance imaging at 1 year postoperatively and compared between two groups. RESULTS A significant improvement in each clinical score was observed in both groups, and no significant difference was seen in clinical outcomes. Moreover, no significant difference in postoperative MME was observed in both groups (TSS and TSS + PMP: 3.5 mm and 3.8 mm, respectively). Though no significant progression of MME was observed in TSS group, a significant progression of it was observed in TSS + PMP group postoperatively. CONCLUSIONS This study demonstrated that both techniques improved clinical outcomes in the short-term postoperative period. However, MME was progressed significantly in TSS + PMP group 1 year postoperatively, which indicated that PMP might not be a useful additional procedure for reducing the postoperative MME.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Eur Radiol 2020; 30:3996-4004. [PMID: 32140818 DOI: 10.1007/s00330-020-06749-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA) through a 5-year follow-up. METHODS Overall, 472 participants and 944 knees were eligible. MME (mm) was measured at the baseline, and KOA was radiographically evaluated at both baseline and 5-year follow-up by Kellgren-Lawrence grade (KLG). Radiographic KOA (ROA) was defined as the knee showing KLG ≥ 2. Incident ROA (iROA) was defined if the baseline KLG of 0-1 increased to KLG ≥ 2 in 5 years. Progressive ROA (pROA) was defined if the baseline KLG of 2-3 worsened to a higher grade in 5 years. Receiver operating characteristic (ROC) curve and generalized estimating equations were used for analysis. RESULTS Of 574 non-ROA knees at the baseline, 43 knees (7.5%) developed iROA; of 370 ROA knees, 47 knees (12.7%) developed pROA. Based on the ROC curves, 4 mm was the optimal cutoff to detect the risk of iROA (area under curve [AUC] 0.639 [right knee]; AUC 0.641 [left knee]) and that of pROA (AUC 0.750 [right knee]; AUC 0.863 [left knee]). Multiple regression analysis showed that the 4-mm cutoff of MME was significantly associated with both the prevalence of iROA (regression coefficient [B] 1.909; p ≤ 0.001; adjusted odds ratio [aOR] 6.746) and that of pROA (B 1.791; p ≤ 0.001; aOR 5.993). CONCLUSIONS On ultrasonography, the participants with more extruded medial meniscus showed a higher prevalence of both iROA and pROA. Ultrasonography could identify patients who had a risk of developing KOA. KEY POINTS • Through a 5-year follow-up, the current cohort study was conducted to clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA). • More extruded medial meniscus evaluated by ultrasonography was associated with the development of radiographic KOA. • Ultrasonography could identify the patients who had a risk of developing KOA, and the 4-mm cutoff of MME was optimal to detect this risk.
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Jiang P, Cui J, Chen Z, Dai Z, Zhang Y, Yi G. Biomechanical study of medial meniscus after posterior horn injury: a finite element analysis. Comput Methods Biomech Biomed Engin 2020; 23:127-137. [PMID: 31931606 DOI: 10.1080/10255842.2019.1702167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We established an effective finite element model of knee joint for observation of stress and displacement of meniscus related changes after medial meniscus injury. Different types of medial meniscus injury can lead to varied meniscus stress and displacement changes. Stress and displacement concentration were found in fissure tip of meniscus tear compared to normal meniscus. The posterior horn injury of medial meniscus may initiate combined injury of medial meniscus posterior horn (MMPH) and that of medial meniscus body, and combined injury of MMPH and that of lateral meniscus anterior horn; fissure expansions regarding horizontal fissure, longitudinal fissure and grip-shaped fissure of MMPH were spotted.
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Affiliation(s)
- Peishi Jiang
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Juncheng Cui
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Zhiwei Chen
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Zhu Dai
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Yangchun Zhang
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
| | - Guoliang Yi
- Department of Orthopedic, The First Affiliated Hospital of University of South China, Hengyang City, Hunan Province, China
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Uğur L. Comparison of reaction forces on the anterior cruciate and anterolateral ligaments during internal rotation and anterior drawer forces at different flexion angles of the knee joint. Int J Med Robot 2017; 13. [PMID: 28251769 DOI: 10.1002/rcs.1815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Having a complicated anatomy, the knee joint has been further detailed and a new formation defined, the anterolateral ligament (ALL), in recent studies. While the importance of this ligament, which previously was associated with Segond fractures, was explained via clinical, radiologic and biomechanical studies, and basically, is thought to be a fixator structures for the tibia against internal rotation stress. Although in recent studies efficient surgical treatment was applied to patients who underwent anterior cruciate ligament (ACL) operation, some patients having a positive pivot test highlights the clinical importance of the ALL. The aim of this study is to evaluate reaction forces of different flexion angles on the tibia during internal rotation and anterior drawer tests on both the ALL and ACL, and to examine theimportance of this ligament in knee biomechanics by a finite element analysis method. METHOD In this study, normal anatomy knee joint was modelled using Computed Tomography images from lower extremity length in DICOM format. 0°, 15°,30°,45°,60°,75° and 90° angles of flexion were applied, respectively, to these models and reaction force vectors formed on both ligaments were examined separately and as total vector and size by applying internal rotation and anterior drawer forces on each model. Non-linear analysis was conducted using ANSYS (version 17) with the same limit conditions applied to all models. RESULTS After all models were examined, in general when comparing reaction forces, those on the ACL were found to be higher. However, when vectoral directions were examined, forces on ALL increased with increased flexion ratio and internal rotation momentum. Beyond 30° flexion, the tensile force on the ALL is increased and compressive overload on the ACL occurs. CONCLUSION The ALL plays an important role in stability, especially against internal rotation forces, and an increased knee joint flexion ratio increases the stability contribution ratio. In particular, at 30° and higher angles, ACL reflects an antagonist effect and contributes to knee joint stability for rotational and mediolateral transposition.
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Affiliation(s)
- Levent Uğur
- Amasya University, Faculty of Technology, Department of Automotive Engineering, Amasya, Turkey
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