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Familiari F, Chahla J, Compagnoni R, DePhillipo NN, Moatshe G, LaPrade RF. Meniscal extrusion consensus statement: A collaborative survey within the Meniscus International Network (MenIN) Study Group. Knee Surg Sports Traumatol Arthrosc 2024; 32:1446-1454. [PMID: 38606565 DOI: 10.1002/ksa.12183] [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: 02/21/2024] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE The purpose of the present study was to perform a survey administered to members of the Meniscus International Network (MenIN) Study Group, seeking to delineate the most contentious aspects of meniscal extrusion classification and provide a foundation for new, more comprehensive definitions and treatments for these pathologies. METHODS MenIN Study Group is a group of international experts treating and performing research on meniscus pathology and treatment. All MenIN Study Group members were asked to complete a survey aimed at establishing criteria for the optimal classification system for meniscal extrusion. Data obtained from the completed questionnaires were transferred into a spreadsheet and then analysed. All responses are presented as counts, percentages or means. RESULTS Forty-seven (85.5%) MenIN Study Group members completed the survey and were included in this analysis. Key aspects recommended for inclusion in a comprehensive classification system for meniscal extrusion included laterality (93.6%), anatomical location (76.6%), patient age (76.6%), body mass index (BMI) (68.1%) and aetiology (68.1%). For classifying meniscal extrusion, 53.2% considered the distance in millimetres from the tibial plateau's outer margin as the most reliable measurement technique on imaging. Preferences for imaging modalities varied, with 44.7% favouring weight-bearing magnetic resonance imaging (MRI) and 36.2% opting for weight-bearing ultrasound due to its greater availability. Respondents advocated for a classification system addressing stability or progression of meniscal extrusion (66%), reducibility (53.2%), potential progression of knee osteoarthritis (OA) (83%), influencing treatment approaches (83%), a gradation system (83%), consideration of dynamic factors (66%), association with clinical outcomes and prognosis (76.6%) and investigation around centralization procedures (57.4%). CONCLUSIONS In conclusion, the findings of this survey shed light on the global perspectives regarding meniscal extrusion classification. It was generally felt that a new classification of extrusion measured on MRI scans at the mid-tibial plateau should be developed, which considers factors such as laterality, anatomical location, age, BMI and aetiology. Additionally, the results support the integration of dynamic factors and clinical outcomes in MRI-based classifications to inform treatment approaches. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Catanzaro, Italy
- Research Center on Musculoskeletal Health, Magna Graecia University, Catanzaro, Italy
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Riccardo Compagnoni
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Nicholas N DePhillipo
- Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gilbert Moatshe
- Norwegian School of Sports Science, Oslo Sport Trauma Research Center, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
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van Minnen BS, van Tienen TG. The Current State of Meniscus Replacements. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09902-1. [PMID: 38744802 DOI: 10.1007/s12178-024-09902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW The field of meniscus replacement is changing continuously, with new devices emerging and others disappearing from the market. With the current tendency to preserve the knee joint, meniscus implants may become more relevant than ever. The purpose of this review is to provide an overview of the current state of partial and total meniscus replacements that have been developed beyond the academic phase. The available clinical and pre-clinical data is evaluated, and omissions are identified. RECENT FINDINGS Recent systematic reviews have shown a lack of homogenous clinical data on the CMI and Actifit meniscal scaffolds, especially regarding long-term performance without concomitant surgical interventions. Clinical studies on the medial total meniscus prostheses NUsurface and Artimis are ongoing, with the NUsurface being several years ahead. New techniques for meniscus replacement are rapidly developing, including the Artimis lateral meniscus prosthesis and the MeniscoFix 3D-printed scaffold. All evaluated clinical studies point towards improved clinical outcomes after implantation of partial and total meniscus replacements. Long-term data on survival and performance is of low quality for CMI and Actifit and is unavailable yet for NUsurface and Artimis. It is of major importance that future research focuses on optimizing fixation methods and identifying the optimal treatment strategy for each patient group. New techniques for total and partial replacement of the medial and lateral meniscus will be followed with interest.
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Affiliation(s)
- B S van Minnen
- Orthopaedic Research Lab, Radboud University Medical Centre, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- ATRO Medical BV, Liessentstraat 9A, 5405 AH, Uden, The Netherlands.
| | - T G van Tienen
- Orthopaedic Research Lab, Radboud University Medical Centre, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- ATRO Medical BV, Liessentstraat 9A, 5405 AH, Uden, The Netherlands
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Wagner KR, Kaiser JT, Quigley RA, Hevesi M, Damodar D, Meeker ZD, Cotter EJ, Yanke AB, Cole BJ. Revision and Conversion to Arthroplasty Are Low Among Adolescents Undergoing Meniscal Allograft Transplantation Using the Bridge-In-Slot Technique at Midterm Follow-Up. Arthroscopy 2024; 40:1186-1194.e1. [PMID: 37597703 DOI: 10.1016/j.arthro.2023.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To report midterm outcomes after primary medial and lateral meniscal allograft transplantation (MAT) with fresh-frozen allografts implanted with the bridge-in-slot technique in the adolescent patient population. METHODS Adolescent patients less than 18 years old at the time of primary MAT from 1999 to 2016 were retrospectively identified. International Knee Documentation Committee (IKDC) subjective form, Lysholm, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales scores were collected before surgery and at 1-year, 2-year, and a minimum 5-year follow-up. Thresholds for achieving clinically significant outcomes were calculated, and the proportion of patients achieving minimal clinically important difference (MCID), patient-acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) was determined. Meniscus reoperation (partial, subtotal, or total meniscectomy, repair, or failure) and failure (revision MAT or conversion to arthroplasty) rates were determined. RESULTS Forty-four (female n = 33; male n = 11) of 62 identified patients met inclusion criteria and were followed for a mean of 9.5 ± 3.8 years (range, 5.0-17.7). Lateral MAT was performed in most patients (n = 35/44 [80%]). Isolated MAT was performed in 27 (61%) patients. Common concomitant procedures included osteochondral allograft transplantation (32%), autologous chondrocyte implantation (18%), and anterior cruciate ligament reconstruction (14%). MCID, PASS, and SCB were achieved by patients at a minimum 5-year follow-up for IKDC (62%; 76%; 31%), Lysholm (62%; 79%; 23%), and KOOS questionnaires (Pain [65%; 81%; 41%], Symptoms [58%; 81%; 47%], Activities of Daily Living [53%; 77%; 35%], Sport [86%; 75%; 50%], and Quality of Life [59%; 81%; 59%]), respectively. Fourteen patients (32%) underwent reoperation at an average of 5.0 ± 4.3 years (range, 0.8-14.0) after MAT. Three (7%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range, 2.8-4.9) after transplantation. No patients underwent arthroplasty. Overall survival free from failure at 1, 2, 5, and 10 years was 100%, 100%, 93%, and 93%, respectively. At the time of final follow-up, 80% of patients reported satisfaction with their current physical status. CONCLUSIONS Primary MAT in adolescent patients resulted in significant and durable functional improvements at mid- to long-term follow-up. At an average of 9.5 years after surgery, meniscal reoperation rate was 32% whereas graft survival free of revision MAT was 93%. Adolescents undergoing MAT demonstrated similar functional outcomes and graft survivability when compared to available adult MAT literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan A Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Eric J Cotter
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
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Cho JH, Nam HS, Park SY, Ho JPY, Lee YS. Arthroscopic Meniscal Repair and Meniscectomy for Adult Discoid Lateral Meniscus Results in Progression to Valgus Alignment and Lateral Compartment Degeneration Compared With Nonoperative Treatment and Nondiscoid Lateral Meniscus. Arthroscopy 2024; 40:1223-1233. [PMID: 37717929 DOI: 10.1016/j.arthro.2023.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To analyze the effect of the arthroscopic meniscal procedure in adult discoid lateral meniscus (DLM) according to the age and meniscal-preserving by making comparisons with the nondiscoid lateral meniscus (N-DLM). METHODS From March 2014 to October 2020, a comparative analysis was performed in adults with DLM who underwent arthroscopic meniscal procedures (operative DLM: 134 knees), nonoperative treatment (nonoperative DLM: 56 knees), and adult N-DLM who underwent arthroscopic meniscal procedures (operative N-DLM: 64 knees). These patients were between 20 and 65 years old and completed a minimum follow-up of 2 years. Patients with DLM who underwent arthroscopic procedure were divided into subgroups according to age and extent of the meniscal-preserving. The following parameters were assessed and compared between the groups: (1) coronal limb alignment, (2) osteoarthritis grade, and (3) clinical outcomes and the minimal clinically important difference. RESULTS The coronal limb alignment was significantly changed to valgus in the order of operative DLM, N-DLM, and nonoperative DLM (Δ mechanical hip-knee-ankle angle: 3.23 ± 1.85 vs 1.35 ± 1.03° vs -0.57 ± 1.88°; P < .05). Operative DLM showed most prominent osteoarthritic change in the lateral compartment, followed by the N-DLM and nonoperative DLM groups (40.3% vs 17.2% vs 5.3%; P < .05). These changes in operative DLM were more prominent in older adults who underwent meniscal-sacrificing procedures and resulted in less-satisfactory clinical outcomes (all P < .05). CONCLUSIONS Arthroscopic surgery for adult DLM resulted in progression to valgus alignment and lateral compartment degeneration compared with nonoperative treatment and arthroscopic surgery of the adult N-DLM. Old ager and having a meniscal-sacrificing procedure showed more rapid radiographic changes and lower clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparison study.
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Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
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Popper HR, Fliegel BE, Elliott DM, Su AW. Surgical Management of Traumatic Meniscus Injuries. PATHOPHYSIOLOGY 2023; 30:618-629. [PMID: 38133145 PMCID: PMC10747583 DOI: 10.3390/pathophysiology30040044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries.
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Affiliation(s)
| | | | - Dawn M. Elliott
- Biomedical Engineering Department, University of Delaware, Newark, DE 19716, USA
| | - Alvin W. Su
- Biomedical Engineering Department, University of Delaware, Newark, DE 19716, USA
- Department of Orthopedics, Nemours (duPont) Children’s Hospital, Delaware, Wilmington, DE 19803, USA
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Uchio Y, Takuwa H, Wakatsuki T, Kuwata S. Meniscal Allograft Transplantation Concomitant With Cartilage Repair for Symptomatic Lateral Meniscus-Deficient Knees With Over Two Years of Follow-up. Cureus 2023; 15:e48774. [PMID: 38024091 PMCID: PMC10644150 DOI: 10.7759/cureus.48774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective The treatment for symptomatic meniscus-deficient knees with cartilage defects remains challenging on account of insufficient meniscal substitutes. One solution for this might involve combining meniscal allograft transplantation (MAT) and cartilage repair. In this study, we aimed to analyze the effectiveness and safety of MAT concomitant with cartilage repair for symptomatic lateral meniscus-deficient knees in a setting with limited availability of meniscal transplants in Japan. Methods Nine patients who underwent MAT concomitant with osteochondral transplantation (five) and/or autologous chondrocyte implantations (seven) were followed up for at least two years (mean: 51.2 months, range: 24-84 months). Their demographic data and other characteristics were as follows - mean age: 51.7 years, range: 36-67 years; men/women: 4/5; cause: trauma/discoid meniscus: 8/1; cartilage defect size: mean: 6.7 cm2/knee, range: 1.0-11.3. The effectiveness and safety were evaluated clinically by using the Lysholm Knee Scoring Scale (LKSS) and Japanese Orthopaedic Association (JOA) knee score, physical examination, X-rays, and MRI preoperatively and at one, 12, and 24 months after the implantation. Differences between the variables were analyzed using the Friedman test and Scheffe's multiple comparisons. Results The median LKSS and JOA scores significantly improved from 70 points (range: 21-80) and 35 (25-45) preoperatively to 86.5 (65-98) and 87.5 (80-95) at 24 months after surgery, respectively (p<0.001, p=0.0013). The range of motion (ROM), femorotibial angle, and the lateral joint space showed no significant changes. However, lateral meniscal extrusions (LMEs) increased by 3.0 mm (range: 0-6.3 mm) at one month postoperatively and remained unchanged until two years postoperatively. Treatment failure occurred in one case, which was revised by total knee arthroplasty (TKA) at 18 months postoperatively. Additional surgeries were needed in some cases: lateral meniscal tear (three cases), contracture (two cases), and patellar instability (one case). However, neither infection nor allergic reaction was observed in the blood exams. Conclusions Although MAT concomitant with cartilage repair showed good clinical outcomes, half of the cases needed additional surgeries. Based on our findings, this technique should be adopted only in select cases and performed by a handful of highly experienced surgeons.
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Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Hiroshi Takuwa
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Takuya Wakatsuki
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Suguru Kuwata
- Department of Orthopaedic Surgery, National Hospital Organization Hamada Medical Center, Hamada, JPN
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Kraeutler MJ, McCulloch PC, Sherman SL, Vidal AF. The Principles of Knee Joint Preservation: Operative Treatment Strategies. J Bone Joint Surg Am 2023; 105:1638-1646. [PMID: 37616413 DOI: 10.2106/jbjs.23.00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Seth L Sherman
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
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Zaffagnini S, Romandini I, Filardo G, Dal Fabbro G, Grassi A. Meniscal allograft transplantation, anterior cruciate ligament reconstruction, and valgus high tibial osteotomy for meniscal-deficient, unstable, and varus knees: surgical technique and clinical outcomes. INTERNATIONAL ORTHOPAEDICS 2023; 47:2523-2535. [PMID: 37316682 DOI: 10.1007/s00264-023-05846-2] [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: 07/09/2022] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to determine the clinical and functional outcome of a salvage surgical approach with the combined procedures meniscal allograft transplantation (MAT), anterior cruciate ligament reconstruction (ACLR), and high tibial osteotomy (HTO), in a cohort of patients treated for complex knee lesions evaluated up to a mid-term follow-up. METHODS Eight patients (38.8 ± 4.6 years, 88% males) were treated arthroscopically with MAT without bone plugs combined with primary or revision ACLR and HTO and evaluated at basal, at a minimum of two years (short follow-up), and at a mean follow-up of 5.1 years (mid-term follow-up) with the VAS score for pain, Lysholm score, IKDC subjective score, WOMAC Osteoarthritis index, and Tegner score. Physical examination (Lachman and pivot-shift tests, arthrometer assessment) and radiographic evaluation (pre- and post-operative x-rays) were obtained. Complications and failures were also recorded. RESULTS A statistically significant improvement was observed from baseline to five years in all clinical scores. In particular, the IKDC subjective score improved from 33.3 ± 20.7 to 73.1 ± 18.4 at short follow-up (p < 0.05), up to 78.3 ± 9.8 at the final follow-up (p < 0.05). A similar trend was demonstrated with the Lysholm, VAS, WOMAC, and Tegner score, even though only one patient reached the pre-injury activity level. Two patients had a worsening of the Kellgren-Lawrence (KL) grade from preoperative (grade 1) to final follow-up (grade 2). No major complications and surgical failures were documented. CONCLUSION The combined procedure of MAT, ACLR, and HTO presents few complications and failures and showed to be a valid option to reduce pain, recover knee function, and slow down the osteoarthritis process even in complex patients, with good and stable results up to a mid-term follow-up.
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Affiliation(s)
- Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Iacopo Romandini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy
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Morgan C, Bell R, Burland JP, Edgar CM. Meniscus Allograft Transplantation Augmented With Autologous Bone Marrow Aspirate Concentrate. Arthrosc Tech 2023; 12:e1021-e1026. [PMID: 37533910 PMCID: PMC10390746 DOI: 10.1016/j.eats.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 08/04/2023] Open
Abstract
Meniscus allograft transplantation (MAT) has been shown to be a feasible surgical option for younger patients, below 50 years of age who have meniscal insufficiency and have failed conservative treatment measures. In this technical note, we describe a procedure of harvesting and injecting bone marrow aspirate concentrate in a meniscus allograft during a MAT procedure, which may allow for longer lasting transplants and improve patient outcomes. In this technical note, bone marrow aspirate concentrate is harvested arthroscopically from the intercondylar notch at the surgical site, which prevents additional donor site morbidity, as seen with harvesting from other locations, such as the iliac crest. This also reduces operating time, since harvesting from the iliac crest requires different patient positioning and usually additional anesthesia. The authors of this surgical technique believe that biological augmentation during MATs will assist surgeons in maximizing graft survivorship and, ultimately, lead to better patient outcomes.
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Affiliation(s)
- Courtney Morgan
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julie P. Burland
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- UConn Institute for Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
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10
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Farshidfar SS, Cadman J, Neri T, Parker D, Appleyard R, Dabirrahmani D. Towards a validated musculoskeletal knee model to estimate tibiofemoral kinematics and ligament strains: comparison of different anterolateral augmentation procedures combined with isolated ACL reconstructions. Biomed Eng Online 2023; 22:31. [PMID: 36973768 PMCID: PMC10044816 DOI: 10.1186/s12938-023-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Isolated ACL reconstructions (ACLR) demonstrate limitations in restoring native knee kinematics. This study investigates the knee mechanics of ACLR plus various anterolateral augmentations using a patient-specific musculoskeletal knee model. MATERIALS AND METHODS A patient-specific knee model was developed in OpenSim using contact surfaces and ligament details derived from MRI and CT data. The contact geometry and ligament parameters were varied until the predicted knee angles for intact and ACL-sectioned models were validated against cadaveric test data for that same specimen. Musculoskeletal models of the ACLR combined with various anterolateral augmentations were then simulated. Knee angles were compared between these reconstruction models to determine which technique best matched the intact kinematics. Also, ligament strains calculated by the validated knee model were compared to those of the OpenSim model driven by experimental data. The accuracy of the results was assessed by calculating the normalised RMS error (NRMSE); an NRMSE < 30% was considered acceptable. RESULTS All rotations and translations predicted by the knee model were acceptable when compared to the cadaveric data (NRMSE < 30%), except for the anterior/posterior translation (NRMSE > 60%). Similar errors were observed between ACL strain results (NRMSE > 60%). Other ligament comparisons were acceptable. All ACLR plus anterolateral augmentation models restored kinematics toward the intact state, with ACLR plus anterolateral ligament reconstruction (ACLR + ALLR) achieving the best match and the greatest strain reduction in ACL, PCL, MCL, and DMCL. CONCLUSION The intact and ACL-sectioned models were validated against cadaveric experimental results for all rotations. It is acknowledged that the validation criteria are very lenient; further refinement is required for improved validation. The results indicate that anterolateral augmentation moves the kinematics closer to the intact knee state; combined ACLR and ALLR provide the best outcome for this specimen.
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Affiliation(s)
- Sara Sadat Farshidfar
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Joseph Cadman
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Thomas Neri
- Sydney Orthopaedic Research Institute, Sydney, Australia
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint Etienne, France
- EA 7424-Inter-University Laboratory of Human Movement Science, University Lyon-University Jean Monnet Saint Etienne, Saint Etienne, France
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Richard Appleyard
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Danè Dabirrahmani
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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11
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TWO TO 14 YEAR OUTCOMES OF COMBINED MENISCAL ALLOGRAFT TRANSPLANTATION WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A SYSTEMATIC REVIEW. Arthroscopy 2022; 39:1584-1592.e1. [PMID: 36343764 DOI: 10.1016/j.arthro.2022.10.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with meniscal allograft transplantation (MAT) through systematic review of current available evidence. METHODS A systematic database search of PubMed, Embase, Web of Science and CINAHL was performed from inception up to 7 December 2021 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Follow-up studies (inception cohort studies/non-randomized controlled trials/retrospective cohort studies) and case series that had more than 10 people published in English, which involved patients who underwent a combination of ACLR and MAT were included. Quality of these studies were appraised using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Systematic review of International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores were conducted. RESULTS Seven studies involving 363 patients were included. The average mean follow up time was 4.08 years, ranging from 1.75 to 14 years. All studies used the Lysholm Knee Scoring system to report clinical outcomes, while two studies and four studies used the IKDC Questionnaire and Tegner activity scale respectively to measure clinical outcomes post-operatively. Comparing postoperative to pre-operative scores, we found an improvement above the minimal clinically important difference (MCID) for the Lysholm (Mean Difference (MD) range= 16.00 to 26.10) and Tegner activity scores (MD range = 1.50 to 1.90). All but one study reported an increase above the MCID for IKDC scores post-op (MD range= 5.60 to 23.00). CONCLUSIONS Combined MAT and ACLR have good two to 14 year clinical outcomes post operatively and is an optimal procedure for patients with concurrent ACL injuries with irreparable meniscus injuries. More prospective studies and studies evaluating outcome differences between concurrent ACLR with MAT and staged ACLR with MAT should be conducted. LEVEL OF EVIDENCE IV, systematic review and/or meta-analysis of studies with Levels I to IV.
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12
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Wang S, Hase K, Kita S, Ogaya S. Biomechanical effects of medial meniscus radial tears on the knee joint during gait: A concurrent finite element musculoskeletal framework investigation. Front Bioeng Biotechnol 2022; 10:957435. [PMID: 36299291 PMCID: PMC9589217 DOI: 10.3389/fbioe.2022.957435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
The biomechanical variation in the knee during walking that accompanies medial meniscal radial tears stemming from knee osteoarthritis (OA) has not been explored. This study introduced a finite element musculoskeletal model using concurrent lower limb musculoskeletal dynamics and knee joint finite element analysis in a single framework and expanded the models to include knees with medial meniscal radial tears and total medial meniscectomy. The radial tears involved three locations: anterior horn, midbody, and posterior horn with grades of 33%, 50%, and 83% of the meniscus width. The shear and hoop stresses of the tear meniscus and tibial cartilage contact load, accompanying tears, and postmeniscectomy were evaluated during the stance phase of the gait cycle using the models. In the 83% width midbody tear group, shear stress at the end of the tear was significantly greater than in the intact meniscus and other tear groups, and the maximum shear stress was increased by 310% compared to the intact meniscus. A medial meniscus radial tear has a much smaller effect on the tibial cartilage load (even though in the 83% width tear, the cartilage/total load ratio increased by only 9%). However, the contact force on the tibial cartilage with total postmeniscectomy was increased by 178.93% compared with a healthy intact meniscus, and the peak contact pressure after meniscectomy increased from 11.94 to 12.45 MPa to 17.64 and 13.76 MPa, at the maximum weight acceptance and push-off, respectively. Our study shows that radial tears with larger medial meniscus widths are prone to high stress concentrations at the end of the tears, leading to the potential risk of complete meniscal rupture. Furthermore, although the tears did not change the cartilage load distribution, they disrupted the circumferential stress-transmitting function of the meniscus, thus greatly increasing the likelihood of the onset of knee OA. The significant increase in the tibial cartilage load with total postmeniscectomy indicates a potential risk of OA flare-ups. This study contributes to a better understanding of meniscal tear-induced OA biomechanical changes during human activities and offers some potential directions for surgical guidance of meniscectomies and the prophylaxis and treatment of OA.
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Affiliation(s)
- Sentong Wang
- Human-Mechanical System Laboratory, Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Kazunori Hase
- Human-Mechanical System Laboratory, Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Shunsuke Kita
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Graduate Course of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
- Department of Rehabilitation, Soka Orthopedics Internal Medicine, Saitama, Japan
| | - Shinya Ogaya
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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13
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Patel NM, Edison BR, Carter CW, Pandya NK. The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries. Clin Sports Med 2022; 41:789-798. [DOI: 10.1016/j.csm.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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van Minnen BS, van der Veen AJ, van de Groes SAW, Verdonschot NJJ, van Tienen TG. An anatomically shaped medial meniscus prosthesis is able to partially restore the contact mechanics of the meniscectomized knee joint. J Exp Orthop 2022; 9:91. [PMID: 36071256 PMCID: PMC9452619 DOI: 10.1186/s40634-022-00531-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to determine whether a flexible medial meniscus prosthesis is more capable of sharing loads with the direct tibiofemoral cartilage contact than the stiffer first-generation prosthesis. Additionally, the effect of the prosthesis on the tibial pressure distribution after total meniscectomy was investigated. Methods In an artificial knee joint, the relative amounts of load transferred through both meniscus prostheses and the direct tibiofemoral contact were assessed with pressure-sensitive sensors. Additionally, six cadaveric knee joints were loaded in a physiological environment. Tibial contact pressures were measured with an intact native meniscus, after total meniscectomy and after implantation of the second-generation meniscus prosthesis. Results Whereas the first generation of the meniscus prosthesis transferred virtually all the load from femur to tibia, the second-generation prosthesis allowed for load sharing with the direct tibiofemoral contact. No differences in load sharing were found between the native meniscus and the second-generation meniscus prosthesis. The prosthesis decreased peak and mean pressures on the medial tibial cartilage compared to meniscectomy. No significant differences in pressure were found between the native meniscus and the meniscus prosthesis. Conclusions The second-generation meniscus prosthesis presented in this study can share loads with the direct tibiofemoral contact, a characteristic that the first-generation prosthesis did not have. The flexible meniscus prosthesis significantly reduces the contact pressures on the medial tibial plateau after total meniscectomy. Although the biomechanical performance of the native meniscus could not be reproduced completely, the meniscus prosthesis may have the potential to relieve post-meniscectomy pain symptoms.
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Affiliation(s)
- Branco S van Minnen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands.
| | - Albert J van der Veen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands
| | - Sebastiaan A W van de Groes
- Department of Orthopaedics, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nico J J Verdonschot
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Tony G van Tienen
- Orthopaedic Research Lab, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,ATRO Medical B.V., Liessentstraat 9A, 5405 AH, Uden, The Netherlands
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15
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Benfield KJ, Pinkley ZA, Burruel DE, Lewis KJ, Ferguson DS, Lujan TJ. In vitro method to quantify and visualize mechanical wear in human meniscus subjected to joint loading. J Mech Behav Biomed Mater 2022; 133:105338. [PMID: 35834895 PMCID: PMC9728175 DOI: 10.1016/j.jmbbm.2022.105338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
The mechanical wear and tear of soft connective tissue from repetitive joint loading is a primary factor in degenerative joint disease, and therefore methods are needed to accurately characterize wear in joint structures. Here, we evaluate the accuracy of using a structured light 3D optical scanning system and modeling software to quantify and visualize volume loss in whole human meniscus subjected to in vitro joint loading. Using 3D printed meniscus replicas with known wear volumes, we determined that this novel imaging method has a mean accuracy of approximately 13 mm3, corresponding to a mean error of less than 7% when measuring meniscal volumetric changes of 0.2 cm3 (size of a pea). The imaging method was then applied to measure the in vitro wear of whole human menisci at four time points when a single cadaveric knee was subjected to one million cycles of controlled joint loading. The medial and lateral menisci reached steady state volumetric reductions of 0.72 cm3 and 0.34 cm3 per million cycles, respectively. Colorimetric maps of linear wear depth revealed high wear and deformation in the posterior regions of both the medial and lateral menisci. For the first time, this study has developed a method to accurately characterize volume loss in whole meniscus subjected to in vitro joint loading. This 3D scanning method offers researchers a new investigative tool to study mechanical wear and joint degeneration in meniscus, and other soft connective tissues.
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Affiliation(s)
- Kate J Benfield
- Biomedical Engineering Doctoral Program, Boise State University, Boise, ID, USA; Department of Mechanical & Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Zachary A Pinkley
- Department of Mechanical & Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Dylan E Burruel
- Department of Mechanical & Biomedical Engineering, Boise State University, Boise, ID, USA
| | | | | | - Trevor J Lujan
- Department of Mechanical & Biomedical Engineering, Boise State University, Boise, ID, USA.
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16
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Lee DW, Lee DR, Kim MA, Lee JK, Kim JG. Effect of Preoperative Joint Space Width on Lateral Meniscal Allograft Transplantation: Outcomes at Midterm Follow-up. Orthop J Sports Med 2022; 10:23259671221103845. [PMID: 36081410 PMCID: PMC9445481 DOI: 10.1177/23259671221103845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background: It remains unclear whether lateral joint space narrowing without severe cartilage loss before meniscal allograft transplantation (MAT) affects clinical outcomes and graft extrusion. Hypothesis: Patients with greater preoperative joint space narrowing would show more graft extrusion, more osteoarthritis progression, and worse clinical outcomes than would those with less narrowing. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively evaluated 61 patients who underwent lateral MAT and had a minimum follow-up of 4 to 5 years. The median preoperative joint space width (JSW) on Rosenberg view radiographs was used to classify patients into those with less joint space narrowing (JSW ≥3 mm; group A) and greater joint space narrowing (JSW <3 mm; group B). We compared differences between groups in terms of graft extrusion and articular cartilage loss (modified Outerbridge grade ≥3) on 1-year postoperative magnetic resonance imaging (MRI) scans and changes in JSW and clinical outcomes at the last follow-up. Results: There were 31 patients in group A and 30 patients in group B; the mean follow-up time for all patients was 64.4 ± 10.3 months. All patients showed a significant preoperative to postoperative improvement in outcome scores (P < .001 for all). The mean preoperative JSW was 3.8 ± 0.9 mm in group A and 2.3 ± 0.4 mm in group B (P < .001). In group B, there was more graft extrusion on postoperative MRI scans (3.0 ± 0.9 vs 1.9 ± 0.6 mm, respectively; P < .001) and a higher proportion of patients with pathological graft extrusion at final follow-up (43.3% vs 12.9%, respectively; P = .011) compared with group A. At 1 year postoperatively, cartilage loss grade ≥3 was observed at the lateral femoral condyle in 3.2% and 20.0% of patients in groups A and B (P = .053), respectively, and at the lateral tibial plateau in 3.2% and 30.0% of patients (P = .006), respectively. There were moderate correlations between graft extrusion and preoperative absolute JSW (r = –0.471; P < .001) and preoperative relative JSW (r = –0.428; P = .001). Conclusion: Patients with less preoperative joint space narrowing had less graft extrusion and cartilage loss on 1-year postoperative MRI scans, as well as better radiological and clinical outcomes at midterm follow-up, compared with patients with greater preoperative narrowing.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Min Ah Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Republic of Korea
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17
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Rowe D, Cohen SB, Dugas JR. Performance and Return to Sport After Meniscal Repair in Professional Baseball Players. Orthop J Sports Med 2022; 10:23259671221101914. [PMID: 35757240 PMCID: PMC9218461 DOI: 10.1177/23259671221101914] [Citation(s) in RCA: 1] [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: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Meniscal repair is an effective treatment option for certain meniscal injuries to preserve meniscal function and limit the progression of knee osteoarthritis. Outcomes after meniscal repair in professional baseball players are not well documented. Purposes/Hypothesis: The purposes of this study were to determine performance and return to sport (RTS) in professional baseball players after meniscal repair and compare the results of medial versus lateral meniscal repair. It was hypothesized that there would be a high RTS rate, with no difference in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent meniscal repair between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Descriptive information and performance data (before and after injury) for each player were recorded. The rate and timing of RTS were then compared between players who underwent medial versus lateral meniscal repair. Results: Included were 31 patients (mean age, 24 ± 3 years). There were 6 players (19%) who had failed repair, underwent subsequent meniscectomy within 2 years of meniscal repair, and were thus excluded from the performance analysis. Of the remaining 31 players, 68% returned to the same or a higher level of play, and 6% of players returned to a lower level of play. Most repair procedures (60%) were performed using the all-inside technique, and 72% of players underwent lateral meniscal repair. The mean time missed was 187 ± 67 days, and the mean time to RTS at full competitive play was 209 ± 84 days. There were no significant differences in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair (P ≥ .999 and P = .574, respectively). Pitchers saw a decrease in usage but no change in performance after meniscal repair. For batters, most metrics were unchanged, but there was a significant decrease in base stealing and on-base percentage after surgery. Conclusion: The RTS rate after meniscal repair in Major League Baseball players was 74% at a mean of 209 days; 19% of players had failed repair and underwent subsequent meniscectomy within 2 years of repair. No difference in the rate or timing of RTS was observed between players who underwent medial versus lateral meniscal repair.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Dana Rowe
- Major League Baseball Commissioner's Office, New York, New York, USA
| | | | - Jeffrey R Dugas
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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18
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Brzezinski A, Imbergamo C, Pfaff W, Tarapore R, Nasra M, Simon M, Gatt C. Biomechanical Comparison of Meniscal Allograft Root Fixation Techniques: Anterograde Interference Bone Plug Fixation Yields Favorable Results Compared to Transosseous Suture Fixation Alone. Arthrosc Sports Med Rehabil 2022; 4:e907-e914. [PMID: 35747667 PMCID: PMC9210386 DOI: 10.1016/j.asmr.2022.01.001] [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: 10/06/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the biomechanical properties of 2 different fixation techniques (interference bone plug fixation vs transosseous suture fixation) of the posterior horn of the medial meniscus using a porcine model. Methods Twenty-six matched pairs of fresh-frozen juvenile domestic porcine knees were used in this study. Specimens were randomly distributed among 3 groups: (1) native meniscus groups, (2) interference fixation, and (3) transosseous suture fixation. In each group, the posterior segments of the tested medial menisci were gripped with the freeze clamps and fixed to the tensile testing machine. Samples were preconditioned, followed by cyclic tension-relaxation for 1000 cycles between 10 and 30 N at 0.5 Hz and finally pulled to failure at a rate of 0.55 mm/s. The cyclic elongation, stiffness to failure, mode, and ultimate load to failure were recorded. Results There was no significant difference in ultimate load to failure between the interference fixation (169.71 ± 71.98 N) and transosseous suture fixation (222.73 ± 72.40 N) groups (P = .118), both were significantly less than that of the native meniscus (405.46 ± 95.62) (P < .001). Interference fixation displayed cyclic elongation (1.04 ± 0.71 mm) and stiffness (69.10 ± 25.8 N/mm) that were not significantly different from the native meniscus tissue (0.78 ± 0.53 mm and 83.1 ±26.28 N/mm) (P = .359 and P = .224), in comparison to transosseous suture fixation, which did show increased cyclic elongation (1.85 ± 1.44 mm) (P = .047) and decreased stiffness (34.72 ± 10.2 N/mm) (P < .001). Conclusion Interference fixation of the posterior horn of the medial meniscus has superior cyclic elongation and stiffness when compared to transosseous suture fixation. Interference fixation and the native meniscus model have a similar stiffness and cyclic elongation. Clinical Relevance The significance of our study is that using interference fixation for meniscal allograft transplantation has the potential to reduce short term surgical failures as well as long term complication rates.
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Affiliation(s)
- Andrzej Brzezinski
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | | | - William Pfaff
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Rae Tarapore
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
- Address correspondence to Rae Tarapore, B.A., 125 Paterson St New Brunwsick, NJ, 08901.
| | - Matthew Nasra
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Michael Simon
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Charles Gatt
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
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Masaracchio MF, Kirker K, Loghmani P, Gramling J, Mattia M, States R. The Prevalence of Tibiofemoral Knee Osteoarthritis Following Arthroscopic Partial Meniscectomy Is Variably Reported in General, and Over Time: A Systematic Review With a Minimum of 5-Year Follow-Up. Arthrosc Sports Med Rehabil 2022; 4:e1203-e1218. [PMID: 35747640 PMCID: PMC9210380 DOI: 10.1016/j.asmr.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Michael F. Masaracchio
- Department of Physical Therapy, Long Island University, Brooklyn, New York
- Address correspondence to Michael F. Masaracchio, P.T., Ph.D., 1 University Plaza HS 201, Brooklyn, NY 11201.
| | - Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, New York
| | - Parisa Loghmani
- Department of Physical Therapy, Long Island University, Brooklyn, New York
| | - Jillian Gramling
- Department of Physical Therapy, Long Island University, Brooklyn, New York
| | - Michael Mattia
- Physical Therapist Assistant Program, Department of Allied Health, Kingsborough Community College, Brooklyn, New York, U.S.A
| | - Rebecca States
- Department of Physical Therapy, Long Island University, Brooklyn, New York
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Keyhani S, Vaziri AS, Vosoughi F, Verdonk R, Movahedinia M. Overview of Posterior knee arthroscopy in the medial meniscal repair: technical note. J ISAKOS 2022; 7:33-38. [DOI: 10.1016/j.jisako.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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21
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Shen J, Zhao Q, Qi Y, Cofer G, Johnson GA, Wang N. Tractography of Porcine Meniscus Microstructure Using High-Resolution Diffusion Magnetic Resonance Imaging. Front Endocrinol (Lausanne) 2022; 13:876784. [PMID: 35620393 PMCID: PMC9127075 DOI: 10.3389/fendo.2022.876784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
To noninvasively evaluate the three-dimensional collagen fiber architecture of porcine meniscus using diffusion MRI, meniscal specimens were scanned using a 3D diffusion-weighted spin-echo pulse sequence at 7.0 T. The collagen fiber alignment was revealed in each voxel and the complex 3D collagen network was visualized for the entire meniscus using tractography. The proposed automatic segmentation methods divided the whole meniscus to different zones (Red-Red, Red-White, and White-White) and different parts (anterior, body, and posterior). The diffusion tensor imaging (DTI) metrics were quantified based on the segmentation results. The heatmap was generated to investigate the connections among different regions of meniscus. Strong zonal-dependent diffusion properties were demonstrated by DTI metrics. The fractional anisotropy (FA) value increased from 0.13 (White-White zone) to 0.26 (Red-Red zone) and the radial diffusivity (RD) value changed from 1.0 × 10-3 mm2/s (White-White zone) to 0.7 × 10-3 mm2/s (Red-Red zone). Coexistence of both radial and circumferential collagen fibers in the meniscus was evident by diffusion tractography. Weak connections were found between White-White zone and Red-Red zone in each part of the meniscus. The anterior part and posterior part were less connected, while the body part showed high connections to both anterior part and posterior part. The tractography based on diffusion MRI may provide a complementary method to study the integrity of meniscus and nondestructively visualize the 3D collagen fiber architecture.
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Affiliation(s)
- Jikai Shen
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- School of Life Sciences, Westlake University, Hangzhou, China
| | - Qi Zhao
- Physical Education Institute, Jimei University, Xiamen, China
| | - Yi Qi
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
| | - Gary Cofer
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
| | - G. Allan Johnson
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
| | - Nian Wang
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, United States
- *Correspondence: Nian Wang,
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22
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Zhang X, Furumatsu T, Okazaki Y, Okazaki Y, Hiranaka T, Xue H, Kintaka K, Yamauchi T, Ozaki T. Medial meniscus posterior root repair reduces the extruded meniscus volume during knee flexion with favorable clinical outcome. Knee Surg Sports Traumatol Arthrosc 2021; 29:4205-4212. [PMID: 33704516 DOI: 10.1007/s00167-021-06505-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The volume of medial meniscus (MM) extrusion at 10° and 90° knee flexions using three-dimensional (3D) magnetic resonance imaging (MRI) and assessed relevant clinical outcomes at 1-year follow-up were evaluated. METHODS Twenty-four patients who underwent MM posterior root repair were retrospectively reviewed. At 10° and 90° knee flexions, the meniscal extrusion distance and volume were measured using 3D meniscus models constructed by SYNAPSE VINCENT®. The correlation between Knee Injury and Osteoarthritis Outcome Score, Lysholm, International Knee Documentation Committee scores, Tegner activity, and pain visual analog scales and changes in MM extrusion were assessed. RESULTS No significant differences in the MM medial extrusion were observed between 10° and 90° knee flexions postoperatively. MM posterior extrusion (MMPE) decreased significantly at 10° and 90° knee flexions postoperatively. At 90° knee flexion, the meniscus volume at the intra-tibial surface increased at 3 and 12 months postoperatively. The MM extrusion volume increased slightly at 10° knee flexion; however, the volume decreased significantly at 90° knee flexion postoperatively. The change in MMPE significantly correlated with clinical scores. All 12-month clinical scores were significantly improved compared to preoperative scores. CONCLUSIONS The progression of meniscus posterior extrusion and reduction of its volume at 90° knee flexion can be suppressed by MM posterior root repair. Postoperative clinical scores correlated with reductions of the posterior extrusion. Regarding clinical relevance, the dynamic stability of the meniscus can be maintained by MM posterior root repair, which is an effective therapeutic method for improving its clinical status. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ximing Zhang
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Chikamori Hospital, 1-1-16 Okawasuji, Kochi, 780-8522, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takatsugu Yamauchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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23
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Kim-Wang SY, Holt AG, McGowan AM, Danyluk ST, Goode AP, Lau BC, Toth AP, Wittstein JR, DeFrate LE, Yi JS, McNulty AL. Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries. Arthritis Res Ther 2021; 23:280. [PMID: 34736523 PMCID: PMC8567695 DOI: 10.1186/s13075-021-02661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Abigail G Holt
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alyssa M McGowan
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA. .,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA. .,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
| | - John S Yi
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Department of Pathology, Duke University School of Medicine, Durham, NC, USA
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24
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Smith HE, Lyons MM, Patel NM. Epidemiology of Meniscal Allograft Transplantation at Children's Hospitals in the United States. Orthop J Sports Med 2021; 9:23259671211034877. [PMID: 34604431 PMCID: PMC8485286 DOI: 10.1177/23259671211034877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Meniscal allograft transplantation (MAT) was developed with the goal of delaying the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents; however, there is a paucity of literature on MAT in this population. Purpose: To evaluate the epidemiology of MAT at pediatric hospitals in the United States, with specific attention to regional and characteristic trends. Study Design: Case-control study; Level of evidence, 3. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients younger than 25 years who underwent MAT between 2011 and 2018. Characteristic information and surgical history were collected for each patient. The database was also queried for all patients who underwent other meniscal surgeries (including debridement, meniscectomy, and meniscal repair) during the same period (controls). Characteristic and geographic data from the control group were compared with those of the patients who underwent MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscal surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve (18%) patients underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT (95% CI, 1.03-1.1; P = .002) compared with repair or meniscectomy. Patients who underwent MAT also had 2.0 times higher odds of being women (95% CI, 1.2-3.3; P = .01) and 2.0 times higher odds of being privately insured (95% CI, 1.1-3.6; P = .02). MAT was performed most frequently in the Northeast (4.9/1000 meniscal surgeries) and least often in the South (1.1/1000 meniscal surgeries) (P < .001). Conclusion: In the United States, pediatric and adolescent patients who underwent MAT were older and more likely to be female and have private insurance than those undergoing meniscal repair or meniscectomy. MAT was only performed in 17 of 47 children’s hospitals that perform meniscal surgery. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.
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Affiliation(s)
- Haley E Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Neeraj M Patel
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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25
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Wagala NN, Tisherman RT, Lucidi GA, Eads R, Musahl V. Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do! OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Zaffagnini S, Espinosa M, Neri MP, Marcacci M, Grassi A. Treatment of Meniscal Deficiency with Meniscal Allograft Transplantation and Femoral Osteotomy in a Patient with History of Lateral Discoid Meniscus: 15-Year Follow-up Case Report. JBJS Case Connect 2021; 10:e0079. [PMID: 32044789 DOI: 10.2106/jbjs.cc.19.00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 15-year-old woman with multiple arthroscopic procedures for left lateral discoid meniscus since the age of 9 presented with pain, swelling, and mechanical symptoms. A meniscal allograft transplantation (MAT) and lateral opening-wedge femoral osteotomy was performed. At the 6-year follow-up, the patient presented a visual analog scale (VAS) score of 0, subjective International Knee Documentation Committee (IKDC) of 88, and Lysholm of 95. At 15-year follow-up, the VAS score was 0, subjective IKDC 85.1, and Lysholm 86. CONCLUSIONS MAT associated with femoral osteotomy was an effective procedure in this patient with pain and functional limitation after total meniscectomy in the setting of discoid meniscus and valgus malalignment. Good clinical and magnetic resonance imaging-related outcomes were achieved at the intermediate and long-term follow-up.
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Affiliation(s)
- Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| | - Maximiliano Espinosa
- Departamento de Traumatología, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Maria Pia Neri
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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27
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Kara A, Koçtürk S, Bilici G, Havitcioglu H. Development of biological meniscus scaffold: Decellularization method and recellularization with meniscal cell population derived from mesenchymal stem cells. J Biomater Appl 2021; 35:1192-1207. [PMID: 33444085 DOI: 10.1177/0885328220981189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tissue engineering approaches which include a combination of cells and scaffold materials provide an alternative treatment for meniscus regeneration. Decellularization and recellularization techniques are potential treatment options for transplantation. Maintenance of the ultrastructure composition of the extracellular matrix and repopulation with cells are important factors in constructing a biological scaffold and eliminating immunological reactions.The aim of the study is to develop a method to obtain biological functional meniscus scaffolds for meniscus regeneration. For this purpose, meniscus tissue was decellularized by our modified method, a combination of physical, chemical, and enzymatic methods and then recellularized with a meniscal cell population composed of fibroblasts, chondrocytes and fibrochondrocytes that obtained from mesenchymal stem cells. Decellularized and recellularized meniscus scaffolds were analysed biochemically, biomechanically and histologically. Our results revealed that cellular components of the meniscus were successfully removed by preserving collagen and GAG structures without any significant loss in biomechanical properties. Recellularization results showed that the meniscal cells were localized in the empty lacuna on the decellularized meniscus, and also well distributed and proliferated consistently during the cell culture period (p < 0.05). Furthermore, a high amount of DNA, collagen, and GAG contents (p < 0.05) were obtained with the meniscal cell population in recellularized meniscus tissue.The study demonstrates that our decellularization and recellularization methods were effective to develop a biological functional meniscus scaffold and can mimic the meniscus tissue with structural and biochemical features. We predict that the obtained biological meniscus scaffolds may provide avoidance of adverse immune reactions and an appropriate microenvironment for allogeneic or xenogeneic recipients in the transplantation process. Therefore, as a promising candidate, the obtained biological meniscus scaffolds might be verified with a transplantation experiment.
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Affiliation(s)
- Aylin Kara
- Department of Bioengineering, İzmir Institute of Technology, İzmir, Turkey
| | - Semra Koçtürk
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, İzmir, Turkey
| | - Gokcen Bilici
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, İzmir, Turkey
| | - Hasan Havitcioglu
- Department of Bioengineering, İzmir Institute of Technology, İzmir, Turkey
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28
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Schreiner AJ, Stannard JP, Cook CR, Bozynski CC, Kuroki K, Stoker AM, Smith PA, Cook JL. Comparison of meniscal allograft transplantation techniques using a preclinical canine model. J Orthop Res 2021; 39:154-164. [PMID: 32198782 DOI: 10.1002/jor.24668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with menisco-capsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibial-osteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with menisco-tibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.
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Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Traumatology and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Division of Sports Medicine, Columbia Orthopaedic Group, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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29
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Nishitani K, Nakagawa Y, Matsuda S. Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus-Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant. Orthop J Sports Med 2020; 8:2325967120962753. [PMID: 33225008 PMCID: PMC7653291 DOI: 10.1177/2325967120962753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The treatment of a meniscus-deficient knee is challenging, especially when
patients are young and active and are not favorable candidates for
prosthetic joint replacement. Hypothesis: We hypothesized that osteochondral autologous transplant (OAT) alone can be
considered a salvage treatment for patients with cartilage damage of the
lateral compartment of the knee, even with lateral meniscal deficiency, if
the knee alignment is close to neutral. Study Design: Case series; Level of evidence, 4. Methods: Patients with lateral meniscal deficiency, whose femorotibial angle was 170°
to 180° and who underwent OAT on the lateral compartment of the knee without
concomitant realignment osteotomy, were retrospectively included in this
study. The International Knee Documentation Committee (IKDC) subjective
score and the Japanese Orthopaedic Association score for knee osteoarthritis
(JOA knee score) were recorded. The International Cartilage Repair Society
(ICRS) cartilage repair assessment was used to evaluate the repaired
cartilage at second-look arthroscopy. Results: The study included 10 patients (mean ± SD age, 31.7 ± 19.7 years; 3 men and 7
women) who had ICRS grade 4 cartilage lesions (mean size, 3.5 ± 1.7
cm2); the mean follow-up was 73.8 ± 42.5 months. From
preoperative assessment to final follow-up, the mean IKDC subjective score
improved significantly from 53.5 ± 10.0 to 85.4 ± 10.1, and the mean JOA
knee score improved significantly from 81.0 ± 8.4 to 95.6 ± 5.3
(P = .004 for both). One patient with a femorotibial
angle of 170° underwent revision distal femoral osteotomy owing to prolonged
symptoms and progression of the valgus deformity, and 2 other patients with
femorotibial angles of 170° and 171° also exhibited progression of valgus
malalignment or low clinical scores postoperatively. Patients with a
favorable femorotibial angle (174°-178°) exhibited relieved symptoms and
preservation of femorotibial angle alignment within 1° of change at
follow-up. At second-look arthroscopy (n = 8 patients), 6 patients had an
ICRS score of nearly normal or normal. Conclusion: In the study patients, for which a meniscal allograft was unavailable, the
OAT procedure was able to relieve the symptoms associated with cartilage
lesions, even with lateral meniscal deficiency, when the femorotibial angle
alignment was close to neutral.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
- Kohei Nishitani, MD, PhD, Department of Orthopaedic Surgery,
Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo,
Kyoto 606-8507, Japan (
)
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization
Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
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30
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Agarwalla A, Gowd AK, Liu JN, Amin NH, Werner BC. Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy. Arthrosc Sports Med Rehabil 2020; 2:e443-e449. [PMID: 33134979 PMCID: PMC7588599 DOI: 10.1016/j.asmr.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/17/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose To identify the rates of and risk factors for revision arthroscopy and conversion to total knee arthroplasty (TKA) within 1 year of isolated meniscectomy. Methods Humana and Medicare national insurance databases were queried for patients who underwent isolated meniscectomy. Patients who underwent revision arthroscopy or TKA within 1 year postoperatively were identified by International Classification of Diseases Procedural Codes, Ninth Revision, and Current Procedural Terminology codes. Multivariate binomial logistic regression analysis was used to identify risk factors, and adjusted odds ratios (ORs) and 95% confidence intervals (Cis) were calculated, with P < .05 considered significant. Results A total of 13,142 patients and 407,888 patients underwent isolated meniscectomy in the Humana and Medicare databases, respectively. Of the patients, 395 (3.01%) and 3,770 patients (0.92%) underwent revision arthroscopy, and 629 patients (4.79%) and 38,630 patients (9.47%) underwent TKA within 1 year of meniscectomy in the Humana and Medicare databases, respectively. Obesity (Humana: OR = 1.33, P = 0.003; Medicare: OR = 1.10, P < 0.001) and age < 20 years (Humana: OR = 2.64, P = 0.022), 20-29 years (Humana: OR = 3.30, P = 0.002), 40-49 years (Humana: OR = 3.80, P < 0.001), 50-59 years (Humana: OR = 1.99, P = 0.027), and < 64 years (Medicare: OR = 1.74, P < 0.001) were risk factors for revision arthroscopy. Obesity (Humana: OR = 1.64, P < 0.001; Medicare: OR = 1.37, P < 0.001), morbid obesity (Medicare: OR = 1.20, P < 0.001), age 70-74 (Medicare: OR = 1.12, P < 0.001), 75-79 (Medicare: OR = 1.25, P < 0.001), 80-84 (Medicare: OR = 1.20, P < 0.001), and concomitant osteoarthritis (Humana: OR = 1.42, P < 0.001; Medicare: OR = 1.46, P < 0.001) were risk factors for conversion to TKA. Conclusions Medicare and Humana databases showed that 0.92%-3.01% and 4.79%-9.47% of patients undergo revision arthroscopy or conversion to TKA within a year of isolated meniscectomy. Obesity was a risk factor for early revision arthroscopy and conversion to TKA, whereas concomitant osteoarthritis was a risk factor for conversion to TKA. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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31
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Staged meniscal allograft transplantation as a biologic treatment of the meniscal deficient knee: A prospective case series of 26 patients with maximum 88-month follow-up. Knee 2020; 27:1370-1377. [PMID: 33010750 DOI: 10.1016/j.knee.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/27/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The meniscal deficient knee often exists within the setting of associated pathology including instability, malalignment and chondral injury. The aim of this study was to establish the role of meniscal allograft transplantation (MAT) as part of a staged approach to treatment of the previously menisectomised knee and report: (a) primary data endpoints (pre and post-operative Knee Injury and Osteoarthritis outcome scores (KOOS), Tegner scores, satisfaction scores and graft survival), and (b) secondary endpoints:(complication/reoperation rates, and meniscal extrusion measurements as determined by MRI). MATERIAL AND METHODS This prospective study included all patients that underwent arthroscopic fresh frozen allograft MAT at our institution (2010-2017) using a soft tissue fixation technique. RESULTS Twenty-seven MAT procedures were performed in 26 patients (16 lateral, 11 medial). Ten patients underwent ACL reconstruction, three ACI and two osteotomy in the pre-MAT phase. Seven patients underwent ACI within the post-operative phase. Post-operative mean KOOS scores improved significantly in all subscales (p < .002) as did Tegner scores (p < .05). Graft survival was 100%, satisfaction rate 92%, and mean meniscal extrusion 3.04 mm. Post operatively, three patients required meniscal repair and a single patient, partial menisectomy of graft. Two patients underwent arthroscopic arthrolysis following MAT. CONCLUSIONS This series highlights the multifactorial profile of the meniscal deficient knee and the role of MAT as a safe and reliable technique in the staged and comprehensive biologic treatment available to minimise symptoms and maximise outcomes. LEVEL OF EVIDENCE 4.
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32
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Paletta GA, Crane DM, Konicek J, Piepenbrink M, Higgins LD, Milner JD, Wijdicks CA. Surgical Treatment of Meniscal Extrusion: A Biomechanical Study on the Role of the Medial Meniscotibial Ligaments With Early Clinical Validation. Orthop J Sports Med 2020; 8:2325967120936672. [PMID: 32775474 PMCID: PMC7391441 DOI: 10.1177/2325967120936672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/17/2020] [Indexed: 01/14/2023] Open
Abstract
Background Meniscal extrusion refers to meniscal displacement out of the joint space and over the tibial margin, altering knee mechanics and increasing the risk of osteoarthritis. The meniscotibial ligaments have been shown to have an important role in meniscal stability. However, it remains unclear whether an isolated lesion of the medial meniscotibial ligaments will result in meniscal extrusion and whether repairing the detached ligament will reduce extrusion. Hypothesis A lesion of the medial meniscotibial ligament will result in meniscal extrusion, and repairing the joint capsule will eliminate the extrusion by returning the meniscus back to its original position. Study Design Controlled laboratory study. Methods Fresh-frozen human cadaveric knees (N = 6) were used for biomechanical testing. The test protocol involved 100 flexion-extension cycles. In full extension, meniscal extrusion was measured using ultrasound, in both an otherwise unloaded state and while subjected to a 10-N·m varus load. Each knee was tested in its native condition (baseline), after creating a detachment of the medial meniscotibial ligament, and finally with the joint capsule repaired using 3 knotless SutureTak anchors. We also performed a retrospective review of 15 patients who underwent meniscotibial ligament repair with a minimal follow-up of 5 weeks (mean, 14 weeks; range, 5-35 weeks). Results During biomechanical testing, the mean absolute meniscal extrusion at baseline was 1.5 ± 0.6 mm. After creation of the meniscotibial ligament lesion, the mean absolute meniscal extrusion was significantly increased (3.4 ± 0.7 mm) (P < .001). After repair, the extrusion was reduced to 2.1 ± 0.4 mm (P < .001). Clinically, a reduction in absolute meniscal extrusion of approximately 48% was reached (1.2 ± 0.6 vs 2.4 ± 0.5 mm preoperatively; P < .001). Conclusion This study indicates that the medial meniscotibial ligaments contribute to meniscal stability as lesions cause the meniscus to extrude and that repair of those ligaments can significantly reduce extrusion. Early clinical results using this meniscotibial ligament repair technique support our biomechanical findings, as a significant reduction in meniscal extrusion was achieved. Clinical Relevance Our biomechanical findings suggest that repair of medial meniscotibial ligaments reduces meniscal extrusion and clinically may improve meniscal function, with the possible long-term benefit of reducing the risk for osteoarthritis.
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Affiliation(s)
| | | | - John Konicek
- Department of Orthopedic Research, Arthrex Inc, Naples, Florida, USA
| | | | | | - John D Milner
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Coen A Wijdicks
- Department of Orthopedic Research, Arthrex Inc, Naples, Florida, USA
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Patel JM, Brzezinski A, Ghodbane SA, Tarapore R, Lu TM, Gatt CJ, Dunn MG. Personalized Fiber-Reinforcement Networks for Meniscus Reconstruction. J Biomech Eng 2020; 142:1067325. [PMID: 31701130 DOI: 10.1115/1.4045402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 11/08/2022]
Abstract
The menisci are fibrocartilaginous tissues that are crucial to the load-sharing and stability of the knee, and when injured, these properties are compromised. Meniscus replacement scaffolds have utilized the circumferential alignment of fibers to recapitulate the microstructure of the native meniscus; however, specific consideration of size, shape, and morphology has been largely overlooked. The purpose of this study was to personalize the fiber-reinforcement network of a meniscus reconstruction scaffold. Human cadaveric menisci were measured for a host of tissue (length, width) and subtissue (regional widths, root locations) properties, which all showed considerable variability between donors. Next, the asymmetrical fiber network was optimized to minimize the error between the dimensions of measured menisci and predicted fiber networks, providing a 51.0% decrease (p = 0.0091) in root-mean-square (RMS) error. Finally, a separate set of human cadaveric knees was obtained, and donor-specific fiber-reinforced scaffolds were fabricated. Under cyclic loading for load-distribution analysis, in situ implantation of personalized scaffolds following total meniscectomy restored contact area (253.0 mm2 to 488.9 mm2, p = 0.0060) and decreased contact stress (1.96 MPa to 1.03 MPa, p = 0.0025) to near-native values (597.4 mm2 and 0.83 MPa). Clinical use of personalized meniscus devices that restore physiologic contact stress distributions may prevent the development of post-traumatic osteoarthritis following meniscal injury.
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Affiliation(s)
- Jay M Patel
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901; Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, NJ 08854; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Salim A Ghodbane
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901; Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, NJ 08854
| | - Rae Tarapore
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Tyler M Lu
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901; Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, NJ 08854
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901; Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, NJ 08854
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Hershman EB, Jarvis JL, Mick T, Dushaj K, Elsner JJ. Direct treatment cost outcomes among patients with medial meniscus deficiency: results from a 24-month surveillance study. Curr Med Res Opin 2020; 36:427-437. [PMID: 31914326 DOI: 10.1080/03007995.2020.1713073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Meniscus deficiency is highly prevalent in the United States and represents a substantial societal cost burden. The objective of this case series was to evaluate and compare direct costs associated with treatment for acute or degenerative medial meniscus deficiency.Methods: Case series patients (n = 50) received either non-surgical therapy or an operative partial meniscectomy based on clinical assessment by the principal study investigator which included physical examination and MRI. Cumulative 24-month direct treatment costs were compared between non-surgical and operative cohorts. Direct treatment costs were calculated using billing record reimbursements for all medical services administered by the treating institution, and imputed for medical services prescribed by the treating physician but provided external to the treating institution.Results: At study initiation, 33 patients (67%) were treated with non-surgical care, and 17 patients (33%) received a partial medial meniscectomy. By 24 months, average direct treatment costs were highest for patients who received a partial medial meniscectomy at study initiation ($4488 ± $1265) compared to patients who received non-surgical care at study initiation ($4092 ± $7466), although differences in average direct treatment costs were not statistically significant across treatment cohorts (p = .830). Average direct treatment costs were highest for the subgroup of patients who initiated non-surgical therapy but received a subsequent total knee arthroplasty during the study period (n = 2; $32,197 ± $169).Conclusion: Findings from this case series suggests that patients with acute or degenerative meniscus deficiency incur substantial direct treatment costs related to their knee pathology, particularly for patients receiving total knee arthroplasty.
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Affiliation(s)
- Elliott B Hershman
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | | | - Travis Mick
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Kristina Dushaj
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Southworth TM, Naveen NB, Tauro TM, Chahla J, Cole BJ. Meniscal Allograft Transplants. Clin Sports Med 2020; 39:93-123. [DOI: 10.1016/j.csm.2019.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Meniscal allograft transplantation in The Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions. Knee Surg Sports Traumatol Arthrosc 2020; 28:3551-3560. [PMID: 32979080 PMCID: PMC7591451 DOI: 10.1007/s00167-020-06276-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. METHODS A prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated. RESULTS Prior to MAT, patients had undergone an average of 2.8 (range 1-14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8-17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36, p = 0.009). At 4.5 years (IQR, 2-9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions. CONCLUSION Meniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions. LEVEL OF EVIDENCE Level III. Trial registration Medical ethical review board (METC) number: 17-104 (7 August 2017). Dutch Trial Register (NTR) number: NTR6630 (4 July 2017).
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Rothrauff BB, Sasaki H, Kihara S, Overholt KJ, Gottardi R, Lin H, Fu FH, Tuan RS, Alexander PG. Point-of-Care Procedure for Enhancement of Meniscal Healing in a Goat Model Utilizing Infrapatellar Fat Pad-Derived Stromal Vascular Fraction Cells Seeded in Photocrosslinkable Hydrogel. Am J Sports Med 2019; 47:3396-3405. [PMID: 31644307 DOI: 10.1177/0363546519880468] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large radial tears of the meniscus involving the avascular region can compromise meniscal function and result in poor healing and subsequent osteochondral degeneration. Augmentation of surgical repairs with adipose-derived stromal vascular fraction (SVF), which contains mesenchymal stromal cells, may improve meniscal healing and preserve function (ie, chondroprotection). PURPOSES (1) To develop a goat model of a radial meniscal tear with resulting osteoarthritis and (2) to explore the efficacy of a 1-step procedure utilizing infrapatellar fat pad-derived SVF cells seeded in a photocrosslinkable hydrogel to enhance meniscal healing and mitigate osteochondral degeneration. STUDY DESIGN Controlled laboratory study. METHODS A full-thickness radial tear spanning 90% of the medial meniscal width was made at the junction of the anterior and middle bodies of the goat stifle joint. Tears received 1 of 3 interventions (n = 4 per group): untreated, repair, or repair augmented with photocrosslinkable methacrylated gelatin hydrogel containing 2.0 × 106 SVF cells/mL and 2.0 µg/mL of transforming growth factor β3. The contralateral (left) joint served as a healthy control. At 6 months, meniscal healing and joint health were evaluated by magnetic resonance imaging (MRI) and assessed by histological and macroscopic scoring. The Whole-Organ Magnetic Resonance Imaging Score and the presence of a residual tear, as evaluated with T2 MRI sequences, were determined by a single blinded orthopaedic surgeon. RESULTS When compared with tears left untreated or repaired with suture alone, augmented repairs demonstrated increased tissue formation in the meniscal tear site, as seen on MRI and macroscopically. Likewise, the neotissue of augmented repairs possessed a histological appearance more similar, although still inferior, to healthy meniscus. Osteochondral degeneration in the medial compartment, as evaluated by the Whole-Organ Magnetic Resonance Imaging Score and Inoue (macroscopic) scale, revealed increased degeneration in the untreated and repair groups, which was mitigated in the augmented repair group. Histological evaluation with a modified Mankin score showed a similar trend. In all measures of osteochondral degeneration, the augmented repair group did not differ significantly from the uninjured control. CONCLUSION A radial tear spanning 90% of the medial meniscal width in a goat stifle joint showed poor healing potential and resulted in osteochondral degeneration by 6 months, even if suture repair was performed. Augmentation of the repair with a photocrosslinkable hydrogel containing transforming growth factor β3 and SVF cells, isolated intraoperatively by rapid enzymatic digestion, improved meniscal healing and mitigated osteoarthritic changes. CLINICAL RELEVANCE Repair augmentation with an SVF cell-seeded hydrogel may support successful repair of meniscal tears previously considered irreparable.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hiroshi Sasaki
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shinsuke Kihara
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kalon J Overholt
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hackl W, Schneider F, Liebensteiner M, Runer A. Meniskustransplantation mit Allograft. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Whittingslow DC, Jeong HK, Ganti VG, Kirkpatrick NJ, Kogler GF, Inan OT. Acoustic Emissions as a Non-invasive Biomarker of the Structural Health of the Knee. Ann Biomed Eng 2019; 48:225-235. [PMID: 31350620 DOI: 10.1007/s10439-019-02333-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/20/2019] [Indexed: 11/26/2022]
Abstract
The longitudinal assessment of joint health is a long-standing issue in the management of musculoskeletal injuries. The acoustic emissions (AEs) produced by joint articulation could serve as a biomarker for joint health assessment, but their use has been limited by a lack of mechanistic understanding of their creation. In this paper, we investigate that mechanism using an injury model in human lower-limb cadavers, and relate AEs to joint kinematics. Using our custom joint sound recording system, we recorded the AEs from nine cadaver legs in four stages: at baseline, after a sham surgery, after a meniscus tear, and post-meniscectomy. We compare the resulting AEs using their b-values. We then compare joint anatomy/kinematics to the AEs using the X-ray reconstruction of moving morphology (XROMM) technique. After the meniscus tear the number and amplitude of the AE peaks greatly increased from baseline and sham (b-value = 1.33 ± 0.15; p < 0.05). The XROMM analysis showed a close correlation between the minimal inter-joint distances (0.251 ± 0.082 cm during extension, 0.265 ± .003 during flexion, at 145°) and a large increase in the AEs. This work provides key insight into the nature of joint AEs, and details a novel technique and analysis for recording and interpreting these biosignals.
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Affiliation(s)
- Daniel C Whittingslow
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Hyeon-Ki Jeong
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Venu G Ganti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Nathan J Kirkpatrick
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Geza F Kogler
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Omer T Inan
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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40
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Abstract
BACKGROUND In order to determine whether treatments are effective in the treatment of meniscus tears, it is first necessary to understand the natural history of meniscus tears. The purpose of this paper is to review the literature to ascertain the natural history of meniscus tears in children and adolescents. METHODS A search of the Pubmed and Embase databases was performed using the search terms "meniscus tears," "natural history of meniscus tears," "knee meniscus," "discoid meniscus," and "natural history of discoid meniscus tears." RESULTS A total of 2567 articles on meniscus tears, 28 articles on natural history of meniscus tears, 8065 articles on "menisci," 396 articles on "discoid meniscus," and only 2 on the "natural history of discoid meniscus" were found. After reviewing the titles of these articles and reviewing the abstracts of 237 articles, it was clear that there was little true long-term natural history data of untreated meniscus tears nor whether treating meniscus tears altered the natural history. Twenty-five articles were chosen as there was some mention of natural history in their studies. CONCLUSIONS There are few long-term data on untreated meniscal tears or discoid meniscus, or tears in children and adolescents. The literature suggests that there is a higher incidence of chondral injury and subsequent osteoarthritis, but there are many confounding variables which are not controlled for in these relatively short-term papers.
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Drobnič M, Ercin E, Gamelas J, Papacostas ET, Slynarski K, Zdanowicz U, Spalding T, Verdonk P. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc 2019; 27:1817-1824. [PMID: 30859265 DOI: 10.1007/s00167-019-05424-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/15/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. METHODS A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. RESULTS Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA. CONCLUSIONS Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000, Ljubljana, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Ersin Ercin
- Department of Orthopaedics and Traumatology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Joao Gamelas
- Department of Orthopaedics and Traumatology, Lusíadas Hospital, NOVA Medical School, Lisbon, Portugal
| | | | | | - Urszula Zdanowicz
- Carolina Medical Center, Warsaw, Poland.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium
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Gowd AK, Lalehzarian SP, Liu JN, Agarwalla A, Christian DR, Forsythe B, Cole BJ, Verma NN. Factors Associated With Clinically Significant Patient-Reported Outcomes After Primary Arthroscopic Partial Meniscectomy. Arthroscopy 2019; 35:1567-1575.e3. [PMID: 31000386 DOI: 10.1016/j.arthro.2018.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to establish minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) after meniscectomy and factors associated with achieving these goals. METHODS A prospectively maintained institutional registry was retrospectively reviewed for all patients undergoing isolated arthroscopic partial meniscectomy from 2014 through 2017. MCID, SCB, and PASS were calculated for the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores by using the anchor-based methodology and nonparametric receiver operating characteristic curves. Subscores included joint replacement (JR), physical function (PF), symptoms (Sx), pain, activities of daily living (ADL), sport, and quality of life (QOL). RESULTS A total of 269 patients were analyzed in the study, which reported outcomes between 6 and 7 months after surgery. The average age of our population was 48.9 ± 12.4 years. Twenty patients reported no change, 53 reported minimal improvement, and 137 reported substantial change after surgery; whereas 59 patients reported worse outcomes. One hundred seventy-seven patients were satisfied and 92 were not satisfied with the outcome of surgery. Established MCID/SCB/PASS for the IKDC, KOOS JR, KOOS PF, KOOS Sx, KOOS Pain, KOOS ADL, and KOOS QOL were 10.6/25.3/57.9, 10.7/13.2/68.3, -8.2/-11.3/26.2, 8.9/7.1/71.4, 9.7/22.2/76.4, 11.0/16.9/89.0, 12.5/27.5/55.6, and 15.6/34.4/46.9, respectively. Higher preoperative scores were associated with reduced odds of achieving MCID and SCB but greater odds of achieving PASS for nearly all scores (P < .05). Workers' compensation status, degenerative tears, medial-sided tears, and root tears were associated with reduced odds of achieving 2 or more clinically meaningful outcomes in 2 or more scores (P < .05). CONCLUSIONS Clinically meaningful outcomes were established by patient self-assessment. Variables associated with achieving these outcomes include preoperative score (positively correlated with MCID/SCB, negatively correlated with PASS); workers' compensation; degenerative, medial-sided tears; and root tears (remaining negatively correlated with MCID/SCB/PASS). These variables should be accordingly measured for confounding in future outcome reporting.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Simon P Lalehzarian
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Avinesh Agarwalla
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - David R Christian
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Abram SGF, Hopewell S, Monk AP, Bayliss LE, Beard DJ, Price AJ. Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. Br J Sports Med 2019; 54:652-663. [PMID: 30796103 DOI: 10.1136/bjsports-2018-100223] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the benefit of arthroscopic partial meniscectomy (APM) in adults with a meniscal tear and knee pain in three defined populations (taking account of the comparison intervention): (A) all patients (any type of meniscal tear with or without radiographic osteoarthritis); (B) patients with any type of meniscal tear in a non-osteoarthritic knee; and (C) patients with an unstable meniscal tear in a non-osteoarthritic knee. DESIGN Systematic review and meta-analysis. DATASOURCES A search of MEDLINE, Embase, CENTRAL, Scopus, Web of Science, Clinicaltrials.gov and ISRCTN was performed, unlimited by language or publication date (inception to 18 October 2018). ELIGIBILITYCRITERIA Randomised controlled trials performed in adults with meniscal tears, comparing APM versus (1) non-surgical intervention; (2) pharmacological intervention; (3) surgical intervention; and (4) no intervention. RESULTS Ten trials were identified: seven compared with non-surgery, one pharmacological and two surgical. Findings were limited by small sample size, small number of trials and cross-over of participants to APM from comparator interventions. In group A (all patients) receiving APM versus non-surgical intervention (physiotherapy), at 6-12 months, there was a small mean improvement in knee pain (standardised mean difference [SMD] 0.22 [95% CI 0.03 to 0.40]; five trials, 943 patients; I2 48%; Grading of Recommendations Assessment, Development and Evaluation [GRADE]: low), knee-specific quality of life (SMD 0.43 [95% CI 0.10 to 0.75]; three trials, 350 patients; I2 56%; GRADE: low) and knee function (SMD 0.18 [95% CI 0.04 to 0.33]; six trials, 1050 patients; I2 27%; GRADE: low). When the analysis was restricted to people without osteoarthritis (group B), there was a small to moderate improvement in knee pain (SMD 0.35 [95% CI 0.04 to 0.66]; three trials, 402 patients; I2 58%; GRADE: very low), knee-specific quality of life (SMD 0.59 [95% CI 0.11 to 1.07]; two trials, 244 patients; I2 71%; GRADE: low) and knee function (SMD 0.30 [95% CI 0.06 to 0.53]; four trials, 507 patients; I2 44%; GRADE: very low). There was no improvement in knee pain, function or quality of life in patients receiving APM compared with placebo surgery at 6-12 months in group A or B (pain: SMD 0.08 [95% CI -0.24 to 0.41]; one trial, 146 patients; GRADE: low; function: SMD -0.08 [95% CI -0.41 to 0.24]; one trial, 146 patients; GRADE: high; quality of life: SMD 0.05 [95% CI -0.27 to 0.38]; one trial; 146 patients; GRADE: high). No trials were identified for people in group C. CONCLUSION Performing APM in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention. There may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis. No trial has been limited to patients failing non-operative treatment or patients with an unstable meniscal tear in a non-arthritic joint; research is needed to establish the value of APM in this population. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42017056844.
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Affiliation(s)
- Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Oxford, UK
| | - Andrew Paul Monk
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lee E Bayliss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ha JK, Kim YS, Kwon MS, Chung KS, Kim SB, Kim JG. The International Knee Documentation Committee Score Indicates Midterm Patient Satisfaction with Outcomes after Meniscal Allograft Transplantation. Indian J Orthop 2019; 53:431-436. [PMID: 31080283 PMCID: PMC6501627 DOI: 10.4103/ortho.ijortho_244_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to identify the factors associated with patient satisfaction with the outcome of meniscal allograft transplantation (MAT). MATERIALS AND METHODS Patients treated with MAT from March 2006 to May 2009 were asked to complete a five-point Likert scale regarding satisfaction with the outcome of MAT, in addition to the following subjective outcome evaluation forms: the International Knee Documentation Committee (IKDC) subjective forms, Knee Society Score knee and function forms, and Lysholm Knee Scoring Scale. We collected radiologic data using X-ray and magnetic resonance imaging and assessed isokinetic muscle strength test using the Biodex System 3. We investigated whether these parameters were significantly associated with patient satisfaction. Statistical analysis was computed using univariate and multivariable logistic regression. RESULTS Among the 130 patients who underwent MAT, 49 participated in the interview and were included in this study. The mean followup period was 50.4 months. Mean patient age was 40 (±9) years; 33 were male and 16 were female (33%). The lateral meniscus was transplanted in 13 (27%) patients, while the medial meniscus was involved in 36 (73%) patients. On univariate analysis, sex and isokinetic extension strength deficit at 60° and 180° as well as the IKDC, Knee Society, and Lysholm scores showed significant association with patient satisfaction regarding the outcome. On multivariable logistic regression, only the IKDC score showed a significant association, with P = 0.04. CONCLUSIONS The study results support the importance of patient-reported subjective outcomes in terms of patient satisfaction following a surgical procedure. Regarding MAT, the IKDC outcome score reflects patient satisfaction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeong Ku Ha
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Yoon Seok Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Min Soo Kwon
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Sang Bum Kim
- Department of Orthopedic Surgery, Sunsoochon Hospital, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea,Address for correspondence: Dr. Jin Goo Kim, Department of Orthopedic Surgery, Konkuk University Medical Center 4-12 Hwayang-Dong, Gwangjin-Gu, Seoul, Korea. E-mail:
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Isolated revision meniscal repair - failure rates, clinical outcome, and patient satisfaction. BMC Musculoskelet Disord 2018; 19:446. [PMID: 30577789 PMCID: PMC6303960 DOI: 10.1186/s12891-018-2368-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/03/2018] [Indexed: 01/11/2023] Open
Abstract
Background Failure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable knee joints. Methods A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction. Results A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 (± 4.2) with a range of 90–100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the outcome. Conclusion In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair is worthwhile in selected cases in order to save as much meniscal tissue as possible.
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Muacevic A, Adler JR. A Switch of an Idea: Simultaneous High Tibial Osteotomy and Lateral Meniscal Allograft Transplantation. Cureus 2018; 10:e2950. [PMID: 30210948 PMCID: PMC6130588 DOI: 10.7759/cureus.2950] [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] [Indexed: 11/05/2022] Open
Abstract
High tibial osteotomy (HTO) has been regarded as an effective treatment modality for isolated medial compartment knee osteoarthritis (OA) with varus deformity. However, management for relatively young active patients with both varus-aligned medial compartment knee OA and symptomatic irreparable lateral meniscus tear can be challenging. In this situation, correction of varus alignment by HTO and restoring the function of the lateral meniscus by meniscal allograft transplantation (MAT) can be a possible solution. We present the clinical result and technical considerations for a case of varus-aligned medial compartment OA combined with lateral meniscus tear treated by simultaneously performed medial open wedge HTO and lateral MAT.
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Patel JM, Ghodbane SA, Brzezinski A, Gatt CJ, Dunn MG. Tissue-Engineered Total Meniscus Replacement With a Fiber-Reinforced Scaffold in a 2-Year Ovine Model. Am J Sports Med 2018; 46:1844-1856. [PMID: 29953287 DOI: 10.1177/0363546517752668] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscus injuries and associated meniscectomies cause patients long-term pain and discomfort and can lead to joint deterioration. PURPOSE To evaluate a collagen-hyaluronan sponge reinforced with synthetic resorbable polymer fiber for total meniscus reconstruction in a long-term ovine model. STUDY DESIGN Controlled laboratory study. METHODS Eleven skeletally mature sheep were implanted with the total meniscus scaffold. At 2 years, explants were evaluated biologically (radial/circumferential histology, immunofluorescence) and mechanically (compression, tension), and articular surfaces were examined for damage. RESULTS The fiber-reinforced scaffold induced formation of functional neomeniscus tissue that was intact in 8 of 11 animals. The implant was remodeled into organized circumferentially aligned collagen bundles to resist meniscus hoop stresses. Moreover, type II collagen and proteoglycan deposition near the inner margin suggested a direct response to compressive stresses and confirmed fibrocartilage formation. Cartilage damage was observed, but end-stage (severe) joint deterioration associated with meniscectomy was avoided, even with limitations regarding the ovine surgical procedure and postoperative care. CONCLUSION A fiber-reinforced total meniscus replacement device induces formation of functional neomeniscus tissue that has the potential to prevent catastrophic joint deterioration associated with meniscectomy. CLINICAL RELEVANCE An off-the-shelf meniscus device that can be remodeled into functional tissue and thus prevent or delay the onset of osteoarthritis could address a widespread clinical need after meniscus injury.
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Affiliation(s)
- Jay M Patel
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA.,McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salim A Ghodbane
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Charles J Gatt
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michael G Dunn
- Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Biomedical Engineering, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
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Hart HF, Crossley KM, Felson D, Jarraya M, Guermazi A, Roemer F, Lewis B, Torner J, Nevitt M, Stefanik JJ. Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the Multicenter Osteoarthritis Study. Osteoarthritis Cartilage 2018; 26:912-919. [PMID: 29427724 PMCID: PMC6005722 DOI: 10.1016/j.joca.2017.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the relationship of meniscal damage to magnetic resonance imaging (MRI) features of compartment-specific patellofemoral joint (PFJ) osteoarthritis (OA) at baseline and 2 years later. METHOD Individuals from a prospective cohort of individuals aged 50-79 with or at risk of knee OA were included. At the 60-month and 84-month study visit, Whole-Organ MRI Score (WORMS) was used to assess meniscal tears and extrusions as well as cartilage damage and bone marrow lesions (BMLs) in the medial and lateral patella and trochlea. Worsening of structural features was defined as any increase in WORMS score from 60 to 84 months. Logistic regression was used to determine the cross-sectional and longitudinal relation of meniscus damage to features of compartment-specific PFJ OA. RESULTS Relative to knees without lateral meniscal pathology at baseline, those with grades 3-4 lateral meniscal tear and extrusion had greater risk of worsening of cartilage damage in the lateral PFJ 2 years later (Risk ratio: 1.7 [95% CI: 1.1-2.7) and (1.7 [1.2-2.5]), respectively. Relative to those without medial meniscal pathology at baseline, those with grades 1-2 (0.6 [0.4-0.9]) and 3-4 (0.7 [0.5-1.0]) medial meniscal tears had lower risk of worsening of BMLs in the medial PFJ 2 years later. CONCLUSION Meniscal tear and extrusion are associated with increased risk of medial and lateral PFJ OA and more severe meniscal pathology is associated with worsening of PFJ OA 2 years later. Lateral meniscal pathology appears to be more detrimental to the lateral PFJ.
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Affiliation(s)
- Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - David Felson
- Boston University, School of Medicine, Boston, USA
| | | | - Ali Guermazi
- Boston University, School of Medicine, Boston, USA
| | - Frank Roemer
- Boston University, School of Medicine, Boston, USA,University of Erlangen-Nuremberg, Erlangen, Germany
| | - Beth Lewis
- Univerity of Alabama at Birmingham, Birmingham, USA
| | | | - Michael Nevitt
- University of California San Francisco, San Francisco, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, United States
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Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7189714. [PMID: 29850554 PMCID: PMC5937613 DOI: 10.1155/2018/7189714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/01/2023]
Abstract
Purpose The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics. Methods Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked. Results Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees. Conclusion We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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Southam BR, Colosimo AJ, Grawe B. Underappreciated Factors to Consider in Revision Anterior Cruciate Ligament Reconstruction: A Current Concepts Review. Orthop J Sports Med 2018; 6:2325967117751689. [PMID: 29399591 PMCID: PMC5788104 DOI: 10.1177/2325967117751689] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary anterior cruciate ligament (ACL) reconstructions (ACLRs) are being performed with increasing frequency. While many of these will have successful outcomes, failures will occur in a subset of patients who will require revision ACLRs. As such, the number of revision procedures will continue to rise as well. While many reviews have focused on factors that commonly contribute to failure of primary ACLR, including graft choice, patient factors, early return to sport, and technical errors, this review focused on several factors that have received less attention in the literature. These include posterior tibial slope, varus malalignment, injury to the anterolateral ligament, and meniscal injury or deficiency. This review also appraised several emerging techniques that may be useful in the context of revision ACL surgery. While outcomes of revision ACLR are generally inferior to those of primary procedures, identifying these potentially underappreciated contributing factors preoperatively will allow the surgeon to address them at the time of revision, ideally improving patient outcomes and preventing recurrent ACL failure.
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Affiliation(s)
- Brendan R Southam
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angelo J Colosimo
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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