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Zhang D, Baker HP, Lee CS, Pathuri M, Reddy S, Strelzow J. Corticosteroid injection of the knee within one month prior to meniscus repair increases the risk of repair failure requiring meniscectomy. PHYSICIAN SPORTSMED 2024; 52:369-373. [PMID: 37811919 DOI: 10.1080/00913847.2023.2268604] [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: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Meniscal tears are common knee injuries with limited endogenous healing capacity. This study aimed to investigate the association between the timing and administration of preoperative intra-articular corticosteroid injections (CSIs) and the risk of subsequent meniscectomy following meniscus repair. METHODS Using a national insurance claims database, patients aged 18-40 years undergoing meniscus repair within six months of tear diagnosis were studied. Patients were categorized based on whether they received preoperative CSIs within three intervals prior to repair. Multivariable logistic regression was used to analyze the risk of follow-up meniscectomy while controlling for various patient-related variables. RESULTS Among 5,390 patients meeting inclusion criteria, 201 received preoperative CSIs. The CSI group was older and had higher rates of diabetes, obesity, and knee osteoarthritis. The overall rate of follow-up meniscectomy did not differ between groups. However, CSIs performed within one month prior to repair were associated with significantly higher odds of subsequent meniscectomy compared to CSIs performed between three and six months prior. Obesity, tobacco use, and knee osteoarthritis were also independently associated with higher risk, while increasing age was associated with lower risk. CONCLUSION The study highlights an increased risk of repair failure requiring follow-up meniscectomy for patients receiving intra-articular CSIs within one month prior to meniscus repair. These findings suggest caution when considering CSIs as a treatment option for patients scheduled for meniscus repair. Further research is needed to establish optimal timing guidelines for CSIs in relation to meniscus repair and to understand the underlying mechanisms.
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Affiliation(s)
- Douglas Zhang
- Department of Orthopaedic Surgery, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Hayden P Baker
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Cody S Lee
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Manish Pathuri
- Department of Orthopaedic Surgery, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Sai Reddy
- Department of Orthopaedic Surgery, The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL, USA
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2
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Inoue T, Kano T, Nakasa T, Ishikawa M, Inoue K, Kawabata S, Miyaki S, Kamei N, Adachi N. Development of a novel approach for restoration of the meniscus using silk-elastin in a rabbit meniscus injury model. BMC Musculoskelet Disord 2024; 25:545. [PMID: 39010063 PMCID: PMC11247742 DOI: 10.1186/s12891-024-07675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Limited healing potential of the meniscus remains a burden for the successful repair of meniscus injuries in the orthopaedic fields. Silk-elastin (SE) is a novel recombinant protein with favorable properties for wound healing. This proof-of-concept study aimed to investigate the therapeutic effect of silk-elastin in a rabbit meniscal defect model. METHODS A migration assay using rabbit meniscus and synovial cells with various concentrations of SE in a culture medium was conducted to investigate the mechanism of meniscal healing by SE. Additionally, cylindrical defects with a 1.5 mm diameter were created at the anterior horn of the medial meniscus of rabbits. The animals were divided into three groups: 1) the Blank group; defect only, 2) the Col I group; implantation of type I atelocollagen sponge, and 3) the SE group; implantation of SE (150 mg/ml) sponge. Whole medial menisci were harvested at 4, 8, 12, and 24 weeks after surgery. Histological analyses including immunohistochemical staining were performed to assess meniscal healing. RESULTS In vitro study, Migration assay demonstrated a significantly higher number of migrated cells only in synovial cells. Especially, the SE concentration of 10 µg/mL demonstrated the highest number of migrated cells compared with other concentrations. In vivo study, the SE group exhibited significantly higher Ishida scores than other groups at all time points. Furthermore, the SE group showed higher synovial coverage scores than the Col I group at 4 and 8 weeks. Immunohistochemical staining demonstrated higher type II collagen staining in the SE group compared to other groups at 12 weeks. Implanted SE was efficiently replaced by safranin-O staining positive tissue within 8 weeks. CONCLUSIONS SE could effectively repair a meniscal defect by inducing coverage of synovial cells. SE has the potential to be a useful material for meniscal repair.
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Affiliation(s)
- Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Toshiya Kano
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | - Shigeru Miyaki
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
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Sonnier JH, Looney AM, Johnson EE, Fuller Z, Tjoumakaris FP, Freedman KB. Analyzing Resilience in the Orthopedic Sports Medicine Patient Population. Orthopedics 2024; 47:95-100. [PMID: 37561104 DOI: 10.3928/01477447-20230804-04] [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: 08/11/2023]
Abstract
Little research has been done to compare resilience, as measured by the Brief Resilience Scale (BRS), across common sports medicine patient populations. Our purpose was to investigate resilience levels across sports medicine patient populations. All patients who underwent reconstruction of the anterior cruciate ligament (ACLR), partial meniscectomy (PM), meniscal repair (MR), rotator cuff repair (RCR), or shoulder stabilization (SS) between January 1 and June 30, 2020, were screened for inclusion. At our institution, BRS scores are routinely collected during the preoperative period. Patients with preoperative BRS scores available were included for analysis. Patients who were eligible on the basis of ACLR who underwent concomitant PM or MR were included in the ACL group. A total of 655 patients with a median age of 49 years were included in analysis. The median preoperative resilience score across all patients was 3.83 (interquartile range, 3.50-4.17), and the highest scores were seen in the ACLR group (median, 4.00; interquartile range, 3.67-4.17). On multivariate regression, scores were significantly and independently lower in the PM and RCR groups. Male patients were found to have significantly higher scores than female patients overall (P=.028), but in subgroup analysis by pathology, this effect was only seen in the SS and PM groups. Psychological factors are important to consider when surgically treating patients, and resilience specifically may play a role in predicting treatment success. Patients undergoing PM and RCR tend to report lower resilience scores than patients undergoing ACLR at preoperative baseline. [Orthopedics. 2024;47(2):95-100.].
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Nelson PA, George T, Bowen E, Sheean AJ, Bedi A. An Update on Orthobiologics: Cautious Optimism. Am J Sports Med 2024; 52:242-257. [PMID: 38164688 DOI: 10.1177/03635465231192473] [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] [Indexed: 01/03/2024]
Abstract
Orthobiologics are rapidly growing in use given their potential to augment healing for multiple musculoskeletal conditions. Orthobiologics consist of a variety of treatments including platelet-rich plasma and stem cells that provide conceptual appeal in providing local delivery of growth factors and inflammation modulation. The lack of standardization in nomenclature and applications within the literature has led to a paucity of high-quality evidence to support their frequent use. The purpose of this review was to describe the current landscape of orthobiologics and the most recent evidence regarding their use.
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Affiliation(s)
- Patrick A Nelson
- University of Chicago Department of Orthopedic Surgery, Chicago, Illinois, USA
| | - Tom George
- Northshore University Healthcare System, Evanston, Illinois, USA
| | - Edward Bowen
- Weill Cornell Medicine, New York City, New York, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, Department of Orthopedic Surgery, San Antonio, Texas, USA
| | - Asheesh Bedi
- Northshore University Healthcare System, Evanston, Illinois, USA
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Moon HS, Jung M, Choi CH, Yoo JH, Nam BJ, Lee SH, Shin SH, Kim DK, Kim SH. Marrow stimulation procedures for high-grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility. Knee Surg Sports Traumatol Arthrosc 2023; 31:5812-5822. [PMID: 37938328 DOI: 10.1007/s00167-023-07642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To investigate the surgical outcomes of arthroscopic pull-out repair for medial meniscus root tear (MMRT) combined with the marrow stimulation procedures (MSP) for accompanying high-grade cartilage lesions. METHODS Patients who underwent arthroscopic pull-out repair for MMRT between 2010 and 2019 were retrospectively reviewed. Patients who had at least 3 years of follow-up were included and classified into two groups according to whether MSP (microfracture or microdrilling) were performed on cartilage lesions in the medial tibiofemoral joint (group 1, patients with International Cartilage Repair Society [ICRS] grade 0-3a lesions and did not undergo MSP; group 2, patients with ICRS grade 3b-3d lesions and underwent MSP). Comparative analyses, including non-inferiority trials, were conducted between groups for subjective and objective outcomes. In addition, group 2 was further divided into two subgroups according to cartilage lesion size and compared with group 1 (group S, ≤ 2.0 cm2; group L, > 2.0 cm2). RESULTS A total of 94 patients were included (group 1, 68 patients; group 2, 26 patients). There were no significant differences in clinical scores at postoperative 3 years and final follow-up between groups 1 and 2, but group 2 failed to satisfy the non-inferiority criteria compared to group 1 overall. In objective outcomes, group 2 did not meet the non-inferiority criteria for the rate of osteoarthritis progression compared to group 1, and it also showed a significantly higher proportion of high-grade osteoarthritis at final follow-up (P = 0.044) and a higher degree of osteoarthritis progression than group 1 (P = 0.03 for pre- to postoperative 3 years, and P = 0.006 for pre- to final follow-up). In additional evaluations comparing the subgroups of group 2 and group 1, group S showed relatively favourable results compared to group L in objective outcomes at final follow-up. CONCLUSION Patients who underwent arthroscopic pull-out repair for MMRT combined with MSP for accompanying high-grade cartilage lesions showed suboptimal outcomes compared to those with no or low-grade lesions at mid-term follow-up. High-grade cartilage lesions ≤ 2.0 cm2 may be candidates for the surgical repair of MMRT if MSP are performed, but those with larger lesions may require alternative treatment strategies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Bum-Joon Nam
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hun Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Seung-Hwan Shin
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Ki Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Katz JN, Collins JE, Brophy RH, Cole BJ, Cox CL, Guermazi A, Jones MH, Levy BA, MacFarlane LA, Mandl LA, Marx RG, Selzer F, Spindler KP, Wright RW, Losina E, Chang Y. Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25197. [PMID: 37474452 PMCID: PMC10799184 DOI: 10.1002/acr.25197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Meniscal tear in persons aged ≥45 years is typically managed with physical therapy (PT), and arthroscopic partial meniscectomy (APM) is offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes. METHODS We assessed changes between baseline and 60 months in the Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 years enrolled into a seven-center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed a 60-month change in the OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group. RESULTS We analyzed data from 142 subjects (100 APM, 42 PT). The mean ± SD weighted baseline OARSI radiographic score was 3.8 ± 3.5 in the APM group and 4.0 ± 4.9 in the PT group. OARSI scores increased by a mean of 4.1 (95% confidence interval [95% CI] 3.5-4.7) in the APM group and 2.4 (95% CI 1.7-3.2) in the PT group (P < 0.001) due to changes in the osteophyte component. We did not observe statistically significant differences in the KL grade. Sensitivity analyses yielded similar findings to the primary analysis. CONCLUSION Subjects treated with APM had greater progression in the OARSI score because of osteophyte progression but not in the KL grade. The clinical implications of these findings require investigation.
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Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert H Brophy
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Ali Guermazi
- Boston Veteran's Medical Center and Boston University Medical Center, Boston, Massachusetts
| | - Morgan H Jones
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York
| | | | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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7
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Kunze KN, Haddad A, White AE, Cohn MR, LaPrade RF, Chahla J. The Top 50 Most Cited Publications in Meniscus Research. J Knee Surg 2023; 36:329-334. [PMID: 34359092 DOI: 10.1055/s-0041-1733881] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Injuries to the menisci of the knee are common in orthopedic sports medicine. Bibliometric studies can identify the core literature on a topic and help further our collective knowledge for both clinical and educational purposes. The purpose of the current study was to (1) identify and describe the 50 most cited articles in meniscus research over an 80-year time period to capture a wide range of influential articles and (2) identify the "citation classics" and milestone articles related to the meniscus of the knee. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched for the 50 most cited meniscus articles. Data pertaining to bibliometric and publication characteristics were extracted and reported using descriptive statistics. The top 50 articles were published between the years 1941 and 2014 and collectively cited 13,152 times. The median (interquartile [IQR]) number of total citations per article was 203.5 (167.0-261.8), while the median citation rate was 9.6 (7.4-13.9) citations per year. The most cited article was "Knee joint changes after meniscectomy," published in 1948. The article with the highest citation rate of 78.4 citations per year was "The long-term consequence of anterior cruciate ligaments and meniscus injuries - osteoarthritis," published in 2007. The majority of articles were clinical outcome studies (n = 28, 56%). The top 50 most cited meniscus articles represent a compilation of highly influential articles which may augment reading curriculums and provide a strong knowledge base for orthopaedic surgery residents and fellows. The decade with the most articles was the 2000s, representing a recent acceleration in meniscus-based research. This is a level IV, cross-sectional study.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Aidan Haddad
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alexander E White
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Matthew R Cohn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert F LaPrade
- Department of Orthopaedic Surgery, Twin Cities Orthopedics, Minneapolis, Minnesota
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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8
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Park CM, Ryoo S, Choi M, Lee SJ, Yoo JJ, Kim HA. Total Knee Replacement After Arthroscopic Meniscectomy in Knee Osteoarthritis: A Nationwide Population-Based Cohort Study. J Korean Med Sci 2023; 38:e6. [PMID: 36593689 PMCID: PMC9807768 DOI: 10.3346/jkms.2023.38.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/21/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recent studies raise concerns that arthroscopic meniscectomy (AM) for degenerative tear may be detrimental to the maintenance of the joint structure. This study was performed to examine the rate of total knee replacement (TKR) among patients with knee osteoarthritis (OA) who underwent AM for meniscal tears and compare this rate with those who did not. METHODS A retrospective cohort study was conducted using the National Health Insurance Database of South Korea. Among knee OA patients aged 50-79, those who were treated with AM due to meniscal damage from 2007 to 2009 were selected as the AM group while those not treated with AM despite the presence of meniscal damage were selected as control group. Both were matched based on a propensity score and followed-up until the earliest occurrence of: TKR, death, or 10 years. Cox proportional hazards models were used to compare the outcome. RESULTS A total of 36,974 patients were included in AM groups and non-AM group after 1:1 matching. TKR occurred in 9.62% and 7.64% in AM and non-AM groups with the average duration after meniscectomy of 5.88 ± 2.77 and 5.50 ± 2.94 years, respectively. After adjustment for baseline confounders, the TKR rate in the AM group was calculated to be 25% higher than that in the non-AM group (subdistribution hazard ratio, 1.25; 95% confidence interval, 1.16-1.34). The mortality rate was 5.20%, which did not significantly differ between groups. CONCLUSION OA patients who underwent AM for the meniscal injury had higher incidence of TKR up to 10 years of follow-up than the non-operated group. The greater TKR utilization observed in patients undergoing AM merits caution when treating OA patients with meniscal injury.
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Affiliation(s)
- Chan Mi Park
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Su Jung Lee
- College of Nursing, Institute of Health Science Research, Inje University, Gimhae, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute for Skeletal Aging, Hallym University, Chuncheon, Korea.
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López-Vega M, Doménech-Fernández J, Peiró S, Ridao-López M. Has Arthroscopic Meniscectomy Use Changed in Response to the Evidence? A Large-database Study From Spain. Clin Orthop Relat Res 2023; 481:7-16. [PMID: 36190489 PMCID: PMC9750592 DOI: 10.1097/corr.0000000000002421] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several randomized clinical trials on the treatment of meniscal tears have shown that surgery is not superior to nonoperative treatment in middle-aged and older adults. However, clinical practice has not changed consistently worldwide in response to this evidence, and arthroscopic meniscectomy remains one of the most frequently performed operations. QUESTIONS/PURPOSES (1) How has the use of arthroscopic meniscectomy changed in Spain between 2003 and 2018, particularly in middle-aged (35 to 59 years) and older patients (over 60 years) relative to younger patients? (2) How have surgical volumes changed across different healthcare areas in the same health system? (3) How has the proportion of outpatient versus inpatient arthroscopic procedures changed over time? METHODS Data on all 420,228 arthroscopic meniscectomies performed in Spain between 2003 and 2018 were obtained through the Atlas of Variations in Medical Practice project (these years were chosen because data in that atlas for 2002 and 2019 were incomplete). This database has been promoted by the Spanish Health Ministry since 2002, and it collects basic information on all admissions to public and public-private partnership hospitals. The Spanish population of 2003 was used to calculate age- and sex-standardized rates of interventions per 10,000 inhabitants and year. To assess the change in standardized rates among the age groups over the study period, a linear regression analysis was used. Standard small-area variation statistics were used to analyze variation among healthcare areas. Data on outpatient surgery and length of stay for inpatient procedures were also included. RESULTS The standardized rate of arthroscopic meniscectomy in Spain in 2003 was 4.8 procedures per 10,000 population (95% CI 3.9 to 5.6), while in 2018, there were 6.3 procedures per 10,000 population (95% CI 5.4 to 7.3), which represents an increase of 33%. Standardized rates increased slightly in the age group < 35 years (0.06 interventions per 10,000 inhabitants per year [95% CI 0.05 to 0.08]), whereas they increased more markedly in the age groups of 35 to 59 years (0.14 interventions per 10,000 inhabitants per year [95% CI 0.11 to 0.17]) and in those 60 years and older (0.13 interventions per 10,000 inhabitants per year [95% CI 0.09 to 0.17]). The variability among healthcare areas in the meniscectomy rate progressively decreased from 2003 to 2018. In 2003, 32% (6544 of 20,384) of knee arthroscopies were performed on an outpatient basis, while in 2018, these accounted for 67% (19,573 of 29,430). CONCLUSION We observed a progressive increase in arthroscopic meniscectomies in Spain; this procedure was more prevalent in older patients presumed to have degenerative pathologic findings. This increase occurred despite increasing high-level evidence of a lack of the additional benefit of meniscectomy over other less-invasive treatments in middle-aged and older people. Our study highlights the need for action in health systems with the use of financial, regulatory, or incentive strategies to reduce the use of low-value procedures, as well as interventions to disseminate the available evidence to clinicians and patients. Research is needed to identify the barriers that are preventing the reversal of interventions that high-quality evidence shows are ineffective. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Marcos López-Vega
- Department of Orthopaedic Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | | | - Salvador Peiró
- Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO), Valencia, Spain
- Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Manuel Ridao-López
- Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Instituto Aragonés de Ciencias de la Salud (IIS Aragón), Zaragoza, Spain
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10
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Mahmoud EE, Mawas AS, Mohamed AA, Noby MA, Abdel-Hady ANA, Zayed M. Treatment strategies for meniscal lesions: from past to prospective therapeutics. Regen Med 2022; 17:547-560. [PMID: 35638397 DOI: 10.2217/rme-2021-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Menisci play an important role in the biomechanics of knee joint function, including loading transmission, joint lubrication, prevention of soft tissue impingement during motion and joint stability. Meniscal repair presents a challenge due to a lack of vascularization that limits the healing capacity of meniscal tissue. In this review, the authors aimed to untangle the available treatment options for repairing meniscal tears. Various surgical procedures have been developed to treat meniscal tears; however, clinical outcomes are limited. Consequently, numerous researchers have focused on different treatments such as the application of exogenous and/or autologous growth factors, scaffolds including tissue-derived matrix, cell-based therapy and miRNA-210. The authors present current and prospective treatment strategies for meniscal lesions.
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Affiliation(s)
- Elhussein E Mahmoud
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Amany S Mawas
- Department of Pathology & Clinical Pathology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Alsayed A Mohamed
- Department of Anatomy & Embryology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Mohammed A Noby
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | | | - Mohammed Zayed
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
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Sebastianelli WJ, Hanna T, Smith NP. Treatment, Return to Play, and Performance Following Meniscus Surgery. Curr Rev Musculoskelet Med 2022; 15:157-169. [PMID: 35467166 DOI: 10.1007/s12178-022-09754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The standard of care in meniscal tear management is constantly evolving, especially for athletes and high-demand patients. Meniscus repairs, meniscus transplants, and partial meniscectomies are commonly performed, and rehabilitation methods following these operations are becoming more sophisticated. The ultimate goal of these procedures is returning patients to full activity with minimal risks. Return to play should be systematic, pathology dependent, and individualized to an athlete's needs, expectations, and level of play. This article provides a review of the current treatment modalities of meniscus tears, the rehabilitation protocols following each modality, and the return to play criteria that must be met before releasing the player to competition. In addition, it overviews articles that describe performance outcomes of patients that have undergone meniscus surgery. RECENT FINDINGS Current research shows high return to play rates for athletes that undergo meniscus surgery and describes effective rehabilitation protocols to facilitate recovery. There is an increased emphasis on meniscus preservation in recent literature. In addition, meniscus allograft transplantation has demonstrated its efficacy as a salvage procedure and has become a stronger consideration in the athlete with meniscus pathology. No standardized return to play protocol can be applied uniformly to all kinds of meniscal surgeries, and two athletes with the same pathology cannot be expected to follow identical paths towards full recovery. A multidisciplinary approach to care should be provided to the patients, and in the case of patients with high levels of athleticism, the road to recovery starts even before the injury itself.
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Affiliation(s)
- Wayne J Sebastianelli
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA.
| | - Tammam Hanna
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA
| | - Nathan P Smith
- Penn State College of Medicine, Department of Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
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12
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Yoon KH, Wan WS, Kim YS, Park JY. The efficacy of intraarticular viscosupplementation after arthroscopic partial meniscectomy: a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:32. [PMID: 34983471 PMCID: PMC8729128 DOI: 10.1186/s12891-021-04990-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of viscosupplementation after arthroscopic partial meniscectomy. METHOD A randomized controlled trial of 47 patients who underwent arthroscopic partial meniscectomy was conducted between March 2020 and March 2021. Patients were randomized into two groups: a viscosupplementation group (n = 23) and a control group (n = 24). A single-dose intraarticular hyaluronic acid injection was used as viscosupplementation. The 100 mm visual analogue scale (VAS) for pain assessment was measured at baseline and at 1 day, 2 weeks, 6 weeks, and 3 months post-surgery. The International Knee Documentation Committee (IKDC), Tegner, Lysholm, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and range of motion (ROM) of the knee were measured at baseline, 2 weeks, 6 weeks, and 3 months. RESULTS The 100 mm VAS score for pain was significantly lower in the viscosupplementation group at 2 weeks post-surgery (27.5 mm vs. 40.7 mm, P = 0.047). ROM was significantly greater in the viscosupplementation group than in the control group at 2 weeks (131.5° vs. 121.0°, P = 0.044) post-surgery. No significant differences were observed in the IKDC or in the Tegner, Lysholm, and WOMAC scores between the two groups. CONCLUSIONS Viscosupplementation after arthroscopic partial meniscectomy significantly reduced pain at 2 weeks post-surgery and improved ROM of the knee at 2 weeks post-surgery. There might be some benefits in terms of pain and functional recovery of viscosupplementation after arthroscopic surgery. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. TRIAL REGISTRATION This randomized controlled trial was registered at cris.nih.go.kr # KCT0004921 .
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Woo Seung Wan
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yoon-Seok Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea.
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13
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Chung KS. An increasing trend of posterior cruciate ligament reconstruction in South Korea: epidemiologic analysis using Korean National Health Insurance System Database. Knee Surg Relat Res 2021; 33:44. [PMID: 34863316 PMCID: PMC8645088 DOI: 10.1186/s43019-021-00126-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The posterior cruciate ligament is crucial for posterior stability of the knee joint, and, as well as anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction (PCLR) has attracted interest in orthopedic literature. A few studies have investigated epidemiologic data of PCLR in Western countries. However, there has been no report on the epidemiological pattern of PCLR in the Asian population, including South Korea. Therefore, this study investigated the incidence and trends of PCLR in South Korea using the Korean National Health Insurance (NHI) System Database. Methods The data was collected by the Korean Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016 in South Korea. Patients with a record of cruciate ligament reconstruction and PCLR were allocated from the database. An analysis of the total number and incidence per 100,000 people/year of PCLR procedures and other epidemiologic parameters was conducted according to sex and age. Results The incidence of PCLR procedures rose from 2.3 to 2.6 per 100,000 people (from 1101 to 1299 total cases; 13% increase) between 2008 and 2016: from 3.8 to 4.0 (from 901 to 1000) in males, and from 0.8 to 1.2 (from 200 to 299) in females. PCLR was performed more frequently in males than in females, however, the rate of increase was higher in females than males. The incidence of PCLR over 9 years was highest in patients in their 20s, followed by patients in their 40s and 30s. Conclusion The incidence of PCLR procedures increased by 13% over 9 years in South Korea. PCLR was performed approximately three times more in men than in women. The incidence of PCLR was highest in patients in their 20s, followed by those in their 40s. The current study will enhance our understanding of the epidemiology of PCLR. Study design Descriptive Epidemiology Study.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, 9, Mareunnae-ro, Jung-gu, Seoul, Korea.
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14
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Chung KS, Lee MK, Kim JH, Kim JG, Ha JK. An increasing trend of the number of meniscus allograft transplantation in Korea. Knee Surg Sports Traumatol Arthrosc 2021; 29:4131-4137. [PMID: 33638685 DOI: 10.1007/s00167-021-06441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Meniscus allograft transplantation (MAT) can be performed to treat symptomatic patients with meniscus-deficient knees. However, the current epidemiologic status of MAT is unknown in many countries, including Korea. This study aimed to investigate the national trends of MAT in Korea which covers MAT procedures by the Korean national health insurance system. METHODS Information from the national database was acquired through the Korean Health Insurance Review and Assessment Service (HIRA) from 2010 to 2017. All patients encoded as MAT were included. The total number of MATs and their incidence per 100,000 persons were determined, and the results were stratified by age and sex. RESULTS The total number of MATs and their incidence per 100,000 persons per year were 369 and 0.77, respectively, in 2010, which increased to 826 and 1.72, respectively, in 2017. The number of MATs increased by 124% over 8 years. The peaks for the total number of MATs and their incidence were seen in patients in their 20 s in 2010, but in 2017, the peaks were observed in patients who were in their 40 s. MAT was performed more frequently in males (61%) than in females (39%) over the study period. CONCLUSION The total number of MATs and their incidence had increased by 124% between 2010 and 2017. The peak treatment age range for MAT changed from 20 years of age in 2010 to 40 years of age in 2017, and MAT was performed more frequently in males than in females. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, College of Medicine, Seoul Paik Hospital, Inje University, 9, Mareunnae-ro, Jung-gu, Seoul, Republic of Korea
| | - Min Ki Lee
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, College of Medicine, Seoul Paik Hospital, Inje University, 9, Mareunnae-ro, Jung-gu, Seoul, Republic of Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery and Sports Center, Myong-Ji Hospital, Seoul, South Korea
| | - Jeong Ku Ha
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, College of Medicine, Seoul Paik Hospital, Inje University, 9, Mareunnae-ro, Jung-gu, Seoul, Republic of Korea.
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15
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Bansal S, Floyd ER, Kowalski MA, Aikman E, Elrod P, Burkey K, Chahla J, LaPrade RF, Maher SA, Robinson JL, Patel JM. Meniscal repair: The current state and recent advances in augmentation. J Orthop Res 2021; 39:1368-1382. [PMID: 33751642 PMCID: PMC8249336 DOI: 10.1002/jor.25021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Meniscal injuries represent one of the most common orthopedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, meniscal repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of meniscal injuries and to explore current approaches being developed to enhance meniscal repair. Through a systematic literature review, we identified meniscal tear classifications and prevalence, approaches being used to improve meniscal repair, and biological- and material-based systems being developed to promote meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent meniscal reparative techniques.
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Affiliation(s)
- Sonia Bansal
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Kyley Burkey
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | - Jay M. Patel
- Emory University, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Decatur, Georgia, USA
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16
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Barahona M, de Los Santos D, Diaz N, Barrientos C, Infante CA. Trends in Orthopedic Surgery in Chile: Analysis Between 2004 and 2020. Cureus 2021; 13:e15080. [PMID: 34017670 PMCID: PMC8129445 DOI: 10.7759/cureus.15080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To describe the trends of orthopedic surgery in Chile since 2004 in terms of the number and gender of surgeons, the incidence of procedures per 100,000 inhabitants (IR), and access by health insurance and type of health center. Methods A cross-sectional study was designed. Three databases were analyzed: the free access database of the Chilean Department of Statistics and Health Information (DEIS), which had information on all procedures performed in health institutions in Chile from 2004 to 2020. Then, the orthopedic surgeon registry was requested from the National Superintendence of Health (NSH). Finally, the database of the Chilean Society of Orthopaedic Surgeons (SCHOT) was analyzed. Spearman's correlation was used to determine significant trends during the analyzed period. Results The NSH reported 1770 orthopedic surgeons in 2020; 56% were affiliated with SCHOT. An upward trend in the proportion of female orthopedic surgeons was found, from 4.8% in 2004 to 7.6% in 2020. Since 2004, the IR of orthopaedic surgeries has been increasing significantly in both health insurances; the growth in public insurance follows a linear model (R2 = 0.970) of parameters β0 = - 55982.6 (p <0.000) and β1 = 28.02 (p <0.000) while in private insurance, the growth is also linear (R2 = 0.890) but with a greater slope: β0 = - 104136 (p <0.000) and β1 = 52.15 (p <0.000). A significant downward trend was found in the proportion of surgeries performed in the public health network (rho = -0.797, p = 0.0002). Conclusions There is a significant increase in the number of orthopedic surgeons and the number of procedures per 100,000 inhabitants. Nevertheless, there is evident inequity in access to orthopedic surgery in Chile and low gender diversity.
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department/Knee Surgery, Clinica Bupa Santiago, Santiago, CHL
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | | | - Nicolas Diaz
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
| | - Cristian Barrientos
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
- Orthopaedic Department, Clínica Santa María, Santiago, CHL
| | - Carlos A Infante
- Orthopaedic Department, Hospital Clinico Universidad De Chile, Santiago, CHL
- Orthopaedic Department, Clínica Las Condes, Santiago, CHL
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17
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Wasserburger JN, Shultz CL, Hankins DA, Korcek L, Martin DF, Amendola A, Richter DL, Schenck RC, Treme GP. Long-term National Trends of Arthroscopic Meniscal Repair and Debridement. Am J Sports Med 2021; 49:1530-1537. [PMID: 33797976 DOI: 10.1177/0363546521999419] [Citation(s) in RCA: 9] [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 Optimal treatment of meniscal pathology continues to evolve in orthopaedic surgery, with a growing understanding of which patients benefit from which procedure and which patients might be best treated nonsurgically. In 2002, Moseley et al found no difference between arthroscopic procedures, including meniscal debridement and sham surgery, in patients with osteoarthritis of the knee. This called into question the role of routine arthroscopic debridement in these patients. Additionally, an increased interest in understanding and maintaining the function of the meniscus has more recently resulted in a greater focus on meniscal preservation procedures. STUDY DESIGN Descriptive epidemiology study. PURPOSE/HYPOTHESIS The purpose was to evaluate the trends of arthroscopic meniscal debridement and repair and the characteristics of the patients receiving these treatments, compare the differences in practice between newly trained orthopaedic sports medicine specialists and those of other specialties, and analyze if there are differences in practice by region. It was hypothesized that the American Board of Orthopaedic Surgery (ABOS) database would evaluate practice patterns of recent graduates as a surrogate for current treatment and training and, consequently, demonstrate a decreased rate of meniscal debridement. METHODS Data from ABOS Part II examinees from 2001 to 2017 were obtained from the ABOS Case List. Current Procedure Terminology (CPT) codes related to arthroscopic meniscal treatment were selected. The examination year, age of the patient, practice region, and examinee subspecialty were analyzed. Patient age was stratified into 4 groups: <30, 30 to 50, 51 to 65, and >65 years. Examinee subspecialty was stratified into sports medicine and non-sports medicine. Statistical regression analysis was performed. RESULTS Between 2001 and 2017, ABOS Part II examinees submitted 131,047 cases with CPT codes 29880 to 29883. Meniscal debridement volume decreased for all age groups during the study period, while repair increased. Sports medicine subspecialists were more likely than their counterparts to perform repair over debridement in patients aged younger than 30 years (P = .0004) and between 30 and 50 years (P = .0005). CONCLUSION This study provides insights into arthroscopic meniscal debridement and repair practice trends among ABOS Part II examinees. Meniscal debridement is decreasing and meniscal repair is increasing. Younger patient age and treatment by a sports medicine subspecialty examinee are associated with a higher likelihood of repair over debridement.
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Affiliation(s)
- Jory N Wasserburger
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - David A Hankins
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lucas Korcek
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - David F Martin
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina, USA.,Department of Orthopaedics and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Dustin L Richter
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Robert C Schenck
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Gehron P Treme
- Department of Orthopaedics & Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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18
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Jeon SH, Kwon GH, Kim MS. Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic meniscus surgery: A case report. Medicine (Baltimore) 2021; 100:e25372. [PMID: 33787641 PMCID: PMC8021312 DOI: 10.1097/md.0000000000025372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery. PATIENT CONCERNS The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing. DIAGNOSIS On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins. INTERVENTIONS After 3 days of low-molecular-weight heparin 1 mg/kg every 12 hours, treatment was changed to an oral drug, dabigatran, for 6 months. OUTCOMES There were no PTE or DVT findings on computed tomography at 6 months postoperative. The patient did not complain of symptoms related to PTE or DVT at 6 months after the operation, has returned to work, and is living without discomfort. LESSIONS The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of ∼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
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Affiliation(s)
- Sang Hyun Jeon
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Geon Ho Kwon
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Park JG, Bin SI, Kim JM, Lee BS, Lee SM. Trends in Meniscal Allograft Transplant in the Republic of Korea, 2010-2018: An Analysis Based on the Korean National Health Insurance Claims Database. Orthop J Sports Med 2021; 9:2325967121996395. [PMID: 35146024 PMCID: PMC8822109 DOI: 10.1177/2325967121996395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Analyzing the current trends in meniscal allograft transplant (MAT) is important. However, no recent descriptive epidemiological study based on a national registry database has been reported. Purpose: To assess serial trends in the incidence of MAT in the Republic of Korea between 2010 and 2018, stratified by age and sex. Study Design: Descriptive epidemiology study. Methods: The number of MAT procedures between 2010 and 2018 was assessed using the Korean National Health Insurance claims database. We used code N0825 for isolated MAT and code N0820 for MAT combined with other procedures, such as ligament reconstruction, realignment surgery, and cartilage procedures. The incidence of MAT was calculated using the general population data of the Republic of Korea, and Poisson log-linear regression analysis was used to assess statistical serial trends. Results: A total of 369 patients underwent MAT in 2010 and 774 in 2018, with an increase of 47.6%. The incidence of MAT per 100,000 person-years in the Republic of Korea increased significantly during the period studied, from 0.75 in 2010 to 1.50 in 2018 (annual relative risk = 1.09; 95% CI, 1.08-1.10; P < .001), whereas the rate of MAT combined with other procedures increased from 5.1% in 2014 to 16.0% in 2018. MAT was mostly performed in men in their early 20s. Most MAT procedures were performed in the summer and winter, with distinct seasonal variances. Conclusion: In the Republic of Korea, the incidence of MAT in 2018 was 1.50 per 100,000 person-years, with an average annual increase of 10% since 2010. MAT was mostly performed in men in their early 20s, and the rate of MAT combined with other procedures has increased since 2014.
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Affiliation(s)
- Jun-Gu Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University 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
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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20
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Chung KS, Kim JH, Kong DH, Park I, Kim JG, Ha JK. An Increasing Trend in the Number of Anterior Cruciate Ligament Reconstruction in Korea: A Nationwide Epidemiologic Study. Clin Orthop Surg 2021; 14:220-226. [PMID: 35685966 PMCID: PMC9152897 DOI: 10.4055/cios20276] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyu Sung Chung
- Department of Orthopaedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Korea
| | - Doo Hwan Kong
- Department of Orthopaedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - InKeun Park
- Department of Orthopaedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery and Sports Center, Myongji Hospital, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopaedic Surgery and Sports Medical Center and Sports Medical Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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21
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Hong CY, Lee CG, Kim DH, Cho YS, Kim KY, Ryu SY, Song HS. Work-Related Risk Factors of Knee Meniscal Tears in Korean Farmers: A Cross-Sectional Study. Saf Health Work 2020; 11:485-490. [PMID: 33329915 PMCID: PMC7728704 DOI: 10.1016/j.shaw.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/12/2023] Open
Abstract
Background Meniscal tears are among the major risk factors for knee osteoarthritis progression. This study aimed to investigate the relationship between meniscal tears and work-related factors in the farming occupation. Methods The participants included 486 farmers (238 men and 248 women), aged 40–69 years, who were among the 550 farmers registered in the Korea Farmer's Knee Cohort (KFKC). Data such as those on gender, age, body mass index (BMI), mechanical axis, cumulative heavy-lifting working time (CLWT), cumulative squatting working time (CSWT), and previous knee injury history were collected from the questionnaire, along with whole leg radiographic findings. Two radiologists assessed the magnetic resonance images of both knees to confirm the presence of meniscal tears. The factors related to meniscal tears were analyzed by multiple logistic regression. Results A total of 54.5% of the farmers (48.7% of men and 60.1% of women) had meniscal tears. These tears were associated with gender, age, and BMI. We also identified an association between meniscal tears and CSWT, an especially important factor in farming [10,000–19,999 working hours, odds ratio = 2.16, 95% confidence interval (CI): 1.14-4.07, ≥20,000 working hours, odds ratio = 2.35, 1.45-3.80]. However, mechanical axis, knee injury history, and CLWT were not significantly related to meniscal tears. Conclusion This study's findings show that squatting for long periods, as an occupational factor, is related to meniscal tears.
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Affiliation(s)
- Chae Young Hong
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Chul Gab Lee
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Dong Hwi Kim
- Department of Orthopedic Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Yong Soo Cho
- Department of Radiology, Chosun University Hospital, Gwangju, South Korea
| | - Kweon Young Kim
- Department of Rehabilitation Medicine, Chosun University Hospital, Gwangju, South Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Han Soo Song
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
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Abstract
Whether to repair or resect meniscal tears remains a matter of controversy. In theory, partial meniscectomy increases contact pressure, which may result in progressive and early cartilage degeneration and early osteoarthritis. Meniscal preservation is the preferred treatment option, but only a small percentage of meniscal tears are suitable for repair. Two recent registry studies challenge this approach and suggest that partial meniscectomy has similar clinical outcomes in the short term. Whether these findings can be maintained in the long term remains to be seen.
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Park JW. Higher Meniscus Surgery Incidence in Korea Compared to Japan or the USA. J Korean Med Sci 2019; 34:e233. [PMID: 31432655 PMCID: PMC6698455 DOI: 10.3346/jkms.2019.34.e233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jang Won Park
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Ewha Seoul Hospital, Seoul, Korea.
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