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Tamura M, Furumatsu T, Yokoyama Y, Higashihara N, Kawada K, Ozaki T. Superior outcomes of pullout repairs for medial meniscus posterior root tears in partial tear compared to complete radial tear. Knee Surg Relat Res 2024; 36:8. [PMID: 38331953 PMCID: PMC10854085 DOI: 10.1186/s43019-023-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE To reveal the outcomes of partial medial meniscus posterior root tears following transtibial pullout repair compared with the outcomes of complete radial meniscus posterior root tears. MATERIALS AND METHODS We retrospectively evaluated 15 consecutive patients (male/female, 5/10; average age, 64.4 years) who underwent transtibial pullout repair for partial medial meniscus posterior root tears and compared their results with those of 86 consecutive patients who underwent the same surgery for complete medial meniscus posterior root tears. All patients underwent second-look arthroscopy on average 1 year postoperatively, and a semi-quantitative meniscal healing score (anteroposterior width, stability, and synovial coverage, total 10 points) was evaluated. Medial meniscus extrusion was evaluated preoperatively and at second-look arthroscopy. RESULTS Postoperative clinical scores were not significantly different in the short term. However, second-look arthroscopy revealed a significant difference in repaired meniscal stability (partial tear; 3.3 points, complete tear; 2.3 points, p < 0.001) and total meniscal healing scores (partial tear; 8.3 points, complete tear; 7.1 points, p < 0.001). Medial meniscus extrusion progression was significantly different (partial tear; 0.4 mm, complete tear; 1.0 mm, p < 0.001). CONCLUSION Partial medial meniscus posterior root tears showed better meniscal healing and less medial meniscus extrusion progression following pullout repair than complete medial meniscus posterior root tears.
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Affiliation(s)
- Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Kelly SR, Daniel AV, Smith PA. Open Medial Meniscotibial Ligament Repair With Concomitant Open Superficial Medial Collateral Ligament Repair With Internal Brace Augmentation. Arthrosc Tech 2024; 13:102837. [PMID: 38312884 PMCID: PMC10838063 DOI: 10.1016/j.eats.2023.09.013] [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: 07/23/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024] Open
Abstract
The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Historically, nonsurgical management for these injuries has been favored for a majority of grade I-III sprains, particularly femoral-based. However, when coupled with other injuries such as meniscotibial ligament tears or distal Stener type avulsion tears, early surgical management for these cases is recommended. This will allow for stabilization and protection of the meniscus in addition to preventing residual valgus laxity, especially related to more severe Stener-like avulsions of the superficial MCL that can be seen with meniscotibial ligament tears. Utilizing an open approach, meniscotibial repair with suture anchors with internal brace augmentation for the MCL repair can provide a strong final construct, and a safe and fast recovery.
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Affiliation(s)
- Shayne R Kelly
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri, U.S.A
| | - Adam V Daniel
- Columbia Orthopedic Group, Columbia, Missouri, U.S.A
| | - Patrick A Smith
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri, U.S.A
- Columbia Orthopedic Group, Columbia, Missouri, U.S.A
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Barreira F, Gomes E, Oliveira S, Valente C, Bastos R, Sánchez M, Andrade R, Espregueira-Mendes J. Meniscal extrusion in knees with and without osteoarticular pathology: A systematic review of normative values and cut-offs for diagnostic criteria. Knee 2023; 45:156-167. [PMID: 37925806 DOI: 10.1016/j.knee.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this systematic review was to compare diagnostic methods and summarize the data of medial and lateral meniscal extrusion in knees with and without osteoarticular pathology. METHODS This systematic review was conducted according to the PRISMA 2020 statement. Searches were conducted on PubMed, EMBASE and Cochrane databases to identify studies that measured meniscal extrusion using magnetic resonance imaging (MRI) or ultrasound (US). Meniscal extrusion data was summarized as weighted mean for medial and lateral meniscus, and stratified according to the method of measurement (MRI or US) and presence of knee osteoarticular pathology. RESULTS A total of 26 studies were included in this review. Weighted mean values of meniscal extrusion were always higher for the medial than the lateral meniscus, regardless of the method of measurement. The medial meniscus extrusion was always higher in knees with osteoarticular pathology than those without. For the lateral meniscus extrusion, the mean values were higher in those knees without osteoarticular pathology. When classifying pathological meniscal extrusion with pre-defined cut-off values, the higher the cut-off used, the lower the percentage of knees classified as pathological meniscal extrusion. CONCLUSIONS The medial meniscus presents on mean higher extrusion and extrusion is higher in knees with osteoarticular pathology. Based on summary data, the most suitable cut-offs for pathological meniscal extrusion for both MRI and US seem to fall within >2 and >3 mm.
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Affiliation(s)
| | - Eluana Gomes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
| | - Sofia Oliveira
- Center for MicroElectroMechanical Systems (CMEMS UMINHO), University of Minho, Azurém Campus, 4800-058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal
| | - Ricardo Bastos
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Mikel Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain; Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal
| | - João Espregueira-Mendes
- School of Medicine, University of Minho, Braga, Portugal; Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3B's Research Group Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal.
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Compagnoni R, Ferrua P, Minoli C, Fajury R, Ravaglia R, Menon A, Randelli PS. The meniscal extrusion index is a reliable indirect sign of different meniscal lesion patterns: a classification based on percentage of meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 2023; 31:5005-5011. [PMID: 37653144 PMCID: PMC10598112 DOI: 10.1007/s00167-023-07525-6] [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: 05/07/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This study's goal is to propose a straightforward classification system based on the MEI (Meniscal Extrusion Index), a measure of meniscal extrusion, that relates to various meniscal lesion patterns and has clinical and biomechanical significance. The study's secondary goal is to determine whether the standard 3 mm meniscal extrusion parameter still has value by correlating the MEI with it. METHODS 1350 knee MRIs that were performed over the course of 2 years made up the study cohort. Following the application of inclusion and exclusion criteria, 200 of those patients were qualified to participate in the study. All the measurements examined for this study underwent an interobserver reliability test. RESULTS In the 1350 MRIs that were examined for this study, meniscal extrusion of any grade was present 18.9% of the time. The use of the MEI revealed three groups of patients: those with a MEI < 20%, who are likely para-physiological; those with a MEY between 20% and 40%, who are in a grey area; and those with a MEY > 40%, who have lesions that are impairing the proper meniscal function. According to the authors' findings, the percentage of meniscal extrusion did not correlate with the finite number (3 mm), making the 3 mm parameter an unreliable evaluation method. CONCLUSIONS This study is clinically relevant, because it proposes a simple and reproducible classification of meniscal extrusion that may aid in evaluating the severity of an extrusion and help in the diagnosis of lesions that might be difficult to identify on MRI. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo Compagnoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via della Commenda, 10, 20122, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Paolo Ferrua
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Carlo Minoli
- U.O.C. Week Surgery, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
- Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Raschid Fajury
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Rossella Ravaglia
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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Morales-Avalos R, Diabb-Zavala JM, Mohamed-Noriega N, Vilchez-Cavazos F, Perelli S, Padilla-Medina JR, Torres-Gaytán AG, Huesca-Pérez HA, Erosa-Villarreal RA, Monllau JC. Effect of Injury to the Lateral Meniscotibial Ligament and Meniscofibular Ligament on Meniscal Extrusion: Biomechanical Evaluation of the Capsulodesis and Centralization Techniques in a Porcine Knee Model. Orthop J Sports Med 2023; 11:23259671231212856. [PMID: 38021298 PMCID: PMC10668570 DOI: 10.1177/23259671231212856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Previous biomechanical studies of the meniscotibial ligament have determined that it contributes to meniscal stability. An injury to it can cause the meniscus to extrude, and reconstruction of that ligament significantly reduces extrusion. Purpose To assess the biomechanical effects of sectioning the lateral meniscotibial ligament (LMTL) and the meniscofibular ligament (MFL) with respect to the radial mobility of the lateral meniscus and to evaluate the biomechanical effects of the capsulodesis and centralization techniques. Study Design Controlled laboratory study. Methods The lateral meniscus of 22 porcine knees was evaluated. They were mounted on a testing apparatus to apply muscle and ground-reaction forces. The meniscus was evaluated at 30° and 60° of knee flexion using 2 markers placed on the posterior cruciate ligament and the lateral meniscus after applying an axial compression of 200 N to the knee joint. Measurements were recorded under 5 conditions: intact lateral meniscus, injury of the LMTL, subsequent injury of the MFL, the use of the open capsulodesis technique, and the reconstruction of the LMTL and the MFL with the centralization technique. Results The distance between the 2 markers was significantly greater in the extrusion group (combined lesion of the LMTL and MFL) than in the intact or reconstruction groups (capsulodesis and centralization techniques; P < .001 in all cases). In the cases of load application, no significant differences were observed between the control group (intact meniscus) and the groups on which the reconstruction techniques were performed. There were also no differences when comparing the results obtained between both reconstruction techniques. In all settings, the distance between the 2 markers increased with the increase in the knee flexion angle. Conclusion In a porcine model, the LMTL and the MFL participated as restrictors of the radial mobility of the lateral meniscus during loading. Their injury caused a significant increase in lateral meniscal extrusion, and the centralization and the capsulodesis procedures were able to reduce extrusion. Clinical Relevance This study demonstrates the capacity of the LMTL and the MFL to restrict the radial mobility of the lateral meniscus during loading and how it is affected when they are injured.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery; Department of Physiology, Faculty of Medicine, Universidad Autonoma de Nuevo Leon (UANL), Monterrey, Nuevo Leon, Mexico
- Departamento de Cirugia, Facultad de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - José Manuel Diabb-Zavala
- Facultad de Ingeniería Mecánica y Eléctrica (FIME), Universidad Autónoma de Nuevo León (UANL), San Nicolás de los Garza, Nuevo León, Mexico
| | - Nasser Mohamed-Noriega
- Facultad de Ingeniería Mecánica y Eléctrica (FIME), Universidad Autónoma de Nuevo León (UANL), San Nicolás de los Garza, Nuevo León, Mexico
| | - Félix Vilchez-Cavazos
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo León (UANL), Monterrey, Nuevo León, México
| | - Simone Perelli
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - José Ramón Padilla-Medina
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo León (UANL), Monterrey, Nuevo León, México
| | - Adrián Gerardo Torres-Gaytán
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo León (UANL), Monterrey, Nuevo León, México
| | - Héctor Adán Huesca-Pérez
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo León (UANL), Monterrey, Nuevo León, México
| | - Roger Armando Erosa-Villarreal
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo León (UANL), Monterrey, Nuevo León, México
| | - Joan Carles Monllau
- Departamento de Cirugia, Facultad de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
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Pan H, Wang C, Ni L, Shen Z, Kang S, Liu J. Introduction of an easy-to-operate arthroscopic test in detecting and treatment of meniscal instability: "suction drift" test. Am J Transl Res 2023; 15:5594-5601. [PMID: 37854208 PMCID: PMC10579001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/31/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To explore the surgical guidance value of "suction drift" in osteoarticular meniscal instability. METHODS The clinical data of 104 patients with significant knee symptoms following surgery were retrospectively analyzed. "Suction drift" was diagnosed in both groups. Depending on the treatment, patients treated with conventional debridement were assigned to group A, and those treated by meniscus suture until the disappearance of the "suction drift" phenomenon were included in group B. All patients were followed up for a minimum of 6 months after surgery. The postoperative Visual Analogue Scale (VAS) score, Lysholm knee score and the occurrence of meniscus-related symptoms were compared between the two groups. RESULTS After puncture, 78 patients (75.0%) had excessive displacement of the meniscus, with 53 (67.9%) of them being followed-up for at least 6 months. Twenty-five patients in group A and twenty-eight in group B were included in the final analysis (The number of patients with "suction drift" in two groups was tested to be comparable, P>0.05). VAS score was significantly decreased and Lysholm knee score was markedly increased in both groups after treatment, with lower VAS score and higher Lysholm knee score in group B compared with group A. In addition, group A had a significantly higher incidence of meniscus-related symptoms (joint space tenderness, joint clicks, and noose sensation) than group B. CONCLUSIONS "Suction drift" is a quick and easy-to-operate arthroscopic test, which can not only diagnose meniscus instability due to knee osteoarthrosis-induced meniscus degeneration, but also help determine the recovery of meniscus stability after suture, and significantly relieve symptoms.
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Affiliation(s)
| | | | - Linying Ni
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150086, Heilongjiang, China
| | - Zilong Shen
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150086, Heilongjiang, China
| | - Simiao Kang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150086, Heilongjiang, China
| | - Jiang Liu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150086, Heilongjiang, China
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Gilat R, Mitchnik IY, Mimouni T, Agar G, Lindner D, Beer Y. The meniscotibial ligament role in meniscal extrusion: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5777-5786. [PMID: 37266692 DOI: 10.1007/s00402-023-04934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The meniscotibial ligament (MTL) limits extrusion of the medial meniscus (MM). While meniscal extrusion may be detrimental to knee joint biomechanics, the role of the MTL in meniscal extrusion is debatable. We sought to perform a systematic review and meta-analysis to evaluate the role of the MTL and surgical techniques for MTL repair. MATERIALS AND METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines we searched PubMed, Cochrane Library, and Embase for: (("Meniscotibial") OR ("Coronary") OR ("Ramp")) AND ("Extrusion"). After screening and applying eligibility criteria, data were extracted for MTL pathology types ("traumatic" ruptures or "induced" injuries) and meniscal extrusion. A meta-analysis evaluated the mean difference of extrusion between "intact" MTLs (native or repaired) and "injured" MTLs (induced or traumatic). We further performed a subgroup analysis between traumatic and induced MTL lesions. RESULTS This systematic review included six studies, which all evaluated MM extrusion. There were 74 knees with induced MTL injuries and 19 knees with traumatic MTL ruptures. Study designs were heterogenic and utilized three types of MTL repair procedures. The meta-analysis included 18 human knees and revealed that sectioning the MTL created a 2.92 mm [- 0.18 to 6.03] MM extrusion, while MTL repair decreased MM extrusion by - 2.11 mm [- 3.03 to - 1.21]. CONCLUSIONS MTL injury may result in approximately 3 mm of MM extrusion, while repair of the MTL can decrease extrusion by 2 mm. Several novel surgical techniques exist to repair the MTL. However, studies reporting clinical outcomes of these various procedures are scarce.
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Affiliation(s)
- Ron Gilat
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Y Mitchnik
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Tomer Mimouni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Meadows KD, Peloquin JM, Markhali MI, Zgonis MH, Schaer TP, Mauck RL, Elliott DM. Acute Repair of Meniscus Root Tear Partially Restores Joint Displacements as Measured With Magnetic Resonance Images and Loading in a Cadaveric Porcine Knee. J Biomech Eng 2023; 145:081002. [PMID: 37255448 PMCID: PMC10259466 DOI: 10.1115/1.4062524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
The meniscus serves important load-bearing functions and protects the underlying articular cartilage. Unfortunately, meniscus tears are common and impair the ability of the meniscus to distribute loads, increasing the risk of developing osteoarthritis. Therefore, surgical repair of the meniscus is a frequently performed procedure; however, repair does not always prevent osteoarthritis. This is hypothesized to be due to altered joint loading post-injury and repair, where the functional deficit of the meniscus prevents it from performing its role of distributing forces. The objective of this study was to quantify joint kinematics in an intact joint, after a meniscus root tear, and after suture repair in cadaveric porcine knees, a frequently used in vivo model. We utilized an magnetic resonance images-compatible loading device and novel use of a T1 vibe sequence to measure meniscus and femur displacements under physiological axial loads. We found that anterior root tear led to large meniscus displacements under physiological axial loading and that suture anchor repair reduced these displacements but did not fully restore intact joint kinematics. After tear and repair, the anterior region of the meniscus moved posteriorly and medially as it was forced out of the joint space under loading, while the posterior region had small displacements as the posterior attachment acted as a hinge about which the meniscus pivoted in the axial plane. Methods from this study can be applied to assess altered joint kinematics following human knee injuries and evaluate repair strategies aimed to restore joint kinematics.
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Affiliation(s)
- Kyle D. Meadows
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - John M. Peloquin
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Miltiadis H. Zgonis
- Department of Orthopaedic Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104; Translational Musculoskeletal Research Center, CMC VA Medical Center, Philadelphia, PA 19104
| | - Dawn M. Elliott
- Biomedical Engineering, University of Delaware, 201 STAR Health Sciences Center, Newark, DE 19716
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Langhans MT, Lamba A, Saris DBF, Smith P, Krych AJ. Meniscal Extrusion: Diagnosis, Etiology, and Treatment Options. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09840-4. [PMID: 37191818 DOI: 10.1007/s12178-023-09840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. RECENT FINDINGS Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration. Meniscus extrusion has been associated with degenerative joint disease, posterior root and radial meniscal tears, and acute trauma. Meniscus centralization and meniscotibial ligament repair have been proposed as techniques to address meniscal extrusion with promising biomechanical, animal model, and early clinical reports. Further studies on the epidemiology of meniscus extrusion and associated long-term nonoperative outcomes will help to elucidate its role in meniscus dysfunction and resultant arthritic development. Understanding and appreciation for the anatomic attachments of the meniscus will help to inform future repair techniques. Long-term reporting on the clinical outcomes of meniscus centralization techniques will yield insights into the clinical significance of meniscus extrusion correction.
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Affiliation(s)
- Mark T Langhans
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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10
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Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop 2023; 14:171-185. [PMID: 37155506 PMCID: PMC10122773 DOI: 10.5312/wjo.v14.i4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
Over the years, several studies demonstrated the crucial role of knee menisci in joint biomechanics. As a result, save the meniscus has become the new imperative nowadays, and more and more studies addressed this topic. The huge amount of data on this topic may create confusion in those who want to approach this surgery. The aim of this review is to provide a practical guide for treatment of meniscus tears, including an overview of technical aspects, outcomes in the literature and personal tips. Taking inspiration from a famous movie directed by Sergio Leone in 1966, the authors classified meniscus tears in three categories: The good, the bad and the ugly lesions. The inclusion in each group was determined by the lesion pattern, its biomechanical effects on knee joint, the technical challenge, and prognosis. This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a reader-friendly narrative review of an otherwise difficult topic. Furthermore, the authors provide a concise premise to deal with some aspects of menisci phylogeny, anatomy and biomechanics.
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Affiliation(s)
- Roberto Simonetta
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, Enna 94100, Italy
| | - Michelangelo Palco
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | | | - Pier Paolo Mariani
- Department of Orthopaedic and Traumatology, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Roma 00135, Italy
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Wang X, Du G, Liu Y. Lateral meniscal body extrusion is associated with MRI-defined knee structural damage progression over 4 years: Data from the osteoarthritis initiative. Eur J Radiol 2023; 162:110791. [PMID: 36963331 DOI: 10.1016/j.ejrad.2023.110791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To investigate the association of lateral meniscal body extrusion (LMBE) with OA-related knee structural damage progression over 4 years and to obtain thresholds of LMBE in predicting knee structural damage progression. METHOD We studied 196 subjects (67 male) with a mean age of 59.5 ± 7.9 (SD) years (range45-78 years) that were randomly selected from the Osteoarthritis Initiative. Radiological assessment was performed using the Osteoarthritis Research Society International grading system. Baseline LMBE was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3.0 T scanner. Knee structural damages were measured using the whole-organ MRI score. Linear regression analysis and binary logistic regression analysis was used to assess the correlation between LMBE and knee structural damage. ROC analysis and Youden index were used for calculating thresholds. RESULTS Cross-sectionally, increased LMBE was significantly associated with more severe lateral meniscal damage, patellofemoral and lateral compartment cartilage damage, and posterior cruciate ligament damage. Longitudinally, LMBE was statistically associated with progression of lateral meniscal damage, lateral compartment cartilage damage and bone marrow edema patterns, posterior cruciate ligament lesions and popliteal cysts. The thresholds of LMBE in suggesting progression of lateral meniscal lesions and lateral compartment cartilage lesions were 1.4 mm and 1.3 mm, respectively. CONCLUSION Baseline LMBE was associated with structural damage progression over 4 years in knees with or at risks for OA. Thresholds of 1.4 mm and 1.3 mm could be used in predicting progression over 4 years of lateral meniscal damage and lateral compartment cartilage damage, respectively.
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Affiliation(s)
- Xiaohong Wang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Guiying Du
- Department of Radiology, Teda International Cardiovascular Hospital, Tianjin, China.
| | - Yao Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Lee HY, Bin SI, Kim JM, Lee BS, Kim SM, Lee SJ. Nonextruded Grafts Result in Better Cartilage Quality After Lateral Meniscal Allograft Transplantation: Quantitative 3-T MRI T2 Mapping. Am J Sports Med 2023; 51:404-412. [PMID: 36607167 DOI: 10.1177/03635465221143373] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Several studies have reported that graft extrusion after meniscal allograft transplantation (MAT) is associated with deterioration of surgical outcomes. However, no study has investigated the effect of graft extrusion on the articular cartilage using objective quantitative methods. PURPOSE/HYPOTHESIS This study aimed to investigate the influence of graft extrusion on the chondroprotective effect of lateral MAT on knee articular cartilage. We hypothesized that MAT without graft extrusion would result in better cartilage quality than MAT with graft extrusion. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Altogether, 105 patients who underwent isolated lateral MAT were divided into the extrusion and nonextrusion groups based on postoperative 3-month magnetic resonance imaging. Quantitative T2 mapping was performed on pre- and postoperative magnetic resonance imaging at midterm follow-up (mean ± SD, 3.2 ± 0.7 years). The weightbearing area of the femoral and tibial plateau articular cartilage was divided into 6 segments (F1, F2, F3, TP1, TP2, and TP3) from the anterior to posterior direction according to the meniscal coverage area. Each segment was further segmented into superficial and deep layers for zonal analysis. Longitudinal change in cartilage T2 value was compared between the groups. Lysholm scores were used to evaluate clinical function. RESULTS The mean T2 value of the nonextrusion group showed a significant improvement in 14 of 18 segments after lateral MAT, whereas the extrusion group demonstrated no statistically significant change. The biochemical properties of cartilage tissue as judged by quantitative T2 mapping indicated improvement in the nonextrusion group as compared with the extrusion group in the F2, TP2, and TP3 segments overall; the deep layers of the F1, F2, and TP2 segments; and the superficial layer of the TP3 segment (P < .05). CONCLUSION This study shows that the nonextruded graft results in better cartilage properties of the knee joint after lateral MAT as compared with the extruded graft at midterm follow-up.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji Medical Center Daejeon Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea.,Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, College of Medicine, Wonkwang University, Gunpo, Republic of Korea
| | - Seon-Jong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Grasso D, Gnesutta A, Calvi M, Duvia M, Atria MG, Celentano A, Callegari L, Genovese EA. MRI evaluation of meniscal anatomy: which parameters reach the best inter-observer concordance? Radiol Med 2022; 127:991-997. [PMID: 35834110 PMCID: PMC9508209 DOI: 10.1007/s11547-022-01527-z] [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: 12/30/2021] [Accepted: 07/04/2022] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
The aim of the study is to evaluate which MRI parameters achieve the best degree of inter-individual concordance in the description of meniscal fibrocartilage, regarding its morphology, signal and position.
Materials and methods
Eighty-nine knee MRIs were included in the study, retrospectively re-evaluated by three radiologists who completed a binary report (normal/abnormal) describing the meniscus signal, position relative to the tibial plateau margin and morphology. The inter-individual concordance value was calculated using Cohen's test.
Results
We obtained different inter-individual concordance values according to the parameters considered. The concordance was poor in the description of the meniscal position relative to the tibial plateau margin (average k = 0.6); the result was comparable in the description of the meniscal morphology (average k = 0.56). The best results were obtained with the meniscal signal analysis (average k = 0.8).
Conclusion
To the best of our knowledge, there are no studies in the literature assessing the concordance between multiple readers in the description of the parameters we studied. The results we obtained suggest that the most reliable parameter for describing meniscal fibrocartilage is its signal intensity, whereas morphology and position may lead to different interpretations that are not always unequivocal.
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Kaiser JT, Damodar D, Udine MJ, Meeker ZD, McCormick JR, Wagner KR, Krych AJ, Chahla JA, Cole BJ. Meniscal Extrusion: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202208000-00001. [PMID: 35922395 DOI: 10.2106/jbjs.rvw.22.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Pathologic meniscal extrusion can compromise meniscal function, leading to increased contact forces in the tibiofemoral compartment and the acceleration of osteoarthritic changes. ➢ Extrusion is typically defined as radial displacement of ≥3 mm outside the tibial border and is best diagnosed via magnetic resonance imaging, although ultrasonography has also demonstrated encouraging diagnostic utility. ➢ Surgical management of meniscal extrusion is based on the underlying etiology, the patient's symptom profile, the preexisting health of the articular surface, and the risk of future chondral injury and osteoarthritis.
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Affiliation(s)
- Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Matthew J Udine
- University of South Florida College of Medicine, Tampa, Florida
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | | | - Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jorge A Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
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Hirose T, Mae T, Ogasawara I, Yamakawa S, Nakata K, Ohori T, Tsujii A, Okada S. Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus. Am J Sports Med 2022; 50:1850-1857. [PMID: 35416074 DOI: 10.1177/03635465221090543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal extrusion/translation has been used as an index for meniscal treatment. However, the relationship between meniscal displacement and the degree of meniscal tear or load-transmission function of the lateral meniscus (LM) remains unclear. PURPOSE To clarify the relationship between the width of the radial tear of the LM and (1) meniscal displacement or (2) resultant force through the meniscus under axial compressive load in the porcine model. STUDY DESIGN Controlled laboratory study. METHODS Eight intact porcine knees with or without a partial radial tear at the midbody of the LM (involving 30%, 60%, or 90% of its width) were investigated. Reflective markers were attached to the outer wall of the anterior, anteromiddle, posteromiddle, and posterior segments of the LM. A 300-N axial load was applied at 2 flexion angles (30° and 60°), and the 3-dimensional forces and trajectories of the knees were recorded. Marker movements were simultaneously tracked using a motion capture camera system. After total meniscectomy of the LM, the recorded knee trajectories were reproduced, and the resultant force through the LM was calculated (a force carried only by the meniscus in response to a load applied to the whole knee joint). RESULTS At both flexion angles, the change in distance (mean ± SD) between the anterior and posterior markers under load increased significantly more in the anteroposterior direction in LMs with a 90% tear than in intact LMs (30°, 0.4 ± 0.3 vs 1.4 ± 0.8 mm, P = .004; 60°, 0.1 ± 0.7 vs 1.4 ± 1.0 mm, P < .001 [intact vs 90% tear]). The change in distance between the anteromiddle and posteromiddle markers at 30° also significantly increased in LMs with a 90% tear (0.2 ± 0.2 vs 1.3 ± 1.2 mm, P = .02 [intact vs 90% tear]). The resultant force was significantly lower in LMs with a 90% tear than in intact LMs (30°, 125 ± 47 vs 48 ± 20 N, P < .001; 60°, 93 ± 46 vs 43 ± 11 N, P = .002 [intact vs 90% tear]). We found no significant differences in either meniscal displacements or resultant forces between intact LMs and those with 30% or 60% tears. CONCLUSION LMs with a 90%-width midbody radial tear lost load-transmission function with their displacement relative to the tibia primarily in the anteroposterior direction in the porcine model. CLINICAL RELEVANCE Even 1 mm of displacement after meniscal injury is evidence that the load-transmission function of the meniscus is greatly impaired. When a displaced torn LM is diagnosed in preoperative imaging, meniscal repair surgery should be considered.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Issei Ogasawara
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ken Nakata
- Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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