1
|
Wang H, Wu J, Yang L, Liu S, Sui X, Guo Q, Chen M. Surgical therapy and tissue engineering for meniscal repair. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 39083434 DOI: 10.1089/ten.teb.2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Meniscal damage is one of the prevalent causes of knee pain, swelling, instability, and functional compromise, frequently culminating in osteoarthritis (OA). Timely and appropriate interventions are crucial to relieve symptoms and prevent or delay the onset of OA. Contemporary surgical treatments include total or partial meniscectomy, meniscal repair, allograft meniscal transplantation, and synthetic meniscal implants, but each presents its specific limitations. Recently, regenerative medicine and tissue engineering have emerged as promising fields, offering innovative prospects for meniscal regeneration and repair. This review delineates current surgical methods, elucidating their specific indications, advantages, and disadvantages. Concurrently, it delves into state-of-the-art tissue engineering techniques aimed at the functional regenerative repair of meniscus. Recommendations for future research and clinical practice are also provided.
Collapse
Affiliation(s)
- Hao Wang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China;
| | - Jie Wu
- Chinese PLA General Hospital, Beijing, Beijing, China;
| | - Liupu Yang
- Chinese PLA General Hospital, Beijing, Beijing, China;
| | - Shuyun Liu
- Institute of Orthopedics, Chinese PLA General Hospital, Key Laboratory of PLA (People's Liberation Army), Beijing, China;
| | - Xiang Sui
- Chinese PLA General Hospital, Institute of Orthopaedics, Beijing, China;
| | - Quanyi Guo
- Chinese PLA General Hospital, Institute of Orthopaedics, 28 Fuxing Road, Haidian District, Beijing, People's Republic of China, Beijing, China, 100853;
| | - Mingxue Chen
- Beijing Jishuitan Hospital Affiliated to Capital Medical University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China., Beijing, China, 100035;
| |
Collapse
|
2
|
Zhang Y, Zhang Y, Wang C, Heo Y, Tumenbayar BI, Lee SH, Bae Y, Chin Heo S. Epigenetic Dynamics in Meniscus Cell Migration and its Zonal Dependency in Response to Inflammatory Conditions: Implications for Regeneration Strategies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.22.604178. [PMID: 39091842 PMCID: PMC11291020 DOI: 10.1101/2024.07.22.604178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Meniscus injuries pose significant challenges in clinical settings, primarily due to the intrinsic heterogeneity of the tissue and the limited efficacy of current treatments. Endogenous cell migration is crucial for the healing process, yet the regulatory mechanisms of meniscus cell migration and its zonal dependency within the meniscus are not fully understood. Thus, this study investigates the role of epigenetic mechanisms in governing meniscus cell migration under inflammatory conditions, with a focus on their implications for injury healing and regeneration. Here, we discovered that a proinflammatory cytokine, TNF-α treatment significantly impedes the migration speed of inner meniscus cells, while outer meniscus cells are unaffected, underscoring a zonal-dependent response within the meniscus. Our analysis identified distinct histone modification patterns and chromatin dynamics between inner and outer meniscus cells during migration, highlighting the necessity to consider these zonal-dependent properties in devising repair strategies. Specifically, we found that TNF-α differentially influences histone modifications, particularly H3K27me3, between the two cell types. Transcriptome analysis further revealed that TNF-α treatment induces substantial gene expression changes, with inner meniscus cells exhibiting more pronounced alterations than outer cells. Gene cluster analysis pointed to distinct responses in chromatin remodeling, extracellular matrix assembly, and wound healing processes between the zonal cell populations. Moreover, we identified potential therapeutic targets by employing existing epigenetic drugs, GSKJ4 (a histone demethylase inhibitor) and C646 (a histone acetyltransferase inhibitor), to successfully restore the migration speed of inner meniscus cells under inflammatory conditions. This highlights their potential utility in treating meniscus tear injuries. Overall, our findings elucidate the intricate interplay between epigenetic mechanisms and meniscus cell migration, along with its meniscus zonal dependency. This study provides insights into potential targets for enhancing meniscus repair and regeneration, which may lead to improved clinical outcomes for patients with meniscus injuries and osteoarthritis.
Collapse
Affiliation(s)
- Yize Zhang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Yujia Zhang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Wang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuna Heo
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Bat-Ider Tumenbayar
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Se-Hwan Lee
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yongho Bae
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Biomedical Engineering, School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, USA
| | - Su Chin Heo
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Jiang K, Xie Y, Zhang X, Zhang X, Zhou B, Li M, Chen Y, Hu J, Zhang Z, Chen S, Yu K, Qiu C, Zhang X. Fully and Weakly Supervised Deep Learning for Meniscal Injury Classification, and Location Based on MRI. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01198-4. [PMID: 39020156 DOI: 10.1007/s10278-024-01198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
Meniscal injury is a common cause of knee joint pain and a precursor to knee osteoarthritis (KOA). The purpose of this study is to develop an automatic pipeline for meniscal injury classification and localization using fully and weakly supervised networks based on MRI images. In this retrospective study, data were from the osteoarthritis initiative (OAI). The MR images were reconstructed using a sagittal intermediate-weighted fat-suppressed turbo spin-echo sequence. (1) We used 130 knees from the OAI to develop the LGSA-UNet model which fuses the features of adjacent slices and adjusts the blocks in Siam to enable the central slice to obtain rich contextual information. (2) One thousand seven hundred and fifty-six knees from the OAI were included to establish segmentation and classification models. The segmentation model achieved a DICE coefficient ranging from 0.84 to 0.93. The AUC values ranged from 0.85 to 0.95 in the binary models. The accuracy for the three types of menisci (normal, tear, and maceration) ranged from 0.60 to 0.88. Furthermore, 206 knees from the orthopedic hospital were used as an external validation data set to evaluate the performance of the model. The segmentation and classification models still performed well on the external validation set. To compare the diagnostic performances between the deep learning (DL) models and radiologists, the external validation sets were sent to two radiologists. The binary classification model outperformed the diagnostic performance of the junior radiologist (0.82-0.87 versus 0.74-0.88). This study highlights the potential of DL in knee meniscus segmentation and injury classification which can help improve diagnostic efficiency.
Collapse
Affiliation(s)
- Kexin Jiang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Yuhan Xie
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xintao Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Xinru Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Beibei Zhou
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Mianwen Li
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Jiaping Hu
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Zhiyong Zhang
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Shaolong Chen
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Keyan Yu
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Changzhen Qiu
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China.
| | - Xiaodong Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China.
| |
Collapse
|
4
|
Yatsonsky D, Gunn JL, Dong T, Maxwell A, Sohn D. Novel Meniscus Transfer Technique: A Case Report. Cureus 2024; 16:e63677. [PMID: 39092400 PMCID: PMC11293484 DOI: 10.7759/cureus.63677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
The meniscus is an essential component of the knee joint, acting as a shock absorber as well as assisting in the transmission of forces. Due to the meniscus importance of the knee, much of the current literature focuses on treatment techniques that can spare and repair the meniscus when it is torn. The unique vasculature of the meniscus often makes repair difficult or, in many cases, impossible. A current focus within orthopedics has been on meniscal allograft transplantation to fill this gap. The lack of a universal surgical technique for graft fixation, along with the current failure rates, demonstrates the need for further improvements. The senior author proposes a novel technique for meniscal allograft transplantation that has shown decreased blood loss and surgical time, while also reducing intra-operative trauma to the knee. This case reports a 16-year-old patient who underwent a right lateral meniscal allograft transplant following a large segmental defect tear of the lateral meniscus. The patient initially underwent arthroscopy and meniscectomy with screw fixation of the lateral femoral condyle lesion. After physical therapy, the patient experienced increased pain and swelling, with magnetic resonance imaging (MRI) demonstrating a meniscal defect unamenable to repair. The patient met indications for meniscal allograft transplantation given the failed meniscectomy, absence of cartilage loss and significant osteoarthritis, and the patient's age of less than 50 years old.
Collapse
Affiliation(s)
- David Yatsonsky
- Orthopedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Jenna L Gunn
- College of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Tony Dong
- College of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Aidan Maxwell
- College of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - David Sohn
- Orthopedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| |
Collapse
|
5
|
Ibañez M, Hoffmann F, Mouton C, Seil R. Horizontal Cleavage Meniscus Tear: "The Quad Tendon Augmentation Technique". Arthrosc Tech 2024; 13:102977. [PMID: 39036403 PMCID: PMC11258872 DOI: 10.1016/j.eats.2024.102977] [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: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
The management of medial meniscus horizontal cleavage tears can be challenging. Currently, several treatment options, including nonoperative and surgical options, have been proposed in the literature. Different repair techniques aiming to promote the healing process have been reported and have shown good outcomes. However, recurrent parameniscal cysts and decreased meniscal volume have also been reported. In this Technical Note, a novel surgical technique to repair a horizontal cleavage tear of the posterior horn of the medial meniscus is reported in young patients. The technique uses a strip of autologous quadriceps tendon to fill the void between the upper and lower meniscal leaflets followed by an all-inside compression suture. Both of these technical features aim to overcome the limitations of current repair techniques.
Collapse
Affiliation(s)
- Maximiliano Ibañez
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Hoffmann
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg
| |
Collapse
|
6
|
Reiter CR, Wyatt PB, O'Neill CN, Satalich JR, O'Connell RS, Vap AR. Increased Age, Operative Time, American Society of Anesthesiologists Classification, Functional Dependency, and Comorbidity Burden Are Risk Factors for Adverse Events After Meniscectomy and Meniscus Repair: 10-Year Analysis of 64,223 Patients. Arthroscopy 2024; 40:1848-1855. [PMID: 37967730 DOI: 10.1016/j.arthro.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To use the National Surgical Quality Improvement Program (NSQIP) database to identify risk factors for 30-day adverse events and hospital readmission following isolated and unilateral meniscectomy or meniscus repair. METHODS A retrospective review of the NSQIP database from the years 2012 to 2021 identified all patients undergoing isolated, unilateral meniscectomy or meniscus repair. Multivariable analyses were performed for each procedure to identify patient characteristics associated with any adverse event (AAE) or unplanned hospital readmission within 30 days of surgery. RESULTS From 2012 to 2021, 59,450 (93%) patients underwent meniscectomy, and 4,773 (7%) patients underwent meniscus repair. Overall adverse event rate was 0.95% after meniscectomy and 1.40% after repair. Risk factors for AAE after meniscectomy included increased age (odds ratio [OR] = 1.010; P = .009), increased operative time (OR = 1.003; P = 0.011), American Society of Anesthesiologists (ASA) class IV (OR = 2.048; P = .045), functional dependency (OR = 3.527; P = .001), and current smoking (OR = 1.308; P = .018). Risk factors for AAE after meniscus repair included age (OR = 1.024; P = .016), operative time (OR = 1.004; P = .038), and bleeding disorders (OR = 7.000; P = .014). ASA class III increased risk of hospital readmission after both procedures (OR = 1.906; P = .008; OR = 4.101; P = .038), and medical comorbidities of heart failure (OR = 3.924; P = .016), hypertension (OR = 1.412; P = .011), and chronic obstructive pulmonary disease (OR = 2.350; P < .001) increased readmission risk after meniscectomy only. CONCLUSIONS Per analysis of the American College of Surgeons (ACS)-NSQIP database, surgical treatment of meniscal tears in the knee has been performed frequently over the past 10 years, with meniscectomies comprising over 90% of cases. Increased age and operative time were associated with a modest risk of adverse events after both meniscectomy and meniscus repair. Increased comorbidity burden, evidenced by ASA class, dependent functional status, current smoking, and systemic medical conditions, such as heart failure, hypertension, chronic obstructive pulmonary disease, and bleeding disorders, greatly increased rates of unfavorable outcomes within 30 days of meniscus surgery. LEVEL OF EVIDENCE Level III, retrospective prognostic comparative investigation.
Collapse
Affiliation(s)
- Charles R Reiter
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A..
| | - Phillip B Wyatt
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Conor N O'Neill
- Duke University Health System, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - James R Satalich
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Robert S O'Connell
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| |
Collapse
|
7
|
Tsourmas NF, Bernacki EJ, Hunt DL, Kalia N, Lavin RA, Yuspeh L, Leung N, Green-McKenzie J, Tao XG. Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier. J Occup Environ Med 2024; 66:280-285. [PMID: 38234200 DOI: 10.1097/jom.0000000000003044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS Undergoing an AM is associated with an increased risk of TKA in WC claimants.
Collapse
Affiliation(s)
- Nicholas F Tsourmas
- From the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (N.F.T., E.J.B., R.A.L., N.K., L.Y., N.L., X.T.); AF Group, Lansing, MI (D.L.H.); General Electric, Norwalk, Connecticut (N.K.); Corporate Administration Office, Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (N.F.T., N.L.). University of Pennsylvania, Philadelphia, Pennsylvania (J.G.-M.)
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Hurmuz M, Ionac M, Hogea B, Miu CA, Tatu F. Osteoarthritis Development Following Meniscectomy vs. Meniscal Repair for Posterior Medial Meniscus Injuries: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:569. [PMID: 38674215 PMCID: PMC11052089 DOI: 10.3390/medicina60040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.
Collapse
Affiliation(s)
- Mihai Hurmuz
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Mihai Ionac
- Department X, Discipline of Vascular Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Bogdan Hogea
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Profesor Universitar Doctor Teodor Șora Research Centre, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Catalin Adrian Miu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Fabian Tatu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| |
Collapse
|
9
|
Ciapini G, Varchetta G, Bizzocchi F, Gadsby G, Lombardi L, Sgadò F, Ipponi E, Scaglione M, Parchi PD. All-Inside Arthroscopic Meniscus Repair for Patients Over 40 Years of Age: Is Forty the New Twenty? Cureus 2024; 16:e56413. [PMID: 38638784 PMCID: PMC11024730 DOI: 10.7759/cureus.56413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Meniscal injuries are a common challenge in orthopedic surgery. For decades, partial or total meniscectomy has been the primary surgical treatment for meniscal tears. In recent years, the increased recognition of menisci's biomechanical importance has progressively shifted the paradigm towards meniscus repair. However, meniscus-sparing surgery remains the treatment of choice for selected lesions in young and active patients, especially for young and active patients. In this study, we evaluated the effectiveness of all-inside sutures in treating meniscus tears in patients over 40. METHODS In our retrospective evaluation, we evaluated the clinical and functional outcomes of cases over 40 years of age with post-traumatic acute meniscus tears that received meniscus repairs using the all-inside technique. The pre-operative and post-operative functionality of treated patients were assessed using the knee injury and osteoarthritis outcome score (KOOS) score. Major complications were recorded. RESULTS Twenty-three cases met our inclusion criteria. Eight females and fifteen males with a mean age of 44.9 were included in our study. Their mean follow-up was 35.1 months. Before surgery, our patients' mean KOOS score was 55.4 (18-80). At the patients' latest follow-up, the value had risen to 87.4 (63-100). There was no statistical correlation between patients' age and their functional recovery. No surgical failure was recorded at the latest follow-up. CONCLUSION The all-inside suture technique can represent a suitable and reliable solution for suturable meniscal tears, even for patients over 40. Preserving the meniscus and restoring patients' functionality allows patients to return to their daily activities and promote their quality of life.
Collapse
Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giorgio Varchetta
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Federico Bizzocchi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giulio Gadsby
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Leonardo Lombardi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Francesca Sgadò
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Edoardo Ipponi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | | | | |
Collapse
|
10
|
Zabrzyńska M, Pasiński M, Gagat M, Kułakowski M, Woźniak Ł, Elster K, Antosik P, Zabrzyński J. The Association between the Extent of the Osteoarthritic Meniscus Degeneration and Cigarette Smoking-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:323. [PMID: 38399610 PMCID: PMC10890507 DOI: 10.3390/medicina60020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.
Collapse
Affiliation(s)
- Maria Zabrzyńska
- Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Maciej Pasiński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Płock, 09-402 Płock, Poland
| | - Michał Kułakowski
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Łukasz Woźniak
- Department of Orthopaedics and Traumatology, University of Medical Sciences, 61-701 Poznan, Poland
| | - Karol Elster
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Paulina Antosik
- Department of Clinical Pathology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
| | - Jan Zabrzyński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
| |
Collapse
|
11
|
Gill VS, Haglin JM, Tummala SV, Iturregui J, Economopoulos KJ, Chhabra A. Meniscectomy Reimbursement and Utilization Are Declining at Different Rates Across the United States. Arthroscopy 2024:S0749-8063(24)00095-1. [PMID: 38336106 DOI: 10.1016/j.arthro.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate how arthroscopic meniscectomy utilization, reimbursement, physician billing practices, and patient populations have changed within the Medicare population from 2013 to 2021 at a national level and regional level. METHODS The Medicare Physician & Other Practitioners database was queried for all episodes of 2-compartment and single-compartment arthroscopic meniscectomy between 2013 and 2021. Utilization per 10,000 beneficiaries and average inflation-adjusted reimbursement were assessed. Physician practice styles, measured through changes in the services billed, and Medicare beneficiary demographic characteristics were extracted each year. The Kruskal-Wallis test was performed to compare regions. RESULTS Between 2013 and 2021, two-compartment meniscectomy utilization per 10,000 Medicare beneficiaries declined by 54.9% and single-compartment meniscectomy utilization declined by 54.2%. Average reimbursement declined by 9.3% and 12.5% for 2-compartment meniscectomy and single-compartment meniscectomy, respectively. In 2021, the South had the highest utilization of both 2-compartment (3.8/10,000) and single-compartment (4.7/10,000) meniscectomies while having the lowest average reimbursement for 2-compartment meniscectomy ($383.02, P < .001). Nationally, the average number of beneficiaries per surgeon performing single-compartment meniscectomy declined by 3.8% whereas the average number of billable services performed per beneficiary increased by 46.6%. The comorbidity risk score of these patients decreased by 8.7%, with the West having the healthiest patients in 2021. CONCLUSIONS Meniscectomy utilization and reimbursement have been declining nationally within the Medicare population. Surgeons in the South performed the most meniscectomies while having among the lowest reimbursement. The practice patterns of surgeons performing meniscectomies have been changing, with surgeons performing nearly 50% more total billable services per beneficiary while performing fewer unique billable services. Additionally, the patient population of surgeons who perform meniscectomy was healthier in 2021 than in 2013. CLINICAL RELEVANCE This study highlights changes in meniscectomy utilization and reimbursement over time in the face of changing evidence of meniscectomy use in elderly patients and new Medicare legislature regarding reimbursement.
Collapse
Affiliation(s)
- Vikram S Gill
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A.; Mayo Clinic Alix School of Medicine, Phoenix, Arizona, U.S.A..
| | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Jose Iturregui
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| |
Collapse
|
12
|
Dzidzishvili L, Berreta RS, Jackson GR, Mowers CC, Cotter EJ, Allahabadi S, Chahla J. All-Inside and Inside-Out Repair Techniques for Bucket-Handle Meniscus Tears Both Result in Improved Patient Outcomes and a Broad Range of Failure Rates: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00065-3. [PMID: 38311264 DOI: 10.1016/j.arthro.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare patient-reported outcomes, failure rates, risk factors for failure, and complications in patients with bucket-handle meniscus tears (BHMTs) undergoing repair with inside-out (IO) versus all-inside (AI) techniques. METHODS A literature search was performed using the PubMed, Embase, and Scopus databases from database inception to August 2023 according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria consisted of Level I to IV clinical studies published in the past 10 years with greater than 2 years of follow-up that evaluated patient-reported outcome scores and/or the incidence of failure after IO or AI repairs for BHMTs. Clinical studies not reporting outcomes or failure rates, older studies using outdated implants, animal studies, reviews, letters to the editor, case reports, cadaveric studies, and articles not written in the English language or with English-language translation were excluded. Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) criteria. Outcomes were reported as ranges and qualitatively compared. RESULTS A total of 16 studies published from 2013 to 2023, consisting of 1,062 patients with BHMTs, were identified. Thirteen studies (14 cohorts, 649 patients) reported on AI repair (mean age range, 23.7-32 years) and 7 studies (7 cohorts, 413 patients) reported on IO repair (mean age range, 16.7-34.6 years). Both groups had improved postoperative Lysholm and Tegner scores. Decreased range of motion was the most commonly reported complication in the AI group (range, 2.6%-4%), whereas adhesions for arthrofibrosis were the most commonly reported complication in the IO group (n = 12; range, 6%-7.9%). The overall reported failure rate ranged from 6.9% to 20.5% within the AI group and from 0% to 20% within the IO group. CONCLUSIONS AI and IO repair techniques for BHMTs both result in improved Lysholm and Tegner scores. However, broad ranges of failure are reported in the literature, with overall failure rates ranging from 6.9% to 20.5% after AI repair and from 0% to 20% after IO repair. Younger age and isolated medial BHMT repair are the most frequently reported risk factors for the AI technique, whereas postoperative stiffness is the most frequently reported complication after both repair techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
Collapse
Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Rodrigo Saad Berreta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Colton C Mowers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Eric J Cotter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
| |
Collapse
|
13
|
Sato EH, O'Neill DC, Steffenson LN, Myhre LA, Higgins TF, Rothberg DL, Marchand LS, Haller JM. Meniscus Tear Requiring Intraoperative Repair Does Not Influence Midterm Patient-Reported Outcomes in Operatively Treated Tibial Plateau Fractures. J Orthop Trauma 2024; 38:109-114. [PMID: 38031250 DOI: 10.1097/bot.0000000000002724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Evaluate whether intraoperatively repaired lateral meniscus injuries impact midterm patient-reported outcomes in those undergoing operative fixation of tibial plateau fracture. METHODS DESIGN Retrospective cohort study. SETTING Level I trauma center. PATIENT SELECTION CRITERIA All patients (n = 207) who underwent operative fixation of a tibial plateau fracture from 2016 to 2021 with a minimum of 10-month follow-up. OUTCOME MEASURES AND COMPARISONS The Patient-Reported Outcomes Measurement Information System Physical Function, Knee Injury and Osteoarthritis Outcome Score, and the PROMIS-Preference health utility score. RESULTS Overall, 207 patients were included with average follow-up of 2.9 years. Seventy-three patients (35%) underwent intraoperative lateral meniscus repair. Gender, age, body mass index, Charlson comorbidity index, days to surgery, ligamentous knee injury, open fracture, vascular injury, polytraumatic injuries, Schatzker classification, and Orthopaedic Trauma Association classification were not associated with meniscal repair ( P > 0.05). Rates of reoperation (42% vs. 31%, P = 0.11), infection (8% vs. 10%, P = 0.60), return to work (78% vs. 75%, P = 0.73), and subsequent total knee arthroplasty (8% vs. 5%, P = 0.39) were also similar between those who had a meniscal repair and those without a meniscal injury, respectively. There was no difference in Patient-Reported Outcomes Measurement Information System Physical Function (46.3 vs. 45.8, P = 0.707), PROMIS-Preference (0.51 vs. 0.50, P = 0.729), and all Knee Injury and Osteoarthritis Outcome Score domain scores at the final follow-up between those who had a meniscal repair and those without a meniscal injury, respectively. CONCLUSIONS In patients with an operatively treated tibial plateau fracture, the presence of a concomitant intraoperatively identified and repaired lateral meniscal tear results in similar midterm PROMs and complication rates when compared with patients without meniscal injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Eleanor H Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Migliorini F, Schäfer L, Bell A, Weber CD, Vecchio G, Maffulli N. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5485-5495. [PMID: 37812251 PMCID: PMC10719156 DOI: 10.1007/s00167-023-07600-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography. METHODS This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Two reviewers independently performed the analysis and a methodological quality assessment of the included studies. All the clinical investigations which compared repair versus resection of meniscal tears were accessed. RESULTS Data from 20 studies (31,783 patients) were collected. The mean BMI was 28.28 ± 3.2 kg/m2, and the mean age was 37.6 ± 14.0 years. The mean time elapsed from injury to surgery was 12.1 ± 10.2 months and the mean medial joint width was 4.9 ± 0.8 mm. Between studies comparability at baseline was found in age, women, BMI, time from injury to surgery and length of the follow-up, PROMs, medial joint width, and stage of OA. The resection group demonstrated a greater Lysholm score (P = 0.02). No difference was found in the International Knee Documentation Committee (P = 0.2). Nine studies reported data on the rate of failures at a mean of 63.00 ± 24.7 months. No difference was found between the two groups in terms of persistent meniscal symptoms (P = 0.8). Six studies reported data on the rate of progression to total knee arthroplasty at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to knee arthroplasty (P = 0.0001). Six studies reported data on the rate of advanced knee OA at a mean of 48.0 ± 14.7 months of follow-up. The repair group evidenced a lower rate of advanced knee OA (P = 0.0001). No difference was found in the mean joint space width (P = 0.09). CONCLUSION Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy. No difference in PROMs, medial joint width, and failures were evidenced. LEVEL OF EVIDENCE Level III, meta-analysis.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Christian David Weber
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | - Nicola Maffulli
- Faculty of Medicine and Psychology, University Hospital Sant' Andrea, University La Sapienza, 00185, Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, UK
| |
Collapse
|
15
|
Jaibaji R, Khaleel F, Jaibaji M, Volpin A. Outcomes of Meniscal Repair in Patients Aged 40 and Above: A Systematic Review. J Clin Med 2023; 12:6922. [PMID: 37959387 PMCID: PMC10649032 DOI: 10.3390/jcm12216922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE Meniscal injuries are increasingly common in older age groups. Age is often cited as a contraindication to undergoing meniscal repair due to concerns regarding failure rates. There has recently, however, been an increasing shift towards repair in older populations. The purpose of this study was to review outcomes of meniscal repair in patients over the age of 40. METHODS A systematic search of the following databases was conducted of PubMed, SCOPUS, Web of Science, and Cochrane Library to identify studies reporting failure rates of patients over 40 with meniscal injuries undergoing repair. The definition of meniscus failure was noted for each study evaluated in this systematic review. Further data surrounding clinical and radiological outcomes were recorded and evaluated, when available. RESULTS Thirteen studies were included in this review, encompassing a total of 316 meniscal repairs in patients over the age of 40 years. The overall failure rate was found to be 15.5% (49/316) (range 0-33.3%). There was no difference in the failure rate in those over 40 vs. under 40, and the two groups had equivalent functional outcomes. CONCLUSIONS Age should not be considered a contra-indication for meniscal repair. Appropriately selected older patients can have acceptably low failure rates with meniscal repair and similar functional outcomes to those under the age of forty. Meniscal repairs in those over 40 achieved better functional outcomes than patients of the same age group who underwent meniscectomy.
Collapse
Affiliation(s)
- Rawan Jaibaji
- Imperial College NHS Healthcare Trust, London W2 1NY, UK;
| | - Faisal Khaleel
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Monketh Jaibaji
- Health Education North East England, Newcastle upon Tyne NE15 8NY, UK;
| | | |
Collapse
|
16
|
Yadav A, Kushwaha S, Kamal R, Khan FA, Sood A. Predictive Factors Influencing the Return to Sports Following Arthroscopic Knee Meniscectomy in Sports Persons: A Prospective Cohort Study. Cureus 2023; 15:e49334. [PMID: 38143636 PMCID: PMC10748851 DOI: 10.7759/cureus.49334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Meniscus tears are among the common knee injuries in sports, with arthroscopic meniscectomy being one of the most commonly performed orthopedic procedures. Return to sports of the same level following arthroscopic meniscectomy is an important aspect for athletes. Numerous factors may influence the time required for athletes to resume sports activities after meniscectomy. This prospective cohort study aimed to investigate the timeframe for returning to sports in athletes who underwent arthroscopic meniscectomy and to identify predictive factors that influence this return. Ninety sports persons who had undergone arthroscopic meniscectomy were included in this study. The patients were analyzed for their time to return to sports and nine proposed predictive factors that may influence their return to sports. Out of the 90 participants, 75 were able to return to their previous activity level, while the remaining 15 were unable to do so. Among the nine pre-defined factors studied, age older than 25 years (p < 0.0001), participation in non-contact sports (p < 0.0001), and engagement in recreational activities (p < 0.0001) were found to be statistically significant. In conclusion, this study reveals that with the increase in age, time to return to sports following arthroscopic meniscectomy increases. Additionally, athletes involved in non-contact sports and those having recreational sports activity levels experience greater delays in their return to sports as compared to athletes involved in combat and contact sports and athletes having elite and competitive sports levels, respectively.
Collapse
Affiliation(s)
- Anil Yadav
- Sports Medicine, Sports Injury Center, Safdarjung Hospital, New Delhi, IND
| | - Sushmita Kushwaha
- Sports Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Rafat Kamal
- Sports Medicine, Sports Injury Center, Safdarjung Hospital, New Delhi, IND
| | - Firoz A Khan
- Sports Medicine, Sports Injury Center, Safdarjung Hospital, New Delhi, IND
| | - Aditya Sood
- Sports Medicine, Sports Injury Center, Safdarjung Hospital, New Delhi, IND
| |
Collapse
|
17
|
Tfayli Y, Nassar JE, Naja AS, Al-Taki M. Arthroscopic Meniscus Trephination: A Novel Technique for the Treatment of Symptomatic Meniscal Degeneration: Surgical Technique and Literature Review. J Orthop Case Rep 2023; 13:141-144. [PMID: 37885655 PMCID: PMC10599380 DOI: 10.13107/jocr.2023.v13.i10.3968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Meniscal pathology constitutes a major reason for a vast number of patients suffering from knee pain. It is, in general, attributed either to meniscal tearing or degeneration. Debridement and partial meniscectomy, or repair, when possible, is the mainstay surgical approach for refractory knee pain from meniscal degeneration or tears. Sometimes, the patient has clinical symptoms of meniscal pathology, but despite those highly suggestive clinical symptoms, the patient turns out, during knee arthroscopy, to have meniscal degeneration and hardening of the meniscus without frank tearing of the meniscus. Surgical Technique To initiate meniscal trephination, we first conduct a diagnostic knee arthroscopy to examine the suprapatellar space, the gutters, and the anterior knee space for any pathologies. Following this, both menisci are inspected for any signs of tearing or hardening. For the purposes of our study, the medial meniscus is considered pathological if it shows signs of degeneration or hardening, which then justifies our intervention. An 18-gauge spinal needle, manually bent for the procedure, is inserted through the portal to perform trephination on the hardened menisci. Care is taken to adequately space the needle insertion points to prevent accidental tearing. Our trephination technique aims to soften the meniscus, facilitating its ability to compact and compress when patients ambulate. Additionally, the needle insertion points help attract blood flow to the meniscus, thereby enriching it with growth factors and stem cells that may aid in improving the degenerative condition. Conclusion Meniscal trephination is benign and effective for meniscal degenerative pathologies. The procedure allows for a healthier meniscus, free from degeneration, that would otherwise disable patients. The intervention does not have long-term adverse effects. To this end, more comparative trials are required to confirm the effectiveness of the technique and to ensure minimal to no associated side effects.
Collapse
Affiliation(s)
- Yehia Tfayli
- Jefferson Health Northeast 3B Orthopaedics, Philadelphia, PA, USA
| | - Joseph E Nassar
- Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhyeddine Al-Taki
- Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
18
|
Sánchez M, Jorquera C, Bilbao AM, García S, Beitia M, Espregueira-Mendes J, González S, Oraa J, Guadilla J, Delgado D. High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2023; 31:4246-4256. [PMID: 37302993 DOI: 10.1007/s00167-023-07470-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the efficacy of applying a combination of intrameniscal and intraarticular infiltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may influence the positive response to this treatment. METHODS Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was defined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 months and 18 months. Other patient- and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables. RESULTS The PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4 months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a significant statistical increase from baseline to 6 months (N = 93) and 18 months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6 months and 18 months post-treatment was 65 (69.9%) and 43 (65.2%), respectively. CONCLUSION The combination of intrameniscal and intraarticular PRP infiltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its efficacy is higher in horizontal tears and decreases when joint degeneration is present. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain
| | - Cristina Jorquera
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain
| | - Ane Miren Bilbao
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Saínza García
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain
| | - Maider Beitia
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain
| | - João Espregueira-Mendes
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, University of Minho, Braga, 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, Barco, Guimarães, Portugal
| | - Sergio González
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Jaime Oraa
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Jorge Guadilla
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain.
| |
Collapse
|
19
|
Deviandri R, Daulay MC, Iskandar D, Kautsar AP, Lubis AMT, Postma MJ. Health-economic evaluation of meniscus tear treatments: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3582-3593. [PMID: 36637478 PMCID: PMC10435400 DOI: 10.1007/s00167-022-07278-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. METHODS Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. RESULTS Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. CONCLUSION Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. LEVEL OF EVIDENCE Systematic review of level IV studies.
Collapse
Affiliation(s)
- R Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia.
- Division of Orthopedics, Arifin Achmad Hospital, Pekanbaru, Indonesia.
| | - M C Daulay
- Division of Orthopedics, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - D Iskandar
- Faculty of Pharmacy, Universitas Bhakti Kencana, Bandung, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - A P Kautsar
- Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - A M T Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - M J Postma
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
20
|
Bottomley J, Al-Dadah O. Arthroscopic Meniscectomy vs Meniscal Repair: Comparison of Clinical Outcomes. Cureus 2023; 15:e44122. [PMID: 37750149 PMCID: PMC10518210 DOI: 10.7759/cureus.44122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Background Meniscal tears are the most common injury of the knee. Surgical treatment has fallen into contention recently and includes arthroscopic meniscectomy and meniscal repair. The primary aim of this study was to quantitatively evaluate patients with isolated meniscal tears and compare their outcomes with patients who have undergone arthroscopic meniscus surgery. The secondary aim of this study was to compare the clinical outcomes of patients who have undergone arthroscopic meniscectomy with patients who have undergone arthroscopic meniscal repair. Methods This comparative clinical study screened 334 patients to identify subjects who underwent arthroscopic knee surgery for isolated meniscal tears and compare them to patients with symptomatic isolated meniscal tears awaiting surgery using validated patient-reported outcome measures. These included the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Form, Lysholm score, Tegner score, EuroQol-5 Dimension, and the 12-Item Short Form Health Survey. Results A total of 117 patients (Meniscal Tear group (n=36), Meniscectomy group (n=64), and Meniscal Repair group (n=17)) were included in the final data analysis. Both the Meniscectomy group and the Meniscal Repair group (mean 55-month follow-up) showed significantly better clinical outcomes than patients in the Meniscal Tear group (p<0.05). Overall, the Meniscal Repair group demonstrated superior clinical outcomes when compared to the Meniscectomy group (p<0.05). Conclusion Arthroscopic knee surgery showed significant clinical benefit at medium-term follow-up in treating patients with isolated meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy.
Collapse
Affiliation(s)
- James Bottomley
- Trauma and Orthopedic Surgery, South Tyneside District Hospital, South Shields, GBR
| | - Oday Al-Dadah
- Orthopedics, Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, GBR
- Trauma and Orthopedic Surgery, South Tyneside District Hospital, South Shields, GBR
| |
Collapse
|
21
|
Milliron EM, Moews L, Cavendish PA, Barnes RH, Flanigan DC. Anterolateral Radial Meniscus Tear Repair using Traction Suture and Super-Hashtag Technique. Arthrosc Tech 2023; 12:e1347-e1353. [PMID: 37654885 PMCID: PMC10466241 DOI: 10.1016/j.eats.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/18/2023] [Accepted: 04/11/2023] [Indexed: 09/02/2023] Open
Abstract
Radial meniscus tears occur commonly as traumatic tears in younger patients, as well as in association with concomitant degenerative changes. Traditional management of these tears has centered around partial meniscectomy; however, there has been a more recent trend toward preserving the meniscus and attempting repair. Because of the gapping and displacement that frequently occurs with these tears, repair is often challenging and is done under high amounts of tension. The following article describes a technique using a traction suture to aid in maintaining reduction throughout repair. This is followed by the use of a combination of techniques to form a "super-hashtag" configuration of both vertical and horizontal mattress sutures, leading to a secure repair under little tension.
Collapse
Affiliation(s)
- Eric M. Milliron
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Logan Moews
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Parker A. Cavendish
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Ryan H. Barnes
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - David C. Flanigan
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| |
Collapse
|
22
|
Ma Y, Qin Y, Liang C, Li X, Li M, Wang R, Yu J, Xu X, Lv S, Luo H, Jiang Y. Visual Cascaded-Progressive Convolutional Neural Network (C-PCNN) for Diagnosis of Meniscus Injury. Diagnostics (Basel) 2023; 13:2049. [PMID: 37370944 DOI: 10.3390/diagnostics13122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The objective of this study is to develop a novel automatic convolutional neural network (CNN) that aids in the diagnosis of meniscus injury, while enabling the visualization of lesion characteristics. This will improve the accuracy and reduce diagnosis times. METHODS We presented a cascaded-progressive convolutional neural network (C-PCNN) method for diagnosing meniscus injuries using magnetic resonance imaging (MRI). A total of 1396 images collected in the hospital were used for training and testing. The method used for training and testing was 5-fold cross validation. Using intraoperative arthroscopic diagnosis and MRI diagnosis as criteria, the C-PCNN was evaluated based on accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and evaluation performance. At the same time, the diagnostic accuracy of doctors with the assistance of cascade- progressive convolutional neural networks was evaluated. The diagnostic accuracy of a C-PCNN assistant with an attending doctor and chief doctor was compared to evaluate the clinical significance. RESULTS C-PCNN showed 85.6% accuracy in diagnosing and identifying anterior horn injury, and 92% accuracy in diagnosing and identifying posterior horn injury. The average accuracy of C-PCNN was 89.8%, AUC = 0.86. The diagnosis accuracy of the attending physician with the aid of the C-PCNN was comparable to that of the chief physician. CONCLUSION The C-PCNN-based MRI technique for diagnosing knee meniscus injuries has significant practical value in clinical practice. With a high rate of accuracy, clinical auxiliary physicians can increase the speed and accuracy of diagnosis and decrease the number of incorrect diagnoses.
Collapse
Affiliation(s)
- Yingkai Ma
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Yong Qin
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Chen Liang
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Xiang Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Haerbin 150001, China
| | - Minglei Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Haerbin 150001, China
| | - Ren Wang
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Jinping Yu
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Xiangning Xu
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Songcen Lv
- Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Haerbin 150001, China
| | - Hao Luo
- Department of Control Science and Engineering, Harbin Institute of Technology, Haerbin 150001, China
| | - Yuchen Jiang
- Department of Control Science and Engineering, Harbin Institute of Technology, Haerbin 150001, China
| |
Collapse
|
23
|
Cook JL, Cook CR, Rucinski K, Stannard JP. Serial ultrasonographic imaging can predict failure after meniscus allograft transplantation. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:139-146. [PMID: 37144223 PMCID: PMC10152313 DOI: 10.1177/1742271x221131283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022]
Abstract
Introduction Treatment monitoring after meniscus allograft transplantation (MAT) is challenging. Ultrasonographic (US) imaging has been proposed as a modality that may allow for treatment monitoring after MAT, but has yet to be clinically validated for this purpose. The objective of this study was to assess the capabilities for serial US imaging during the first year after surgery to predict short-term MAT failure. Methods Patients who had undergone Meniscus-only or Meniscus-Tibia MAT for treatment of medial or lateral meniscus deficiency were prospectively evaluated by US imaging at various time points after transplantation. Each meniscus was evaluated for abnormalities in echogenicity, shape, associated effusion, extrusion and extrusion with weightbearing (WB). Results Data from 31 patients with a mean follow-up of 32 ± 16 (range, 12-55) months were analysed. MAT failure occurred in 6 patients (19.4%) at a median time point of 20 (range, 14-28) months with 4 (12.9%) converted to total knee arthroplasty. US imaging was effective for assessing MAT extrusion and imaging with WB demonstrated dynamic changes in MAT extrusion. US characteristics that were significantly associated with higher likelihood for MAT failure included abnormal echogenicity, localised effusion, extrusion with WB at 6 months, and localised effusion and extrusion with WB at 1 year. Conclusions US assessments of meniscus allografts at 6 months after transplantation can effectively determine risk for short-term failure. Abnormal meniscus echogenicity, persistent localised effusion and extrusion with weightbearing were associated with 8-15 times higher odds for failure, which occurred at a median of 20 months post-transplantation.
Collapse
Affiliation(s)
- James L Cook
- Department of Orthopaedic Surgery,
University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative
Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Cristi R Cook
- Department of Orthopaedic Surgery,
University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative
Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery,
University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative
Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James P Stannard
- Department of Orthopaedic Surgery,
University of Missouri, Columbia, MO, USA
- Thompson Laboratory for Regenerative
Orthopaedics, University of Missouri, Columbia, MO, USA
| |
Collapse
|
24
|
Shephard L, Abed V, Nichols M, Kennedy A, Khalily C, Conley C, Jacobs C, Stone AV. International Knee Documentation Committee (IKDC) Is the Most Responsive Patient Reported Outcome Measure After Meniscal Surgery. Arthrosc Sports Med Rehabil 2023. [DOI: 10.1016/j.asmr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
|
25
|
Lopez SG, Kim J, Estroff LA, Bonassar LJ. Removal of GAGs Regulates Mechanical Properties, Collagen Fiber Formation, and Alignment in Tissue Engineered Meniscus. ACS Biomater Sci Eng 2023; 9:1608-1619. [PMID: 36802372 DOI: 10.1021/acsbiomaterials.3c00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The complex fibrillar architecture of native meniscus is essential for proper function and difficult to recapitulate in vitro. In the native meniscus, proteoglycan content is low during the development of collagen fibers and progressively increases with aging. In vitro, fibrochondrocytes produce glycosaminoglycans (GAGs) early in culture, in contrast to native tissue, where they are deposited after collagen fibers have formed. This difference in the timing of GAG production hinders the formation of a mature fiber network in such in vitro models. In this study, we removed GAGs from collagen gel-based tissue engineered constructs using chondroitinase ABC (cABC) and evaluated the effect on the formation and alignment of collagen fibers and the subsequent effect on tensile and compressive mechanical properties. Removal of GAGs during maturation of in vitro constructs improved collagen fiber alignment in tissue engineered meniscus constructs. Additionally, removal of GAGs during maturation improved fiber alignment without compromising compressive strength, and this removal improved not only fiber alignment and formation but also tensile properties. The increased fiber organization in cABC-treated groups also appeared to influence the size, shape, and location of defects in these constructs, suggesting that treatment may prevent the propagation of large defects under loading. This data gives another method of modulating the ECM for improved collagen fiber formation and mechanical properties in tissue engineered constructs.
Collapse
Affiliation(s)
- Serafina G Lopez
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Jongkil Kim
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, New York 14853, United States
- Kavli Institute for Nanoscale Science at Cornell, Cornell University, Ithaca, New York 14853, United States
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
| |
Collapse
|
26
|
Hung TNK, Vy VPT, Tri NM, Hoang LN, Tuan LV, Ho QT, Le NQK, Kang JH. Automatic Detection of Meniscus Tears Using Backbone Convolutional Neural Networks on Knee MRI. J Magn Reson Imaging 2023; 57:740-749. [PMID: 35648374 DOI: 10.1002/jmri.28284] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Timely diagnosis of meniscus injuries is key for preventing knee joint dysfunction and improving patient outcomes because it decreases morbidity and facilitates treatment planning. PURPOSE To train and evaluate a deep learning model for automated detection of meniscus tears on knee magnetic resonance imaging (MRI). STUDY TYPE Bicentric retrospective study. SUBJECTS In total, 584 knee MRI studies, divided among training (n = 234), testing (n = 200), and external validation (n = 150) data sets, were used in this study. The public data set MRNet was used as a second external validation data set to evaluate the performance of the model. SEQUENCE A 3 T, coronal, and sagittal images from T1-weighted proton density (PD) fast spin-echo (FSE) with fat saturation and T2-weighted FSE with fat saturation sequences. ASSESSMENT The detection system for meniscus tear was based on the improved YOLOv4 model with Darknet-53 as the backbone. The performance of the model was also compared with that of three radiologists of varying levels of experience. The determination of the presence of a meniscus tear from surgery reports was used as the ground truth for the images. STATISTICAL TESTS Sensitivity, specificity, prevalence, positive predictive value, negative predictive value, accuracy, and receiver operating characteristic curve were used to evaluate the performance of the detection model. Two-way analysis of variance, Wilcoxon signed-rank test, and Tukey's multiple tests were used to evaluate differences in performance between the model and radiologists. RESULTS The overall accuracies for detecting meniscus tears using our model on the internal testing, internal validation, and external validation data sets were 95.4%, 95.8%, and 78.8%, respectively. One radiologist had significantly lower performance than our model in detecting meniscal tears (accuracy: 0.9025 ± 0.093 vs. 0.9580 ± 0.025). DATA CONCLUSION The proposed model had high sensitivity, specificity, and accuracy for detecting meniscus tears on knee MRIs. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Truong Nguyen Khanh Hung
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic and Trauma, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Vu Pham Thao Vy
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, Thai Nguyen National Hospital, Thai Nguyen City, Vietnam
| | - Nguyen Minh Tri
- Advance Program in Computer Science, University of Science, Ho Chi Minh City, Vietnam
| | - Le Ngoc Hoang
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Le Van Tuan
- Department of Orthopedic and Trauma, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Quang Thai Ho
- Department of Computer Science and Engineering, Yuan Ze University, Chung-Li, Taiwan
| | - Nguyen Quoc Khanh Le
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.,Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
27
|
Migliorini F, Vecchio G, Giorgino R, Eschweiler J, Hildebrand F, Maffulli N. Micro RNA in meniscal ailments: current concepts. Br Med Bull 2023; 145:141-150. [PMID: 36721952 DOI: 10.1093/bmb/ldac039] [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: 05/01/2022] [Revised: 05/01/2022] [Accepted: 12/13/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Micro RNAs (miRNAs) are short non-coding RNAs that act primarily in posttranscriptional gene silencing, and are attracting increasing interest in musculoskeletal conditions. SOURCE OF DATA Current scientific literature published in PubMed, Google Scholar, Embase and Web of Science databases. AREAS OF AGREEMENT Recently, the potential of miRNAs as biomarkers for diagnosis and treatment of meniscal injuries has been postulated. AREAS OF CONTROVERSY Evaluation of the role of miRNAs in patients with meniscal tears is still controversial. GROWING POINTS A systematic review was conducted to investigate the potential of miRNA in the diagnosis and management of meniscal damage. AREAS TIMELY FOR DEVELOPING RESEARCH Intra-articular injection of microRNA-210 in vivo may represent a potential innovative methodology for the management of meniscal injuries. Characterization of the miRNAs expression in the synovial fluid could lead to the development of better early diagnosis and management strategies for meniscal tears.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi 84081, Italy
| | - Riccardo Giorgino
- Department of Orthopedics, IRCCS Orthopaedic Institute Galeazzi, Milano 20161, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic and Trauma Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic and Trauma Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Orthopedics, IRCCS Orthopaedic Institute Galeazzi, Milano 20161, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
| |
Collapse
|
28
|
Zabrzyński J, Paczesny Ł, Zabrzyńska A, Huri G, Graboń K, Pielak T, Kruczyński J, Łapaj Ł. Smoking Has No Influence on Outcomes after Repair of the Medial Meniscus in the Hypo and Avascular Zones-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16127. [PMID: 36498202 PMCID: PMC9737454 DOI: 10.3390/ijerph192316127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Complete loss of the meniscus inevitably leads to knee joint degeneration. Smoking is an important factor predicting poor outcome in orthopedics; however, data about its role in meniscus surgery are inconclusive. Smoking could be an important negative factor in isolated meniscus repair. The aim of this paper was to determine the influence of smoking on functional outcomes after isolated all-inside medial meniscus repair. This study included 50 consecutive patients with isolated, traumatic tear of the medial meniscus who underwent knee joint arthroscopy between 2016 and 2019. All-inside arthroscopic repair of the medial meniscus was performed in each case. All patients followed a uniform, postoperative rehabilitation protocol for 8 weeks. The follow-up examination was based on the functional scores at 3 and 6 months postoperatively. According to smoking status there were 17 smokers and 33 non-smokers. The mean number of cigarettes smoked per day was 11, for a mean of 7.4 years, and the mean pack-years index value was 4.9. There was no correlation between smoking years, number of cigarettes smoked per day, pack-years index, and functional outcomes. The arthroscopic inspection of the knee joints revealed cartilage lesions (≤IIº) in eight subjects, suggesting the secondary pathology to the meniscus tear. In this study, we found no evidence of an association between smoking indices and functional outcomes after all-inside repair of chronic medial meniscus tear. The nature of the chronic meniscal tear could be smoking-resistant owing to the poor blood supply to the sites in which these specific lesions occur.
Collapse
Affiliation(s)
- Jan Zabrzyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-545 Poznan, Poland
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland
- Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-092 Bydgoszcz, Poland
| | - Łukasz Paczesny
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland
| | | | - Gazi Huri
- Orthopaedics and Traumatology Departament, Hacettepe University School of Medicine, Ankara 06-230, Turkey
| | - Kamil Graboń
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland
| | - Tomasz Pielak
- Department of Orthopaedics, Clinical Hospital, 25-736 Kielce, Poland
| | - Jacek Kruczyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-545 Poznan, Poland
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-545 Poznan, Poland
| |
Collapse
|
29
|
Kohli S, Schwenck J, Barlow I. Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review. Knee Surg Relat Res 2022; 34:27. [PMID: 35692048 PMCID: PMC9190156 DOI: 10.1186/s43019-022-00155-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds. Methods MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature. Results Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3–31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0–11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI. Conclusion The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.
Collapse
|
30
|
Shamseer CM, Nizaj N, Thomas AB, Kandathil JC, Theruvil B. The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study. Indian J Orthop 2022; 56:2077-2085. [PMID: 36507197 PMCID: PMC9705615 DOI: 10.1007/s43465-022-00755-9] [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: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023]
Abstract
Introduction This simulation study on MRI of the knee was performed to assess the risk of injury to the popliteal artery (PA) and common peroneal nerve (CPN) during all-inside meniscal repairs in adults. Methods We simulated repair of the posterior horn of both medial (PHMM) and lateral menisci (PHLM) through anteromedial (AM) and anterolateral (AL) portals, using straight and curved devices, on 200 magnetic resonance imaging (MRI) scans taken with the knee in extension. For simulation using straight devices, the shortest distance from the menisco-capsular junction (MCJ) and the free edge of the meniscus to PA and CPN in vectors of AM and AL portals was measured. In curved devices, the closest extracapsular distance from the device tip to PA was measured. Results With a straight device through AM portal, the mean distance from the MCJ of PHMM to the PA was 20.7 ± 3.15 mm (13.5-27.4). In PHMM repair through AM portal using a curved device, the mean extracapsular distance from the device tip to PA was 18.8 ± 4 mm (7.7-27.2) while pointing toward and 26 ± 4.5 mm (15.5-35.6) while pointing away from the midline. When using straight devices, the average distance from free edge of LM to PA was 18.5 ± 3.3 mm (9.6-31.2) and from MCJ to PA was 8.9 ± 2.4 mm (3.5-18.8). The average distance measured from the MCJ to CPN through AM and AL portals using straight devices was 19.4 ± 2.8 mm (10.2-32.5) and 22 ± 2.8 mm (10.4-36.7) respectively. Conclusion In adults, PA is safe in PHMM repairs using both straight and curved devices irrespective of depth and direction of insertion. In PHLM repairs, the PA is at risk with both straight and curved devices. We recommend adjusting the depth of insertion to as minimum as possible to just penetrate the capsule. The CPN is safe in LM repairs using all-inside devices. Level of Evidence Level IV.
Collapse
Affiliation(s)
| | - N. Nizaj
- Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India
| | | | | | - Bipin Theruvil
- Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India
- Present Address: Arthroplasty and Sports Medicine, Medical Trust Hospital, Ernakulam, India
| |
Collapse
|
31
|
Bucket-Handle Meniscus Tear Management With Meniscectomy Versus Repair Correlates With Patient, Socioeconomic, and Hospital Factors. J Am Acad Orthop Surg 2022; 31:565-573. [PMID: 36730692 DOI: 10.5435/jaaos-d-21-01052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Bucket-handle meniscus tears are common knee injuries that are often treated surgically with meniscectomy or meniscal repair. Although clinical factors may influence the choice of one treatment approach over the other, the influence of patient, socioeconomic, and hospital factors remains poorly characterized. This study aimed to estimate the relative nationwide utilization of these two procedures and delineate a variety of factors that are associated with the selection of one treatment approach over the other. METHODS Meniscal repair and meniscectomy procedures conducted for isolated bucket-handle meniscus tears in 2016 and 2017 were identified in the Nationwide Ambulatory Surgery Sample database. Cases were weighted using nationally representative discharge weights. Univariate analyses and a multivariable logistic regression model were used to compare patient, socioeconomic, and hospital factors associated with meniscal repair versus meniscectomy. RESULTS In total, 12,239 cases were identified, which represented 17,236 cases after weighting. Of these, meniscal repair was conducted for 4,138 (24.0%). Based on the logistic regression model, meniscal repair was less likely for older and sicker patients. By contrast, several factors were associated with markedly higher odds of undergoing meniscal repair compared with meniscectomy. These included urban teaching hospitals; geographic location in the midwest, south, and west; and higher median household income. DISCUSSION Using a large nationally representative cohort, the current data revealed that only 24.0% of surgically treated bucket-handle meniscus tears were treated using repair. Identification of patient, socioeconomic, and hospital factors differentially associated with meniscal repair suggest that other factors may systematically influence surgical decision-making for this patient population. Surgeons should be conscious of these potential healthcare disparities when determining the optimal treatment for their patients. LEVEL OF EVIDENCE Level III.
Collapse
|
32
|
Schwartz G, Morejon A, Best TM, Jackson AR, Travascio F. Strain-Dependent Diffusivity of Small and Large Molecules in Meniscus. J Biomech Eng 2022; 144:111010. [PMID: 35789377 PMCID: PMC9309715 DOI: 10.1115/1.4054931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/28/2022] [Indexed: 11/08/2022]
Abstract
Due to lack of full vascularization, the meniscus relies on diffusion through the extracellular matrix to deliver small (e.g., nutrients) and large (e.g., proteins) to resident cells. Under normal physiological conditions, the meniscus undergoes up to 20% compressive strains. While previous studies characterized solute diffusivity in the uncompressed meniscus, to date, little is known about the diffusive transport under physiological strain levels. This information is crucial to fully understand the pathophysiology of the meniscus. The objective of this study was to investigate strain-dependent diffusive properties of the meniscus fibrocartilage. Tissue samples were harvested from the central portion of porcine medial menisci and tested via fluorescence recovery after photobleaching to measure diffusivity of fluorescein (332 Da) and 40 K Da dextran (D40K) under 0%, 10%, and 20% compressive strain. Specifically, average diffusion coefficient and anisotropic ratio, defined as the ratio of the diffusion coefficient in the direction of the tissue collagen fibers to that orthogonal, were determined. For all the experimental conditions investigated, fluorescein diffusivity was statistically faster than that of D40K. Also, for both molecules, diffusion coefficients significantly decreased, up to ∼45%, as the strain increased. In contrast, the anisotropic ratios of both molecules were similar and not affected by the strain applied to the tissue. This suggests that compressive strains used in this study did not alter the diffusive pathways in the meniscus. Our findings provide new knowledge on the transport properties of the meniscus fibrocartilage that can be leveraged to further understand tissue pathophysiology and approaches to tissue restoration.
Collapse
Affiliation(s)
- Gabi Schwartz
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146
| | - Andy Morejon
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL 33146
| | - Thomas M Best
- Department of Orthopaedic Surgery, University of Miami, Miami, FL 33136; Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146;UHealth Sports Medicine Institute, Coral Gables, FL 33146
| | - Alicia R Jackson
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL 33146; Department of Orthopaedic Surgery, University of Miami, Miami, FL 33136; Max Biedermann Institute for Biomechanics at Mount, Sinai Medical Center, Miami Beach, FL 33140
| |
Collapse
|
33
|
Mameri ES, Verdejo FG, Dasari SP, Kerzner B, Shah S, Kasson LB, Khan ZA, Fortier LM, Damodar D, Gursoy S, Chahla J. Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation. Arthrosc Tech 2022; 11:e1937-e1944. [PMID: 36457397 PMCID: PMC9705603 DOI: 10.1016/j.eats.2022.07.008] [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: 05/08/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Horizontal cleavage tears (HCTs) are challenging meniscal tear patterns, as they split the meniscus into inferior and superior leaflets, while also involving the central, less vascular portions of the meniscus. Circumferential compression sutures using an all-inside self-retrieving suture passing device like the Novostitch Pro (Smith & Nephew, Andover, MA) have demonstrated the ability to create stable repair constructs with uniform compression across both leaflets in the setting of HCTs. Additionally, biological augmentation of meniscal repairs using a marrow venting procedure (MVP) has demonstrated superior clinical outcomes relative to isolated meniscal repairs. Thus, the purpose of this technical note is to outline our procedure for implementing circumferential compression sutures and biologic augmentation using an MVP for repairing an HCT of the lateral meniscus.
Collapse
Affiliation(s)
| | | | | | - Benjamin Kerzner
- Address correspondence to Benjamin Kerzner, B.S., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite 300, Chicago, IL 60612, U.S.A..
| | | | | | | | | | | | | | | |
Collapse
|
34
|
The Effects of Korean Medicine Treatment for Meniscus Tears: A Retrospective Chart Review. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2022.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Changes in symptoms and dysfunction related to meniscus tears following the use of Korean medicine for ≥ 4 days were studied. The medical charts of 53 cases of diagnosed meniscus tears (magnetic resonance imaging) with an admission Numeric Rating Scale (NRS) score ≥ 4, between 2017 and 2022 were retrospectively reviewed. Treatments included acupuncture, pharmacopuncture, herbal treatment, Chuna therapy, and physiotherapy. The NRS, Western Ontario and McMaster Universities Osteoarthritis Index, and European Quality of Life 5 Dimensions were performed at admission and discharge. There were 42 females and 11 males in this study. Patients were more likely to be in their 60s (38.18%), have an unknown etiology (81.13%), and have complex tears (50.94%). After receiving a combination of alternative Korean medicine during hospitalization, the mean NRS score improved from 6.82 ± 1.19 to 3.66 ± 1.83 (p < 0.001), the Western Ontario and McMaster Universities Osteoarthritis Index score improved from 46.47 ± 20.99 to 37.98 ± 19.23 (p < 0.001), and the mean European Quality of Life Five Dimensions score improved from 0.61 ± 0.18 to 0.68 ± 0.14 (p < 0.001) after treatment. These results suggest that Korean medicine treatment of meniscus tears alleviated pain and improved physical function.
Collapse
|
35
|
Avila A, Vasavada K, Shankar DS, Petrera M, Jazrawi LM, Strauss EJ. Current Controversies in Arthroscopic Partial Meniscectomy. Curr Rev Musculoskelet Med 2022; 15:336-343. [PMID: 35727503 DOI: 10.1007/s12178-022-09770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. RECENT FINDINGS In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management.
Collapse
Affiliation(s)
- Amanda Avila
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA.
| | - Kinjal Vasavada
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Dhruv S Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Massimo Petrera
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| |
Collapse
|
36
|
Shin H, Choi GS, Shon OJ, Kim GB, Chang MC. Development of convolutional neural network model for diagnosing meniscus tear using magnetic resonance image. BMC Musculoskelet Disord 2022; 23:510. [PMID: 35637451 PMCID: PMC9150332 DOI: 10.1186/s12891-022-05468-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Deep learning (DL) is an advanced machine learning approach used in diverse areas, such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is advantageous for image recognition and classification. In this study, we aimed to develop a CNN to detect meniscal tears and classify tear types using coronal and sagittal magnetic resonance (MR) images of each patient. Methods We retrospectively collected 599 cases (medial meniscus tear = 384, lateral meniscus tear = 167, and medial and lateral meniscus tear = 48) of knee MR images from patients with meniscal tears and 449 cases of knee MR images from patients without meniscal tears. To develop the DL model for evaluating the presence of meniscal tears, all the collected knee MR images of 1048 cases were used. To develop the DL model for evaluating the type of meniscal tear, 538 cases with meniscal tears (horizontal tear = 268, complex tear = 147, radial tear = 48, and longitudinal tear = 75) and 449 cases without meniscal tears were used. Additionally, a CNN algorithm was used. To measure the model’s performance, 70% of the included data were randomly assigned to the training set, and the remaining 30% were assigned to the test set. Results The area under the curves (AUCs) of our model were 0.889, 0.817, and 0.924 for medial meniscal tears, lateral meniscal tears, and medial and lateral meniscal tears, respectively. The AUCs of the horizontal, complex, radial, and longitudinal tears were 0.761, 0.850, 0.601, and 0.858, respectively. Conclusion Our study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears.
Collapse
Affiliation(s)
- Hyunkwang Shin
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Gyu Sang Choi
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 42415, Republic of Korea.
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 42415, Republic of Korea.
| |
Collapse
|
37
|
Kouzelis A, Solou K, Panagopoulos A, Kokkalis Z, Gliatis J. Arthroscopic Treatment of a “Bucket-Handle Like Tear” Lesion of the Medial Meniscus. Cureus 2022; 14:e22830. [PMID: 35382175 PMCID: PMC8976876 DOI: 10.7759/cureus.22830] [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] [Accepted: 03/03/2022] [Indexed: 11/09/2022] Open
Abstract
Menisci are involved in providing shock absorption, knee stability, and load transfer. Age, tear pattern, location, size and extent, repair time and technique, and patient habits are among various factors that affect meniscal healing. Meniscus repair has become the procedure of choice for the treatment of meniscal tears. However, treatment of meniscal tears in patients over 40 years of age is still debatable. Rare patterns of lesions have been described in the literature. We report a zone 2, partial thickness, “bucket-handle like tear” medial meniscal lesion with two attached ends in a 48-year-old male patient with persistent symptoms after six months of conservative treatment. Arthroscopic excision and debridement were performed. At a six-month follow-up, the patient regained 90% of his functional capacity.
Collapse
|
38
|
Patel JM. Impediments to Meniscal Repair: Factors at Play Beyond Vascularity. Front Bioeng Biotechnol 2022; 10:843166. [PMID: 35299635 PMCID: PMC8921501 DOI: 10.3389/fbioe.2022.843166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jay M. Patel
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Medical Center, Department of Veterans Affairs, Decatur, GA, United States
- *Correspondence: Jay M. Patel,
| |
Collapse
|
39
|
Alomar AZ, Al Jedia KM, Shadid AM, Almaawi A, Sinha S, Khan R, Mittal S, Kumar A. Concurrent Research Around Meniscus: A Bibliometric Analysis and Review of the Top Fifty Cited Papers. Indian J Orthop 2022; 56:785-796. [PMID: 35547349 PMCID: PMC9043149 DOI: 10.1007/s43465-021-00592-2] [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] [Received: 08/06/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The knowledge regarding meniscus has vastly evolved over the past few decades. The meniscus's intact, injured, and repaired status can affect other joint structures, i.e., ligaments, articular surfaces, and overall biomechanics of the knee joint. Due to available evidence's extensiveness, it is challenging to determine the most influential topics and the emerging trends in concurrent meniscus research. This study aims to identify the top fifty cited papers in meniscus research and concurrent knee issues and analyse their characteristics. METHODS A comprehensive search was conducted on the Thompson Reuters Web of Science database to prepare a list of top fifty cited articles that included original articles and review articles concerning meniscus. The included articles were analysed for the source journal, investigating institution, country of the corresponding author, year of publication, total citations, annual citation rate, and a qualitative review. RESULTS The search strategy resulted in 6768 original articles and 453 review articles. The top fifty cited articles were published from 1969 to 2014 and belonged to 14 journal sources. There were 43 original articles and seven review articles. The average citations per article were 417.4 and the average citations per paper per year were 22.6. Besides the meniscus, a general interest in the clinical assessment scores, anterior cruciate ligament, long-term osteoarthritis, and cartilage was observed. CONCLUSION Most of the research concerning meniscus relates to the importance of meniscus preservation, the link between meniscus injuries and concomitant anterior cruciate ligament and chondral injuries, and its role in long-term gonarthrosis. The western countries have contributed the maximum to the top-cited evidence concerning meniscus. The meniscus repair and transplantation techniques have recently gained importance and need further research to qualify for the top-cited evidence.
Collapse
Affiliation(s)
- Abdulaziz Z. Alomar
- grid.56302.320000 0004 1773 5396Arthroscopy and Sports Medicine Division, Department of Orthopaedic Surgery, College of Medicine, King Saud University. KSU Sports Medicine Center, King Saud University Medical-City, Riyadh, Kingdom of Saudi Arabia
| | - Khaled Mohammed Al Jedia
- grid.56302.320000 0004 1773 5396Department of Orthopaedic Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Mustafa Shadid
- grid.56302.320000 0004 1773 5396Department of Orthopaedic Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Almaawi
- grid.56302.320000 0004 1773 5396Department of Orthopaedic Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Siddhartha Sinha
- grid.411816.b0000 0004 0498 8167Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Rizwan Khan
- grid.411816.b0000 0004 0498 8167Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Samarth Mittal
- grid.413618.90000 0004 1767 6103JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- grid.411816.b0000 0004 0498 8167Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| |
Collapse
|
40
|
Leggit J, Mark R, Hulsopple C, Carey PM, Alisangco JB. Disorders of the Lower Extremity. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
41
|
Bansal S, Meadows KD, Miller LM, Saleh KS, Patel JM, Stoeckl BD, Lemmon EA, Hast MW, Zgonis MH, Scanzello CR, Elliott DM, Mauck RL. Six-Month Outcomes of Clinically Relevant Meniscal Injury in a Large-Animal Model. Orthop J Sports Med 2021; 9:23259671211035444. [PMID: 34796238 PMCID: PMC8593308 DOI: 10.1177/23259671211035444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The corrective procedures for meniscal injury are dependent on tear type, severity, and location. Vertical longitudinal tears are common in young and active individuals, but their natural progression and impact on osteoarthritis (OA) development are not known. Root tears are challenging and they often indicate poor outcomes, although the timing and mechanisms of initiation of joint dysfunction are poorly understood, particularly in large-animal and human models. PURPOSE/HYPOTHESIS In this study, vertical longitudinal and root tears were made in a large-animal model to determine the progression of joint-wide dysfunction. We hypothesized that OA onset and progression would depend on the extent of injury-based load disruption in the tissue, such that root tears would cause earlier and more severe changes to the joint. STUDY DESIGN Controlled laboratory study. METHODS Sham surgeries and procedures to create either vertical longitudinal or root tears were performed in juvenile Yucatan mini pigs through randomized and bilateral arthroscopic procedures. Animals were sacrificed at 1, 3, or 6 months after injury and assessed at the joint and tissue level for evidence of OA. Functional measures of joint load transfer, cartilage indentation mechanics, and meniscal tensile properties were performed, as well as histological evaluation of the cartilage, meniscus, and synovium. RESULTS Outcomes suggested a progressive and sustained degeneration of the knee joint and meniscus after root tear, as evidenced by histological analysis of the cartilage and meniscus. This occurred in spite of spontaneous reattachment of the root, suggesting that this reattachment did not fully restore the function of the native attachment. In contrast, the vertical longitudinal tear did not cause significant changes to the joint, with only mild differences compared with sham surgery at the 6-month time point. CONCLUSION Given that the root tear, which severs circumferential connectivity and load transfer, caused more intense OA compared with the circumferentially stable vertical longitudinal tear, our findings suggest that without timely and mechanically competent fixation, root tears may cause irreversible joint damage. CLINICAL RELEVANCE More generally, this new model can serve as a test bed for experimental surgical, scaffold-based, and small molecule-driven interventions after injury to prevent OA progression.
Collapse
Affiliation(s)
- Sonia Bansal
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle D. Meadows
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Liane M. Miller
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Kamiel S. Saleh
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Jay M. Patel
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Brendan D. Stoeckl
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Elisabeth A. Lemmon
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Michael W. Hast
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miltiadis H. Zgonis
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Carla R. Scanzello
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dawn M. Elliott
- Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Robert L. Mauck, PhD, Department of Orthopedic Surgery, University of Pennsylvania, 3450 Hamilton Walk, 371 Stemmler Hall, Philadelphia, PA 19104, USA () (Twitter: @MauckLab)
| |
Collapse
|
42
|
Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: Case series study. Int J Surg Case Rep 2021; 88:106492. [PMID: 34655974 PMCID: PMC8551519 DOI: 10.1016/j.ijscr.2021.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Meniscal tear is one of the most common knee injuries and knee surgery procedures. It is frequently associated with an anterior cruciate ligament (ACL) injury. We conducted this study, on patients with ACL reconstruction surgeries, which were occasionally accompanied by meniscal tears, in order to determine the diagnostic value of clinical examinations for meniscal tear, both individually and in combination, in correlations to magnetic resonance imaging (MRI) scans, with the goal of improving clinical diagnosis for patients with meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries. Case presentation 50 patients were thoroughly clinically examined, using Joint line tenderness, Thessaly test, McMurray's test, Apley's test followed by MRI, before their scheduled ACL reconstruction arthroscopic surgeries. The meniscal tears were then identified during the procedure, and were treated, if necessary. The data before and after the surgery was taken into calculating, with arthroscopic findings serving as the gold standard. Results: the sensitivity, specificity and accuracy of each clinical tests and MRI scans respectively were: for medial meniscus, Joint line tenderness (70%; 53,3%; 60%); McMurray's test (80%; 73,3%: 76%); Apley's test (65%; 70%; 68%); Thessaly test(70%; 76,7%; 74%); MRI (90%; 83,3%; 86%); lateral meniscus: Joint line tenderness (73%; 66,7%; 70%); McMurray's test (69,2%; 75%: 72%); Apley's test (69,2%; 70,8%; 70%); Thessaly test (73,1%; 75%; 74%); MRI (88,5%; 87,5%; 88%). However, when combining at least two positive tests into a single composite test, the diagnostic value is considerably enhanced with sensitivity, specificity and accuracy of 85%, 73,3%, 78% for medial meniscus, 92,3%, 87,5%, 90% for lateral meniscus. Clinical discussion Clinical tests are essential for diagnosis of meniscal tears, although inconsistent. A composite test consisting of at least two positive tests can considerably enhance the diagnostic value, even comparable to MRI scans. However, after the clinical examination, MRI is still necessary for the diagnostic process of meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries. Conclusion The combination of clinical tests and MRI images will give a precise diagnosis as well as surgical indication for meniscus injury in patients with anterior cruciate ligament tear. Meniscus tear is frequently associated with ACL injury Identifying, classifying and grading meniscus lesion is very important because it can assist surgeon in providing appropriate treatment plans (meniscectomy or repair) and having an accurate prognosis for patients. Determine the diagnostic value in term of clinical in correlation with preoperative MRI images is the purpose of this study
Collapse
|
43
|
Rhim HC, Jeon OH, Han SB, Bae JH, Suh DW, Jang KM. Mesenchymal stem cells for enhancing biological healing after meniscal injuries. World J Stem Cells 2021; 13:1005-1029. [PMID: 34567422 PMCID: PMC8422933 DOI: 10.4252/wjsc.v13.i8.1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
The meniscus is a semilunar fibrocartilage structure that plays important roles in maintaining normal knee biomechanics and function. The roles of the meniscus, including load distribution, force transmission, shock absorption, joint stability, lubrication, and proprioception, have been well established. Injury to the meniscus can disrupt overall joint stability and cause various symptoms including pain, swelling, giving-way, and locking. Unless treated properly, it can lead to early degeneration of the knee joint. Because meniscal injuries remain a significant challenge due to its low intrinsic healing potential, most notably in avascular and aneural inner two-thirds of the area, more efficient repair methods are needed. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential in vitro and in vivo. Thus far, the application of MSCs, including bone marrow-derived, synovium-derived, and adipose-derived MSCs, has shown promising results in preclinical studies in different animal models. These preclinical studies could be categorized into intra-articular injection and tissue-engineered construct application according to delivery method. Despite promising results in preclinical studies, there is still a lack of clinical evidence. This review describes the basic knowledge, current treatment, and recent studies regarding the application of MSCs in treating meniscal injuries. Future directions for MSC-based approaches to enhance meniscal healing are suggested.
Collapse
Affiliation(s)
- Hye Chang Rhim
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Seoul, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam 13497, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| |
Collapse
|
44
|
Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
Collapse
Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
| |
Collapse
|
45
|
Fedje-Johnston W, Johnson CP, Tóth F, Carlson CS, Ellingson AM, Albersheim M, Lewis J, Bechtold J, Ellermann J, Rendahl A, Tompkins M. A pilot study to assess the healing of meniscal tears in young adult goats. Sci Rep 2021; 11:14181. [PMID: 34244551 PMCID: PMC8270994 DOI: 10.1038/s41598-021-93405-3] [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: 11/02/2020] [Accepted: 06/18/2021] [Indexed: 11/09/2022] Open
Abstract
Meniscal tears are a common orthopedic injury, yet their healing is difficult to assess post-operatively. This impedes clinical decisions as the healing status of the meniscus cannot be accurately determined non-invasively. Thus, the objectives of this study were to explore the utility of a goat model and to use quantitative magnetic resonance imaging (MRI) techniques, histology, and biomechanical testing to assess the healing status of surgically induced meniscal tears. Adiabatic T1ρ, T2, and T2* relaxation times were quantified for both operated and control menisci ex vivo. Histology was used to assign healing status, assess compositional elements, and associate healing status with compositional elements. Biomechanical testing determined the failure load of healing lesions. Adiabatic T1ρ, T2, and T2* were able to quantitatively identify different healing states. Histology showed evidence of diminished proteoglycans and increased vascularity in both healed and non-healed menisci with surgically induced tears. Biomechanical results revealed that increased healing (as assessed histologically and on MRI) was associated with greater failure load. Our findings indicate increased healing is associated with greater meniscal strength and decreased signal differences (relative to contralateral controls) on MRI. This indicates that quantitative MRI may be a viable method to assess meniscal tears post-operatively.
Collapse
Affiliation(s)
- William Fedje-Johnston
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Casey P Johnson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.,Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Arin M Ellingson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Albersheim
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jack Lewis
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Joan Bechtold
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Aaron Rendahl
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA. .,Tria Orthopedic Center, Bloomington, MN, USA.
| |
Collapse
|
46
|
Donaldson ET, Doma K, Parkinson B. Surgeons respond to growing evidence by performing less knee arthroscopic surgery in older patients. ANZ J Surg 2021; 91:1919-1922. [PMID: 34224195 DOI: 10.1111/ans.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent research has shown that knee arthroscopy does not provide a meaningful clinical benefit for degenerative knee changes in the older population. The 2016 Australian Orthopaedic Association (AOA) Annual Scientific Meeting held a plenary session on this topic to educate surgeons about these research findings and communicate their clinical practice statement on this issue. This paper set out to find if there has been a change in clinical practice since this meeting. METHODS The analysis consisted of all knee arthroscopies performed in a single city of Far North Queensland, Australia, over an 8-year period. The number and type of arthroscopies performed in patients <50 and ≥50 years of age was compared before and after the 2016 AOA plenary session. RESULTS After the 2016 AOA educational session, there was a significant reduction in the number of debridement procedures performed in patients aged 50 years or older (275 vs. 142 per year, P < 0.01) but not in patients under 50 years of age (192 vs. 135 per year, P = 0.91). The annual number of repair procedures for all ages combined, increased from 11 per year to 60 per year (P < 0.01). CONCLUSION The surgeons of this city have changed their knee arthroscopy clinical practice in line with the evidence and advice from their professional body.
Collapse
Affiliation(s)
- Eric T Donaldson
- Department of Orthopaedics, Royal Brisbane and Woman's Hospital Health Service District, Brisbane, Queensland, Australia
| | - Kenji Doma
- Department of Orthopaedics, ORIQL-The Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia.,James Cook University, James Cook University Health Sciences, Townsville, Queensland, Australia
| | - Ben Parkinson
- Department of Orthopaedics, Cairns Hospital, Cairns, Queensland, Australia
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Karamchandani U, Bhattacharyya R, Patel R, Oussedik S, Bhattacharya R, Gupte C. Training Surgeons to Perform Arthroscopic All-Inside Meniscal Repair: A Randomized Controlled Trial Evaluating the Effectiveness of a Novel Cognitive Task Analysis Teaching Tool, Imperial College London/University College London Meniscus Repair Cognitive Task Analysis (IUMeRCTA). Am J Sports Med 2021; 49:2341-2350. [PMID: 34166100 PMCID: PMC8283189 DOI: 10.1177/03635465211021652] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside meniscal repair is an increasingly common technique for the surgical treatment of meniscal tears. There are currently no standardized techniques for training residents in this procedure. Cognitive task analysis (CTA) is a method of analyzing and standardizing key steps in a procedure that allows training to be conducted in a validated and reproducible manner. PURPOSE (1) To design a digital CTA teaching tool for a standardized all-inside meniscal repair. (2) To evaluate whether CTA-trained residents would perform better in a meniscal repair task compared with a control group who underwent traditional apprenticeship methods of training. STUDY DESIGN Controlled laboratory study. METHODS Three expert knee surgeons were interviewed using a modified Delphi method to generate a consensus among the ideal technical steps, cognitive decision points, and common errors and solutions for an all-inside meniscal repair. This written information was then combined with visual and audio components and integrated onto a digital platform to create the Imperial College London/University College London Meniscus Repair Cognitive Task Analysis (IUMeRCTA) tool. Eighteen novice residents were randomized into an intervention group (digital CTA tool) and control group (equipment instruction manual). Both groups performed an all-inside meniscal repair on high-fidelity, phantom knee models and were assessed by expert surgeons, blinded to the interventions, using a validated global rating scale (GRS). After a power calculation, median GRS scores were compared between groups using the Mann-Whitney U test; significance was set at P < .05. RESULTS For the IUMeRCTA tool design, the procedure was divided into 55 steps across 9 phases: (1) preoperative planning, (2) theater and patient setup, (3) portal placement, (4) meniscal examination, (5) tear reduction, (6) suture planning, (7) suture insertion, (8) repair completion, and (9) postoperative care and rehabilitation. For the trial, the intervention group (mean ± SD GRS, 32 ± 2.9) performed significantly better than did the control group (GRS, 24 ± 3.3; P < .001). CONCLUSION This is the first CTA tool to demonstrate objective benefits in training novices to perform an arthroscopic all-inside meniscal repair. CLINICAL RELEVANCE The IUMeRCTA tool is an easily accessible and effective adjunct to traditional teaching that enhances learning the all-inside meniscal repair for novice surgeons.
Collapse
Affiliation(s)
- Urvi Karamchandani
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Rahul Bhattacharyya
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Rahul Patel
- Department of Orthopaedics, University College London Hospitals NHS Trust, UK,Wellington Knee Unit, London, UK
| | - Sam Oussedik
- Department of Orthopaedics, University College London Hospitals NHS Trust, UK,Wellington Knee Unit, London, UK
| | - Rajarshi Bhattacharya
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Chinmay Gupte
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK,Wellington Knee Unit, London, UK,Chinmay Gupte, PhD, MA, BM BCh, MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK ()
| |
Collapse
|
49
|
Grossi S, Ipponi E, Bufalino E, Gariffo G, Filoni G, Ceccoli M, Simonetti M, Ciapini G, Scaglione M. All-Inside Arthroscopic Repair For Longitudinal Meniscal Tears: Clinical and Functional Results. Surg Technol Int 2021; 38:387-392. [PMID: 33624831 DOI: 10.52198/21.sti.38.os1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Meniscal injuries are a common challenge in orthopaedic surgery. Depending on their location and the patient's age and functional needs, they can be treated either conservatively or surgically. A surgical approach can consist of arthroscopic meniscectomy or meniscal suture. The latter is the treatment of choice in case of lesions involving the red-red or red-white areas of the meniscus, especially for young high-demanding patients. We report here our experience with the repair of longitudinal meniscal tears using the all-inside technique with the Fast-Fix™ 360 Meniscal Repair System (Smith & Nephew Endoscopy, Andover, MA). We retrospectively evaluated 20 consecutive cases of longitudinal meniscal tears. In 4 cases, concomitant ACL rupture was diagnosed and treated alongside the meniscal repair. All patients underwent periodic clinical evaluations. At the latest check-up, their functional outcomes were rated according to the Tegner-Lysholm Knee and KOOS scoring scales. The mean Tegner-Lysholm Knee score was 84.85 (44-100) and the mean KOOS score was 88.58. No failure or major complications were observed. Furthermore, a negative statistical association was observed between age at surgery and the post-operative Tegner-Lysholm Knee score (coef. = -1.01189 [-1.942073,-0.0817063], p = 0.035). This relation, independent of gender, meniscus involved, eventual associated ACL reconstruction, and chondral injury, suggests that functional outcomes worsen with increasing patient age. Our results suggest that the arthroscopic all-inside suture is both safe and effective in cases of longitudinal meniscal tear, considering the good post-operative functionality and low rates of local complications and surgical failures.
Collapse
Affiliation(s)
- Stefano Grossi
- Unità Operativa di Ortopedia e Traumatologia, Ospedale di Cecina, Usl Toscana Nord Ovest, Cecina, Italy
| | - Edoardo Ipponi
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Eric Bufalino
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gabriele Gariffo
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gabriele Filoni
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Matteo Ceccoli
- Unità Operativa di Ortopedia e Traumatologia, Ospedale di Cecina, Usl Toscana Nord Ovest, Cecina, Italy
| | - Matteo Simonetti
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gianluca Ciapini
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| |
Collapse
|
50
|
Sales E, Gupta S, Daines B, Baker A, Landgrabe M, Zeini IM, Youmans DH, Osbahr DC. Bicompartmental Bucket Handle Meniscal Tear with Chronic ACL Deficiency Causing a Rare Triple PCL and Triple Cruciate Sign: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00064. [PMID: 33974600 DOI: 10.2106/jbjs.cc.20.00694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 16-year-old football player presented with chronic ACL deficiency along with bicompartmental bucket handle meniscal tears. CONCLUSION We present a "triple cruciate" sign in addition to the triple posterior cruciate ligament (PCL) sign seen on Magnetic Resonance Imaging (MRI) to aid in diagnosing this injury.
Collapse
Affiliation(s)
- Eric Sales
- Sunshine Valley Pediatrics, Las Vegas, NV
| | - Sunny Gupta
- University of Pennsylvania, Philadelphia, PA
| | - Benjamin Daines
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alexandra Baker
- University of Central Florida College of Medicine, Orlando, Florida
| | | | | | | | | |
Collapse
|