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Mazy D, Lu D, Leclerc S, Laor B, Wang J, Pinvicy A, Moldovan F, Nault ML. Animal models used in meniscal repair research from ex vivo to in vivo: A systematic review. J Orthop 2024; 55:23-31. [PMID: 38638113 PMCID: PMC11021913 DOI: 10.1016/j.jor.2024.03.038] [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: 03/14/2024] [Accepted: 03/30/2024] [Indexed: 04/20/2024] Open
Abstract
This systematic review, registered with Prospero, aims to identify an optimal animal model for meniscus repair research, moving from ex vivo experimentation to in vivo studies. Data sources included PubMed, Medline, all Evidence-Based Medicine Reviews, Web of Science, and Embase searched in March 2023. Studies were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted data including animal model, type of experiment, type of tear, surgical techniques, and measured outcomes, were recorded, reviewed, and analyzed by four independent reviewers. The SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) Rob tool was used for critical appraisal and risk of bias assessment. Out of 11,719 studies, 72 manuscripts were included for data extraction and analysis; 41 ex vivo extra-articular studies, 20 ex vivo intra-articular studies, and only 11 in vivo studies. Six animal models were employed: porcine, bovine, lapine, caprine, canine, and ovine. Longitudinal lesions were the most frequently studied tear pattern and sutures the most common repair technique. Studied outcomes focused mainly on biomechanical assessments and gross observations. This systematic review can guide researchers in their choice of animal model for meniscus repair research; it highlighted the strengths of the porcine, caprine, and bovine models for ex vivo cadaveric studies, while the porcine and caprine models were found to be more suited to in vivo studies due to their similarities with human anatomy. Research teams should familiarize themselves with the advantages and disadvantages of various animal models before initiating protocols to improve standardization in the field.
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Affiliation(s)
- David Mazy
- CHU Sainte-Justine, 7905-3175 Côte Ste-Catherine, Montréal, QC, H3T 1C5, Canada
- Department of Surgery, Université de Montréal, 2900 boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Daisy Lu
- CHU Sainte-Justine Azrieli Research Center, 7905-3175 Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada
| | - Sebastien Leclerc
- CHU Sainte-Justine Azrieli Research Center, 7905-3175 Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada
| | - Boaz Laor
- Faculty of Medecine, McGill university, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada
| | - Jessica Wang
- CHU Sainte-Justine Azrieli Research Center, 7905-3175 Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada
| | - Alix Pinvicy
- CHU Sainte-Justine, 7905-3175 Côte Ste-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Florina Moldovan
- CHU Sainte-Justine Azrieli Research Center, 7905-3175 Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, 7905-3175 Côte Ste-Catherine, Montréal, QC, H3T 1C5, Canada
- Department of Surgery, Université de Montréal, 2900 boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
- CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic surgery, 5400 boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
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Petersen W, Mustafa HA, Fricke LV, Braun K, Häner M. [Refixation of a posterior medial root lesion in combination with centralization by a meniscotibial suture]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024:10.1007/s00064-024-00858-6. [PMID: 39172276 DOI: 10.1007/s00064-024-00858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization). INDICATIONS Posterior root lesion of the medial meniscus. CONTRAINDICATIONS Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region. SURGICAL TECHNIQUE Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor. POSTOPERATIVE MANAGEMENT Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0-0-60°, 2 weeks 0-0-90°, optionally use of a valgus brace (varus of < 5°). RESULTS In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland.
| | - Hassan Al Mustafa
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Leo Vincent Fricke
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Karl Braun
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
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Sukopp M, Frey J, Schwer J, Kalbitz M, Ignatius A, Seitz AM. Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions. J Orthop Res 2024; 42:1134-1144. [PMID: 37986646 DOI: 10.1002/jor.25743] [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: 04/13/2023] [Revised: 10/19/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Meniscal tearing can increase the contact pressure between the tibia and femur by causing gapping of torn meniscus tissue. The aim of this study was to quantify gapping behavior of radial and longitudinal tears and their impact on peak contact pressure and mean contact area. Twelve porcine knee joints underwent unicondylar, convertible osteotomy for exact tear application and consecutive suturing. Six tantalum marker beads were positioned along meniscus tears. The joints were preloaded with sinusoidal loading cycles ranging between 0 N and 350 N. Peak load was held constant and two synchronized Roentgen stereophotogrammetric analysis x-ray images were obtained to evaluate gapping, peak contact pressure and mean contact area in the native, torn and repaired states. There was no change in gapping or peak contact pressure in longitudinal tear. By contrast, the radial tear led to a significant gapping when compared to the native state, while the inside-out suture was able to restore gapping in parts of the meniscus. An increase in contact pressure after radial tear was detected, which was again normalized after suturing. The most important finding of the study is that longitudinal tears did not gap under pure axial loading, whereas radial tears tended to separate the tear interfaces.
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Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Julian Frey
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Jonas Schwer
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Miriam Kalbitz
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Ulm University Medical Centre, Ulm, Germany
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Schlumberger M, Michalski S, Beel W, Mayer P, Schuster P, Immendörfer M, Mayr R, Richter J. Short-term results of tibial interference screw fixation for transtibial medial meniscus posterior root pull-out repair. J Orthop 2024; 50:155-161. [PMID: 38229771 PMCID: PMC10788779 DOI: 10.1016/j.jor.2023.12.017] [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: 12/09/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024] Open
Abstract
Background To evaluate the technique of transtibial pull-out repair with tibial interference screw fixation for medial meniscus posterior root (MMPR) tear by reporting on short-term outcomes and complications. Methods All MMPR repairs performed between January 2019 and August 2021 (n = 70) were retrospectively screened regarding demographic data and surgical parameters. The patients were questioned for performed revision surgery, symptoms and complications. The Numeric Rating Scale (NRS) for pain, Lysholm Knee Score and International Knee Documentation Committee Subjective Knee Form (IKDC) questionnaires were used to evaluate clinical outcome. In cases of revision surgery for re-tear the mode of failure was intraoperatively classified (patients with re-tear were excluded from the clinical follow-up examination). The influence of demographic and treatment parameters (surgical and rehabilitation) on the incidence and mode of re-tear and clinical scores was evaluated. Results After 2.3 ± 0.7 years, 62 patients (88.6 %) were available for follow-up. There were no direct intra- or postoperative complications. No revision was performed due to symptoms related to the tibial fixation material. The mean surgery time was 33.5 ± 10.8 min. The overall re-tear rate was 17.7 % (11 patients) of whom 10 were treated surgically and one conservatively. Primary mode of failure was suture cut-out from the meniscus (70 %). The NRS, Lysholm Knee Score and subjective IKDC were obtained in 38 patients and improved from 6.8 ± 2.4, 40.1 ± 23.9 and 32.8 ± 16.3 to 2.2 ± 2.2, 80.5 ± 16.3 and 63.0 ± 13.9, respectively (all p < 0.001). No influence was observed from demographic and treatment parameters on re-tear rates or clinical Scores. Conclusions Tibial interference screw fixation is a fast and promising technique for MMPR transtibial pull-out repair. In the presented technique, utilizing non-absorbable locking sutures alongside tibial interfenrence screw fixation, the primary mode of failure was suture cut-out from the meniscus.
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Affiliation(s)
- Michael Schlumberger
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Michalski
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Wouter Beel
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Philipp Mayer
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Philipp Schuster
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
- Paracelsus Medical Private University, Clinic Nuremberg, Department of Orthopedics and Traumatology, Breslauer Straße 201, 90471, Nuremberg, Germany
| | - Micha Immendörfer
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Raul Mayr
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Jörg Richter
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
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Saengpetch N, Noowan S, Boonrod A, Jaruwanneechai K, Sumanont S, Vijittrakarnrung C. Comparison of medial tibiofemoral joint mechanics between all-suture anchors and transtibial pullout technique for posterior medial meniscal root tears. J Orthop Surg Res 2023; 18:591. [PMID: 37559157 PMCID: PMC10413628 DOI: 10.1186/s13018-023-04071-2] [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: 06/25/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The posterior medial meniscal root tear (PMMRT) seriously impacts the tibiofemoral joint biomechanics. Two available techniques for PMMRT repair include the transtibial pullout (TPO) repair and all-suture anchor (ASA) repair techniques. These techniques have not been compared biomechanically. METHODS A total of 20 fresh porcine cadaveric knee specimens were used. All 20 knees were randomly and evenly distributed into four groups (five specimens per group): (1) intact posterior meniscal root, (2) PMMRT, (3) TPO repair technique for PMMRT, and (4) ASA repair technique for PMMRT. The tibiofemoral contact mechanics were investigated using a pressure sensor. All knee specimens were tested by being loaded with 600 N axial compressive force at three different flexion angles (0°, 45°, and 90°). The contact surface area, contact pressure, peak pressure, and time-zero displacement were recorded. RESULTS The PMMRT caused a significant decrease in contact surface area, an increase in contact pressure, and peak pressure from the reference values observed in the intact meniscus group (P = 0.05, 0.016, and 0.008, respectively). After fixation, no significant difference was observed between the ASA and intact group. Meanwhile, significant differences were found between the TPO and intact group in terms of contact surface area, contact pressure, and peak pressure. In the comparison between the two techniques, the ASA group demonstrated higher contact surface area than the TPO group at the average knee flexion angle (p = 0.05). CONCLUSION For most testing conditions, the ASA technique demonstrated superior biomechanical property in terms of contact surface area compared with the TPO technique under compressive loading conditions. The ASA technique could also restore the tibiofemoral contact mechanics to be comparable with those of the native intact knee. Meanwhile, a significant difference in tibiofemoral mechanics, compared with the intact knee, could be observed in the TPO technique.
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Affiliation(s)
- Nadhaporn Saengpetch
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Sutip Noowan
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Artit Boonrod
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Khananut Jaruwanneechai
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Sermsak Sumanont
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Chaiyanun Vijittrakarnrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
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Li J, Qian K, Liu J, Huang Z, Zhang Y, Zhao G, Wang H, Li M, Liang X, Zhou F, Yu X, Li L, Wang X, Yang X, Jiang Q. Identification and diagnosis of meniscus tear by magnetic resonance imaging using a deep learning model. J Orthop Translat 2022; 34:91-101. [PMID: 35847603 PMCID: PMC9253363 DOI: 10.1016/j.jot.2022.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Meniscus tear is a common problem in sports trauma, and its imaging diagnosis mainly relies on MRI. To improve the diagnostic accuracy and efficiency, a deep learning model was employed in this study and the identification efficiency was evaluated. Methods Standard knee MRI images from 924 individual patients were used to complete the training, validation and testing processes. Mask regional convolutional neural network (R–CNN) was used to build the deep learning network structure, and ResNet50 was adopted to develop the backbone network. The deep learning model was trained and validated with a dataset containing 504 and 220 patients, respectively. Internal testing was performed based on a dataset of 200 patients, and 180 patients from 8 hospitals were regarded as an external dataset for model validation. Additionally, 40 patients who were diagnosed by the arthroscopic surgery were enrolled as the final test dataset. Results After training and validation, the deep learning model effectively recognized healthy and injured menisci. Average precision for the three types of menisci (healthy, torn and degenerated menisci) ranged from 68% to 80%. Diagnostic accuracy for healthy, torn and degenerated menisci was 87.50%, 86.96%, and 84.78%, respectively. Validation results from external dataset demonstrated that the accuracy of diagnosing torn and intact meniscus tear through 3.0T MRI images was higher than 80%, while the accuracy verified by arthroscopic surgery was 87.50%. Conclusion Mask R–CNN effectively identified and diagnosed meniscal injuries, especially for tears that occurred in different parts of the meniscus. The recognition ability was admirable, and the diagnostic accuracy could be further improved with increased training sample size. Therefore, this deep learning model showed great potential in diagnosing meniscus injuries. Translational potential of this article Deep learning model exerted unique effect in terms of reducing doctors’ workload and improving diagnostic accuracy. Injured and healthy menisci could be more accurately identified and classified based on training and learning datasets. This model could also distinguish torn from degenerated menisci, making it an effective tool for MRI-assisted diagnosis of meniscus injuries in clinical practice.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, China
- School of Mechanical Engineering, Southeast University, China
| | - Kun Qian
- Hangzhou Lancet Robotics Company Ltd, China
| | | | | | | | - Guoqian Zhao
- Danyang Hospital of Traditional Chinese Medicine, China
| | - Huifen Wang
- The Second People's Hospital of Xuanwei, China
| | - Meng Li
- Cancer Hospital Chinese Academy of Medical Science, China
| | - Xiaohan Liang
- The First Affiliated Hospital of Bengbu Medical College, China
| | | | - Xiuying Yu
- Lin Yi Hospital of Traditional Chinese Medicine, China
| | - Lan Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, China
| | - Xingsong Wang
- School of Mechanical Engineering, Southeast University, China
- Corresponding author. No. 2 Southeast University Road, Nanjing, 210000, China.
| | - Xianfeng Yang
- Department of Radiology, Drum Tower Hospital Affiliated to Medical School of Nanjing University, China
- Corresponding author. No. 321 Zhongshan Road, Nanjing, 210000, China.
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, China
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Arthroscopic Medial Meniscus Posterior Root Reconstruction and Pull-Out Repair Combined Technique for Root Tear of Medial Meniscus. Arthrosc Tech 2022; 11:e109-e114. [PMID: 35155100 PMCID: PMC8822129 DOI: 10.1016/j.eats.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
Repair of medial meniscus posterior root tear is important in preventing rapid progression of knee osteoarthritis. There are many repair techniques for medial meniscus posterior root tears, and good clinical results have been reported. Conversely, in terms of improving extrusion and healing meniscal injuries, sufficient results have not been obtained. Reconstruction of the medial meniscus posterior root can restore meniscal hoop action and normal knee biomechanics. Moreover, pull-out repair technique provides strong traction. We describe arthroscopic medial meniscus posterior root reconstruction and pull-out repair technique combined technique for medial meniscus root tear.
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Affiliation(s)
- Chelsea Hopkins
- The Chinese University of Hong Kong, Prince of Wales Hospital, Department of Orthopaedics & Traumatology, Shatin, N.T, Hong Kong, China
| | - Ling Qin
- The Chinese University of Hong Kong, Prince of Wales Hospital, Department of Orthopaedics & Traumatology, Shatin, N.T, Hong Kong, China
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