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Jin J, Xu X, Piao M, Sun W, Pan G, Liu Y. Clinical efficacy and pain follow-up after arthroscopic discoid meniscoplasty of the knee: a retrospective study. BMC Musculoskelet Disord 2024; 25:570. [PMID: 39034413 PMCID: PMC11265089 DOI: 10.1186/s12891-024-07683-9] [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: 05/17/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND To assess the viability and efficiency of performing arthroscopic meniscoplasty in treating discoid meniscus (DM) in the knee joint. METHODS A total of 29 patients diagnosed with symptomatic lateral DM between October 2014 and December 2019 were included in the study. Among them, 7 patients with intact DM underwent arthroscopic discoid meniscoplasty (group A), while 22 patients with torn DM received arthroscopic DM plasty along with repair and suturing (group B). Both Visual Analog Scale (VAS) score and Lysholm score assessments were conducted preoperatively and postoperatively. RESULT The favorable and acceptable outcome rate was 85.71% in group A and 95.45% in group B (P > 0.05). The VAS scores post-operatively at each follow-up time point were consistently lower compared to pre-operative values, while the Lysholm knee function scores showed improvement. There were no significant differences in VAS score and Lysholm score between group A and group B at different stages (P > 0.05). Both surgical techniques (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) showed significant improvement in postoperative VAS score and Lysholm score, but there was no difference in outcomes between the two groups. CONCLUSION Overall, the two surgical techniques studied in this study (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) produced similar results in terms of pain reduction and improved knee function.
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Affiliation(s)
- Jingri Jin
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Xiaodan Xu
- Department of Operating Room, The Affiliated Hospital of Yanbian University, Yanji City, Jilin Province, China
| | - Mingjun Piao
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Weize Sun
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Guangzhi Pan
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Yanqun Liu
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China.
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Vosoughi F, Mafhoumi A, Gouravani M, LaPrade RF, Sherafat Vaziri A, Movahedinia M, Keyhani S. Hypermobile lateral meniscus: A systematic review of current treatment options. Knee Surg Sports Traumatol Arthrosc 2024; 32:843-863. [PMID: 38431797 DOI: 10.1002/ksa.12102] [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: 11/07/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The reliable data on the incidence of hypermobile lateral meniscus (HLM) and its clinical manifestations, diagnostic methods and therapeutic approaches are limited. This systematic study aimed to review available treatment options for HLM and the outcomes of each approach. METHODS A systematic search was performed in four electronic databases (PubMed, EMBASE, Scopus, Web of Science) to identify studies in which arthroscopically confirmed cases of HLM were treated surgically or nonsurgically, and the required data comprising study characteristics, patient data, treatment approaches and outcome measures were extracted from eligible studies. RESULTS Twenty studies with a total of 212 patients (138 males and 74 females) and 219 knees were included. The most frequently reported symptoms were locking sensations, knee pain, giving way and snapping. Treatments used by the studies were: radiofrequency energy in two studies; arthroscopic partial meniscectomy in one study; open surgery in two studies; and arthroscopic meniscal repair in 17 studies. Eleven studies used an all-inside repair method and an inside-out meniscal repair was reported in eight studies. Three studies reported the usage of posterior arthroscopy for therapeutic or diagnostic approaches. Evaluation of symptom resolution was the main outcome measurement for which almost all of the studies stated relief of symptoms after intervention. CONCLUSION Despite the lack of definite consensus about the most appropriate intervention for HLM, therapeutic preference was directed towards arthroscopic all-inside and inside-out repair techniques. Although the surgeon's decision remains the key factor in choosing the most suitable treatment option for each individual, posterior arthroscopic meniscal repair may be considered as a better option for HLM treatment according to the findings of this review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Fardis Vosoughi
- Department of Orthopedic and Trauma Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Asma Mafhoumi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Sohrab Keyhani
- Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bauwens PH, Vandergugten S, Fiquet C, Raux S, Cance N, Chotel F. Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4816-4823. [PMID: 37659011 DOI: 10.1007/s00167-023-07538-1] [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: 06/06/2020] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Despite an improved understanding of discoid lateral meniscus (DLM), the treatment of symptomatic discoid lateral meniscus remains controversial. METHODS The aim of this retrospective, single-centred, consecutive-case study was to evaluate the clinical outcome of 60 DLM treated arthroscopically by the "meniscoplasty or saucerisation-suture" technique in children and adolescents [median (range) age 11 (4-17) years], and to investigate surgical failures. The instability was assessed before any saucerisation. The hypotheses were that: (i) the management of instability with suture first was effective and that (ii) a combined classification with clinical and MRI data had a prognostic value. RESULTS In 57 knees (95%), the DLM was unstable, and a suture fixation was performed. After a median follow-up of 41.5 months, the median (range) IKDC score was improved from 55 (10-70) preoperatively to 90 (37.5-100) postoperatively. The median (range) Lysholm score at last follow-up was 93.5 (45-100). The procedure was effective in 49 knees (81.6%) after a single procedure. Eleven patients had a failure with a new meniscal tear after a median (range) delay of 42 months (24-60) after the initial procedure. The patterns of discoid lateral meniscus instability were not found to have a prognostic value for surgical failure since they mainly occurred after sport-related injuries. All the patients with initial repair failures but one achieved a good clinical outcome after revision repair without any further meniscectomy. CONCLUSION In contrast to adult knees, symptomatic discoid lateral meniscus is rarely stable in children (5%). Meniscal repair is effective to preserve the meniscus tissue, but revision repair became necessary in 18% of the cases and was finally successful. Level of evidence Level III.
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Affiliation(s)
- Paul Henri Bauwens
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Simon Vandergugten
- Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, and in Grand Hopital de Charleroi, Lyon, France
| | - Charles Fiquet
- Clinique de l'infirmerie Protestante of Lyon, 1-3 Chemin du Penthod, 69300, Caluire et Cuire, France
| | - Sébastien Raux
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Nicolas Cance
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Franck Chotel
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children and Claude Bernard University Lyon I., Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France.
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Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04819-9. [PMID: 36811665 DOI: 10.1007/s00402-023-04819-9] [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: 07/27/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Discoid lateral meniscus (DLM) is an anatomic knee variant associated with increased tears and degeneration. This study aimed to quantify meniscal status with magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic reshaping surgery for DLM. MATERIALS AND METHODS We retrospectively reviewed the records of patients undergoing arthroscopic reshaping surgery for symptomatic DLM with ≥ 2-year follow-up. MRI T2 mapping was performed preoperatively and at 12 and 24 months postoperatively. T2 relaxation times of the anterior and posterior horns of both menisci and of the adjacent cartilage were assessed. RESULTS Thirty-six knees from 32 patients were included. The mean age at surgery was 13.7 years (range 7-24), and the mean follow-up duration was 31.0 months. Saucerization alone was performed on five knees and saucerization with repair on 31 knees. Preoperatively, the T2 relaxation time of the anterior horn of the lateral meniscus was significantly longer than that of the medial meniscus (P < 0.01). T2 relaxation time significantly decreased at 12 and 24 months postoperatively (P < 0.01). Assessments of the posterior horn were comparable. The T2 relaxation time was significantly longer in the tear versus non-tear side at each time point (P < 0.01). There were significant correlations between the T2 relaxation time of the meniscus and that of the corresponding area of the lateral femoral condyle cartilage (anterior horn: r = 0.504, P = 0.002; posterior horn: r = 0.365, P = 0.029). CONCLUSIONS The T2 relaxation time of symptomatic DLM was significantly longer than that of the medial meniscus preoperatively, and it decreased 24 months after arthroscopic reshaping surgery. The meniscal T2 relaxation time of the tear side was significantly longer than that of the non-tear side. There were significant correlations between the cartilage and meniscal T2 relaxation times at 24 months after surgery.
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Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile discoid lateral meniscus with peripheral tear. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04747-0. [PMID: 36595029 DOI: 10.1007/s00402-022-04747-0] [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: 09/02/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We compared subtotal meniscectomy and saucerization with stabilization for osteocartilaginous damage based on injured location and further examined the factors related to osteocartilaginous damage in juvenile discoid lateral meniscus (DLM) with peripheral tear after a follow-up period of at least 5 years. MATERIALS AND METHODS We retrospectively reviewed juvenile DLM patients with peripheral tear who underwent arthroscopic surgery with more than 5 years of follow-up. Osteocartilaginous damage, which was identified by osteochondritis dissecans (OCD) development and the whole-organ magnetic resonance imaging score (WORMS) of cartilage grade ≥ 3, was compared between subtotal meniscectomy and saucerization with stabilization. A subgroup analysis examining the location of the tear site was performed. Factors for osteocartilaginous damage were analyzed between the damaged and non-damaged groups. RESULTS Forty-one patients, including 29 who underwent saucerization with stabilization and 12 who underwent subtotal meniscectomy, were included in this study. Seven patients developed OCD lesions; six patients showed cartilage WORMS of more than grade 3. Overall, there was a significant difference in the total cartilage and meniscus WORMS between the two groups at the final follow-up. The subgroup analysis demonstrated more severe osteocartilaginous damage developed in posterior subtotal meniscectomy than in posterior stabilization following saucerization. The damaged group showed significant difference compared to the non-damaged group in terms of age (p = 0.003), sex (p = 0.036), and posterior subtotal meniscectomy (p < 0.001). CONCLUSIONS Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile DLM with peripheral tear over a minimum follow-up period of 5 years.
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Wang DY, Meng XY, Gong X, Yu JK, Jiang D. Meniscal allograft transplantation in discoid meniscus patients achieves good clinical outcomes and superior chondroprotection compared to meniscectomy in the long term. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07263-1. [PMID: 36454294 DOI: 10.1007/s00167-022-07263-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To compare the long-term clinical and radiological results of meniscal allograft transplantation (MAT) for discoid lateral meniscus (DLM) patients with MAT for non-discoid lateral meniscus patients and meniscectomy (ME) for DLM patients and, thus, to determine whether DLM patients are suitable candidates for MAT. METHODS Eight MAT cases in DLM patients were identified (discoid MAT group), six MAT cases in non-discoid lateral meniscus patients (non-discoid MAT group) and ten total meniscectomy cases in DLM patients (discoid ME group) were matched as controls. Subjective evaluations, postoperative radiography and magnetic resonance imaging (MRI) were conducted at 5 years and 10-14 years, respectively. Joint degeneration was evaluated by the Kellgren-Lawrance (KL) grade and joint space width (JSW). MRI with T2 mapping sequences was used to quantitatively evaluate degeneration of the joint cartilage and shrinkage of the allografts. Student's t test was used to compare quantitative variables and the Mann‒Whitney U test was used to compare categorical variables. RESULTS There was no difference in Lysholm, IKDC, Tegner or VAS scores amongst the discoid MAT, non-discoid MAT and discoid ME groups at the final follow-up. No revision surgery was performed in any MAT patient. The JSW narrowing in the discoid MAT group was better than that in the discoid ME group (0.8 ± 0.4 mm vs. 2.1 ± 1.3 mm, p = 0.012) and worse than that in the non-discoid MAT group (0.1 ± 0.1 mm, p = 0.003). The KL progression of the discoid MAT group was less than that of the discoid ME group (1.3 ± 0.7 vs. 2.3 ± 0.9, p = 0.034). The discoid ME group had worse cartilage lesion progression than the discoid MAT and non-discoid MAT groups. The allograft width of the DLM patients shrank more than that of the non-discoid patients at the meniscus midbody (3.6 ± 0.9 mm vs. 6.2 ± 1.9 mm, p = 0.015). CONCLUSION Compared to meniscectomy, MAT achieved similar long-term symptom relief and superior chondroprotection in discoid meniscus patients. Despite more graft shrinkage, the outcomes of MAT in discoid meniscus patients were comparable to those in non-discoid meniscus patients. Therefore, DLM patients may be suitable candidates for MAT procedures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ding-Yu Wang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xiang-Yu Meng
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xi Gong
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Jia-Kuo Yu
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
| | - Dong Jiang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
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Morales-Sánchez V, Falcó C, Hernández-Mendo A, Reigal RE. Efficacy of Electromyographic Biofeedback in Muscle Recovery after Meniscectomy in Soccer Players. SENSORS 2022; 22:s22114024. [PMID: 35684645 PMCID: PMC9185253 DOI: 10.3390/s22114024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022]
Abstract
Electromyographic biofeedback (EMG-BF) is a therapeutic technique that has been used successfully in the rehabilitation of injuries. Although it has been applied to athletes, its use in this field is not very widespread. The objective of this study is to analyze its effectiveness in the recovery of electromyographic activity of the quadriceps after meniscectomy, evaluated through isometric contraction of the vastus lateralis. The sample comprised ten professional footballers in the Spanish League (2nd Division A) who had previously suffered a meniscus injury in their knee and had undergone a meniscectomy. The intervention consisted of EMG-BF treatment lasting between 6 and 10 sessions. The electromyographic signal was recorded using a Thought Technology ProComp Infiniti 8-channel biofeedback unit with a sampling rate of 2048 samples/second. For each session, a within-subject ABA design of 6 or 10 trials per session was used, with three pre- and three post-measures, which determined the gain for each session. The results indicated (1) improvements in all cases, (2) EMG-BF was effective, (3) the working model was statistically significant with an explained variance of between 67% and 75%, and (4) the generalizability analysis showed that the results are reliable and generalizable. The results indicate that EMG-BF is effective in neuromuscular rehabilitation after this type of intervention.
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Affiliation(s)
- Verónica Morales-Sánchez
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
| | - Coral Falcó
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, 5020 Bergen, Norway;
| | - Antonio Hernández-Mendo
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
| | - Rafael E. Reigal
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
- Correspondence:
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Ren S, Zhou R, Zhang X, Bai L, Jiang C, Ren Y, You T, Zhang W. Anatomical knee variables result in worse outcomes of lateral meniscal allograft transplantation with discoid lateral menisci than with nondiscoid lateral menisci. Knee Surg Sports Traumatol Arthrosc 2021; 29:4146-4153. [PMID: 33660054 DOI: 10.1007/s00167-021-06509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the clinical results of meniscal allograft transplantation (MAT) between patients with discoid lateral meniscus (DLM) and non-DLM (NDLM) and to analyse whether anatomical deformities cause worse clinical results in DLM patients. METHODS Patients who underwent unilateral MAT from 2005 to 2017, including 115 patients with DLMs or NDLMs, were included in this study. Clinical outcomes [International Knee Documentation Committee (IKDC) scores, Lysholm scores, Tegner scores, and visual analogue scale (VAS) scores] and radiographic and MRI data were assessed. Clinical outcomes and anatomical knee variables were analysed by multivariate stepwise regression. RESULTS After more than 2 years of follow-up, 9 patients were lost to follow-up, and 59 patients with DLM and 47 patients with NDLM were included. The mean postoperative results were significantly better than the preoperative data (P < 0.05) in both the DLM and NDLM groups. In addition, postoperative IKDC, Lysholm, and VAS scores but not Tegner scores were better in the NDLM group than in the DLM group. Several anatomical knee variables differed significantly between the NDLM and DLM groups and were associated with MAT outcomes. The condylar prominence ratio of the lateral and medial femoral condyles adjacent to the intercondylar notch and squaring of the lateral femoral condyle (the distance of the straight articular condylar surface) were independent factors significantly correlated with the Lysholm scores for MAT at last follow-up. CONCLUSION MAT improved knee function in both patients with DLM and patients with NDLM, but patients NDLM had better clinical outcomes than patients with DLM. The condylar prominence ratio and squaring of the lateral femoral condyle may underlie this result. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shiyou Ren
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Ri Zhou
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Lu Bai
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Changqing Jiang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Yuxiang Ren
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Tian You
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Wentao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China.
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Nishino K, Hashimoto Y, Tsumoto S, Yamasaki S, Nakamura H. Morphological Changes in the Residual Meniscus After Reshaping Surgery for a Discoid Lateral Meniscus. Am J Sports Med 2021; 49:3270-3278. [PMID: 34415178 DOI: 10.1177/03635465211033586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic reshaping surgery is the first treatment option for a symptomatic discoid lateral meniscus (DLM) to preserve the peripheral rim. However, the degree of postoperative morphological change in the residual meniscus is unclear. PURPOSE/HYPOTHESIS The purpose of this study was to measure the meniscus after reshaping surgery for a DLM, to verify when the morphological change occurred, and to examine the related risk factors. The hypothesis was that the residual meniscal width would decrease throughout the postoperative course. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We retrospectively reviewed the medical records of patients who underwent reshaping surgery for a symptomatic DLM and had undergone follow-up for ≥2 years. Magnetic resonance imaging (MRI) was routinely performed preoperatively and at 3, 6, 12, and 24 months postoperatively, and the width, height, and extrusion of the residual meniscus were measured. According to the width of the midbody on final MRI scans, we compared the preoperative and postoperative data for the preserved group (≥5 mm) and decreased group (<5 mm). The associated risk factors for a decreased meniscal width (<5 mm) of the midbody were analyzed on final MRI scans. RESULTS We included 61 knees of 54 patients in this study. The mean age at the time of surgery was 11.7 years. The intraobserver and interobserver reliabilities of the midbody width were 0.937 and 0.921, respectively. The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery (from 9.1 to 8.6 mm [P < .001], from 7.5 to 6.1 mm [P < .001], and from 9.5 to 8.9 mm [P = .001], respectively). Meniscal extrusion of the midbody did not change significantly (from 1.2 to 1.5 mm; P = .062). Overall, 46 knees (n = 20/32 in the preserved group and n = 26/29 in the decreased group) had longitudinal tears that required meniscal repair. Clinical outcomes did not differ significantly between the 2 groups. Multivariate logistic analysis showed that intrameniscal degeneration (odds ratio, 4.36; P = .023) significantly increased the risk of a decreased meniscal width. CONCLUSION The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery. In particular, the average decrease rate of the midbody was 19%. No clinical difference was seen in patients with a decreased width and height or with peripheral extrusion. Increased intrameniscal signals on preoperative MRI scans were associated with an increased risk of a decreased meniscal width. Surgeons should consider this result to determine the amount of resection.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Syuko Tsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Ahn J, Lee SH. Editorial Commentary: Saucerization Is Superior to Total Meniscectomy in Patients With Symptomatic Discoid Lateral Meniscus. Arthroscopy 2021; 37:655-656. [PMID: 33546802 DOI: 10.1016/j.arthro.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Current treatment recommendations favor meniscal rim preservation through partial meniscectomy with repair when indicated in patients with symptomatic discoid lateral menisci. Although many studies have shown the importance of meniscal rim preservation, some have shown that suture repair does not yield improved outcomes over partial meniscectomy without repair, considering the cost of repair and lack of available data. However, partial meniscectomy with repair is essential when peripheral instability is seen in patients with symptomatic discoid lateral menisci. Arthroscopic reshaping in young patients can be challenging for an inexperienced surgeon because visualization within the lateral joint space may be limited by a thickened meniscus and the small size of the pediatric knee. To preserve a stable peripheral rim, various meniscal repair methods should be used for stabilizing the reshaped meniscus on the capsule based on repair location, tear type, and surgeon preference.
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Multivariate ordered logistic regression analysis of the postoperative effect of symptomatic discoid lateral meniscus. Arch Orthop Trauma Surg 2021; 141:1935-1944. [PMID: 33616721 PMCID: PMC8497286 DOI: 10.1007/s00402-021-03821-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/07/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The postoperative effect of arthroscopy in the treatment of symptomatic discoid lateral meniscus (DLM) varies greatly among individuals. Therefore, this study aims to investigate the factors affecting the postoperative outcomes of symptomatic DLM. MATERIALS AND METHODS According to the inclusion and exclusion criteria, patients with symptomatic single-knee DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were included. Retrospectively collected 16 factors probably affecting postoperative outcomes. The Ikeuchi grade system was used to evaluate the knee joint function. Univariate analysis was performed by Kruskal-Wallis rank-sum test or Mann-Whitney U test, and multivariate analysis by ordered logistic regression. P < 0.05 was considered statistically significant. RESULTS A sum of 502 patients was included, including 353 females (70.3%) and 149 males (29.7%). Difference between preoperative and postoperative Ikeuchi grade was statistically significant (P < 0.001). Female was bad to obtain a good Ikeuchi grade (P = 0.009, OR 0.458). Outerbridge grade (P = 0.018, OR 0.638) was negatively correlated with Ikeuchi grade. BMI (P = 0.001, OR 0.875) and work intensity (P = 0.020, OR 0.611) were inversely correlated with Ikeuchi grade. Age of onset (P < 0.001, OR 0.956) and symptoms duration (P < 0.001, OR 0.988) were negatively correlated with Ikeuchi grade. Besides, compared to total meniscectomy, meniscoplasty with a repair was an unfavourable factor for Ikeuchi grade (P = 0.044, OR 0.245). CONCLUSIONS With the increase of BMI, work intensity, age of onset, duration of symptoms, and the severity of cartilage lesion, the postoperative results become worse. Moreover, female and meniscoplasty with repair are risk factors for the postoperative outcomes.
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Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020; 7:81. [PMID: 33044686 PMCID: PMC7550551 DOI: 10.1186/s40634-020-00294-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea
| | - Jin Hwan Ahn
- Department of Orthopedic Surgery, Saeum Hospital, Seoul, South Korea
| | - Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS 2020; 6:14-21. [PMID: 33833041 DOI: 10.1136/jisakos-2017-000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
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Affiliation(s)
- Sachin Tapasvi
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Anshu Shekhar
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Karl Eriksson
- Orthopedic Surgery, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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Smoak JB, Matthews JR, Vinod AV, Kluczynski MA, Bisson LJ. An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses. Orthop J Sports Med 2020; 8:2325967120950306. [PMID: 32953923 PMCID: PMC7485005 DOI: 10.1177/2325967120950306] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: A large number of systematic reviews and meta-analyses regarding the meniscus
have been published. Purpose: To provide a qualitative summary of the published systematic reviews and
meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the
meniscus and published between July 2009 and July 2019 was performed with
PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts,
narrative reviews, articles not written in English, commentaries, study
protocols, and topics that were not focused on the meniscus were excluded.
The most pertinent results were extracted and summarized from each
study. Results: A total of 332 articles were found, of which 142 were included. Included
articles were summarized and divided into 16 topics: epidemiology,
diagnosis, histology, biomechanics, comorbid pathology, animal models,
arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root
repairs, meniscal allograft transplantation (MAT), meniscal implants and
scaffolds, mesenchymal stem cells and growth factors, postoperative
rehabilitation, postoperative imaging assessment, patient-reported outcome
measures, and cost-effectiveness. The majority of articles focused on APM
(20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a
single source of the current evidence regarding the meniscus.
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Affiliation(s)
- Jason B Smoak
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - John R Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
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Yang SJ, Ding ZJ, Li J, Xue Y, Chen G. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculoskelet Disord 2020; 21:551. [PMID: 32799843 PMCID: PMC7429813 DOI: 10.1186/s12891-020-03573-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Due to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM. METHODS Patients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes. P < 0.05 was considered statistically significant. RESULTS A total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4 ~ 97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9 ~ 64.9; IQR, 9.7) (P < 0.001). Male sex was predictive of a higher IKDC score (P = 0.023, OR = 1.702). Compared with BMI ≥25 kg/m2, < 18.5 kg/m2 was associated with better IKDC score (P = 0.026, OR = 3.016). Contrasting with age of onset ≥45 years, ≤14 years (P < 0.001, OR = 20.780) and 14 ~ 25 years (P < 0.001, OR = 8.516) were associated with better IKDC score. In comparison with symptoms duration> 24 months, IKDC scores for patients with symptoms duration ≤1 month (P = 0.001, OR = 3.511), 1 ~ 6 months (P < 0.001, OR = 3.463) and 6 ~ 24 months (P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III ~ IV, no injury (P < 0.001, OR = 6.379) and grade I (P = 0.01, OR = 4.332) were associated with higher IKDC score. CONCLUSIONS Arthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5 kg/m2, age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade ≥ 2) reduces postoperative effect.
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Affiliation(s)
- Shun-Jie Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong-Jun Ding
- Department of Orthopedic Surgery, West China Longquan Hospital Sichuan University, No.201, Yihe Group 3, Longquanyi District, Chengdu, 610100, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Yang Xue
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Gang Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
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Knee orthopedic problems in newborns and infancy: a review. Curr Opin Pediatr 2020; 32:113-119. [PMID: 31789974 DOI: 10.1097/mop.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age. RECENT FINDINGS With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future. SUMMARY Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients' functional status for life.
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Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRI and X-ray. Orthop Traumatol Surg Res 2019; 105:1389-1394. [PMID: 31607576 DOI: 10.1016/j.otsr.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of bilateral discoid lateral meniscus (DLM) is as high as 73 to 85%, and associated contralateral meniscus tears ranged from 4 to 33% in symptomatic surgical DLM. The goal of the study was analyzing the factors that predict contralateral presence and tearing of DLM in patients who underwent surgery for symptomatic DLM. Our hypothesis was that there is a significant correlation between operative DLM properties and the incidence of bilateral DLM with associated contralateral meniscus tears. These properties include tear patterns, younger patient age, and characteristic X-ray findings. PATIENTS AND METHODS This prospective study included 76 patients who underwent arthroscopic surgery for symptomatic DLM. The contralateral knees were evaluated with X-ray and MRI. Based on the MRI findings, DLM was categorized into three types, and tear patterns were analyzed. The characteristic X-ray findings were evaluated as follows: (1) high fibular head, (2) squared-off appearance of the lateral femoral condyle, (3) cupping of the lateral tibial plateau, (4) widened femorotibial joint space, (5) hypoplasia of the lateral intercondylar spine, (6) notching of the LFC. The number of characteristic X-ray findings (0/1/more than 2) was noted. Binary logistic analysis was performed to find the factors that predict the presence and tear of contralateral DLM. RESULTS MRI of contralateral knees revealed 43 cases (57%) of complete DLM, 25 cases (33%) of incomplete DLM, and 8 cases (11%) of normal meniscus. Meniscus tears were found in 29 cases (38%) in the contralateral knee. X-ray of the contralateral knee revealed that 27 patients (36%) had one and 24 patients (32%) had two or more characteristic X-ray findings. On logistic regression analysis, the associations between contralateral knee meniscal tear and the presence of one or more than two characteristic X-ray findings were statistically significant (OR: 16.5, p=0.028; OR: 264.0, p=0.000, respectively). DISCUSSION The number of characteristic X-ray findings in the contralateral knee is a significant predictive factor for contralateral DLM type and/or tear. Symptomatic DLM patients with characteristic X-ray findings should be carefully evaluated for contralateral DLM and meniscal tears. LEVEL OF EVIDENCE III, prospective diagnostic study of consecutive patients.
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