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Jeong HW, Kim JS, Nam HS, Noh GS, Lee YS. Assessment of Anatomic Restoration and Clinical Outcomes Between Medial and Lateral Meniscal Allograft Transplantation. Orthop J Sports Med 2022; 10:23259671221113280. [PMID: 36105654 PMCID: PMC9465589 DOI: 10.1177/23259671221113280] [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: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Proper anatomic restoration is an important consideration for meniscal
allograft transplantation (MAT), even with the different anatomica
characteristics between the medial meniscus and lateral meniscus. Purpose/Hypothesis: The purpose of this study was to assess the accuracy of anatomic restoration
in medial and lateral MAT (MMAT and LMAT) procedures and to compare their
outcomes. We hypothesized that (1) the anatomic differences between the
medial and lateral menisci will mean a less accurate anatomic restoration
for MMAT and (2) clinical outcomes after MMAT will be inferior compared with
LMAT. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively evaluated 20 patients who underwent MMAT using the bone
plug technique and 21 patients who underwent LMAT using the keyhole
technique at a single institution from July 2014 to June 2019. Demographic
data, previous surgeries, and concomitant procedures were recorded, as were
lower limb alignment and osteoarthritis grade on radiographs. Using
preoperative and follow-up magnetic resonance imaging, the meniscal
position, rotation, extrusion, and intrameniscal signal intensity were
evaluated. Clinical outcomes were evaluated using the International Knee
Documentation Committee and Lysholm scores. Results: The mean follow-up was 41.15 ± 18.86 and 45.43 ± 21.32 months for the MMAT
and LMAT patients, respectively. Concomitant procedures were performed in
90% of MMATs and 15% of LMATs. There was no significant difference between
the native and postoperative root positions after LMAT; however, for MMAT,
the position of the anterior root was located significantly posteriorly
(P = .002) and medially (P = .007)
compared with preoperatively. In addition, the allograft medial meniscus was
restored in a more internally rotated position (P = .029).
MMATs also exhibited significantly increased meniscal extrusion compared
with LMATs (posterior horn, P < .001; midbody,
P = .027; anterior horn, P = .006).
However, there was no significant difference between the 2 groups at final
follow-up in intrameniscal signal intensity or clinical scores. Conclusion: LMAT showed higher accuracy than MMAT in restoring meniscal position and
rotation, and there was less meniscal extrusion. However, clinical scores
improved after both LMAT and MMAT compared with preoperative values, and
midterm clinical outcomes were similar. The small anatomical errors seen in
the MMAT technique were not clinically relevant at midterm follow-up.
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Affiliation(s)
- Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of
Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of
Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of
Korea
| | - Gwon Seok Noh
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of
Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College
of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of
Korea
- Yong Seuk Lee, MD, PhD, Department of Orthopaedic Surgery, Seoul
National University College of Medicine, Bundang Hospital, 82, Gumi-ro
173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea (
,
)
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Makiev KG, Vasios IS, Georgoulas P, Tilkeridis K, Drosos G, Ververidis A. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res 2022; 34:35. [PMID: 35851067 PMCID: PMC9290229 DOI: 10.1186/s43019-022-00163-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3 mm is considered significant. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. To the best of our knowledge, this is the first study to elaborate on these topics.
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Affiliation(s)
- Konstantinos G Makiev
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece.
| | - Ioannis S Vasios
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Paraskevas Georgoulas
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Drosos
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Athanasios Ververidis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Unal M, Aktan C, Levent A, Cetin M, Kose O, Sarikcioglu L. Variations of cross-sectional meniscal morphology between similar-sized menisci: implications on donor selection for meniscal allograft transplantation. Arch Orthop Trauma Surg 2022; 142:1099-1107. [PMID: 33950275 DOI: 10.1007/s00402-021-03909-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate the morphological variations in the cross-sectional anatomy of the meniscus between similar-sized matched menisci. MATERIALS AND METHODS Knee MRI of 329 patients with intact menisci were retrospectively reviewed, and the meniscal length (ML), meniscal width (MW), and cross-sectional dimensions (meniscal height and width) of the anterior, posterior horns, and the corpus were measured. Patients with similar-sized menisci who had less than 1 mm difference in ML and MW were matched. 330 male-to-male medial menisci (MM), 623 male-to-male lateral menisci (LM), 82 female-to-female MM, 233 female-to-female LM, 176 cross-gender MM, and 265 cross-gender LM unique combination of ideally matched pairs (total: 1709) were generated. The disparity in the cross-sectional dimensions, absolute difference, and the paired percent differences was statistically analyzed. RESULTS The ML and MW in all groups were statistically similar, with a predefined absolute difference of 1 mm both for ML and MW (paired percent difference < 5%). The cross-sectional segmental meniscal dimensions were similar within all groups, but the paired percent differences showed high variations between a mean of 12.1-21.5% and up to 150.9%. The paired percent difference of MM in each segmental dimension was similar among different gender combinations. However, segmental paired percent differences of LM showed statistical differences in anterior horn width (AHW) (p: 0.001) and posterior horn width (PHW) (p: 0.001). In subgroup comparisons, the paired percent difference of AHW was higher in the female-to-female group compared to cross-gender (p: 0.023) and male-to-male groups (p: 0.001). The paired percent difference of PHW was smaller in the male-to-male group compared to female-to-female and cross-gender groups (p: 0.001 for both). CONCLUSIONS Segmental cross-sectional anatomy showed wide variations despite strict matching in ML and MW. These variations were present in all gender combinations. The meniscal 3D shape is unique, but acceptable limits of similarity need further research. LEVEL OF EVIDENCE Retrospective study, Level III.
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Affiliation(s)
- Melih Unal
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey
| | - Cemil Aktan
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey
| | - Ali Levent
- Department of Orthopedics and Traumatology, Mehmet Akif Inan Education and Research Hospital, University of Health Sciences School of Medicine, Sanlıurfa, Turkey
| | - Mustafa Cetin
- Department of Radiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey.
| | - Levent Sarikcioglu
- Department of Anatomy, Akdeniz University Medical Faculty, Antalya, Turkey
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Yoon KH, Kang SG, Lee YJ, Kwon YB, Kim EJ, Kim SG. Is Lateral Posterior Tibial Slope Correlated With Clinical Outcomes of Lateral Meniscus Allograft Transplantation? Arthroscopy 2019; 35:3099-3106. [PMID: 31699263 DOI: 10.1016/j.arthro.2019.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate (1) the correlation between lateral posterior tibial slope (PTS) and clinical outcomes of lateral meniscus allograft transplantation (MAT) and (2) the difference of lateral PTS between the extrusion and nonextrusion groups or between the failure and nonfailure groups in lateral MAT. METHODS Between January 2001 and February 2016, we retrospectively evaluated 61 patients (mean age, 29.1 ± 12.2 years) who underwent postoperative magnetic resonance imaging (MRI) and were followed for a minimum of 2 years after primary lateral MAT. The lateral PTS and graft extrusion in the coronal and sagittal planes were assessed by using MRI performed at 1 year postoperatively. Clinical scores and graft failure were evaluated at the last follow-up visit. The correlation between lateral PTS and clinical outcomes (clinical scores, graft extrusion) was analyzed. Lateral PTS was compared between the extrusion and nonextrusion groups and between the failure and nonfailure groups. RESULTS Mean lateral PTS on MRI was 6.6° ± 3.1° (range, 0.8° to 15.7°). A significant correlation was not identified between lateral PTS and clinical outcomes (clinical scores, graft extrusion in the coronal and sagittal planes). A significant difference in lateral PTS was not identified between the extrusion and nonextrusion groups in the coronal (6.2° ± 2.5° vs 7.0° ± 3.4°, P = .400) and sagittal (anterior horn, 6.5° ± 2.3° vs 6.7° ± 3.7°, P = .988; posterior horn, 6.8° ± 3.5° vs 6.5° ± 2.7°, P = .771) planes. Moreover, a significant difference was not identified between the failure and nonfailure groups (7.5° ± 3.3° vs 6.4° ± 3.0°, P = .388). CONCLUSIONS A significant correlation between lateral PTS and clinical or radiologic outcomes of lateral MAT was not identified. LEVEL OF EVIDENCE Level IV, therapeutic case series with subgroup analysis.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul
| | - Se Gu Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul
| | - Yeon Jae Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul
| | - Yoo Beom Kwon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul
| | - Eung Ju Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul.
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Liang Z, Liang L, Cai Y, Bertoni A. The influence factors of the stability of tailings dam based on multi-source information fusion method. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zhenyu Liang
- School of Resources and Civil Engineering, Northeastern University, Shenyang, China
- School of Architecture and Civil Engineering, Shenyang University, Shenyang, China
| | - Li Liang
- School of Resources and Civil Engineering, Northeastern University, Shenyang, China
| | - Yuze Cai
- Department of Art Design, Shenyang Urban Construction University, Shenyang, China
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Luczkiewicz P, Daszkiewicz K, Witkowski W, Chróścielewski J, Ferenc T, Baczkowski B. The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion. PLoS One 2018; 13:e0193020. [PMID: 29447236 PMCID: PMC5814050 DOI: 10.1371/journal.pone.0193020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 02/02/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the influence of a change in the meniscus cross sectional shape on its position and on the biomechanics of a knee joint. METHODS One main finite element model of a left knee joint was created on the basis of MRI images. The model consisted of bones, articular cartilages, menisci and ligaments. Eight variants of this model with an increased or decreased meniscus height were then prepared. Nonlinear static analyses with a fixed flexion/extension movement for a compressive load of 1000 N were performed. The additional analyses for those models with a constrained medio-lateral relative bone translation allowed for an evaluation of the influence of this translation on a meniscus external shift. RESULTS It was observed that a decrease in the meniscus height caused a decrease in the contact area, together with a decrease in the contact force between the flattened meniscus and the cartilage. For the models with an increased meniscus height, a maximal value of force acting on the meniscus in a medio-lateral direction was obtained. The results have shown that the meniscus external shift was approximately proportional to the meniscus slope angle, but that relationship was modified by a medio-lateral relative bone translation. It was found that the translation of the femur relative to the tibia may be dependent on the geometry of the menisci. CONCLUSIONS The results have suggested that a change in the meniscus geometry in the cross sectional plane can considerably affect not only the meniscal external shift, but also the medio-lateral translation of the knee joint as well as the congruency of the knee joint.
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MESH Headings
- Adult
- Biomechanical Phenomena
- Cartilage, Articular/anatomy & histology
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/physiology
- Female
- Finite Element Analysis
- Humans
- Imaging, Three-Dimensional
- Knee Joint/anatomy & histology
- Knee Joint/diagnostic imaging
- Knee Joint/physiology
- Magnetic Resonance Imaging
- Menisci, Tibial/anatomy & histology
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/physiology
- Models, Anatomic
- Models, Biological
- Stress, Mechanical
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Affiliation(s)
- Piotr Luczkiewicz
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | - Karol Daszkiewicz
- Department of Mechanics of Materials, Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Wojciech Witkowski
- Department of Mechanics of Materials, Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Jacek Chróścielewski
- Department of Mechanics of Materials, Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Tomasz Ferenc
- Department of Mechanics of Materials, Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Boguslaw Baczkowski
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Gdansk, Poland
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