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Meng XY, Li ZQ, Ding HF, Wang DY, Dai LH, Jiang D. A Novel Ultrasound Method of Evaluating Dynamic Extrusion of Lateral Meniscus in Healthy Population: Different Patterns of Dynamic Extrusion Revealed Between Lateral and Medial Meniscus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1723-1732. [PMID: 38975721 DOI: 10.1002/jum.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To establish a reliable ultrasound (US) method of evaluating dynamic extrusion of lateral meniscus in healthy population, and to investigate the pattern of dynamic meniscus extrusion (ME) in lateral meniscus under loading conditions. METHODS The lateral ME was examined via US method in unloaded, double-leg standing, and single-leg standing positions. Two different US measurement methods were compared to the magnetic resonance imaging (MRI) results to determine the optimal measurement methods. The US results obtained by different researchers were tested for interobserver consistency and the results obtained by the same researcher on two separate days were tested for intraobserver consistency. The patterns of dynamic extrusion were compared between medial and lateral sides. RESULTS A total of healthy 44 volunteers were included in the study, with 86 knees assessed by US, and 25 knees evaluated by MRI. The US evaluation of dynamic lateral ME demonstrated excellent interobserver and intraobserver reliability. The US measurements using method A were consistent with the MRI results with no significant difference (P = .861, intraclass correlation coefficient [ICC] = 0.868), while method B underestimated the lateral ME compared to MRI (P = .001, ICC = 0.649). Lateral ME decreased slightly from unloaded (1.0 ± 0.8 mm) to single-leg standing position (0.8 ± 0.8 mm), whereas medial ME increased significantly in both double-leg and single-leg standing positions (2.4 ± 0.7 mm, 2.6 ± 0.7 mm). CONCLUSION A novel US evaluation method of lateral ME was established with reliable and accurate results compared to the MRI. Lateral ME in healthy populations decreased slightly as the loadings increased, which was different from the pattern of dynamic extrusion in medial meniscus.
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Affiliation(s)
- Xiang-Yu Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Zhi-Qiang Li
- Department of Ultrasound Medicine, Peking University Third Hospital, Beijing, China
| | - Hong-Fu Ding
- Department of Ultrasound Medicine, People's Hospital of Ningxia Autonomous Region, Yinchuan, China
| | - Ding-Yu Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
| | - Ling-Hui Dai
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine, Peking University, Beijing, China
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Natsuyama Y, Mitsuya Y, Kuramasu M, Kawata S, Yakura T, Li ZL, Yi SQ, Itoh M. Vascular anatomy of the lateral meniscus with special focus on the joint capsule. Anat Sci Int 2024:10.1007/s12565-024-00797-z. [PMID: 39217269 DOI: 10.1007/s12565-024-00797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Previous studies have reported that the lateral meniscus (LM) has two regions, the popliteal hiatus area (PH) with a scarce blood supply and the roots with an abundant one. However, the description of its vascular anatomy remains insufficient. We hypothesized that the difference in the width of the meniscus hilum (MH) affects the scarcity and abundance of blood supply to the LM. The MH is a concept proposed by us and is the only site of entrance or exit of blood vessels and nerves associated with the meniscus. The purpose of this study was to provide a structural explanation for the disparity of blood supply to the LM using the concept of MH. Sixteen knees were examined to investigate the blood supply to LM. In most areas, the femoral joint capsule (FJC) and tibial joint capsule (TJC) continued to the cranial and caudal edges of the LM, respectively. In the roots, the FJC and TJC covered the femoral and the outer-femoral surfaces. In contrast, the FJC in the PH did not attach to the cranial edge and only the TJC there did to the caudal edge of the LM. Histochemical examination showed that the blood vessels enter the LM via the MH. In the PH, the MH at the caudal edge was extremely narrow; and in the roots, the MH on the outer-femoral surfaces was wide. The results suggest that the difference in the width of the MH affected the scarcity and abundance of blood supply to the LM.
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Affiliation(s)
- Yutaro Natsuyama
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan.
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, 116-8551, Japan.
| | - Yuka Mitsuya
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
| | - Miyuki Kuramasu
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
| | - Shinichi Kawata
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
| | - Tomiko Yakura
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
| | - Zhong-Lian Li
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
| | - Shuang-Qin Yi
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, 116-8551, Japan
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Tokyo, Japan
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Gil Noriega GA, Llinás Hernández PJ, Herrera Huependo GA, Sanchez Cruz DA. Ramp-like lateral meniscus tear. Description of an infrequent lesion. J ISAKOS 2024; 9:734-739. [PMID: 38636903 DOI: 10.1016/j.jisako.2024.04.005] [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: 10/09/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
Numerous studies on meniscal tears have been published, a pathology that continues to evolve in terms of treatment and patient outcomes. As our understanding of anatomy and biomechanics improves, new entities have emerged. The lateral meniscus, especially its posterior attachment, tends to be overlooked due to its greater mobility compared to the medial meniscus. Evaluating the instability of the posterior horn poses a challenge, even during arthroscopy, therefore, it is crucial to understand the posterior menisco-synovial detachment lesions, which are indeed real and, to date, haven't received enough attention in the existing literature. The aim is to describe a new entity affecting the posterior synovial attachment of the lateral meniscus, without injury to the posterior horn of the lateral meniscus (PHLM). We also aim to present a case report detailing the intraoperative diagnosis and management of a 20-year-old patient with a sports trauma that led to a combined anterior cruciate ligament (ACL) and lateral meniscus tear managed with arthroscopic ACL reconstruction and all-inside meniscal suture. Through conventional arthroscopic evaluation of the posterior capsule anatomy and dissections, we have identified a distinct lesion of the PHLM at the menisco-synovial junction. Further research is necessary in this field to understand the biomechanical repercussions and determine the ideal surgical management.
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Affiliation(s)
- Gustavo Antonio Gil Noriega
- Orthopedic Surgeon, Knee and Shoulder Surgeon, Clínica Fundación Valle del Lili, Cra. 98 #18-49, Cali, Colombia.
| | - Paulo José Llinás Hernández
- Orthopedic Surgeon, Knee and Shoulder Surgeon, Director of the Knee and Surgery Fellowship Program ICESI, Clínica Fundación Valle del Lili, Cra. 98 #18-49, Cali, Colombia.
| | | | - Diego A Sanchez Cruz
- Orthopedic Surgeon, Knee and Shoulder Surgeon, Centro de Ortopedia y Traumatología, Cra. 15 #124 - 47, Cali, Colombia.
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Song ST, Wang XJ, Ye J, Zhang JY, Chen YR, Song YF, Yu JK, Xu BB. The meniscotibial ligament does exist: An anatomic and histological description. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 37:33-39. [PMID: 39113679 PMCID: PMC11303972 DOI: 10.1016/j.asmart.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/20/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose To describe the anatomical and histological characteristics of the human MTL (meniscotibial ligament) that keeps the meniscus stable and are rarely discussed. Study design Descriptive laboratory study. Methods In total, six fresh-frozen adult cadaver knees were dissected, and the dissection protocol were designed by two experienced anatomy professors. The anatomical morphology of MTL was observed. The main anatomical specimens included meniscus, tibial plateau, MTL. The osteotome was used to excise the portion of the tibial plateau, which could obtain the complex including partial meniscus, MTL, and a tibial fragment. A histopathologic study was performed by two experienced pathologists. Results Macroscopically, the MTL could be divided into two parts: medial meniscotibial ligament (MMTL)and lateral meniscotibial ligament (LMTL). The MMTL is distributed continuously, whereas the LMTL is discontinuous on the tibial plateau. The average length from the tibial attachment of the LMTL to the articular surface was 19 ± 1.0mm (mean ± SD). The average length from the tibial attachment of the MMTL to the articular surface was 10 ± 1.2 mm (mean ± SD). Microscopy of the MTL showed that the MTL is a ligamentous tissue, composed of a network of oriented collagenous fibers. Conclusions In all knees, the MTL was inserted on the outer edge of the meniscus, attaching to the tibia below the level of articular cartilage, which was key to maintaining the rotational stability of knee and the meniscus in the physiological position on the tibial plateau. Histological analysis of this ligament demonstrated that the MTL is a veritable ligamentous structure, which is made up of collagen type I-expressing fibroblasts. Clinical relevance This article contributes to the understanding of the anatomical and histological characteristics of the MTL. It is beneficial to promote the development of relevant surgical techniques for the MTL lesion.
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Affiliation(s)
- Shi-Tang Song
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xin-Jie Wang
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jing Ye
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ji-Ying Zhang
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - You-Rong Chen
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yi-Fan Song
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jia-Kuo Yu
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Bing-Bing Xu
- .Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- .Beijing Key Laboratory of Sports Injuries, Beijing, China
- .Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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Suganuma J, Mochizuki R. Anterior Mobility of the Posterior Horn of the Lateral Meniscus Is Associated With Abnormal Magnetic Resonance Imaging Findings of Anteroinferior Popliteomeniscal Fascicle and Posterosuperior Popliteomeniscal Fascicle as Well as a Clinical History of Catching or Locking Symptoms. Arthrosc Sports Med Rehabil 2024; 6:100922. [PMID: 39006791 PMCID: PMC11240034 DOI: 10.1016/j.asmr.2024.100922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To identify predictors of anterior mobility of the posterior horn of the lateral meniscus (PHLM) among patient demographics (age, sex), clinical characteristics (a history of catching or locking symptoms [CLS], body mass index, alignment of limb), and magnetic resonance imaging (MRI) findings of 4 restraints: anteroinferior popliteomeniscal fascicle (aiPMF), posterosuperior popliteomeniscal fascicle (psPMF), posteroinferior popliteomeniscal fascicle (piPMF), and meniscofibular ligament (MFibL). Methods Between October 2010 and December 2014, patients who underwent arthroscopic measurement of mobility of the PHLM were identified. The Sakai classification was used to classify aiPMF and psPMF on MRI into the following 3 types: type A, the fascicle was depicted with obvious continuity and with a low-intensity band; type B, depicted with continuity but with an ambiguous intensity structure; and type C, depicted with discontinuity or not visible. Magnetic resonance images of the piPMF and MFibL were evaluated as presence or absence. The mobility of the PHLM was measured arthroscopically at traction forces of 10 and 20 N. Results A total of 73 patients (47 men, mean age 41.8 ± 19.3 years) were included. Multivariate regression analyses revealed aiPMF type C and psPMF types B and C to be independent factors associated with mobility at both traction forces, and CLS was an independent factor at a traction force of 20 N. Compared with that of type A, the increased mobility of aiPMF type C was 5.0 mm (P = .019) and 5.6 mm (P = .011) at 10 and 20 N, respectively; the increased mobility of psPMF type B was 2.5 mm (P = .007) and 3.5 mm (P = .0003), respectively; and the increased mobility of psPMF type C was 3.3 mm (P = .021) and 3.6 mm (P = .014), respectively. The increased mobility associated with CLS was 3.5 mm at 20 N (P = .022). Conclusions Anterior displacement of the PHLM induced by an external traction force at 90° of flexion of the knee joint was associated with abnormal MRI findings of the anteroinferior popliteomeniscal fascicle and posterosuperior popliteomeniscal fascicle, as well as a history of catching or locking symptoms. Clinical Relevance Understanding signs and symptoms and associated pathology in patients with symptomatic anterior mobility of the posterior horn of the lateral meniscus may help guide best treatment.
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Affiliation(s)
- Jun Suganuma
- Department of Orthopedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
- Yamabiko Hiratsuka Clinic for Orthopedic and Rheumatic Disease, Hiratsuka, Japan
| | - Ryuta Mochizuki
- Department of Orthopedic Surgery, Isehara Kyodo Hospital, Isehara, Japan
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Dingel AB, Tompkins M, Yen YM, Karius AK, Cinque M, Vuong BB, Taylor V, Pham NS, Ganley TJ, Wilson P, Ellis HB, Green D, Fabricant PD, Boucher L, Shea KG. A Recess Is Observed Between the Posterior Knee Capsule and the Meniscotibial Ligament Complex in Pediatric Specimens. Arthrosc Sports Med Rehabil 2024; 6:100852. [PMID: 39006787 PMCID: PMC11240032 DOI: 10.1016/j.asmr.2023.100852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/19/2023] [Indexed: 07/16/2024] Open
Abstract
Purpose To define the surgical anatomy of the meniscotibial ligament complex of the pediatric medial and lateral menisci and their relation to the proximal tibial physis and posterior joint capsule. Methods Fourteen pediatric cadaveric knee specimens (aged 3 months to 11 years) were dissected to clarify the relation of the posterior knee capsule, the meniscus, and the meniscotibial ligament complex. Metallic markers were placed marking the meniscotibial ligament capsular attachment on the proximal tibia. Specimens underwent computed tomography scanning to evaluate pin placement and relation to the physis. A digital measurement tool was used to measure the distances between the proximal tibial physis and the pins (placed at 5 points on both the lateral and medial menisci). Results In each specimen, clear separation was noted between the posterior joint capsule from the meniscus and meniscotibial ligament complex in the medial and lateral compartments. There was an increase in the distance between the proximal tibial physis and the insertion points of the meniscotibial ligament complex with increasing specimen age. For both the medical and lateral menisci in group 1, the median meniscotibial ligament insertion points were often less than 7 mm (interquartile range, 0.00-7.8 mm) away from the physis. The median meniscotibial ligament insertion points in group 2 tended to be farther from the physis but always less than 20 mm (interquartile range, 2.5-17.5 mm)-and as close as less than 5 mm (lateral posterior root). Conclusions In this anatomic study of pediatric knees, we observed a distinct recess/cul-de-sac space between the posterior knee capsule and meniscal attachments in all specimens. This defines a distinct plane between the posterior knee capsule and the meniscotibial ligament complex, with a distance between the physis and meniscotibial ligament capsular attachments that increases with age. Clinical Relevance The anatomic parameters evaluated in our study should be considered as future meniscal repair and transplantation techniques aim to restore the meniscal anatomy, stability, and mobility provided by the meniscotibial ligament complex and capsule structures.
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Affiliation(s)
- Aleksei B. Dingel
- School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Marc Tompkins
- TRIA Orthopaedic Center, Minneapolis, Minnesota, U.S.A
- University of Minnesota, Minneapolis, Minnesota, U.S.A
- Gillette Children’s Specialty Healthcare, St. Paul, Minnesota, U.S.A
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | | | - Mark Cinque
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Brian B. Vuong
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Vanessa Taylor
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Nicole S. Pham
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Theodore J. Ganley
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | | | | | - Daniel Green
- Pediatric Orthopaedic Surgery Division, Hospital for Special Surgery, New York, New York, U.S.A
| | - Peter D. Fabricant
- Pediatric Orthopaedic Surgery Division, Hospital for Special Surgery, New York, New York, U.S.A
| | - Laura Boucher
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
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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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Heaton DJ, Collins MS, Johnson AC, Krych AJ, Dancy ME, Tiegs-Heiden CA. Retrospective evaluation of MRI findings in arthroscopically confirmed cases of hypermobile lateral meniscus. Skeletal Radiol 2024; 53:465-472. [PMID: 37620610 DOI: 10.1007/s00256-023-04433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To identify preoperative MRI findings in patients with arthroscopically confirmed hypermobile lateral meniscus utilizing a standard MRI knee protocol, with comparison to normal control and lateral meniscal tear groups. SUBJECTS AND METHODS All patients with arthroscopically confirmed hypermobile lateral meniscus diagnosed at our institution were retrospectively identified. The following structures were evaluated on preoperative knee MRIs: superior and inferior popliteomeniscal fascicles, lateral meniscus and meniscocapsular junction, popliteal hiatus, and soft tissue edema around the popliteal hiatus. The same MRI features were evaluated in the normal control and lateral meniscal tear groups. RESULTS Study, normal control, and lateral meniscal tear patients (18 each) were included. In the study group, 94.4% had superior popliteomeniscal fascicle abnormality, 89.0% had inferior popliteomeniscal fascicle abnormality, and 72.2% had lateral meniscal abnormality. Incidence of these abnormalities was significantly higher than in the normal control group. Meniscal abnormalities in the study group all involved the posterior horn meniscocapsular junction, 12/13 of which had vertical signal abnormality at the junction and 1/13 with anterior subluxation of the entire posterior horn. Popliteus hiatus measurements were largest in the lateral meniscal tear group. CONCLUSION In patients with hypermobile lateral meniscus, the combination of popliteomeniscal fascicle abnormality and vertical signal abnormality at the meniscocapsular junction was seen in the majority of patients. Popliteomeniscal fascicle signal abnormality without identifiable lateral meniscal injury was the next most common imaging appearance. Radiologists may provide valuable information by suggesting the diagnosis of hypermobile lateral meniscus in such cases.
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Affiliation(s)
- Dennis J Heaton
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Mark S Collins
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Malik E Dancy
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Masoni V, Giustra F, Bosco F, Camarda L, Rovere G, Sciannameo V, Berchialla P, Massè A. Surgical treatment of popliteomeniscal fascicles tears is associated with better patient-reported outcome measures. A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:9-20. [PMID: 37481735 PMCID: PMC10771597 DOI: 10.1007/s00590-023-03645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Popliteomeniscal fascicles (PMFs) are a component of the popliteal hiatus complex in the knee, and their injury primarily affects young athletes participating in sports activities involving twisting movements. The identification of PMFs tears presents a challenge, often accompanied by lateral pain and a locking sensation. The objective of this systematic review (SR) and meta-analysis is to enhance the suspicion and recognition of PMFs tears, aiming to facilitate the treatment of this condition, particularly in symptomatic young patients. METHODS A comprehensive search, focused on studies examining PMFs injuries and their treatment, was conducted in four databases, PubMed, Scopus, Embase, and Web of Science. The ROBINS-I tool was used to evaluate the risks of bias. The PRISMA flow diagram was used to conduct the research and select the included studies. A meta-analysis was conducted for the Lysholm score, the Tegner Activity Scale, and the subjective IKDC score. The present SR and meta-analysis was registered on PROSPERO. RESULTS Five clinical studies were included in the final analysis, comprising 96 patients. All the patients underwent a preoperative MRI assessment and a diagnostic arthroscopy to detect the PMFs tears, with a subsequent surgical procedure either open or arthroscopically performed. Surgery was associated with the resolution of symptoms. A statistically significant improvement in the Lysholm score (p: 0.0005) and the subjective IKDC score (p: 0.003) after the surgical procedure with respect to the preoperative evaluation was found. CONCLUSION This SR and meta-analysis showed a significant improvement in the Lysholm score and subjective IKDC score following surgery for PMFs tears. However, controversy persists regarding the optimal surgical approach, with current literature favoring arthroscopic procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Virginia Masoni
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Sciannameo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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10
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Dancy ME, Tagliero AJ, Till SE, Saris DB, Levy BA, Camp CL, Krych AJ. Surgical Repair of Hypermobile Lateral Meniscus Secondary to Popliteomeniscal Fascicle Tears Improves Pain and Mechanical Symptoms. Arthrosc Sports Med Rehabil 2023; 5:100802. [PMID: 37766858 PMCID: PMC10520307 DOI: 10.1016/j.asmr.2023.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To describe the clinical and radiographic features associated with isolated hypermobile lateral meniscus (HLM), and report patient outcomes following surgically repaired isolated HLM. Methods All patients diagnosed with HLM from 2000 to 2020 at a single academic institution were identified and reviewed. Patients were excluded if they had concomitant ligament injury or lacked 2-year follow-up. Preoperative and postoperative visual analog scale (VAS) pain scores were determined from clinical notes. Statistical analysis was performed in JMP, and statistical significance was determined with use of a paired t-test. Results Eighteen knees in 17 patients met inclusion criteria. Mean patient age was 24.1 (range: 6-61) years. Mean follow-up was 73 months (25-151 months). All 18 knees reported pain at presentation; 94% (17/18) had mechanical symptoms. All 18 knees had preoperative MRIs, but only 1 (5.6%) knee was correctly diagnosed by a musculoskeletal trained radiologist. Most repairs were performed with an all-inside technique (61%, 11/18). VAS score improved significantly from 7.2 ± 2.9 preoperatively to 0.7 ± 1.9 postoperatively, with average improvement of VAS score of 6.5 (P < .001). Only one (5.6%) knee required revision meniscal surgery. Conclusion Hypermobile lateral meniscus patients commonly see multiple providers, fail to have their HLM diagnosed on MRI, and undergo various treatments prior to a successful diagnosis. Localized lateral joint line pain, mechanical symptoms, and absence of distinct meniscus tear on MRI are the most frequent clinical presentations. Surgery with meniscus repair is a reliable solution to improve pain and mechanical symptoms. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Malik E. Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Adam J. Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Daniël B. Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester Minnesota, U.S.A
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11
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Neto JBDA, Cardoso AB, Munhoz GDS, Neto LHP, Clazzer R, Ariel de Lima D. Medial Meniscotibial Ligament of the Knee: A Step by-Step Dissection. Rev Bras Ortop 2023; 58:e755-e759. [PMID: 37908524 PMCID: PMC10615610 DOI: 10.1055/s-0043-1776137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/23/2022] [Indexed: 11/02/2023] Open
Abstract
Objective Considerable attention has been paid to meniscotibial ligaments (MTLs), also known as coronary ligaments, especially after the "Save the Meniscus" initiative gained importance among knee surgeons. Technically challenging, the diagnosis and treatment of ramp lesion show the importance of MTLs. These ligaments were discovered long ago, but their contribution to knee stability has only recently been studied and still lacks information. Thus, the aim of the present study was to describe step-by-step an dissection technique of the medial MTL, efficient, reproducible and that may lead to further research. Method Twenty fresh cadaver knees were used, with no preference for sex or age. The knees were dissected using the same technique standardized by our team. Each dissection step was recorded digitally. Results The medial MTL was found in all 20 knees studied using the aforementioned technique. In our sample, the medial MTL exhibited an average length of 70.0 ± 13.4 mm and width of 32.25 ± 3.09 mm, thickness of 35.3 ± 2.7 mm and weight of 0.672 ± 0.134 g. In all the cases, the medial MTL originated proximally and deeply to the deep MTL in the tibia. Conclusion We describe a simple effective and reproducible medial MTL dissection technique that makes it possible to identify the ligament over the entire medial extension of the knee.
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Affiliation(s)
- Jonatas Brito de Alencar Neto
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Instituto Doutor José Frota, Fortaleza, CE, Brasil
| | - Alexia Barros Cardoso
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Instituto Doutor José Frota, Fortaleza, CE, Brasil
| | - Gerônimo de Souza Munhoz
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Instituto Doutor José Frota, Fortaleza, CE, Brasil
| | - Luiz Holanda Pinto Neto
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Instituto Doutor José Frota, Fortaleza, CE, Brasil
| | - Renata Clazzer
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Hospital Otávio de Freitas, Recife, PE, Brasil
| | - Diego Ariel de Lima
- Médico, Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Hospital Otávio de Freitas, Recife, PE, Brasil
- Professor, Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido, Mossoró, RN, Brasil
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12
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Natsuyama Y, Zhang M, Yang T, Shimada K, Ren K, Kamikawa Y, Tokita K, Fujiwara M, Chen J, Yi SQ. The continuous structure of the joint capsule and meniscus in the pig knee. Anat Histol Embryol 2023; 52:789-797. [PMID: 37306076 DOI: 10.1111/ahe.12938] [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: 02/15/2023] [Revised: 04/27/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
The knee joint capsules composed of a fibrous layer and a synovial layer. The knee meniscus consists of the superficial network, lamellar layer, tie fibre and circumferential bundles. However, the continuous structure of the knee joint capsule and meniscus has not been reported. Fetal and adult pigs were used to investigate the structural relationship between the stifle joint capsule and meniscus based on the gross anatomy and histological findings. In the gross anatomical examination, the joint capsule appeared to have separated attachments to the meniscus, except for the lower aspect of the popliteal hiatus. Histologically, the lower half of the popliteal hiatus was found to have separated attachments, with vessels running between the attachments of the joint capsules. The synovial layer of the joint capsule continued to the superficial network, and the fibrous layer of the joint capsule continued to the lamellar layer and tie fibres. There were two routes of arterial entry into the meniscus: intracapsular and intercapsular. It appeared that the presence of separated attachments of the joint capsule was necessary to allow the intercapsular route. This study clarified for the first time the routes of feeding vessels entering the meniscus and proposed to call this entry point the meniscus hilum. We consider that this detailed anatomical information is important for understanding the continuation between the joint capsule and the meniscus.
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Affiliation(s)
- Yutaro Natsuyama
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Mingshou Zhang
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ting Yang
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Kazuyuki Shimada
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ke Ren
- Faculty of Physical Education, Qu Jing Normal University, Yun Nan, China
| | - Yasuko Kamikawa
- Department of Maxillofacial Diagnostic and Surgical Science Field of Oral and Maxillofacial Rehabilitation, Graduate School of medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Konosuke Tokita
- Department of Physical Therapy, Faculty of Health Sciences, Saitama Medical University, Saitama, Japan
| | - Motoi Fujiwara
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Juefei Chen
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shuang-Qin Yi
- Department of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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13
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Grassi A, Pizza N, Macchiarola L, Zaffagnini S. Clinical presentation and arthroscopic treatment of hypermobile Type III Wrisberg variant of lateral discoid meniscus: Report of nine cases. Knee 2023; 43:224-240. [PMID: 37019691 DOI: 10.1016/j.knee.2023.02.004] [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: 09/20/2022] [Revised: 12/15/2022] [Accepted: 02/02/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND The aim of the present study was to document a series of patients with meniscal hypermobility due to a Type III Wrisberg variant lateral discoid meniscus, describing their clinical presentation, analyzing their magnetic resonance imaging (MRI) and arthroscopic characteristics, and reporting the outcomes of an all-inside stabilization. METHOD Nine cases of Wrisberg variant Type III discoid lateral menisci were identified based on patient's history and clinical examination. Knee MRIs were reviewed to exclude the presence of Type I-II discoid meniscus (complete or incomplete) or bucket handle tears and general arthroscopic criteria. For the Wrisberg variant discoid lateral meniscus were applied for the final diagnosis. RESULTS All nine cases presented similar peculiar clinical, radiological, and arthroscopic features, which led to the diagnosis of hypermobile Wrisberg variant of lateral discoid meniscus. This rareclinical entity is responsible for suggestive symptoms such as pain, popping and knee locking; moreover, subtle but peculiar MRI and arthroscopic characteristics can be observed. CONCLUSION Considering the possibility of repeated dislocation and relocation, diagnosis can be challenging, and a high degree of suspicion should be used, especially in young patients, bilateral symptoms, and absence of trauma.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Pizza
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Italy
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14
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Tomsan H, Gorbachova T, Fritz RC, Abrams GD, Sherman SL, Shea KG, Boutin RD. Knee MRI: Meniscus Roots, Ramps, Repairs, and Repercussions. Radiographics 2023; 43:e220208. [PMID: 37384542 DOI: 10.1148/rg.220208] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Menisci play an essential role in maintaining normal pain-free function of the knee. While there are decades of MRI literature on the tears involving the meniscus body and horns, there is now a surge in knowledge regarding injuries at the meniscus roots and periphery. The authors briefly highlight new insights into meniscus anatomy and then summarize recent developments in the understanding of meniscus injuries that matter, emphasizing meniscus injuries at the root and peripheral (eg, ramp) regions that may be missed easily at MRI and arthroscopy. Root and ramp tears are important to diagnose because they may be amenable to repair. However, if these tears are left untreated, ongoing pain and accelerated cartilage degeneration may ensue. The posterior roots of the medial and lateral menisci are most commonly affected by injury, and each of these injuries is associated with distinctive clinical profiles, MRI findings, and tear patterns. Specific diagnostic pitfalls can make the roots challenging to evaluate, including MRI artifacts and anatomic variations. As with root tears, MRI interpretation and orthopedic treatment have important differences for injuries at the medial versus lateral meniscus (LM) periphery (located at or near the meniscocapsular junction). Medially, ramp lesions typically occur in the setting of an anterior cruciate ligament rupture and are generally classified into five patterns. Laterally, the meniscocapsular junction may be injured in association with tibial plateau fractures, but disruption of the popliteomeniscal fascicles may also result in a hypermobile LM. Updated knowledge of the meniscus root and ramp tears is crucial in optimizing diagnostic imaging before repair and understanding the clinical repercussions. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available in the Online Learning Center.
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Affiliation(s)
- Hanna Tomsan
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Tetyana Gorbachova
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Russell C Fritz
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Geoffrey D Abrams
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Seth L Sherman
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Kevin G Shea
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Robert D Boutin
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
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15
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Neto JBDA, Cavalcante MLC, Messias da Rocha PH, Helito CP, Lima LLD, Ariel de Lima D. Study of the nerve endings and mechanoreceptors of the medial meniscotibial ligament of the knee: A structural and distribution analysis. Knee 2023. [PMID: 36863118 DOI: 10.1016/j.knee.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The aim of the present study is to describe the morphology and distribution of the nerve endings of the meniscotibial ligament (MTL) of the knee, in order to understand the interaction between the proprioceptive system and knee mechanics. METHODS Twenty medial MTLs were obtained from deceased organ donors. The ligaments were measured, weighed and cut. Sections (10 mm) were prepared on hematoxylin and eosin-stained slides for analysis of tissue integrity, and 50 mm sections were submitted to immunofluorescence with the protein gene product (PGP) 9.5 as primary antibody and Alexa Fluor 488 as secondary antibody, followed by microscopic analysis. RESULTS The medial MTL was identified in 100% of the dissections, with average length, width, thickness and weight of 7.07 ± 1.34 mm, 32.25 ± 3.09 mm, 3.53 ± 0.27 mm and 0.67 ± 0.13 g, respectively. The hematoxylin and eosin-stained histological sections exhibited typical ligament structure, with dense well-organized collagen fibers and vascular tissue. All the specimens analyzed contained type I (Ruffini) mechanoreceptors and free (type IV) nerve endings, varying from parallel to intertwined fibers. Nerve endings not classified with different irregular shapes were also found. Most type I mechanoreceptors were found close to the MTL insertions on the tibial plateau, while the free nerve endings were found adjacent to the capsule. CONCLUSION The medial MTL showed a peripheral nerve structure, primarily type I and IV mechanoreceptors. These findings suggest that the medial MTL is important for proprioception and medial knee stabilization.
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16
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LaPrade RF, Geeslin AG, Chahla J, Cohen M, Engebretsen L, Faucett SC, Getgood AM, Inderhaug E, Johnson DL, Kopf S, Krych AJ, Larson CM, Lind M, Moatshe G, Murray IR, Musahl V, Negrin R, Riboh JC, Seil R, Spalding T. Posterior Lateral Meniscal Root and Oblique Radial Tears: The Biomechanical Evidence Supports Repair of These Tears, Although Long-Term Clinical Studies Are Necessary. Arthroscopy 2022; 38:3095-3101. [PMID: 36462774 DOI: 10.1016/j.arthro.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
| | - Andrew G Geeslin
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Moises Cohen
- Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Alan M Getgood
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada
| | | | | | | | | | | | | | | | - Iain R Murray
- Edinburgh Orthopaedics, The University of Edinburgh, Edinburgh, UK
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center Pittsburgh, Pennsylvania, USA
| | | | - Jonathan C Riboh
- Orthocarolina and Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxenbourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg
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17
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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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18
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Jacquet C, Mouton C, Magosch A, Komnos GA, Menetrey J, Ollivier M, Seil R. The aspiration test reveals an instability of the posterior horn of the lateral meniscus in almost one-third of ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:2329-2335. [PMID: 34839369 PMCID: PMC9206618 DOI: 10.1007/s00167-021-06806-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries often lead to associated injuries of the posterior horn of the lateral meniscus (PHLM). Arthroscopic, assessment of PHLM instability may be difficult in the absence of a visible meniscus damage. The main objective of this prospective multi-center study was to compare the ability of the probing and aspiration tests to identify PHLM instability in a population of patients undergoing ACL reconstruction (ACLR) and a control group of patients with an intact ACL undergoing knee arthroscopy. METHODS A prospective case-control analysis was performed in three sports medicine centers. One-hundred and three consecutive patients operated for a primary isolated ACLR without structural lateral meniscus damage other than a root tear were included. They were compared to a control group of 29 consecutive patients who had a knee arthroscopy with an intact ACL and no structural lateral meniscus lesion. The probing and aspiration tests were consecutively executed according to previously published methods. RESULTS In the control group, no lateral meniscus lesions were visualized during arthroscopy, and both probing and aspiration tests were negative in all patients. In the group of ACL-injured patients, a Forkel type I-III posterolateral meniscus root tear (PLMRT) was found in 12 patients (12%). In this subgroup, the probing test was positive in 4/12 patients (33%) and the aspiration test in 5 additional patients (75%). In 15 patients (15%), an elongation of the posterior root of the lateral meniscus (defined as type IV PLMRT as an addendum to the Forkel classification) could be observed during arthroscopy. In this subgroup, only 1 patient displayed a PHLM instability with the probing test (7%), whereas the aspiration test was positive in 13/15 patients (87%). In the remaining 76 patients (74%), no structural lesion of the PHLM could be identified. Nevertheless, an instability of the PHLM could be identified in 8 of them (11%) with the probing test, and the aspiration test was positive in 2 additional knees (13%) of this apparently normal subgroup. Altogether, in the entire ACL injury cohort, a positive probing test was observed in 13/103 patients (13%) and a positive aspiration test in 32/103 knees (31%) (p < 0.01). CONCLUSION Careful observation and examination of the PHLM with the aspiration test revealed a substantial amount of previously undiagnosed lateral meniscus instabilities in ACL-injured knees. The prevalence of PHLM instability as evaluated by the aspiration test was high (31%). The aspiration test was superior to the probing test in detecting an instability of the PHLM in a population of ACL-injured patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christophe Jacquet
- Department of Orthopedic Surgery and Traumatology, Institute for Movement and Locomotion (IML), St. Marguerite Hospital, Marseille, France
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
| | - George A Komnos
- Centre de Medecine du Sport et de l'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique la Colline, Geneva, Switzerland
| | - Jacques Menetrey
- Centre de Medecine du Sport et de l'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique la Colline, Geneva, Switzerland
- Service de Chirurgie Orthopédique, University Hospital of Geneva, Geneva, Switzerland
| | - Matthieu Ollivier
- Department of Orthopedic Surgery and Traumatology, Institute for Movement and Locomotion (IML), St. Marguerite Hospital, Marseille, France
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg.
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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19
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Preoperative Magnetic Resonance Imaging as a Diagnostic Aid for Hypermobile Lateral Meniscus. Diagnostics (Basel) 2021; 11:diagnostics11122276. [PMID: 34943513 PMCID: PMC8699838 DOI: 10.3390/diagnostics11122276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Hypermobile lateral meniscus is difficult to diagnose with imaging due to its absence of tears or anomalies. We aimed to clarify the accuracy of the preoperative diagnosis using magnetic resonance imaging (MRI). Methods: The preoperative MRI status of the posterosuperior popliteomeniscal fascicle (sPMF), anteroinferior popliteomeniscal fascicle (iPMF), and popliteal hiatus were examined retrospectively on sagittal images in the hypermobile lateral meniscus group (n = 22) and an age- and gender-matched control group (n = 44). These statuses were evaluated by a logistic regression analysis to assess their degree of diagnostic accuracy. Results: The area under the curve (AUC) of the sPMF, iPMF, popliteal hiatus, and all three criteria combined was 0.66, 0.74, 0.64, and 0.77, respectively (low, moderate, low, and moderate accuracy, respectively). The odds ratios of the most severe type 3 forms of the sPMF, iPMF, and popliteal hiatus for hypermobile lateral meniscus were significantly high (5.50, 12.20, and 5.00, respectively). Although the diagnostic accuracy was not high enough, the significantly higher odds ratio for type 3 may indicate a hypermobile lateral meniscus. Conclusion: a definitive diagnosis of hypermobile lateral meniscus is difficult with MRI findings alone; however, MRI evaluations of the iPMF, sPMF, and the widening of popliteal hiatus can be used as an adjunct to diagnosis.
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Zheng J, Xiao Q, Wu Q, Deng H, Zhai W, Lin D. Tears of the Popliteomeniscal Fascicles of the Lateral Meniscus: An Arthroscopic Classification. Cartilage 2021; 13:256S-261S. [PMID: 33291993 PMCID: PMC8808902 DOI: 10.1177/1947603520980156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To bring forward an arthroscopic classification of the popliteomeniscal fascicles of the lateral meniscus (PFLM) tears. DESIGN Six fresh frozen knee joint samples of adult males were chosen, and the lateral meniscus at the popliteal hiatus region were measured to analyze their anatomic relationship. Patients who had received magnetic resonance imaging scan at knee joint before the surgery and diagnosed as PFLM tears by arthroscopy from April 2014 to October 2017 were selected. Data regarding the integrity of PFLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos. RESULTS The average length and thickness of the popliteal hiatus of the lateral meniscus were 2.09 ± 0.21 cm and 0.43 ± 0.08 cm, respectively. The average length of anterosuperior popliteomeniscal fascicle (APF) was 0.87 ± 0.18 cm, and the posterosuperior popliteomeniscal fascicle (PPF) was 0.72 ± 0.15 cm. A total of 36 PFLM tears in 36 patients were divided as type I (APF tear; n = 5, 13.9%), type II (PPF tear; n = 20, 55.6%), and type III (both APF and PPF tears; n = 11, 30.6%). All patients were treated with arthroscopic all-inside repair using a suture hook for the PFLM tears and follow-up for 21.1 months. All patients have done well with significantly improved Lysholm and International Knee Documentation Committee scores at the last follow-up relative to preoperative scores (P < 0.01). CONCLUSION This study suggests to possibly classify the PFLM tears for clinical practice.
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Affiliation(s)
- Jiapeng Zheng
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Qi Xiao
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Qingquan Wu
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Huiyun Deng
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Wenliang Zhai
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China
| | - Dasheng Lin
- Orthopaedic Center of People’s
Liberation Army, Xiamen University Affiliated Southeast Hospital, Zhangzhou,
China,Dasheng Lin, Department of Orthopaedic
Surgery, Xiamen University Affiliated Southeast Hospital, Zhanghua Road 269,
Zhangzhou 363000, China.
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Keyhani S, Movahedinia M, Soleymanha M, Verdonk R, Kazemi M, Qoreishy M. Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus. J Exp Orthop 2021; 8:93. [PMID: 34676494 PMCID: PMC8531177 DOI: 10.1186/s40634-021-00412-4] [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: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study investigates the effects of the all-inside repair of posterosuperior popliteomeniscal fascicle (PMF) on lateral meniscus stabilization using a posterior arthroscopic approach. METHODS Between 2015 and 2018, 17 patients with hypermobile lateral meniscus (HLM) underwent posterior knee arthroscopy for PMF repair. The all-inside repair was performed through posteromedial transseptal and posterolateral portals using a suture hook technique. Patients were clinically assessed based on IKDC and Lysholm scores. RESULTS Both IKDC and Lysholm scores improved significantly after an average follow-up of 3.5 years (P < 0.001). No patients underwent reoperation, and no complications associated with posterior knee arthroscopy were reported. CONCLUSION The all-inside suture hook technique using posterolateral and posteromedial transseptal portals fixes HLM with excellent IKDC and Lysholm scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran.
| | - Mohammad Movahedinia
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | | | - Rene Verdonk
- Department of Orthopedics and Traumatology, Gent University, Ghent, Belgium
| | - Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | - Mohamad Qoreishy
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
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22
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[Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021. [PMID: 34650290 PMCID: PMC8517687 DOI: 10.19723/j.issn.1671-167x.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries. METHODS This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears. RESULTS A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01). CONCLUSION We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.
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23
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Abstract
A basic understanding of meniscal anatomy and biomechanics is important for physicians evaluating knee injuries and surgeons treating meniscal injuries. This chapter provides a concise review of meniscal anatomy and biomechanics relevant for the evaluation and treatment of meniscus injuries. Anatomic landmarks relevant for meniscal root repair and transplant are discussed, along with the gross, microscopic, vascular, and neuroanatomy of the menisci.
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Li Z, Fan W, Dai Z, Zhao H, Liao Y, Lei Y, Luo T, Liu Q, Li J. Widening of the popliteal hiatus on sagittal MRI view plays a critical role in the mechanical signs of discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:2843-2850. [PMID: 32728789 DOI: 10.1007/s00167-020-06179-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI) after a torn discoid lateral meniscus (DLM). METHODS Included are 125 knees with meniscal disorders after arthroscopic surgery, divided according to preoperative MRI and symptoms into group A (torn DLM with mechanical symptoms,11 knees); group B (torn DLM without mechanical symptoms,41 knees); group C (asymptomatic DLM, 19 knees); and group D (medial meniscal tears, 54 knees). Popliteal hiatus width was measured on sagittal and coronal MRI. During arthroscopy, total meniscectomy or central partial meniscectomy combined repair of the remaining part was performed in group A and group B. Outcomes were evaluated with MRI, the Tegner, Lysholm Knee Scoring Scale, and visual analog scale (VAS) scores. RESULTS The preoperative width of the popliteal hiatus was significantly larger in group A than in groups C and D (P < 0.05) on both views. Group A had a wider popliteal hiatus on sagittal view compared with group B (P < 0.05); group B had a wider popliteal hiatus on coronal view compared with group D (P < 0.05). The width of the popliteal hiatus on sagittal view was significantly reduced after surgery in group A (P < 0.05). In groups A and B, Lysholm and Tegner scores were improved, while VAS scores were reduced (all P < 0.05). CONCLUSION Widening of the popliteal hiatus on MRI was correlated with torn DLM and accompanied mechanical symptoms. Arthroscopic central partial menisectomy and stabilization of the posterior part of the middle body anterior to the popliteus tendon were effective for the treatment of torn DLM. These findings may help guide appropriate treatment for torn DLM. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Zhou Li
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Weijie Fan
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Zhu Dai
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China.
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Ying Liao
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Yunliang Lei
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Tao Luo
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Quanhui Liu
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Jian Li
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
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25
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [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] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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26
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Abstract
This article highlights five knee injuries that, in the author's experience, are commonly overlooked by readers inexperienced in knee MRI: ramp lesions, meniscocapsular tears, meniscal root ligament tears, posterior capsular ligament tears, and partial anterior cruciate ligament tear. While these injuries are readily apparent when the images are assessed for the given abnormality, the author's belief is that these may be overlooked because either the injury is not considered, or the affected area is not closely inspected. While these injuries may not alter immediate clinical management or require surgical intervention, they may, nevertheless, result in patient symptoms and may potentially increase the risk of further knee injury. Further, these injuries are difficult to recognize clinically and arthroscopically. In this review, we present these five injuries, emphasising relevant anatomy, normal MRI appearances, common injury patterns, and tips to avoid their being overlooked. Routine review of these areas when interpreting knee MRI, with additional imaging as necessary, will allow these injuries to be recognized more regularly.
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27
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Parisien RL, Shin M, Boden LM, Jo SY, Victorius L, Sennett BJ, Zgonis MH. Arthroscopic Diagnosis of Occult Posterolateral Meniscocapsular Separations: Another Hidden Lesion. Arthrosc Sports Med Rehabil 2021; 3:e727-e732. [PMID: 34195638 PMCID: PMC8220620 DOI: 10.1016/j.asmr.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study was to describe the surgical findings and clinical outcomes in a series of patients with occult posterolateral meniscocapsular separations diagnosed arthroscopically after a negative magnetic resonance imaging (MRI) scan. Methods A retrospective analysis of prospectively collected data of consecutive patients who underwent surgical arthroscopy with repair of an occult posterolateral meniscocapsular separation by 2 fellowship-trained orthopaedic sports medicine surgeons at a single institution was performed. All lesions were identified arthroscopically in the posterolateral aspect of the lateral compartment as a distinct pathologic separation between the posterolateral capsule and adjacent meniscal tissue with increased excursion on probing. Clinical examination notes, MRI scans, and operative reports were reviewed. Patient-reported outcome measures were assessed via patient questionnaire. Results A total of 6 patients were included for analysis. MRI evaluation of the lateral meniscus was unrevealing in 4 patients, suggesting a possible tear of the body of the lateral meniscus in one patient and demonstrating a parameniscal cyst abutting the anterior root of the lateral meniscus in another patient. Arthroscopic examination revealed meniscocapsular separations of the posterolateral meniscus in all 6 knees, with 2 knees demonstrating concomitant bucket-handle meniscus tears. Patient-reported outcomes were determined for 67% of study patients. The average reported International Knee Documentation Committee score was 63.8, the average Knee Outcome Survey Activities of Daily Living Scale score was reported as 63, the 12-Item Short Form Survey (SF-12) Physical score averaged 46.8 with an average SF-12 Mental score of 59.9. Conclusions The diagnosis of occult posterolateral meniscocapsular separations (MCS) could be missed on advanced imaging, such as MRI, so arthroscopic diagnosis may be required. This study indicates that arthroscopic diagnosis and repair of occult posterolateral MCS results in good functional and clinical outcomes. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
| | - Max Shin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Lauren M Boden
- University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Stephanie Y Jo
- University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Lisa Victorius
- University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Brian J Sennett
- University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Pękala PA, Rosa MA, Łazarz DP, Pękala JR, Baginski A, Gobbi A, Mann MR, Tomaszewski KA, LaPrade RF. Clinical Anatomy of the Anterior Meniscofemoral Ligament of Humphrey: An Original MRI Study, Meta-analysis, and Systematic Review. Orthop J Sports Med 2021; 9:2325967120973192. [PMID: 33748296 PMCID: PMC7903842 DOI: 10.1177/2325967120973192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background: The anterior meniscofemoral ligament (aMFL) of Humphrey is an anatomically variable fibrous band of connective tissue that attaches between the lateral aspect of the medial femoral condyle and posterior horn of the lateral meniscus, running posterior to the anterior cruciate ligament and anterior to the posterior cruciate ligament (PCL). The presence of an intact aMFL may contribute to stabilization of the lateral compartment of the knee joint. Purpose: The original magnetic resonance imaging (MRI) arm of this study aimed to assess the aMFL incidence among Polish patients. The goal of the systematic review and meta-analysis was to review the literature discussing the clinical anatomy of the aMFL and provide data on its prevalence. It was hypothesized that significant heterogeneity exists within the published literature. Study Design: Cross-sectional study and systematic review; Level of evidence, 3. Methods: A retrospective investigation was performed on the MRI scans of 100 knees (52 right, 48 left) of Polish patients. Scans were randomly selected from a database of MRI examinations performed in 2019. For the meta-analysis, major online databases were queried for data on the aMFL, and 2 authors independently assessed and extracted data from all included studies. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool. Results: In the MRI arm of this study, the aMFL was found in 62 of the 100 lower limbs. The meta-analysis included 41 studies with a total of 4220 limbs. The aMFL was present in 55.5% (95% CI, 45.5%-65.3%) of cases. Arthroscopic studies yielded the highest prevalence (82.3% [95% CI, 36.6%-100.0%]); of MRI studies, the highest prevalence was at 3.0-T strength (51.0% [95% CI, 13.3%-88.2%]). Conclusion: Significant variability in the prevalence of the aMFL was found in the literature. More emphasis should be placed on the clinical relevance of injuries to the aMFL because of its significant role in the function of the knee. It is important to be aware that, because of the anatomy of the aMFL, the ligament can also function to support a torn PCL.
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Affiliation(s)
- Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Mateusz A Rosa
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Dominik P Łazarz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Baginski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, Milan, Italy
| | - Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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Pękala PA, Łazarz DP, Rosa MA, Pękala JR, Baginski A, Gobbi A, Wojciechowski W, Tomaszewski KA, LaPrade RF. Clinical Anatomy of the Posterior Meniscofemoral Ligament of Wrisberg: An Original MRI Study, Meta-analysis, and Systematic Review. Orthop J Sports Med 2021; 9:2325967120973195. [PMID: 33748297 PMCID: PMC7903841 DOI: 10.1177/2325967120973195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial femoral condyle and passes posteriorly to the posterior cruciate ligament (PCL). The pMFL plays a role in recovery after PCL injuries and offers stability to the lateral meniscus, promoting normal knee function. Purpose/Hypothesis The aim of the magnetic resonance imaging (MRI) arm of this study was to evaluate the prevalence of the pMFL in Polish patients. The purpose of the systematic review and meta-analysis was to evaluate the clinical relevance of the pMFL in knee surgery. It was hypothesized that extensive variability exists in reports on the prevalence, function, and clinical significance of the pMFL. Study Design Cross-sectional study and systematic review; Level of evidence, 3. Methods A retrospective MRI investigation was conducted on 100 randomly selected lower limbs of Polish patients (56 male, 44 female) performed in 2019 to determine the prevalence of the pMFL. Additionally, an extensive literature search of major online databases was performed to evaluate all reported data on the pMFL. Assessments of article eligibility and data extraction were completed independently by 2 reviewers, and all disagreements were resolved via a consensus. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool. Results In the MRI arm of this study, the pMFL was observed in 73 of the 100 limbs. In the meta-analysis, 47 studies were included, totaling 4940 lower limbs. The pooled prevalence of the pMFL was found to be 70.4% (95% CI, 63.4%-76.9%); the mean length was 27.7 mm (95% CI, 24.8-30.5 mm) and the mean widths were 4.5, 6.1, and 4.1 mm for the meniscal and femoral attachments and midportion, respectively. The mean pMFL thickness was 2.3 mm (95% CI, 1.8-2.7 mm). Conclusion Despite the variability in the literature, the pMFL was found to be a prevalent and large anatomic structure in the knee joint. The shared features of this ligament with the PCL necessitate the consideration of its value in planning and performing arthroscopic procedures of the knee.
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Affiliation(s)
- Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Dominik P Łazarz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz A Rosa
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Baginski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, Milan, Italy
| | - Wadim Wojciechowski
- Department of Radiology, Comarch Healthcare, Kraków, Poland.,Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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30
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D'Addona A, Izzo A, Di Vico G, Rosa D, Maffulli N. The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature. J Orthop Surg Res 2021; 16:148. [PMID: 33610180 PMCID: PMC7896406 DOI: 10.1186/s13018-021-02290-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Popliteomeniscal fascicles (PMF) are considered the posterolateral meniscocapsular extensions which connect the lateral meniscus to the edge of the tibia. PMFs disruption leads to hypermobility of the lateral meniscus with pain and locking sensation. Recognition and treatment of PMFs tear remain very challenging. The aim of this systematic review is to collect and analyse the articles concerning popliteomeniscal fascicle disruption from diagnosis to surgical approach. Methods PubMed, Scopus, Web of Science and EMBASE were searched. Various combinations of the keywords “Popliteomeniscal Fascicles”, “Lateral Meniscus”, “Popliteal Hiatus”, “Posterolateral Corner”, “Tear” and “Surgical Repair” were used. The original literature search identified a total of 85 articles comprising of duplicates. The PRISMA guidilines were followed. Studies in English language and published in peer-reviewed journals were included. Articles with level of evidence I to IV were included Results A total of three articles were included in the qualitative analysis. All the articles included are retrospective case series, with a level of evidence IV. Studies concerning patients with pre-operative imaging MRI and clinical assessment, reporting surgical technique and clinical outcomes assessed by physical examination and/or subjective evaluation scales were analysed. Conclusions MRI and the Figure-4 test allow to assess PMF tears pre-operatively. Arthroscopic evaluation constitutes the gold standard to confirm the diagnosis. Although surgery is considered resolutive for symptoms, there is still controversy about the most appropriate technique. Further higher quality studies are required.
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Affiliation(s)
- Alessio D'Addona
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy. .,Humanitas Clinical and Research Center-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Andrea Izzo
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Giovanni Di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Maddaloni, CE, Italy
| | - Donato Rosa
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, 275 Bancroft Road, London, E1 4DG, UK
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Grassi A, Pizza N, Andrea Lucidi G, Macchiarola L, Mosca M, Zaffagnini S. Anatomy, magnetic resonance and arthroscopy of the popliteal hiatus of the knee: normal aspect and pathological conditions. EFORT Open Rev 2021; 6:61-74. [PMID: 33532087 PMCID: PMC7845568 DOI: 10.1302/2058-5241.6.200089] [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] [Indexed: 01/11/2023] Open
Abstract
The popliteal hiatus is a complex region, formed by the confluence of various structures connecting the meniscus, popliteal tendon, tibia and fibula.The main structures that can be found are the three popliteomeniscal fascicles (anterior, postero-inferior and postero-superior), the lateral and posterior meniscotibial ligaments, the popliteofibular ligament and the meniscofibular fascicle.These structures can be identified in most cases using magnetic resonance imaging, and their 'static' assessment can be performed.Arthroscopic assessment is useful in identifying and testing 'dynamically' the integrity of the structures around the popliteal hiatus.Injuries or abnormalities of the popliteal hiatus and its structures could result in meniscal hypermobility and subluxation; however, these injuries are often unrecognized.Possible abnormalities in this region, apart from the well-known bucket-handle meniscal tear, are the Wrisberg Type III discoid meniscus, and meniscal fascicles tears. Cite this article: EFORT Open Rev 2021;6:61-74. DOI: 10.1302/2058-5241.6.200089.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Pizza
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Italy
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Winkler PW, Zsidai B, Wagala NN, Hughes JD, Horvath A, Senorski EH, Samuelsson K, Musahl V. Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics. Knee Surg Sports Traumatol Arthrosc 2021; 29:672-681. [PMID: 33201271 PMCID: PMC7917041 DOI: 10.1007/s00167-020-06357-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries.Level of evidence V.
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Affiliation(s)
- Philipp W. Winkler
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Bálint Zsidai
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nyaluma N. Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Alexandra Horvath
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
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Goto K, Duthon V, Menetrey J. An isolated Posterolateral corner injury with rotational instability and hypermobile lateral meniscus: a novel entity. J Exp Orthop 2020; 7:95. [PMID: 33259028 PMCID: PMC7708576 DOI: 10.1186/s40634-020-00313-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Although complete tear of the knee posterolateral corner (PLC) commonly occurs in combination with other knee ligamentous injuries, the incidence of isolated PLC injury was reported only 28% and overlooked in many cases. Nevertheless, an isolated PLC injury does not only provoke posterolateral instability, but also may be associated to hypermobile lateral meniscus. This study aims at showing the characteristics of isolated PLC injuries and to alert potential overlooked cases by describing their arthroscopic findings and clinical characteristics. Methods Seventy-one patients with a clinically proven isolated PLC injury who underwent knee arthroscopy were included in this study. Pre-operative symptoms and clinical signs at examination were recorded: Pain at the posterolateral aspect, feelings of instability, catching, locking; and for clinical signs: McMurray test, varus stress test in extension and at 30° of flexion, posterolateral drawer test at 30° and 80°, dial test at 30° and 80° of flexion. In terms of arthroscopic findings, systematic meniscal stability was performed to evaluate the presence of hypermobile lateral meniscus, “lateral drive through test” was also recorded in all cases. Results Positive Lateral Drive through test was found in 69 patients (95.8%). Hypermobile lateral meniscus was seen in all patients. Conclusions Hyper mobile lateral meniscus was concomitant with all isolated PLC injuries in our case series. As the typical arthroscopic characteristic, lateral drive through test positive were seen in 95.8%. In order to prevent overlooking this concomitant pathology, meticulous arthroscopic observation is crucial. Level of evidence Level IV.
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Affiliation(s)
- Kazumi Goto
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland
| | - Victoria Duthon
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland
| | - Jacques Menetrey
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland. .,University Hospital of Geneva, Geneva, Switzerland.
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Widening of the popliteal hiatus on magnetic resonance imaging leads to recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2020; 28:3532-3538. [PMID: 31786623 DOI: 10.1007/s00167-019-05800-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI), and to document the clinical results and technical aspects of arthroscopic repair of this finding. METHODS Included are 82 knees after arthroscopic surgery, divided according to arthroscopic diagnosis into group A, hypermobility of lateral meniscus, 8 knees; group B, tear of the anterior horn of the lateral meniscus, 32 knees; and group C, no abnormality of the lateral meniscus, 36 knees with medial meniscal tears and 6 with other conditions. Popliteal hiatus diameter was measured and the popliteal hiatus/lateral tibial plateau (LTP) ratio was calculated on preoperative sagittal and coronal MRI. At arthroscopy, the widened popliteal hiatus in group A was tightened anteriorly by outside-in or all-inside suture and posteriorly with all-inside suture. Outcomes were evaluated with MRI, Lysholm, Tegner and VAS scores. RESULTS The preoperative diameter of the popliteal hiatus and the popliteal hiatus/LTP ratio were significantly larger in group A than in groups B and C (p < 0.05) on both views. Threshold popliteal hiatus/LTP values of 0.16 and 0.18 on the sagittal and coronal views demonstrated diagnostic discrimination, and these values were significantly reduced after arthroscopy in Group A. Lysholm and Tegner scores were improved after tightening of the popliteal hiatus, while VAS scores reduced (all p < 0.05). CONCLUSION Widening of the popliteal hiatus on MRI may lead to recurrent subluxation of the lateral meniscus. Arthroscopic anterior and posterior tightening of the popliteal hiatus was a safe and effective treatment. LEVEL OF EVIDENCE II.
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35
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Masferrer-Pino A, Saenz-Navarro I, Rojas G, Perelli S, Erquicia J, Gelber PE, Monllau JC. The Menisco-Tibio-Popliteus-Fibular Complex: Anatomic Description of the Structures That Could Avoid Lateral Meniscal Extrusion. Arthroscopy 2020; 36:1917-1925. [PMID: 32200063 DOI: 10.1016/j.arthro.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze, quantify, and redefine the anatomy of the peripheral attachments of the lateral meniscal body to further understand how the structures might play a part in preventing meniscal extrusion and how it might be applied to surgical techniques. METHODS Ten nonpaired fresh-frozen cadaveric knees without prior injury, a surgical history, or gross anatomic abnormality were included. There were 5 right and 5 left knees, and 50% were from male donors and 50% were from female donors. All the dissections were performed by a group of 3 experts in knee surgery (2 knee surgeons and 1 anatomy professor who oversaw the design of the dissection protocol and guided this protocol). The main peripheral structures associated with the lateral meniscus body were dissected to determine the insertion, size, thickness, and location of the lateral meniscotibial ligament (LMTL), popliteofibular ligament (PFL), and popliteomeniscal ligament (PML). The distance to various landmarks in the lateral compartment was also determined using an electronic caliper. Moreover, a histopathologic study was carried out. RESULTS The average thickness of the LMTL was 0.62 ± 0.18 mm (95% confidence interval [CI], 0.49-0.75 mm); that of the PFL-PML area was 1.05 ± 0.27 mm (95% CI, 0.85-1.24 mm). The anteroposterior distance measured 15.80 ± 4.80 mm (95% CI, 12.40-19.30 mm) for the LMTL and 10.40 ± 1.70 mm (95% CI, 9.21-11.63 mm) for the PFL-PML area. The anteroposterior distance of the whole menisco-tibio-popliteus-fibular complex (MTPFC) was 28.20 ± 4.95 mm (95% CI, 24.70-31.70 mm). The average distance from the MTPFC to the posterior horn of the lateral meniscal root was 29.30 ± 2.29 mm (95% CI, 27.60-30.90 mm), whereas that to the anterior horn was 32.00 ± 4.80 mm (95% CI, 28.60-35.50 mm). The average distance from the tibial insertion of the LMTL to the articular surface was 5.59 ± 1.22 mm (95% CI, 4.72-6.46 mm). In all the anatomic components of the knee, a consistent morphologic and histologic pattern was observed between the fibers of the LMTL, PFL, and PML and those of the lateral meniscal body, making up the proposed MTPFC. CONCLUSIONS A consistent anatomic pattern has been identified between the lateral meniscal body and the LMTL, PFL, and PML, forming an interconnected complex that would seem appropriate to denominate the MTPFC. A precise study of this region and appropriate nomenclature for it could contribute to a better understanding of the mechanism of lateral meniscal injuries at this level, as well as the development of surgical techniques to treat these lesions and prevent extrusion. CLINICAL RELEVANCE This study contributes to the understanding of the lateral meniscal body attachments and the functions they serve. This will lead to improvements in the treatment of lesions in this region, including the development of surgical techniques.
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Affiliation(s)
- Angel Masferrer-Pino
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus-Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Ivan Saenz-Navarro
- Department of Orthopaedic Surgery, Fundació Hospital Esperit Sant, Barcelona, Spain; Department of Anatomy, Universitat de Barcelona, Barcelona, Spain
| | - Gonzalo Rojas
- Department of Orthopaedic Surgery, Hospital Regional de Talca, Talca, Chile
| | - Simone Perelli
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus-Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Erquicia
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus-Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo E Gelber
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus-Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joan C Monllau
- Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus-Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital del Mar-Universitat Autònoma de Barcelona, Barcelona, Spain
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