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Yaya-Quezada C, Fanney L, Patel V, Taragin BH, Williams BA, Simoni P, Nguyen JC. Imaging of the Pediatric Knee. Semin Musculoskelet Radiol 2024; 28:462-476. [PMID: 39074728 DOI: 10.1055/s-0044-1786152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
During normal development, imaging findings in the immature knee joint may mimic pathology or indicate transient sites of weakness, prone to injury. This article reviews the development of the knee joint, age- and maturation-dependent imaging considerations, and various developmental variants that can be encountered, subdivided into those that involve the tibiofemoral and patellofemoral compartments, soft tissues, and osseous components. The tibiofemoral compartment section reviews the focal periphyseal edema zone (FOPE), ossification variants of the femoral condyles, distal femoral metaphyseal cortical irregularity from periosteal traction, and the metaphyseal subperiosteal stripe, which should be distinguished from pathologic mimickers such as endochondral ossification dysfunction, osteochondritis dissecans (OCD), fibroosseous lesion, periosteal and subcortical pathologies. The patellofemoral compartment section includes a review of partite patella, dorsolateral defect, variant trochlear morphology, and maturation-dependent sites of transient weakness that are prone to injury from repetitive overuse (Sinding-Larsen-Johansson syndrome and Osgood-Schlatter disease) and avulsion fractures (patellar sleeve and tibial tubercle avulsions). Finally, soft tissue (discoid lateral meniscus, meniscal flounce, anterior cruciate ligament variants) and osseous components (meniscal ossicle, fabella, and cyamella) are reviewed.
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Affiliation(s)
- Carlos Yaya-Quezada
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lewis Fanney
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Eastern Virginia Medical School, Norfolk, Virginia
| | - Vandan Patel
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin H Taragin
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan A Williams
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paolo Simoni
- Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Jie C Nguyen
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Alkhunayfir HA, AlQahtani AA, Korkoman AJ. Congenital absence of the lateral meniscus: A case report. World J Orthop 2024; 15:477-482. [PMID: 38835691 PMCID: PMC11145968 DOI: 10.5312/wjo.v15.i5.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/24/2024] [Accepted: 04/07/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Congenital absence of the menisci is a rare anatomical variation characterized by the absence or underdevelopment of one or both menisci in the knee joint. The menisci are crucial in load distribution, joint stability, and shock absorption. Understanding the clinical presentation, diagnosis, and management of this condition is important for optimal patient care. CASE SUMMARY A 27-year-old male with a long-standing history of knee pain underwent diagnostic arthroscopy, revealing a congenital absence of the meniscus. The patient's clinical findings, imaging results, surgical procedures, and pertinent images are detailed. This case presents a unique aspect with the congenital absence of the meniscus, contributing valuable insights to the literature on rare anatomical anomalies. CONCLUSION This case of congenital absence of the menisci highlights the diagnostic challenges posed by rare anomalies. The diagnostic arthroscopy played a crucial role in identifying the absence of the meniscus and providing an explanation for the patient's persistent knee pain. The case underscores the importance of individualized treatment approaches, including physical therapy, for optimal management of rare meniscal anomalies. Further research is warranted to explore effective management strategies for the aforementioned cases and to expand our knowledge of these rare conditions.
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Affiliation(s)
- Hamad Ali Alkhunayfir
- Department of Orthopedic Surgery, Prince Muhammed bin Abdulaziz Hospital, Riyadh 61422, Saudi Arabia
| | - Abdulaziz Ali AlQahtani
- Department of Orthopedic Surgery, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
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3
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Modina SC, Aidos L, Millar VRH, Pallaoro M, Polito U, Veronesi MC, Peretti GM, Mangiavini L, Carnevale L, Boschetti F, Abbate F, Di Giancamillo A. Postnatal morpho-functional development of a dog's meniscus. Ann Anat 2023; 250:152141. [PMID: 37499701 DOI: 10.1016/j.aanat.2023.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
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Affiliation(s)
- Silvia Clotilde Modina
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Lucia Aidos
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | | | - Margherita Pallaoro
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Umberto Polito
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Maria Cristina Veronesi
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Giuseppe Maria Peretti
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy; IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università, 6, 26900 Lodi, Italy
| | - Federica Boschetti
- IRCCS, Ospedale Galeazzi - Sant'Ambrogio, Via Cristina Belgioioso 173, 20157, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Polytechnic University of Milan, 20133 Milan, Italy
| | - Francesco Abbate
- Department of Veterinary Sciences, University of Messina, Polo Universitario S.S. Annunziata, 98168 Messina, Italy
| | - Alessia Di Giancamillo
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133 Milan, Italy.
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Mameri ES, Dasari SP, Fortier LM, Verdejo FG, Gursoy S, Yanke AB, Chahla J. Review of Meniscus Anatomy and Biomechanics. Curr Rev Musculoskelet Med 2022; 15:323-335. [PMID: 35947336 DOI: 10.1007/s12178-022-09768-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Anatomic repair of meniscal pathology is critical for restoring native joint biomechanics and kinematics for patients who suffer from meniscal tears. The purpose of this review was to summarize the pertinent anatomy, biomechanics, and kinematics of the meniscus to guide surgeons during meniscal repair procedures. RECENT FINDINGS Over the past decade, there has been a growing trend to save the meniscus whenever possible. The goal of repair should be to recreate native anatomy as close as possible to recapitulate normal mechanics. Studies describing the quantitative and qualitative relationship of the meniscus roots, ligaments, and attachments are key in guiding any meniscus repair. This review summarizes these relationships, with particular emphasis on meniscal roots and other key attachments to the meniscus. The composition, embryology, vascularization, biomechanics, in vivo kinetics, and in vivo kinematics of the meniscus are also discussed in this review. Meniscal tears can cause profound functional, biomechanical, and kinematic derangements within the knee joint leading to accelerated degeneration of the articular cartilage. A strong understanding of the quantitative and qualitative relationships of the meniscus and its attachments with key arthroscopic landmarks will allow a surgeon to anatomically repair meniscal pathology in order to restore native joint biomechanics.
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Affiliation(s)
- Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.,Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.,Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Fernando Gómez Verdejo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St., Chicago, IL, 60612, USA.
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Jin G, Xin T, Weng Z, Zhu Y, Qiu H, Liu D, Chen S, Dong J, Huang F, Chen Y. Symptomatic Complete Discoid Medial Meniscus Completely Coalesced with the Anterior Cruciate Ligament: A Case Report and Literature Review. Orthop Surg 2022; 14:2391-2395. [PMID: 35913195 PMCID: PMC9483042 DOI: 10.1111/os.13377] [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: 12/10/2021] [Revised: 05/14/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Complete discoid medial meniscus is an extremely rare abnormality of the knee joint whose meniscus has a discoid shape rather than a normal semilunar one. Several medial meniscus anomalies including anomalous insertion have been reported in the literature. This report presents a rare case of symptomatic complete discoid medial meniscus whose anterolateral (apical) portion was completely coalesced with the ACL. MRI, radiographic, and arthroscopic findings in the medial compartment are to be submitted. Case Presentation A 29‐year‐old male presented with intermittent pain and swelling of the right knee for 2 years. Based on radiographic, MRI, and physical examination findings, he was diagnosed with discoid medial meniscus tears. Arthroscopic saucerization was performed for the torn discoid medial meniscus of the right knee. Arthroscopic examination revealed a complete discoid medial meniscus and the anterolateral (apical) portion of which was completely coalesced with the ACL. Careful Probing of the meniscal surface revealed there was a longitudinal tear extending from the tibial spine to the midportion of the meniscus. Arthroscopic saucerization of the discoid meniscus was performed after closely cutting the meniscus around the ACL. The patient reported no symptoms, and he had returned to his daily and sports activities, including football, basketball, and jogging, at the 12‐month follow‐up. Conclusion Complete discoid medial meniscus is an extremely rare abnormality, and this case presents the third complete discoid medial meniscus whose anterolateral (apical) portion was completely coalesced with the ACL. The current case we present strongly supports the hypothesis that ACL and meniscus were differentiated from the same mesenchyme.
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Affiliation(s)
- Guorong Jin
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Tong Xin
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Zheng Weng
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Yun Zhu
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Hao Qiu
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Dun Liu
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Shimou Chen
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
| | - Jiangtao Dong
- Department of Joint Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Huang
- Department of Respiratory Medicine, Ninth Peoples's Hospital of Chongqing, Chongqing, China
| | - Yu Chen
- Center for Traumatology, Ninth People's Hospital of Chongqing, Chongqing, China
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Araki S, Tsubosaka M, Muratsu H, Inokuchi T, Maruo H, Miya H, Kuroda R, Matsushita T. Evaluation of morphological characteristics for incomplete discoid medial meniscus with an oversized posterior segment. J Orthop Surg Res 2022; 17:245. [PMID: 35443728 PMCID: PMC9022343 DOI: 10.1186/s13018-022-03132-2] [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: 09/30/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus. METHODS Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups. RESULTS All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm, P < 0.001), whereas there was no significant difference in the AP length of the anterior segment (9.1 ± 2.1 vs. 9.5 ± 1.9 mm, P = 0.869). The ML width of the mid-body in the normal, oversize, and discoid groups was 9.3 ± 1.8, 19.9 ± 2.6, and 25.8 ± 1.9 mm, respectively (normal vs. oversize group: P < 0.001, oversize vs discoid group: P = 0.01, normal vs. discoid group: P < 0.001). CONCLUSIONS Oversized posterior and normal anterior segments characterize this new type of incomplete discoid medial meniscus as a morphological abnormality.
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Affiliation(s)
- Shotaro Araki
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan.
| | - Takao Inokuchi
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hiroaki Maruo
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Szojka ARA, Liang Y, Marqueti RDC, Moore CN, Erkut EJN, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Time course of 3D fibrocartilage formation by expanded human meniscus fibrochondrocytes in hypoxia. J Orthop Res 2022; 40:495-503. [PMID: 33788325 DOI: 10.1002/jor.25046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Adult human meniscus fibrocartilage is avascular and nonhealing after injury. Meniscus tissue engineering aims to replace injured meniscus with lab-grown fibrocartilage. Dynamic culture systems may be necessary to generate fibrocartilage of sufficient mechanical properties for implantation; however, the optimal static preculture conditions before initiation of dynamic culture are unknown. This study thus investigated the time course of fibrocartilage formation by human meniscus fibrochondrocytes on a three-dimensional biomaterial scaffold under various static conditions. Human meniscus fibrochondrocytes from partial meniscectomy were expanded to passage 1 (P1) or P2 (3.0 ± 0.4 and 6.5 ± 0.6 population doublings), seeded onto type I collagen scaffolds, and grown in hypoxia (HYP, 3% O2 ) or normoxia (NRX, 20% O2 ) for 3, 6, and 9 weeks. Mechanical properties were not different between P1 and P2 cell-based constructs. Mechanical properties were lower in HYP, increased continually in NRX only, and were positively correlated with glycosaminoglycan content and accumulation of hyaline cartilage-like matrix components. The most mechanically competent tissues (NRX/9 weeks) reached 1/5 of the native meniscus instantaneous compression modulus but had an increasingly hypertrophic matrix-forming phenotype. HYP consistently suppressed the hypertrophic phenotype. The results provide baselines of engineered meniscus fibrocartilage properties under static conditions, which can be used to select a preculture strategy for dynamic culture depending on the desired combination of mechanical properties, hyaline cartilage-like matrix abundance, and hypertrophic phenotype.
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Affiliation(s)
- Alexander R A Szojka
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Yan Liang
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Rita de Cássia Marqueti
- Graduate Program of Rehabilitation Sciences, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Colleen N Moore
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Esra J N Erkut
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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Prabhath S, Alappatt K, Shetty A, Sumalatha S. An exploratory study of the histomorphogenesis and zonal vascular changes in the human fetal medial meniscus. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Turati M, Anghilieri FM, Accadbled F, Piatti M, Di Benedetto P, Moltrasio F, Zatti G, Zanchi N, Bigoni M. Discoid meniscus in human fetuses: A systematic review. Knee 2021; 30:205-213. [PMID: 33945980 DOI: 10.1016/j.knee.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. METHODS A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation. RESULTS Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. CONCLUSION Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France.
| | | | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Toulouse University Hospital, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Paolo Di Benedetto
- Medical Departement (DAME) - University of Udine, Italy; Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Kim J, Boys AJ, Estroff LA, Bonassar LJ. Combining TGF-β1 and Mechanical Anchoring to Enhance Collagen Fiber Formation and Alignment in Tissue-Engineered Menisci. ACS Biomater Sci Eng 2021; 7:1608-1620. [PMID: 33606521 DOI: 10.1021/acsbiomaterials.0c01791] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recapitulating the collagen fiber structure of native menisci is one of the major challenges in the development of tissue-engineered menisci. Native collagen fibers are developed by the complex interplay of biochemical and biomechanical signals. In this study, we optimized glucose and transforming growth factor-β1 (TGF-β1) concentrations in combination with mechanical anchoring to balance contributions of proteoglycan synthesis and contractile behavior in collagen fiber assembly. Glucose had a profound effect on the final dimensions of collagen-based constructs. TGF-β1 influenced construct contraction rate and glycosaminoglycan (GAG) production with two half-maximal effective concentration (EC50) ranges, which are 0.23 to 0.28 and 0.53 to 1.71 ng/mL, respectively. At concentrations less than the EC50, for the GAG production and contraction rate, TGF-β1 treatment resulted in less organized collagen fibers. At concentrations greater than the EC50, TGF-β1 led to dense, disorganized collagen fibers. Between the two EC50 values, collagen fiber diameter and length increased. The effects of TGF-β1 on fiber development were enhanced by mechanical anchoring, leading to peaks in fiber diameter, length, and alignment index. Fiber diameter and length increased from 7.9 ± 1.4 and 148.7 ± 16.4 to 17.5 ± 2.1 and 262.0 ± 13.0 μm, respectively. The alignment index reached 1.31, comparable to that of native tissue, 1.40. These enhancements in fiber architecture resulted in significant increases in tensile modulus and ultimate tensile stress (UTS) by 1.6- and 1.4-fold. Correlation analysis showed that tensile modulus and UTS strongly correlated with collagen fiber length, diameter, and alignment, while compressive modulus correlated with GAG content. These outcomes highlight the need for optimization of both biochemical and biomechanical cues in the culture environment for enhancing fiber development within tissue-engineered constructs.
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Affiliation(s)
- Jongkil Kim
- Meinig of Biomedical Engineering, Cornell University, 237 Tower Road, Ithaca, New York 14853, United States
| | - Alexander J Boys
- Department of Materials Science and Engineering, Cornell University, 126 Hollister Drive, Ithaca, New York 14853, United States
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, 126 Hollister Drive, Ithaca, New York 14853, United States.,Kavli Institute at Cornell for Nanoscale Science, Cornell University, 245 East Avenue, Ithaca, New York 14853, United States
| | - Lawrence J Bonassar
- Meinig of Biomedical Engineering, Cornell University, 237 Tower Road, Ithaca, New York 14853, United States.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, 313 Campus Road, Ithaca, New York 14853, United States
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11
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Szojka AR, Marqueti RDC, Li DX, Molter CW, Liang Y, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Human engineered meniscus transcriptome after short-term combined hypoxia and dynamic compression. J Tissue Eng 2021; 12:2041731421990842. [PMID: 33613959 PMCID: PMC7874349 DOI: 10.1177/2041731421990842] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/10/2021] [Indexed: 12/30/2022] Open
Abstract
This study investigates the transcriptome response of meniscus fibrochondrocytes (MFCs) to the low oxygen and mechanical loading signals experienced in the knee joint using a model system. We hypothesized that short term exposure to the combined treatment would promote a matrix-forming phenotype supportive of inner meniscus tissue formation. Human MFCs on a collagen scaffold were stimulated to form fibrocartilage over 6 weeks under normoxic (NRX, 20% O2) conditions with supplemented TGF-β3. Tissues experienced a delayed 24h hypoxia treatment (HYP, 3% O2) and then 5 min of dynamic compression (DC) between 30 and 40% strain. Delayed HYP induced an anabolic and anti-catabolic expression profile for hyaline cartilage matrix markers, while DC induced an inflammatory matrix remodeling response along with upregulation of both SOX9 and COL1A1. There were 41 genes regulated by both HYP and DC. Overall, the combined treatment supported a unique gene expression profile favouring the hyaline cartilage aspect of inner meniscus matrix and matrix remodeling.
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Affiliation(s)
- Alexander Ra Szojka
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Rita de Cássia Marqueti
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.,Graduate Program of Rehabilitation Sciences, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - David Xinzheyang Li
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.,Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Clayton W Molter
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Yan Liang
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
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12
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He S, Ruan D, Chen Y, Ran J, Chen X, Yin Z, Tang C, Huang J, Heng BC, Chen J, Chen W, Shen W, Ouyang H. Characterization and Comparison of Postnatal Rat Meniscus Stem Cells at Different Developmental Stages. Stem Cells Transl Med 2019; 8:1318-1329. [PMID: 31638337 PMCID: PMC6877772 DOI: 10.1002/sctm.19-0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
Meniscus‐derived stem cells (MeSCs) are a potential cell source for meniscus tissue engineering. The stark morphological and structural changes of meniscus tissue during development indicate the complexity of MeSCs at different tissue regions and stages of development. In this study, we characterized and compared postnatal rat meniscus tissue and MeSCs at different tissue regions and stages of development. We observed that the rat meniscus tissue exhibited marked changes in tissue morphology during development, with day 7 being the most representative time point of different developmental stages. All rat MeSCs displayed typical stem cell characteristics. Rat MeSCs derived from day 7 inner meniscus tissue exhibited the highest self‐renewal capacity, cell proliferation, differentiation potential toward various mesenchymal lineage and the highest expression levels of chondrogenic genes and proteins. Transplantation of rat MeSCs derived from day 7 inner meniscus tissue promoted neo‐tissue formation and effectively protected joint surface cartilage in vivo. Our results demonstrated for the first time that rat MeSCs are not necessarily better at earlier developmental stages, and that rat MeSCs derived from day 7 inner meniscus tissue may be a superior cell source for effective meniscus regeneration and articular cartilage protection. This information could make a significant contribution to human meniscus tissue engineering in the future. stem cells translational medicine2019;8:1318&1329 (A): Meniscus tissue at different tissue regions and stages of development. (B): MeSCs at different tissue regions and stages of development. (C): Intra‐articular injection of MeSCs for meniscus regeneration and OA suppression. *Significant difference between two groups at p < .05. **Significant difference between two groups at p < .01. ***Significant difference between two groups at p < .001. ****Significant difference between two groups at p < .0001. N.S., No significant difference between two groups at p ≥ .05.![]()
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Affiliation(s)
- Shaoqi He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yangwu Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jisheng Ran
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiao Chen
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zi Yin
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chenqi Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jiayun Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, People's Republic of China
| | - Jialin Chen
- School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Weishan Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Orthopedics, Research Institute of Zhejiang University, Hangzhou, People's Republic of China
| | - Weiliang Shen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Orthopedics, Research Institute of Zhejiang University, Hangzhou, People's Republic of China.,China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, People's Republic of China
| | - Hongwei Ouyang
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, People's Republic of China
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13
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Aydın Kabakçı AD, Büyükmumcu M, Akın D, Bilge O. Morphological structure and variations of fetal lateral meniscus: the significance in convenient diagnosis and treatment. Knee Surg Sports Traumatol Arthrosc 2019; 27:3364-3373. [PMID: 30656371 DOI: 10.1007/s00167-019-05352-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study is to evaluate of morphometry of the lateral meniscus (LM) and determine incidence of the LM shapes. METHODS This study was performed on fetal cadaver collection of Anatomy Department of Necmettin Erbakan University. Fifty human fetal cadavers (25 female, 25 male human fetal cadavers) were used in this study. Microdissection was performed. Morphometric measurements were performed. LM were classified into four types and five subtypes. RESULTS In this study, it was identified that all parameters which were measured were found to be increased with gestational ages. Four morphological types and five morphological subtypes were determined. It was found that 12% of the LM were crescent-shaped, 66% of the LM were C-shaped, 14% of the LM were incomplete-disc-shaped, 2% of the LM were disc-shaped, 6% of the LM were variant C-shaped. CONCLUSIONS A few studies on fetal meniscal anatomy and its development were performed. Each new study is important for having detailed anatomy and development of the fetal menisci which will have both clinical and anatomical impacts during childhood and adulthood for orthopedic surgeons and anatomists, respectively. The most important results of this study were the detailed objective analysis of the macroscopic fetal growth of LM. It was significantly observed that four morphological types and five morphological subtypes of LM. The results of the present study related with both the observation of morphological development of the fetal meniscal anatomy, and its morphological variants, are important in terms of improving our knowledge, and clinical approach on the description, and the management of the symptomatic lateral discoid meniscus tears in children, adolescents, and adults. The clinical relevance of this study was that this classification of fetal menisci could ameliorate our current understanding of the morphology of lateral meniscus in adult, further.
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Affiliation(s)
- Anıl Didem Aydın Kabakçı
- Department of Anatomy, Meram Faculty of Medicine, University of Necmettin Erbakan, Meram, 42080, Konya, Turkey.
| | - Mustafa Büyükmumcu
- Department of Anatomy, Meram Faculty of Medicine, University of Necmettin Erbakan, Meram, 42080, Konya, Turkey
| | - Duygu Akın
- Department of Anatomy, Meram Faculty of Medicine, University of Necmettin Erbakan, Meram, 42080, Konya, Turkey
| | - Onur Bilge
- Department of Orthopaedics and Traumatology, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey.,Department of Sports Medicine, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
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14
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Suga N, Nakasa T, Ishikawa M, Nakamae A, Hayashi S, Yoshikawa M, Sumida Y, Tsuyuguchi Y, Adachi N. Characteristic morphology of the proximal tibiofibular joint in patients with discoid lateral meniscus. Knee 2018; 25:1027-1032. [PMID: 30108012 DOI: 10.1016/j.knee.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/14/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with discoid lateral meniscus (DLM) are prone to meniscal injuries related to its shape and abnormal mobility. The anatomical joint inclination of the proximal tibiofibular joint (PTFJ) can also affect joint movement in knee motion. However, an association between PTFJ morphology and DLM remains unclear. The purpose of this study was to investigate the morphology of the PTFJ on MRI and how this differs between patients with and without DLM. MATERIALS AND METHODS Fifty-eight patients with DLM and 58 age-matched controls (normal meniscus) were included in this study. Slices from preoperative MRI sagittal images that clearly showed the PTFJ were used for measurements. The angle between the PTFJ and the perpendicular line of the fibula axis was measured as the inclination angle, and patients were classified as horizontal-type (<20°) or oblique-type (>20°). The inclination angle was also compared among patients with open and closed epiphysis in both groups to assess the effect of age. RESULTS Patients in the horizontal-type PTFJ group frequently had DLM. Before epiphyseal closure, most patients had a horizontal-type PTFJ, with or without DLM. However, in older patients with a closed epiphysis, most with a normal meniscus had an oblique-type PTFJ, and those with DLM retained the horizontal-type joint. CONCLUSION The horizontal-type PTFJ was significantly associated with DLM, and patients with DLM tended to retain a horizontal-type PTFJ after epiphyseal closure. In contrast, in patients with a normal meniscus, the PTFJ may change from a horizontal-type to an oblique-type PTFJ in line with bone maturity.
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Affiliation(s)
- Norifumi Suga
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Masakazu Ishikawa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Atsuo Nakamae
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Seiju Hayashi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Masahiro Yoshikawa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Yoshikazu Sumida
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Yusuke Tsuyuguchi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Nobuo Adachi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
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15
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Koyuncu E, Özgüner G, Öztürk K, Bilkay C, Dursun A, Sulak O. The Morphological Anatomy of the Menisci of the Knee Joint in Human Fetuses. Balkan Med J 2017; 34:559-566. [PMID: 28832324 PMCID: PMC5785662 DOI: 10.4274/balkanmedj.2016.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Development of the foetal period of the meniscus has been reported in different studies. Aims: Evaluation of lateral and medial meniscus development, typing and the relationship of the tibia during the foetal period. Study Design: Anatomical dissection. Methods: We evaluated 210 knee menisci obtained from 105 human foetuses ranging in age from 9 to 40 weeks’ gestation. Foetuses were divided into four groups, and the intra-articular structure was exposed. We subsequently acquired images (Samsung WB 100 26X Optical Zoom Wide, Beijing, China) of the intra-articular structures with the aid of a millimetric ruler. The images were digitized for morphometric analyses and analysed by using Netcad 5.1 Software (Ak Mühendislik, Ankara, Turkey). Results: The lateral and medial meniscal areas as well as the lateral and the medial articular surface areas of the tibia increased throughout gestation. We found that the medial articular surface areas were larger than the lateral articular surface areas, and the difference was statistically significant. The ratios of the mean lateral and medial meniscal areas to the lateral and medial articular surface areas, respectively, of the tibia decreased gradually from the first trimester to full term. The most common shape of the medial meniscus was crescentic (50%), and that of the lateral meniscus was C-shaped (61%). Conclusion: This study reveals the development of morphological changes and morphometric measurements of the menisci.
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Affiliation(s)
- Esra Koyuncu
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Gülnur Özgüner
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Kenan Öztürk
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Cemil Bilkay
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Ahmet Dursun
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Osman Sulak
- Department of Anatomy, Süleyman Demirel University School of Medicine, Isparta, Turkey
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16
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Abstract
BACKGROUND Achondroplasia is the most common form of skeletal dysplasia that presents to the pediatric orthopaedist. More than half of achondroplasia patients are affected with knee pain. It is thought that the majority of this pain may be due to spinal stenosis, hip pathology, or knee malalignment. Discoid menisci can be a source of lateral knee joint pain in skeletally immature patients in general. We present the first case series of patients with achondroplasia who had symptomatic discoid lateral menisci treated with arthroscopic knee surgery. METHODS The charts of 6 patients (8 knees) with achondroplasia who underwent arthroscopic knee surgery for symptomatic discoid lateral menisci were collected. History and physical examination data, magnetic resonance imaging findings, and operative reports were reviewed. Meniscal tear configuration and treatment type (meniscectomy vs. repair) were noted. RESULTS Each patient was found to have a tear of the discoid meniscus. All menisci were treated with saucerization. In addition, meniscal repair was performed in 2 cases, partial meniscectomy in 3 cases, and subtotal meniscectomy in 3 cases. Two patients had bilateral discoid meniscal tears which were treated. Average follow-up was 2.4 years (range, 1 to 4.5 y) and the average pediatric International Knee Documentation Committee (pedi-IKDC) score was 85.3% (range, 75% to 95.4%). At final follow-up, all patients were pain free and able to return to full activities. CONCLUSIONS Discoid meniscus tears may be a source of lateral joint line pain in patients with achondroplasia. These injuries can be successfully treated with arthroscopic surgery in this patient population. Future studies need to be done to determine the exact incidence of discoid menisci in achondroplasia patients and also to determine whether there is a genetic relationship between the 2 conditions. LEVEL OF EVIDENCE Level IV-case series.
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17
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Shimozaki K, Nakase J, Ohashi Y, Numata H, Oshima T, Takata Y, Tsuchiya H. Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear. J Orthop Case Rep 2017; 6:9-12. [PMID: 28164045 PMCID: PMC5288636 DOI: 10.13107/jocr.2250-0685.546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus. Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial and lateral discoid meniscus. In magnetic resonance imaging, although the lateral discoid meniscus had no tear, the medial discoid meniscus had a horizontal tear. Arthroscopic examination of his right knee similarly revealed that the medial discoid meniscus had a horizontal tear. In addition, the discoid medial meniscus also had an anomalous insertion to the anterior cruciate ligament, and there was also mild fibrillation of the medial tibial cartilage surface. We performed arthroscopic partial meniscectomy for the torn medial discoid meniscus but not for the asymptomatic lateral discoid meniscus. The latest follow-up at 18 months indicated satisfactory results. Conclusion: We report a rare case of ipsilateral medial and lateral discoid meniscus with medial meniscus tear. The medial discoid meniscus with tear was treated with partial meniscectomy, whereas the lateral discoid meniscus without tear was only followed up.
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Affiliation(s)
- Kengo Shimozaki
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Yoshinori Ohashi
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Hitoaki Numata
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan
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18
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Kan H, Arai Y, Nakagawa S, Inoue H, Minami G, Ikoma K, Fujiwara H, Kubo T. Medial and Lateral Discoid Menisci of Both Knees. Knee Surg Relat Res 2016; 28:330-333. [PMID: 27894182 PMCID: PMC5134786 DOI: 10.5792/ksrr.15.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared.
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Affiliation(s)
- Hiroyuki Kan
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ginjiro Minami
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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19
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Puetzer JL, Bonassar LJ. Physiologically Distributed Loading Patterns Drive the Formation of Zonally Organized Collagen Structures in Tissue-Engineered Meniscus. Tissue Eng Part A 2016; 22:907-16. [PMID: 27245484 DOI: 10.1089/ten.tea.2015.0519] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The meniscus is a dense fibrocartilage tissue that withstands the complex loads of the knee via a unique organization of collagen fibers. Attempts to condition engineered menisci with compression or tensile loading alone have failed to reproduce complex structure on the microscale or anatomic scale. Here we show that axial loading of anatomically shaped tissue-engineered meniscus constructs produced spatial distributions of local strain similar to those seen in the meniscus when the knee is loaded at full extension. Such loading drove formation of tissue with large organized collagen fibers, levels of mechanical anisotropy, and compressive moduli that match native tissue. Loading accelerated the development of native-sized and aligned circumferential and radial collagen fibers. These loading patterns contained both tensile and compressive components that enhanced the major biochemical and functional properties of the meniscus, with loading significantly improved glycosaminoglycan (GAG) accumulation 200-250%, collagen accumulation 40-55%, equilibrium modulus 1000-1800%, and tensile moduli 500-1200% (radial and circumferential). Furthermore, this study demonstrates local changes in mechanical environment drive heterogeneous tissue development and organization within individual constructs, highlighting the importance of recapitulating native loading environments. Loaded menisci developed cartilage-like tissue with rounded cells, a dense collagen matrix, and increased GAG accumulation in the more compressively loaded horns, and fibrous collagen-rich tissue in the more tensile loaded outer 2/3, similar to native menisci. Loaded constructs reached a level of organization not seen in any previous engineered menisci and demonstrate great promise as meniscal replacements.
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Affiliation(s)
- Jennifer L Puetzer
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York.,2 Departments of Materials and Bioengineering, Imperial College London, London, United Kingdom
| | - Lawrence J Bonassar
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York.,3 Sibley School of Mechanical and Aerospace Engineering, Cornell University , Ithaca, New York
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Induction of fiber alignment and mechanical anisotropy in tissue engineered menisci with mechanical anchoring. J Biomech 2015; 48:1436-43. [DOI: 10.1016/j.jbiomech.2015.02.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/15/2015] [Indexed: 11/21/2022]
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Di Giancamillo A, Deponti D, Addis A, Domeneghini C, Peretti GM. Meniscus maturation in the swine model: changes occurring along with anterior to posterior and medial to lateral aspect during growth. J Cell Mol Med 2014; 18:1964-74. [PMID: 25216283 PMCID: PMC4244012 DOI: 10.1111/jcmm.12367] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/10/2014] [Indexed: 12/27/2022] Open
Abstract
The meniscus plays important roles in knee function and mechanics and is characterized by a heterogeneous matrix composition. The changes in meniscus vascularization observed during growth suggest that the tissue-specific composition may be the result of a maturation process. This study has the aim to characterize the structural and biochemical variations that occur in the swine meniscus with age. To this purpose, menisci were collected from young and adult pigs and divided into different zones. In study 1, both lateral and medial menisci were divided into the anterior horn, the body and the posterior horn for the evaluation of glycosaminoglycans (GAGs), collagen 1 and 2 content. In study 2, the menisci were sectioned into the inner, the intermediate and the outer zones to determine the variations in the cell phenotype along with the inner–outer direction, through gene expression analysis. According to the results, the swine meniscus is characterized by an increasing enrichment in the cartilaginous component with age, with an increasing deposition in the anterior horn (GAGs and collagen 2; P < 0.01 both); moreover, this cartilaginous matrix strongly increases in the inner avascular and intermediate zone, as a consequence of a specific differentiation of meniscal cells towards a cartilaginous phenotype (collagen 2, P < 0.01). The obtained data add new information on the changes that accompany meniscus maturation, suggesting a specific response of meniscal cells to the regional mechanical stimuli in the knee joint.
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Fox AJS, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2014; 28:269-87. [PMID: 25125315 DOI: 10.1002/ca.22456] [Citation(s) in RCA: 253] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/23/2014] [Indexed: 12/22/2022]
Abstract
Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long-term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York
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Croutze R, Jomha N, Uludag H, Adesida A. Matrix forming characteristics of inner and outer human meniscus cells on 3D collagen scaffolds under normal and low oxygen tensions. BMC Musculoskelet Disord 2013; 14:353. [PMID: 24330551 PMCID: PMC4029534 DOI: 10.1186/1471-2474-14-353] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/29/2013] [Indexed: 12/19/2022] Open
Abstract
Background Limited intrinsic healing potential of the meniscus and a strong correlation between meniscal injury and osteoarthritis have prompted investigation of surgical repair options, including the implantation of functional bioengineered constructs. Cell-based constructs appear promising, however the generation of meniscal constructs is complicated by the presence of diverse cell populations within this heterogeneous tissue and gaps in the information concerning their response to manipulation of oxygen tension during cell culture. Methods Four human lateral menisci were harvested from patients undergoing total knee replacement. Inner and outer meniscal fibrochondrocytes (MFCs) were expanded to passage 3 in growth medium supplemented with basic fibroblast growth factor (FGF-2), then embedded in porous collagen type I scaffolds and chondrogenically stimulated with transforming growth factor β3 (TGF-β3) under 21% (normal or normoxic) or 3% (hypoxic) oxygen tension for 21 days. Following scaffold culture, constructs were analyzed biochemically for glycosaminoglycan production, histologically for deposition of extracellular matrix (ECM), as well as at the molecular level for expression of characteristic mRNA transcripts. Results Constructs cultured under normal oxygen tension expressed higher levels of collagen type II (p = 0.05), aggrecan (p < 0.05) and cartilage oligomeric matrix protein, (COMP) (p < 0.05) compared to hypoxic expanded and cultured constructs. Accumulation of ECM rich in collagen type II and sulfated proteoglycan was evident in normoxic cultured scaffolds compared to those under low oxygen tension. There was no significant difference in expression of these genes between scaffolds seeded with MFCs isolated from inner or outer regions of the tissue following 21 days chondrogenic stimulation (p > 0.05). Conclusions Cells isolated from inner and outer regions of the human meniscus demonstrated equivalent differentiation potential toward chondrogenic phenotype and ECM production. Oxygen tension played a key role in modulating the redifferentiation of meniscal fibrochondrocytes on a 3D collagen scaffold in vitro.
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Affiliation(s)
| | | | | | - Adetola Adesida
- Department of Surgery, Division of Orthopaedic Surgery, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Faculty of Medicine and Dentistry, 3,002E Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada.
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Discoid medial meniscus: report of four cases and literature review. Orthop Traumatol Surg Res 2011; 97:826-32. [PMID: 22024635 DOI: 10.1016/j.otsr.2011.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 04/12/2011] [Accepted: 07/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Discoid medial meniscus is a rare abnormality, with incidence estimated at 0.12%. The present study describes this congenital abnormality anatomically and reports clinical results in four symptomatic cases managed by surgery. MATERIALS AND METHOD A retrospective study included three patients (2 female, 1 male), one of whom had bilateral pathology. Mean age at consultation was 18.5 years (range, 13 to 28 yrs). Presenting symptoms were knee pain, associated with acute locking (1 case) or recurrent effusion (1 case). Plain X-rays were normal. MRI found discoid medial meniscus in all four cases, with intrameniscal hypersignal on T2-weighted sequences. RESULTS Arthroscopy confirmed the discoid abnormality of the medial menisci. Meniscal tear was systematically associated: horizontal in two cases and vertical in the other two. Three cases showed insertion defect of the anterior horn of the discoid medial meniscus. All two cases were managed by meniscoplasty, removing the central part of the meniscus and sparing its peripheral part. Meniscal repair was associated in one case. Subjective results were assessed by KOOS score. At a mean 23 months' follow-up (range, 7 to 54 months), mean KOOS score was 82.7 (range, 77.6 to 86.4): 88 ± 5 for pain, 89 ± 8 for other symptoms, 98 ± 1 for function, 69 ± 17 for sports activity, and 69 ± 16 for quality of life. CONCLUSION Symptomatic discoid medial meniscus is frequently associated with bone insertion abnormality of the anterior horn. Meniscal tear is consistently present and revelatory, indicating meniscal tissue fragility, as in the lateral meniscus. Meniscoplasty, possibly with associated meniscal repair if the remaining meniscal wall is unstable, provides satisfactory but imperfect results while avoiding total meniscectomy, which would be disabling in this age group.
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Bloecker K, Wirth W, Hudelmaier M, Burgkart R, Frobell R, Eckstein F. Morphometric differences between the medial and lateral meniscus in healthy men - a three-dimensional analysis using magnetic resonance imaging. Cells Tissues Organs 2011; 195:353-64. [PMID: 21709397 PMCID: PMC3696373 DOI: 10.1159/000327012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2011] [Indexed: 11/19/2022] Open
Abstract
The objective of this work was to characterize tibial plateau coverage and morphometric differences of the medial (MM) and lateral meniscus (LM) in a male reference cohort using three-dimensional imaging. Coronal multiplanar reconstructions of a sagittal double-echo steady state with water excitation magnetic resonance sequence (slice thickness: 1.5 mm, and in-plane resolution: 0.37 × 0.70 mm) were analyzed in 47 male participants without symptoms, signs or risk factors of knee osteoarthritis of the reference cohort of the Osteoarthritis Initiative. The medial and lateral tibial (LT) plateau cartilage area and the tibial, femoral and external surfaces of the MM and LM were manually segmented throughout the entire knee. This process was assisted by parallel inspection of a coronal intermediately weighted turbo spin echo sequence. Measures of tibial coverage, meniscus size, and meniscus position were computed three-dimensionally for the total menisci, the body, and the anterior and the posterior horn. The LM was found to cover a significantly greater (p < 0.001) proportion of the LT plateau (59 ± 6.8%) than the MM of the medial plateau (50 ± 5.5%). Whereas the volume of both menisci was similar (2.444 vs. 2.438 ml; p = 0.92), the LM displayed larger tibial and femoral surface areas (p < 0.05) and a smaller maximal (7.2 ± 1.0 vs. 7.7 ± 1.1 mm; p < 0.01) and mean thickness (2.7 ± 0.3 vs. 2.8 ± 0.3 mm; p < 0.001) than the medial one. Also, the LM displayed less (physiological) extrusion than the medial one. These data may guide strategies for meniscal tissue engineering and transplantation aiming to restore normal joint conditions.
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Affiliation(s)
- K Bloecker
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria.
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