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Stephens A, Searle H, Carlos W, Gomindes A, Pilarski A, Syed F, Smith N, Khatri C. Diagnostic impacts on management of soft tissue injuries associated with tibial plateau fractures: A narrative review. Injury 2024; 55:111546. [PMID: 38599010 DOI: 10.1016/j.injury.2024.111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes. MATERIALS AND METHODS We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy. RESULTS 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes. CONCLUSION There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.
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Affiliation(s)
- Alastair Stephens
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Henry Searle
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - William Carlos
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Austin Gomindes
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Adam Pilarski
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Farhan Syed
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Nicholas Smith
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Chetan Khatri
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
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Cheema H, Brophy R, Collins J, Cox CL, Guermazi A, Kumara M, Levy BA, MacFarlane L, Mandl LA, Marx R, Selzer F, Spindler K, Katz JN, Murray EJ. Causal relationships between pain, medical treatments, and knee osteoarthritis: A graphical causal model to guide analyses. Osteoarthritis Cartilage 2024; 32:319-328. [PMID: 37939895 DOI: 10.1016/j.joca.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/15/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects. We describe a process for synthesizing expert knowledge and apply this to long-term follow-up of an RCT of treatments for meniscal tears in patients with knee osteoarthritis (OA). METHODS We identified 2 post-randomization events likely to impact accurate assessment of pain outcomes beyond 5 years in trial participants: loss to follow-up and total knee replacement (TKR). We conducted literature searches for covariates related to pain and TKR in individuals with knee OA and combined these with expert input. We synthesized the evidence into graphical models. RESULTS We identified 94 potential covariates potentially related to pain and/or TKR among individuals with knee OA. Of these, 46 were identified in the literature review and 48 by expert panelists. We determined that adjustment for 50 covariates may be required to estimate the long-term effects of knee OA treatments on pain. CONCLUSION We present a process for combining literature reviews with expert input to synthesize existing knowledge and improve covariate selection. We apply this process to the long-term follow-up of a randomized trial and show that expert input provides additional information not obtainable from literature reviews alone.
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Affiliation(s)
- Haadiya Cheema
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Health Sciences, Sargent College, Boston University, Boston, MA, USA
| | - Robert Brophy
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jamie Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Charles L Cox
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ali Guermazi
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Mahima Kumara
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA
| | | | - Lindsey MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lisa A Mandl
- Division of Rheumatology and Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Robert Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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Rhind JH, Khawar H, Webb M, Guthrie H. The locked knee. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38300674 DOI: 10.12968/hmed.2022.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees.
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Affiliation(s)
- John-Henry Rhind
- Department of Trauma and Orthopaedics, Epsom and St. Helier Hospital, Sutton, Surrey, UK
| | - Haseeb Khawar
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke on Trent, Staffordshire, UK
| | - Mark Webb
- Department of Trauma and Orthopaedics, St George's University Hospital, London, UK
| | - Hugo Guthrie
- Department of Trauma and Orthopaedics, St George's University Hospital, London, UK
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Bernardini I, N'dele D, de Gauzy JS, Accadbled F. Influence of a posteromedial meniscocapsular injury on the knee anterior laxity. A cadaveric study. Eur J Orthop Surg Traumatol 2024; 34:517-522. [PMID: 37640796 DOI: 10.1007/s00590-023-03688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The number of anterior cruciate ligament (ACL) injuries has considerably increased in the recent years, especially in young adults and adolescents. Associated meniscal tears increase anterior and rotary laxity. Posterior peripheral meniscocapsular tear of medial meniscus is also called ramp lesion. Prevalence of 9% to 17% in adults and up to 23% in pediatric population has been reported. The aim of this study was to determine anterior laxity of cadaveric ACL-deficient knees with several size of ramp lesions. METHODS Fresh cadaveric knees were explored. Major osteoarthritis and/or ACL and meniscal tears on arthroscopy were exclusion criteria. Mean age at death was 86 years old. Dynamic laximetry with GNRB® device was made in several conditions: Knee prior to any procedure, after arthroscopic exploration, after ACL section, and then after increasing sizes of ramp lesions up to 30 mm. Anteroposterior laxity was measured with 2 loading forces successively (134N and 200N). RESULTS After ACL section only, tibiofemoral joint anterior laxity was significantly increased. Mean increase was 156% regardless of the loading force. No statistical laxity difference was found between knees with ACL section only and knees with ACL and meniscal section for any size of ramp lesions. Increasing size of ramp lesion was not correlated with increasing of laxity. CONCLUSION We could not find a threshold size of ramp lesion which increases knee anterior laxity. We were not able to determine a threshold recommending a ramp lesion repair.
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Affiliation(s)
- Isabelle Bernardini
- Department of Orthopaedics, Children's Hospital, CHU de Toulouse, 31000, Toulouse, France
| | - Daniel N'dele
- Department of Orthopaedics, Children's Hospital, CHU de Toulouse, 31000, Toulouse, France
| | - Jérôme Sales de Gauzy
- Department of Orthopaedics, Children's Hospital, CHU de Toulouse, 31000, Toulouse, France
- Institut de Mécanique Des Fluides de Toulouse, IMFT, CNRS, Université de Toulouse, 31000, Toulouse, France
| | - Franck Accadbled
- Department of Orthopaedics, Children's Hospital, CHU de Toulouse, 31000, Toulouse, France.
- Institut de Mécanique Des Fluides de Toulouse, IMFT, CNRS, Université de Toulouse, 31000, Toulouse, France.
- Anatomy Laboratory, Paul Sabatier University, 31000, Toulouse, France.
- Sport Pro Santé Research, 8 Rue Des Braves, 31300, Toulouse, France.
- Orthopédie Traumatologie, Hôpital Des Enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse Cedex 9, France.
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Oláh T, Cucchiarini M, Madry H. Subchondral bone remodeling patterns in larger animal models of meniscal injuries inducing knee osteoarthritis - a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5346-5364. [PMID: 37742232 PMCID: PMC10719152 DOI: 10.1007/s00167-023-07579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Elucidating subchondral bone remodeling in preclinical models of traumatic meniscus injury may address clinically relevant questions about determinants of knee osteoarthritis (OA). METHODS Studies on subchondral bone remodeling in larger animal models applying meniscal injuries as standardizing entity were systematically analyzed. Of the identified 5367 papers reporting total or partial meniscectomy, meniscal transection or destabilization, 0.4% (in guinea pigs, rabbits, dogs, minipigs, sheep) remained eligible. RESULTS Only early or mid-term time points were available. Larger joint sizes allow reporting higher topographical details. The most frequently reported parameters were BV/TV (61%), BMD (41%), osteophytes (41%) and subchondral bone plate thickness (39%). Subchondral bone plate microstructure is not comprehensively, subarticular spongiosa microstructure is well characterized. The subarticular spongiosa is altered shortly before the subchondral bone plate. These early changes involve degradation of subarticular trabecular elements, reduction of their number, loss of bone volume and reduced mineralization. Soon thereafter, the previously normal subchondral bone plate becomes thicker. Its porosity first increases, then decreases. CONCLUSION The specific human topographical pattern of a thinner subchondral bone plate in the region below both menisci is present solely in the larger species (partly in rabbits), but absent in rodents, an important fact to consider when designing animal studies examining subchondral consequences of meniscus damage. Large animal models are capable of providing high topographical detail, suggesting that they may represent suitable study systems reflecting the clinical complexities. For advanced OA, significant gaps of knowledge exist. Future investigations assessing the subchondral bone in a standardized fashion are warranted.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany.
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Salman R, Ditzler MG, Jadhav SP, Schallert EK, McKay SD, Kan JH. Medial meniscal posterior horn tears and ramp lesions in pediatric patients: lessons learned. Pediatr Radiol 2023; 53:2345-2354. [PMID: 37704923 DOI: 10.1007/s00247-023-05736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
Meniscal injuries are increasingly reported in pediatric patients due to early sports participation and are commonly encountered during anterior cruciate ligament reconstruction. Preoperative identification of meniscal tears is crucial, particularly when involving the posteromedial meniscocapsular junction (ramp lesion). MRI plays an important role in detecting this particular type of meniscal injury. Consequently, pediatric radiologists should be aware of particular MRI findings related to ramp lesions including the presence of a medial meniscal tear, peripheral meniscal irregularity, meniscocapsular junctional fluid-like signal intensity, and capsular ligament tears. Thus, we illustrate the lessons we have learned from our institutional multidisciplinary arthroscopic-MR correlation conference for retrospectively identified posterior horn medial meniscal tears and ramp lesions.
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Affiliation(s)
- Rida Salman
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Matthew G Ditzler
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA.
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Erica K Schallert
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Scott D McKay
- Department of Orthopedics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
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7
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Hernigou P, Karam S, Zhang N, Guo W, Ge J, Liu C, Zhang Q, Hernigou J. Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty. Int Orthop 2023; 47:2477-2485. [PMID: 37500969 DOI: 10.1007/s00264-023-05907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown. METHODS We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment. RESULTS CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions. CONCLUSION On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary.
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MESH Headings
- Humans
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/surgery
- Menisci, Tibial/pathology
- Chondrocalcinosis/complications
- Chondrocalcinosis/diagnostic imaging
- Chondrocalcinosis/surgery
- Knee Joint/diagnostic imaging
- Knee Joint/surgery
- Knee Joint/pathology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/surgery
- Osteoarthritis, Knee/pathology
- Knee Injuries/surgery
- Cartilage Diseases/surgery
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Créteil, France.
| | - Sami Karam
- Department of Orthopaedic Surgery, University Paris East (UPEC), Créteil, France
| | - Nianfei Zhang
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Changquan Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jacques Hernigou
- Department of Orthopedic Surgery, EpiCURA Hospital, 7331, Baudour, Belgium
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Erard J, Cance N, Shatrov J, Fournier G, Gunst S, Ciolli G, Porcelli P, Lustig S, Servien E. Delaying ACL reconstruction is associated with increased rates of medial meniscal tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4458-4466. [PMID: 37486367 DOI: 10.1007/s00167-023-07516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. METHODS Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%). RESULTS Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). CONCLUSION Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
| | - Nicolas Cance
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Stanislas Gunst
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Gianluca Ciolli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Via Della Pineta Sacchetti, 217, 00168, Rome, Italy
| | - Pasquale Porcelli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Orthopaedic and Traumatology Department, Centro Traumatologico Ortopedico, Via Gianfranco Zuretti, 29, 10126, Turin, TO, Italy
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- IFSTTAR, Univ Lyon, Claude Bernard Lyon 1 University, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Labarre C, Kim SH, Pujol N. Incidence and type of meniscal tears in multilligament injured knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:465-474. [PMID: 35854134 DOI: 10.1007/s00167-022-07064-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Meniscal injuries occurring during multi-ligament knee injuries (MLKI) are underreported. The purpose of this study was to compare the incidence and type of meniscal tears seen at the time of multi-ligament reconstruction surgery compared to those occurring during isolated anterior cruciate ligament (ACL) surgery. METHODS Patients undergoing surgical treatment for MLKI and ACL-only injuries between 2010 and 2020 were reviewed. Two-hundred and thirty-five patients were included in the MLKI group. There were 131 chronic injuries and 104 acute injuries. Two-hundred and twenty-two ACL-only chronic injuries were used as a control group for comparison with the chronic MLKI group. Demographic data, type of meniscal tears, ligament injury patterns (Schenck classification) and time from injury to surgery were recorded. A delayed procedure was defined by a 4-week interval after the knee injury. RESULTS A meniscus was torn in 69 knees (29.4%): 36 knees (15.3%) with an isolated medial meniscus tear, 33 knees (17.9%) with an isolated lateral meniscus tear,.Nine knees (3.8%) had both menisci torn. MLKI with medial or lateral-sided bicruciate ligament injuries (KDIIIM-KDIIIL) were significantly associated with a lower rate of meniscal tears than knee injuries involving the ACL-only and medial/lateral-sided ligament injuries (KDI) (medial-sided injuries p = 0.025; lateral-sided injuries p = 0.049). Lateral-sided injuries had significantly less meniscal damage than medial-sided injuries: 22/124 (17.7%) vs. 41/100 (41%); (p < 0.001). No significant differences were found for frequency, type and distribution of meniscal tears between acute and chronic MLKI surgery. ACL-only chronic injuries were associated with a higher rate of meniscal tears: 123/222 knees (55.4%) vs. 35/131 (26.9%) chronic MLKI; (p < 0.001), mainly involving the medial meniscus: 102/222 (46%) vs. 18/131 (13.7%); (p < 0.001). CONCLUSIONS Meniscal tears were less common in the MLKI group than in the isolated ACL injury group. The degree of ligament injury patterns and the side of the injured collateral ligament influenced the type and incidence of meniscal damage. Contrary to isolated ACL injuries, a delayed procedure was not associated with a higher rate of meniscal lesions but did influence the type of treatment. Understanding of meniscal tears patterns in MLKI helps to improve the treatment management of these complex injuries.
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Affiliation(s)
- Chloé Labarre
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles ,André Mignot Hospital, Île-de-France Ouest University, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea
| | - Nicolas Pujol
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles ,André Mignot Hospital, Île-de-France Ouest University, 177 Rue de Versailles, 78150, Le Chesnay, France.
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McHugh CG, Gottreich JR, Kumara MT, Selzer F, Collins JE, Losina E, Katz JN. An approach to virtual clinical trial site visits: Lessons from the MeTeOR trial. Osteoarthr Cartil Open 2023; 5:100337. [PMID: 36798735 PMCID: PMC9926209 DOI: 10.1016/j.ocarto.2023.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Objective To provide a framework for conducting clinical trial site visits virtually over videoconference, and to report on our experience doing so during the twelve-year follow-up of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. Design Using published FDA guidance and prior literature, we created a structure for virtual site visits that prioritized monitoring for protocol compliance, safety, and data integrity. We conducted site visits in three stages: preparation for the visit, the virtual meeting itself, and follow-up. The preparation phase involved a review of relevant site-specific documents and a written report on the findings prior to the visit. The virtual visit itself was focused on any questions the site staff had about the pre-visit report, observing a mock study visit, touring physical spaces, and understanding the site staff's work environment. In the follow-up phase, we wrote a post-visit report summarizing the discussion during the visit and feedback given by the coordinating site. Results We found that the virtual site visits conducted as part of the MeTeOR trial follow-up ran smoothly. Although we could not directly compare in-person and virtual site visits, site staff unanimously appreciated the efficiency and effectiveness of the virtual site visits. We noted that displaying physical workspaces over videoconferencing was difficult, and a notable drawback to this method. Conclusions To our knowledge, this is the first published framework for conducting virtual clinical trial site visits. Conducting these visits virtually confer several advantages in terms of time, money, and efficiency.
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Affiliation(s)
- Claire G. McHugh
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Julia R. Gottreich
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Mahima T. Kumara
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA,Harvard Medical School, USA
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA,Harvard Medical School, USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA,Harvard Medical School, USA,Department of Biostatistics, Boston University School of Public Health, USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA,Division of Rheumatology, Immunology and Immunity, Brigham and Women's Hospital, USA,Harvard Medical School, USA,Department of Epidemiology, Harvard Chan School of Public Health, USA,Corresponding author. Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St., Hale, 5016, USA.
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11
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Bayram E, Şener N, Korkmaz M, Yıldırım C, Aydın M, Yurdaışık I, Çetinus ME. Internal tibial torsion is associated with medial meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:2251-2256. [PMID: 36153779 DOI: 10.1007/s00167-022-07173-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). METHODS This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. RESULTS There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). CONCLUSION The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erhan Bayram
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey.
| | - Nurullah Şener
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Musa Korkmaz
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Cem Yıldırım
- Department of Orthopedics and Traumatology, Çam Ve Sakura Training and Research Hospital, Istanbul, Turkey
| | - Mahmud Aydın
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Işıl Yurdaışık
- Department of Radiology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Istanbul, Turkey
| | - Mahmut Ercan Çetinus
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Borque KA, Jones M, Cohen M, Johnson D, Williams A. Evidence-based rationale for treatment of meniscal lesions in athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1511-1519. [PMID: 34415368 DOI: 10.1007/s00167-021-06694-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid not only to the pathology, but also to a player's contract status, time in the season, specific demands of his/her sport and position on the field, and future consequences. Successful treatment requires the clinician to understand the player's goals and needs, communicate effectively between all stakeholders, and a have knowledge of the challenges posed by the different types of meniscal tear seen in this population. Paramount is the distinction between injuries to the medial and lateral meniscus. Deficiency of the lateral meniscus, as a result of a tear or a meniscectomy, leads to frequent early problems and inexorably to chondral degeneration thereby affecting an athlete's ability to perform. Therefore, it is strongly recommended to repair the majority of lateral meniscal tears. Medial meniscal tears pose a more challenging treatment dilemma, as the success of partial meniscectomy in achieving reproducible, early return to play must be balanced against the long-term degenerative consequences. Many meniscal tears are correctly treated non-operatively.Level of evidence V.
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Affiliation(s)
- Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, USA
| | | | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
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Yoshida K, Hakozaki M, Kobayashi H, Kimura M, Konno S. Surgical treatment for a combined anterior cruciate ligament and posterior cruciate ligament avulsion fracture: A case report. World J Clin Cases 2022; 10:3879-3885. [PMID: 35647157 PMCID: PMC9100726 DOI: 10.12998/wjcc.v10.i12.3879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/11/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Independent avulsion fractures with anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) attachment are relatively common among tibial intercondylar eminence fractures, and their postoperative outcomes are generally favorable. Conversely, huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare, and the reported clinical outcomes are poor.
CASE SUMMARY We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL, together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place. All of these injuries were treated surgically, with anatomical reduction and stable fixation. The limb function at 1 year post-surgery was excellent (Lysholm score: 100 points).
CONCLUSION Although this patient's complete surgical repair was complex, it should be performed in similar cases for an excellent final clinical outcome.
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Affiliation(s)
- Katsuhiro Yoshida
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Higashi-Shirakawa Orthopaedic Academy, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Higashi-Shirakawa Orthopaedic Academy, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Department of Orthopaedic Surgery, Sukagawa Hospital, Fukushima 962-0022, Japan
| | - Masashi Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Gunma 379-2115, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Li MD, Deng F, Chang K, Kalpathy-Cramer J, Huang AJ. Automated Radiology-Arthroscopy Correlation of Knee Meniscal Tears Using Natural Language Processing Algorithms. Acad Radiol 2022; 29:479-87. [PMID: 33583713 DOI: 10.1016/j.acra.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES Train and apply natural language processing (NLP) algorithms for automated radiology-arthroscopy correlation of meniscal tears. MATERIALS AND METHODS In this retrospective single-institution study, we trained supervised machine learning models (logistic regression, support vector machine, and random forest) to detect medial or lateral meniscus tears on free-text MRI reports. We trained and evaluated model performances with cross-validation using 3593 manually annotated knee MRI reports. To assess radiology-arthroscopy correlation, we then randomly partitioned this dataset 80:20 for training and testing, where 108 test set MRIs were followed by knee arthroscopy within 1 year. These free-text arthroscopy reports were also manually annotated. The NLP algorithms trained on the knee MRI training dataset were then evaluated on the MRI and arthroscopy report test datasets. We assessed radiology-arthroscopy agreement using the ensembled NLP-extracted findings versus manually annotated findings. RESULTS The NLP models showed high cross-validation performance for meniscal tear detection on knee MRI reports (medial meniscus F1 scores 0.93-0.94, lateral meniscus F1 scores 0.86-0.88). When these algorithms were evaluated on arthroscopy reports, despite never training on arthroscopy reports, performance was similar, though higher with model ensembling (medial meniscus F1 score 0.97, lateral meniscus F1 score 0.99). However, ensembling did not improve performance on knee MRI reports. In the radiology-arthroscopy test set, the ensembled NLP models were able to detect mismatches between MRI and arthroscopy reports with sensitivity 79% and specificity 87%. CONCLUSION Radiology-arthroscopy correlation can be automated for knee meniscal tears using NLP algorithms, which shows promise for education and quality improvement.
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McHugh CG, Matzkin EG, Katz JN. Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage 2022; 30:178-183. [PMID: 34600120 PMCID: PMC8792212 DOI: 10.1016/j.joca.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify and summarize literature related to the association between mechanical symptoms (catching and locking of the knee), the presence of meniscal tear, and outcomes after arthroscopic surgery. DESIGN We searched PubMed and hand-searched reference lists for relevant articles and selected 38 for analysis. RESULTS Mechanical symptoms appear to have modest sensitivity (ranging 0.32-0.69), specificity (ranging 0.45-0.74) and positive predictive value (ranging 0.75-0.81) for meniscal tear. There is also very little evidence to suggest that those with mechanical symptoms experience better outcomes after arthroscopic surgery. CONCLUSION Our examination of the literature does not support the hypothesis that mechanical symptoms are related to the presence of meniscal tear or portend better outcomes after arthroscopic surgery.
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Affiliation(s)
| | - Elizabeth G. Matzkin
- Department of Orthopedic Surgery, Boston, MA USA,Brigham and Women’s Hospital; Harvard Medical School, Boston, MA USA
| | - Jeffrey N. Katz
- Department of Orthopedic Surgery, Boston, MA USA,Division of Rheumatology, Immunity and Inflammation, Boston, MA USA,Brigham and Women’s Hospital; Harvard Medical School, Boston, MA USA
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Gilat R, Mitchnik IY, Moriah A, Levi A, Cohen O, Lindner D, Beer Y, Agar G. The impact of body mass index on the accuracy of the physical examination of the knee. Int Orthop 2022. [PMID: 34993555 DOI: 10.1007/s00264-021-05277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Obesity is a worldwide pandemic; however, no adaptations were made to the physical examination of obese patient's knees. The accuracy of the physical examination is critical for correct assessment and selection of treatment. We aimed to assess whether body mass index (BMI) affects the sensitivity and specificity of common provocative knee tests. METHODS We studied 210 patients who underwent knee arthroscopy to treat anterior cruciate ligament (ACL) and meniscal pathologies. BMI and the knee's physical examination were documented pre-operatively. Sensitivity, specificity, and accuracy of ACL and meniscal provocative tests in relation to BMI were evaluated using arthroscopy as a gold standard. RESULTS The Anterior Drawer, Lachman, and Pivot-Shift tests for ACL tears were significantly less accurate and sensitive, yet more specific, in obese patients when compared to normal and overweight patients. The McMurray, Apley Grind, and Thessaly tests for medial meniscus tears showed greater sensitivity, but lower specificity, in patients with increased BMI. Above normal BMIs, independently of age and gender, were significantly associated with higher odds for positive ACL tests. CONCLUSION Tests for ACL tears are less sensitive in obese patients and alternatives to the classic tests should be considered. Medial meniscus tests tend to be more sensitive and less specific in patients with greater BMIs. Their results should be carefully interpreted due to possible false positives. The physician should take into consideration the impact of patient BMI on the accuracy of their physical examination of the knee to optimize treatment decision-making.
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Abstract
Background Increased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus. Methods The finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone. Results The maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model. Conclusions Higher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.
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Affiliation(s)
- Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Department of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdańsk, Gdańsk, Poland
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Clementsen JM, Skou ST, Hansen SL, Eshøj HR, Mølgaard CM, Mikkelsen LR, Thorlund JB. The translated Danish version of the Western Ontario Meniscal Evaluation Tool (WOMET) is reliable and responsive. Knee Surg Sports Traumatol Arthrosc 2021; 29:4278-85. [PMID: 33839897 DOI: 10.1007/s00167-021-06551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to translate and cross-culturally adapt the Western Ontario Meniscal Evaluation Tool (WOMET) for use in Denmark and evaluate its test-retest reliability and comparative responsiveness. METHODS Sixty patients (mean age 50 years (range 19-71 years), females 57%) with meniscal injury scheduled for arthroscopic meniscal surgery at a small Danish hospital in the period from September 2017 to February 2018 were included in this study. The WOMET was translated into Danish using forward and backward translation. The WOMET was completed at baseline (pre-surgery), at 3 and 6 months postoperatively. Additionally, reliability was assessed at 3 months and 3 months plus 1 week, for patients with a stable symptom state (global response question) between test and retest. Comparative responsiveness was assessed between the WOMET and the Knee Injury and Osteoarthritis Outcome Score (KOOS4-aggregate score of 4 of the 5 KOOS subscales). RESULTS The Danish version of WOMET showed excellent test-retest reliability, intraclass correlation coefficient of 0.88 (95% CI 0.84-0.92) for the total score. The standard error of measurement was 125 points and the minimal detectable change was 347 points (i.e. 8% and 22% of the total score, respectively). The WOMET was responsive with an effect size (ES) of 1.12 at 6 months after surgery, which was comparable to the KOOS4 (ES 1.10). CONCLUSION The Danish version of the WOMET is a reliable and responsive measure of health-related quality of life in patients with meniscal pathology. LEVEL OF EVIDENCE Level II.
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Snoeker BAM, Ishijima M, Kumm J, Zhang F, Turkiewicz AT, Englund M. Are structural abnormalities on knee MRI associated with osteophyte development? Data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2021; 29:1701-1708. [PMID: 34284113 DOI: 10.1016/j.joca.2021.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess which structural abnormalities on knee MRI are associated with development of osteophytes in middle-aged subjects without radiographic knee osteoarthritis. DESIGN We included subjects from the Osteoarthritis Initiative, aged 40-55 years, Kellgren & Lawrence grade 0 in both knees, and knee MRIs from both knees available at baseline, 24, 48 and 72 months. Structural exposures on MRI assessed using MOAKS included cartilage damage, bone marrow lesions, meniscal tear, meniscal extrusion, and Hoffa/effusion synovitis. We assessed whether each structural exposure was associated with the development of osteophytes on MRI in the medial and lateral tibiofemoral, and patellofemoral compartment. We estimated hazard ratios (HR) including 95% confidence intervals (CI) for osteophyte development using a mixed complementary log-log regression model adjusted for age, sex, and body mass index. RESULTS We included 680 knees from 340 subjects with a mean (SD) age of 50 years (3.0), and 51% men. In the medial tibiofemoral compartment, the absolute risk of osteophyte development in the first 24-month period was 4% in knees without, and 15% in knees with medial meniscal tear. Corresponding adjusted HR was 6.6 (95%CI = 3.4-12.9). In the lateral tibiofemoral compartment, the adjusted HR for developing osteophytes having a lateral meniscal tear was 3.3 (95%CI = 1.3-8.4). In the patellofemoral compartment, patellofemoral cartilage damage was most clearly associated with developing osteophytes (HR = 2.6, 95%CI = 1.8-3.7). CONCLUSIONS Meniscal tear seem to be the strongest structural risk factor for the development of tibiofemoral osteophytes, and patellofemoral cartilage damage for the development of patellofemoral osteophytes, respectively. Local biomechanical factors are important in early osteophyte development.
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Affiliation(s)
- B A M Snoeker
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
| | - M Ishijima
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - J Kumm
- Department of Radiology, University of Tartu, Estonia
| | - F Zhang
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - A T Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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Duong TD, Tran DT, Do BNT, Tran HT, Le SM, Vu TT. 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 DOI: 10.1016/j.ijscr.2021.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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
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22
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Stensby JD, Pringle LC, Crim J. MRI of the Meniscus. Clin Sports Med 2021; 40:641-55. [PMID: 34509203 DOI: 10.1016/j.csm.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The menisci of the knee are accurately evaluated by MRI. Knowledge of normal anatomy, imaging parameters, imaging appearance of the normal and torn meniscus, and common anatomic variants and pitfalls are essential in obtaining the correct imaging diagnosis. There are multiple imaging signs of meniscal tear, including linear signal intensity extending to an articular surface on at least 2 images, altered meniscal shape, displaced meniscal flap, ghost meniscus, meniscal extrusion, and parameniscal cyst. After surgery, granulation tissue may mimic tear. Diagnosis is improved by comparison to preoperative images, operative note, and intra-articular contrast administration.
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23
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Magosch A, Mouton C, Nührenbörger C, Seil R. Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2021; 29:3059-3067. [PMID: 33165632 DOI: 10.1007/s00167-020-06352-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/26/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)-injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns. METHODS Data from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center-based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi-square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury's relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal-Wallis test. Significance was set at p < 0.05. RESULTS Two hundred and thirty-nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non-contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non-contact injuries (10% vs 4%, p < 0.05). CONCLUSION Two-thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL-associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. Biomater Biosyst 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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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Kawashima I, Tsukahara T, Sakai T, Kawai R, Ishizuka S, Hiraiwa H, Imagama S. Delayed anterior cruciate ligament reconstruction increases the incidence of medial meniscal bucket handle tears and medial compartment chondral injuries in patients aged 40 years and older. Arch Orthop Trauma Surg 2021; 141:971-975. [PMID: 33426607 DOI: 10.1007/s00402-020-03745-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION No widely accepted evidence-based indications exist for the initial surgical management of patients with anterior cruciate ligament (ACL) injuries ≥ 40 years old, and treatment for these patients remains controversial. This study aimed to evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injury in patients aged ≥ 40 years. MATERIALS AND METHODS The patients who underwent primary ACL reconstruction were divided into two groups based on elapsed time from injury to surgery: early group, < 12 months; and delayed group, ≥ 12 months. Patient records were reviewed for incidence and types of meniscal tears and chondral injuries in each group. Chondral injury grades were evaluated with International Cartilage Regeneration and Joint Preservation Society (ICRS) Criteria. RESULTS This study evaluated 67 knees in the early group and 33 knees in the delayed group. Mean ages in each group were 46.9 ± 6.5 and 46.9 ± 6.0. The delayed group showed significantly higher rates of medial meniscal tear [31 of 33, 93.9% vs 29 of 67, 43.3%; P < 0.0001; odds ratio (OR), 20.31; 95% confidence interval (CI), 4.49-91.9], medial femoral condyle chondral injuries ≥ ICRS grade II (15 of 33, 45.5% vs 8 of 67, 11.9%; P < 0.001; OR, 6.15; 95% CI 2.24-16.83), and medial tibial chondral injuries ≥ ICRS grade II (7 of 33, 21.2% vs 3 of 67, 4.5%; P < 0.05; OR, 5.74; 95% CI 1.38-23.9) compared with the early group. With respect to types of medial meniscal tear, the delayed group showed a significantly higher frequency of bucket handle tears (11 of 33, 33.3%) compared with the early group (2 of 67, 3.0%; P < 0.0001; OR, 16.25; 95% CI 3.34-79.1). CONCLUSIONS Delayed ACL reconstruction was associated with increased incidence of chondral injuries and medial meniscal tears, particularly bucket handle tears in this cohort. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Itaru Kawashima
- Asahi University Hospital, Gifu, Japan. .,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan. .,Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Takashi Tsukahara
- Asahi University Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Tadahiro Sakai
- Department of Orthopaedic Surgery, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Ryosuke Kawai
- Asahi University Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Ahmed I, Moiz H, Carlos W, Edwin C, Staniszewska S, Parsons N, Price A, Hutchinson C, Metcalfe A. The use of magnetic resonance imaging (MRI) of the knee in current clinical practice: A retrospective evaluation of the MRI reports within a large NHS trust. Knee 2021; 29:557-563. [PMID: 33774589 DOI: 10.1016/j.knee.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study is to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. METHODS Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery. RESULTS 4466 MRI knees were performed in 2017 with 71.2% requested in primary care and 28.1% requested in secondary care. The most common diagnosis was signs of arthritis (55.2%), followed by meniscal tears (42.8%) and ACL tears (8.3%). 49.4% of patients who had an MRI attended outpatients and 15.6% underwent surgery. The rate of knee surgery was significantly higher for patients who had their scans requested in secondary care (32.9% vs 8.9%, p < 0.001). CONCLUSION The rate of surgical intervention following MRI is low and given these results it seems unlikely that the scan changes practice in most cases. The rate of surgery and outpatient follow up was significantly higher in scans requested by secondary care. We urge clinicians avoid wasteful use of MRI and recommend the use of plain radiography prior to MRI where arthritis may be present.
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Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Haseeb Moiz
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - William Carlos
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Claire Edwin
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Sophie Staniszewska
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Nick Parsons
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Andrew Price
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Charles Hutchinson
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratory, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
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Ariyachaipanich A, Kaya E, Statum S, Biswas R, Tran B, Bae WC, Chung CB. MR imaging pattern of tibial subchondral bone structure: considerations of meniscal coverage and integrity. Skeletal Radiol 2020; 49:2019-27. [PMID: 32591855 DOI: 10.1007/s00256-020-03517-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare regional differences in subchondral trabecular structure using high-resolution MRI in meniscus-covered/meniscus-uncovered tibia in cadaveric knees with intact/torn menisci. MATERIALS AND METHODS 3D proton density CUBE MRI of 6 cadaveric knees without significant osteoarthritis (OA) was acquired, 0.25-mm resolution. Menisci were evaluated and classified intact or torn. MR data were transferred to ImageJ program to segment tibial 3D volume of interest (VOI). Data was subdivided into meniscus-covered/meniscus-uncovered regions. Segmented VOI was classified into binary data, trabeculae/bone marrow. The trabecular bone data was used to measure MR biomarkers (apparent subchondral plate-connected bone density (adapted from spine MR), apparent trabecular bone volume fraction, apparent mean trabecular thickness, apparent connectivity density, and structure model index (SMI)). Mean value of parameters was analyzed for the effects of meniscal tear/tibial coverage. RESULTS Nine torn menisci and 3 intact menisci were present. MR measures of bone varied significantly due to meniscal coverage/tear. Subchondral plate-connected bone density under covered meniscus regions increased from 10.9 to 23.5% with meniscal tear. Values increased in uncovered regions, 19.3% (intact) and 32.4% (torn). This reflects higher density when uncovered (p = 0.048) with meniscal tear (p = 0.007). Similar patterns were found for trabecular bone fraction (coverage p < 0.001, tear p = 0.047), trabecular thickness (coverage p = 0.03), connectivity density (coverage p = 0.002), and SMI (coverage p = 0.015). CONCLUSION Quantitative trabecular bone evaluation emphasizes intrinsic structural differences between meniscus-covered/meniscus-uncovered tibias. Results offer insight into bone adaptation with meniscal tear and support the hypothesis that subchondral bone plate-connected bone density could be important in early subchondral bone adaptation.
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28
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Rhatomy S, Septiawan EM. Locked knee due to fat pad adhesion. Int J Surg Case Rep 2020; 77:264-268. [PMID: 33189008 PMCID: PMC7672247 DOI: 10.1016/j.ijscr.2020.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
Locked Knee. Adhesion. Fat Pad Adhesion. Arthroscopic debridement.
Background A "locked" knee is defined as a knee that does not move freely after an injury. Most cases of locked knee are due to intra-articular blockade caused by an unstable meniscal tear, anterior cruciate ligament (ACL) tear, or chondral lesion resulting in a loose limb. In this study, we present a rare case of a locked knee caused by fat pad adhesion Case presentation A 23-year-old male presented with a locked right knee, after sustaining an injury falling one month before. Magnetic Resonance Imaging showed loss of ACL feature, normal posterior cruciate ligament, and meniscal tear of posterior horn. Arthroscopy procedure found fat pad adhesion, immobilizing the knee’s rotation. After removing all of the fat pad adhesion, the patient’s knee could move freely. Conclusion Clinical and radiographic examinations are important for early diagnosis of the cause of locked knee, but arthroscopic examination is the gold standard for diagnosis.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Eko Medio Septiawan
- Department of Orthopedics and Traumatology, Jogja General Hospital, Yogyakarta, Indonesia
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Sgroi M, Gninka J, Fuchs M, Seitz AM, Reichel H, Kappe T. Chondral lesions at the medial femoral condyle, meniscal degeneration, anterior cruciate ligament insufficiency, and lateral meniscal tears impair the middle-term results after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:3488-3496. [PMID: 32036398 DOI: 10.1007/s00167-020-05883-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of the present study was to analyse which clinical, radiological and arthroscopic findings are able to predict the postoperative outcome after arthroscopic partial meniscectomy. Furthermore, the present study aimed to investigate the postoperative outcome after partial meniscectomy in patients with degenerative meniscal lesions. METHODS A total of 91 patients with a follow-up period of 34.7 ± 11.4 months after arthroscopic partial meniscectomy were included in this retrospective study. Clinical, radiological, and arthroscopic data were analysed at the time of follow-up. The multivariable linear regression analysis for postoperative outcome, based on the Western Ontario Meniscal Evaluation Tool (WOMET), included age, gender, body mass index, physical activity, presence of cartilage lesions, leg alignment, grade of radiographic osteoarthritis, location of meniscal lesions, meniscal extrusion, meniscal degeneration, presence of an anterior cruciate ligament tears as well as bone marrow lesions. RESULTS WOMET and WOMAC scores showed a significant improvement of 45.0 ± 48.1 points (CI 34.9-55.1; p ≤ 0.0001) and 75.1 ± 69.3 points (CI 60.6-89.6; p = 0.001) within the follow-up period. Multivariable linear regression analysis showed that poor preoperative WOMET scores (p = 0.001), presence of cartilage lesions at the medial femoral condylus (p = 0.001), meniscal degeneration (p = 0.008), the presence of an anterior cruciate ligament lesion (p = 0.005), and lateral meniscal tears (p = 0.039) were associated with worse postoperative outcomes. Patients with femoral bone marrow lesions had better outcome (p = 0.038). CONCLUSION Poor preoperative WOMET scores, presence of cartilage lesions at the medial femoral condylus, meniscal degeneration, concomitant anterior cruciate ligament lesions as well as lateral meniscal tears are correlated with worse postoperative outcomes after arthroscopic partial meniscectomy. Patients with femoral bone marrow lesions femoral are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. Despite justified recent restrictions in indication, arthroscopic partial meniscectomy seems to effectively reduce pain and alleviate symptoms in carefully selected patients with degenerative meniscal tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mirco Sgroi
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany. .,, 89075, Ulm, Germany.
| | - Johanna Gninka
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Michael Fuchs
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
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A Cavendish P, DiBartola AC, Everhart JS, Kuzma S, Kim WJ, Flanigan DC. Meniscal allograft transplantation: a review of indications, techniques, and outcomes. Knee Surg Sports Traumatol Arthrosc 2020; 28:3539-50. [PMID: 32415360 DOI: 10.1007/s00167-020-06058-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 01/25/2023]
Abstract
When compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50 years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable joint malalignment, and/or knee instability. Outcomes for meniscal allograft transplantation are promising with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures. LEVEL OF EVIDENCE: Level V.
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Abdel Tawab Abdallah M, Said HG, Ramadan EKA, Abd El-Radi M, El-Assal MA. Results of meniscal injuries repair using different arthroscopic techniques. SICOT J 2020; 6:39. [PMID: 33026318 PMCID: PMC7539796 DOI: 10.1051/sicotj/2020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/11/2020] [Indexed: 11/14/2022] Open
Abstract
AIM Evaluation of clinical and radiological outcomes following meniscal repair using different arthroscopic techniques for all meniscal tears amenable for repair. METHODS Sixty-one patients were involved in a prospective study; all cases presented with meniscal tears underwent arthroscopic meniscal repair from December 2016 to December 2017. Outcomes involved the site of tear, the repair technique, and associated injuries. The International Knee Documentation Committee Score (IKDC) and Tegner Lysholm Knee Score were used to analyze the clinical and functional outcomes postoperatively. RESULTS Of the 61 patients, 50 patients (81.9%) had meniscal tear associated with isolated ligamentous ACL injury, 6 cases had corrective osteotomy with ACL reconstruction to correct concomitant genu varus, 2 cases (3.3%) had meniscal tear associated with isolated ligamentous PCL injury, and 9 patients (14.8%) presented with isolated meniscal tear; IKDC was preoperatively (44.52 ± 8.79), postoperatively at 6 months (90.97 ± 6.75) and at 12 months (92.27 ± 2.68) with P-value (0.001). Tegner Lysholm score was preoperatively (52.16 ± 12.22), postoperatively at 6 months (88.03 ± 6.84) and at 12 months (93.26 ± 2.95) with P-value (0.001). Fifty eight patients (95.1%) had no postoperative symptoms at 6 and 12 months' follow-up. The remaining 3 cases (4.9%) underwent partial meniscectomy due to persistent postoperative clinical symptoms with no signs of healing in MRI. CONCLUSIONS Our study concluded that arthroscopic meniscal repair is an effective way in the management of meniscal tears regarding clinical and functional outcomes.
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Affiliation(s)
| | - Hatem G Said
- Professor of Orthopedics and Traumatology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt
| | - Eslam Karam Allah Ramadan
- Lecturer of Orthopedics and Traumatology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt
| | - Mohamed Abd El-Radi
- Lecturer of Orthopedics and Traumatology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt
| | - Maher A El-Assal
- Professor of Orthopedics and Traumatology, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt
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Gupta R, Kapoor A, DavidMasih G. Prevalence of concomitant knee injuries associated with anterior cruciate ligament tear in kabaddi and football players. J Clin Orthop Trauma 2020; 11:S784-8. [PMID: 32999556 DOI: 10.1016/j.jcot.2020.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little literature available about the type of sports and concomitant knee injury. THE PURPOSE OF THE STUDY To help in better prediction of concomitant knee injuries in football and kabaddi players. MATERIAL METHOD Five hundred and seventeen male athletes [Football (n = 226) and Kabaddi players (n = 291)] aged between 16 and 35 years were enrolled in the study. These were categorized into five groups depending upon the time interval between injury and surgery (0-3 months, 3-6 months, 6-9 months, 9-12 months, 12-18 months and 18-24 months). Meniscal and chondral damage present at the time of ACL reconstruction was documented. RESULTS The overall incidence of meniscal tear was more in kabaddi players (220/291) as compared to football players (144/226; p = 0.003). The incidence of both menisci tear was more in kabaddi as compared to football (p = 0.02). Incidence of lateral meniscus tear (147/291) in kabaddi was more as compared to football (84/226; p = 0.002). The incidence of condylar damage was comparable in both groups. Medial femoral condyle was more commonly injured in both the sports irrespective of time frame. CONCLUSION The chances of meniscus injuries were more in kabaddi players compared to football players in ACL deficient knee. The time interval between injury and surgery had a direct correlation with meniscus and chondral injuries. LEVEL OF EVIDENCE Level III, retrospective study.
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Liu Q, Wu J. A commentary on "Arthroscopic Partial Meniscectomy Combined With Medical Exercise Therapy Versus Isolated Medical Exercise Therapy for Degenerative Meniscal Tear: A Meta-Analysis of Randomized Controlled Trials" (Int J Surg 2020 Jul; 79: 222-232). Int J Surg 2020; 82:229-230. [PMID: 32898665 DOI: 10.1016/j.ijsu.2020.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Qixi Liu
- Department of Nursing, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China
| | - Jingqing Wu
- Department of Bone and Joint Surgery, Mindong Hospital of Fujian Medical University, Fujian Province, 355000, China.
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Konrads C, Döbele S, Ateschrang A, Ahmad SS. Outcome of anterior cruciate ligament reconstruction in children and adolescents: A retrospective study. J Clin Orthop Trauma 2020; 13:46-49. [PMID: 33717873 PMCID: PMC7920141 DOI: 10.1016/j.jcot.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Indications and outcomes of anterior cruciate ligament (ACL) reconstruction in children and adolescents is still controversial. It was the aim of this study to analyze outcomes of anterior cruciate ligament reconstruction in this special age group. METHODS Retrospectively, we analyzed 62 consecutive cases of ACL reconstruction using a physis crossing technique in six to 16-year-old patients with a mean follow-up of 69 months. RESULTS Cases operated later than six weeks after trauma had significantly more meniscal lesions than patients operated within six weeks of trauma. At last follow-up, we found good or very good subjective and objective results in 71% of the patients. CONCLUSION In active and healthy children with anterior knee instability after ACL tear, ligament reconstruction is a safe and successful procedure and should be considered within six weeks of trauma because instability seems to promote secondary meniscal lesions.
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Affiliation(s)
- Christian Konrads
- Corresponding author. Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen Schnarrenbergstr. 95 72076, Tübingen, Germany.
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Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A. The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-year follow-up. J Orthop Surg Res 2020; 15:361. [PMID: 32854749 PMCID: PMC7450795 DOI: 10.1186/s13018-020-01878-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023] Open
Abstract
Background Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients’ return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. Methods This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. Results High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. Conclusions Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.
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Affiliation(s)
- Juan M Rodríguez-Roiz
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain. .,CLINICA SAGRADA FAMILIA BARCELONA, c/torras i pujalt 1, 08022, Barcelona, Spain.
| | - Sergi Sastre-Solsona
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Dragos Popescu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Montañana-Burillo
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Andres Combalia-Aleu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
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Kim HJ, Ahn JM, Kim Y, Kang Y, Lee E, Lee JW, Kang HS. Association of meniscal flounce in the knee with the pattern and location of meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles: a magnetic resonance evaluation. Skeletal Radiol 2020; 49:1277-1284. [PMID: 32206830 DOI: 10.1007/s00256-020-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association of meniscal flounce with the pattern and location of the meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles. MATERIALS AND METHODS A total of 283 knees of 280 patients were retrospectively reviewed over a 9-month period. Thirty-one magnetic resonance images of patients with meniscal flounce were compared with those of age- and sex-matched control group (n = 62) without meniscal flounce. The presence of meniscal tear was evaluated and, if present, its location and pattern were recorded. The amount of joint effusion was graded, and the joint angle was measured. The Fisher's exact, Cochran-Armitage trend, and t tests were performed to compare the findings between the two groups. The decision tree analysis was employed to determine the most significant factor of meniscal flounce. RESULTS Meniscal flounce was present in 11.0% (31/283) of the adult population. Approximately 80.6% of meniscal flounce occurred in the torn medial menisci. The presence of meniscal flounce was significantly associated with tears at the body (p = 0.007), posterior horn (p = 0.001), and meniscocapsular junction (p = 0.002) of the medial meniscus. The decision tree analysis revealed that the posterior horn tear of the medial meniscus was the most significant predictor of meniscal flounce. CONCLUSION The most significant factor associated with meniscal flounce is tear at the posterior horn of the medial meniscus, followed by tear at the meniscocapsular junction.
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Affiliation(s)
- Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Youngjune Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Heung-Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Pan H, Zhang P, Zhang Z, Yang Q. Arthroscopic partial meniscectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear: A meta-analysis of randomized controlled trials. Int J Surg 2020; 79:222-232. [PMID: 32522685 DOI: 10.1016/j.ijsu.2020.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Degenerative meniscal tear is a chronic disorder which presents with knee pain, swelling and loss of motion. It is currently unknown whether arthroscopic partial meniscectomy combined with medical exercise therapy is superior to isolated medical exercise therapy for degenerative meniscal tear. OBJECTIVE To determine if medical exercise therapy alone is as effective as arthroscopic partial meniscectomy combined with medical exercise therapy in treating degenerative meniscal tear. METHOD Electronic searches were performed using MEDLINE, EMBASE, and the Cochrane Library Databases for all randomized studies. Two reviewers independently completed the literature screening, data extraction, and risk evaluation of bias. The outcome measures were visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion, the Lysholm Knee Scoring Scale (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS) and postoperative complications. STATA 13.0 software was applied for meta-analysis. RESULT Six randomized controlled trials (RCTs) were conducted, with 900 patients included. The present study revealed that there were significant differences between the two groups regarding the VAS at two months, as well as, WOMAC and range of motion. No significant differences were found in terms of LKSS, KOOS or postoperative complications. LIMITATIONS (1) Only 6 RCTs were included in our meta-analysis and the sample sizes were small; (2) The follow-up period was too short in some included studies. Long-term follow-up studies should be conducted in the future; (3) Heterogeneity among the included studies was unavoidable due to different grade of degenerative meniscal tear and program of exercise. Heterogeneity was also caused by a variety of other factors. (4) Publication bias that came from the process of literature searching was unavoidable and was hard to overcome. (5) There are many other words which could yielded more studies (Ex. physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis). Implications of key findings: This meta-analysis suggests that doctors can choose arthroscopic partial meniscectomy combined with medical exercise therapy for the treatment of degenerative meniscal tear. CONCLUSION Arthroscopic partial meniscectomy combined with medical exercise therapy is effective in reducing pain and improving range of motion in the early postoperative period. Therefore, arthroscopic partial meniscectomy combined with medical exercise therapy may be recommended for the treatment of degenerative meniscal tear. Further research is necessary to determine the type, frequency, and duration of the best exercise program. Systematic review registration number: Reviewregistry884.
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Affiliation(s)
- Huagang Pan
- Department of Orthopedics, Huaihe Hospital, Henan University, Kaifeng, 475000, China.
| | - Peng Zhang
- Department of Orthopedics, Huaihe Hospital, Henan University, Kaifeng, 475000, China
| | - Zhaodong Zhang
- Department of Orthopedics, Huaihe Hospital, Henan University, Kaifeng, 475000, China
| | - Quan Yang
- Department of Imaging, Huaihe Hospital, Henan University, Kaifeng, 475000, China
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Orsini NG, Favreau H, Eichler D, Ollivier M, Bonnomet F, Ehlinger M. Meniscus sutures by arthrotomy for a non-transfixing horizontal lesion associated with a cyst. Int Orthop 2020; 44:1071-1076. [PMID: 31993712 DOI: 10.1007/s00264-020-04491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Meniscal cysts are rare in Stoller grade II horizontal lesions. Several techniques are described in the literature for their management, without any real gold standard. The objective of this work was to report a series of meniscal sutures associated with cyst resection by arthrotomy. The hypothesis was that the results were satisfactory and comparable with the data in the literature regardless of the technique reported without morbidity added by arthrotomy. MATERIALS AND METHODS This was a monocentric retrospective study on 13 patients, aged 33 on average with a grade II meniscus lesion associated with a cyst (9 lateral and 4 medial menisci). Pre-operative data available was the VAS (5.7/10) and the Lysholm score (61/100). Primary endpoints were as follows: pain (visual analogue scale), global satisfaction, Lysholm functional score, and return to sports and professional activities at a minimum of two years. Secondary endpoints were complications, possible recurrence, and/or surgical revision. Recurrences, complications, and surgical recovery were gathered. RESULTS Patients were evaluated with an average follow-up of 32 months. All patients were satisfied or very satisfied. The VAS significantly improved (0.2/10, p < 0.05) as well as the Lysholm score (97/100, p < 0.05). All patients returned to their professional activity: 11 within two months, one within six weeks, and one in the first post-operative week (this patient being a student). Only one patient did not resume pre-operative sport level due to a femoropatellar syndrome, not linked to the meniscal surgery performed. However, only 11 patients resumed their previous sport level (84.6%). No recurrence or surgical revision occurred. DISCUSSION The results are good and similar to the literature, confirming the working hypothesis. These results are equivalent to partial meniscectomies and arthroscopic sutures associated with a procedure on the cyst by arthroscopy or arthrotomy. The literature is in favour of a procedure on the cyst. CONCLUSION The results confirm the effectiveness of a direct approach suture of non-transfixing meniscal lesions associated with a cyst resection with a good functional recovery, without additional morbidity. The hypothesis was confirmed.
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Affiliation(s)
- Nicolas Girodano Orsini
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ollivier
- Département de Chirurgie Orthopédique, Hôpital Sainte-Marguerite, Hôpital Universitaire de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France.
- Laboratoire ICube, équipe MMB, CNRS, Illkirch, France.
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Lee W, Lee J, Hong M, Kim K, Jung T, Kang K, Park K, Song Y. Mechanical alterations in the avascular region of the meniscus following partial meniscectomy: A cadaveric porcine longitudinal meniscal tear model. Clin Biomech (Bristol, Avon) 2020; 75:105005. [PMID: 32353689 DOI: 10.1016/j.clinbiomech.2020.105005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/23/2020] [Accepted: 03/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although partial meniscectomy is a common treatment for the tears in the avascular region of the meniscus, mechanical alterations following meniscectomy are known to initiate mechanically-induced osteoarthritis. We aimed to measure the articular cartilage contact pressure distributions in the knees with surgically repaired and partially resected menisci in the avascular region. METHODS A pneumatic loading device was developed to apply a 1000 N compressive load on the cadaveric porcine knee samples at the flexion angles of 20, 35, 50, and 65°. We simulated longitudinal meniscal tears in the avascular inner 1/3 portion and the well-vascularized middle 1/3 portion of the meniscus. Articular cartilage contact pressures for the knees with intact, torn, repaired, and resected menisci were compared. FINDINGS For the tears in well-vascularized regions, meniscal repairs restored articular cartilage contact pressures to the levels in intact joints. However, partial meniscectomy significantly increases the maximum contact pressures and the average contact pressures in highly compressed areas. However, partial meniscectomy in the avascular region did not alter the maximum articular cartilage contact pressures and the average contact pressures in highly compressed areas. Stabilities in knee samples were not significantly altered following partial meniscectomy in both inner and middle regions. INTERPRETATION Although repair surgeries are beneficial for the tears in well-vascularized areas because the articular cartilage contact mechanics are reconstructed, partial meniscectomy may be a viable alternative treatment for the tears in avascular regions without introducing significant mechanical alterations.
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Affiliation(s)
- Wonhee Lee
- Department of Mechanical Engineering, Korea University, Seoul, Republic of Korea
| | - Jaewook Lee
- Himchan Hospital, Incheon, Republic of Korea
| | - Minpyo Hong
- Department of Mechanical Engineering, Korea University, Seoul, Republic of Korea
| | - Kyungmin Kim
- Department of Mechanical Engineering, Korea University, Seoul, Republic of Korea
| | - Taegon Jung
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Kwansu Kang
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Kwangmin Park
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Yongnam Song
- Department of Mechanical Engineering, Korea University, Seoul, Republic of Korea.
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Gupta R, kapoor A, soni A, Khatri S, Masih GD. Anterior cruciate ligament tear due to non-contact mode of injury associated with higher incidence of meniscal and chondral damage. J Clin Orthop Trauma 2020; 11:S342-S345. [PMID: 32523291 PMCID: PMC7275271 DOI: 10.1016/j.jcot.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Forces acting on the knee are different in contact and non-contact mode of injuries causing anterior cruciate ligament (ACL) tear. Purpose of this study was to determine the effect of mode of injury on the occurrence of meniscal tear and chondral damage in ACL tear. METHOD 72 athletes with acute ACL injury (<3 months) were enrolled in the study. Depending on the mode of injury, athletes were divided into two groups - group A (non-contact mode of injury) and group B (contact mode of injury). 49/72 athletes had the non-contact mode of injury (group A), and 23/72 athletes had contact mode of injury (group B). Meniscal tear and chondral damage seen at the time of ACL reconstruction surgery was noted. All athletes were assessed at 12 months follow-up for return to sports, Lysholm score, and WOMAC score. RESULTS In group A, 35/49 (71%) athletes and in group B, 9/23(39%) athletes had meniscal tear (p = 0.009). Medial meniscus was more commonly injured in group A [24/49] as compared to group B (5/23; p = 0.03). Chondral damage was also more commonly seen in group A [26/49] as compared to group B (5/23; p = 0.01). At one-year follow-up, 65% of the athletes from group B returned to sports as compared to 57% of the athletes from group A (p-value = 0.6). WOMAC score in group A and B was 95.5 ± 4.88 and 96 ± 4.39 respectively (p = 0.67). Lysholm score in group A and B was 1.02 ± 1.7 and 0.96 ± 1.2 respectively (p = 0.88). CONCLUSION Non-contact mode of injury was associated with a higher incidence of meniscal tear and chondral damage. However, the mode of injury does not affect the functional outcome of ACL reconstruction surgery.
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Kim YM, D'Lima DD, Joo YB, Park IY. Huge intrameniscal cyst successfully treated by open debridement and combined arthroscopic and open repair: a case report. BMC Musculoskelet Disord 2020; 21:190. [PMID: 32220248 PMCID: PMC7102424 DOI: 10.1186/s12891-020-03218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meniscal cysts are not uncommon in clinical practice, with reported incidence rates varying from 1 to 22%. Most meniscal cysts are parameniscal cysts, which are created by extravasation of synovial fluid through the meniscal tear into the adjacent soft tissue. In contrast, intrameniscal cysts in which the fluid collects in the meniscus are very rare. We encountered a teenager with a huge intrameniscal cyst accompanied by a small vertical meniscal tear in the red-white zone of the upper surface of the medial meniscus. A literature search revealed no information regarding the appropriate treatment methods and results for this type of lesion. CASE PRESENTATION A 14-year-old boy presented to our outpatient clinic because of right knee pain that had been present for the previous 2 months. The patient participated in Hapkido, but had no specific trauma history. Magnetic resonance imaging revealed a huge intrameniscal cyst located in the central parenchyma of the posteromedial corner of the medial meniscus. In addition, one sagittal slice on MRI revealed a vertical tear in the red-white zone of the upper surface of the medial meniscus. The presence of such a tear accompanied by a huge intrameniscal cyst is very unusual. The patient was treated via arthroscopic inside-out meniscal suture repair and open cystic debridement with additional meniscocapsular suturing. During 4 years of magnetic resonance imaging follow-up, the lesion has completely disappeared and the meniscus has successfully recovered its normal form. CONCLUSIONS Our treatment method may be considered as the first choice for young patients who require surgical treatment for large intrameniscal cysts with accompanying small vertical meniscal tears.
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Affiliation(s)
- Young-Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, 92037, USA
| | - Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea.
| | - Il-Young Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
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Abstract
Meniscal ramp lesions occur much more frequently than was previously considered, and particularly so in ACL-injured knees. The historically high rate of missed diagnoses is a result of unfamiliarity with this injury pattern within the orthopedic community, and also the difficulty in diagnosis. A systematic exploration of the posteromedial compartment of the knee is mandatory to reliably identify ramp lesions. Failure to recognize and repair these injuries is associated with persistent anterior and posteromedial instability. Understanding their nature, biomechanics, and epidemiology is essential in allowing orthopedic surgeons to suspect their presence and adequately treat these lesions.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, Lyon 69008, France.
| | - Raphael Serra Cruz
- Instituto Nacional de Traumatologia e Ortopedia, 500 Avendia Brasil, Caju, Rio de Janeiro, 20940-070, Brazil; Hospital São Vicente de Paulo, Rio de Janeiro, Rio de Janeiro, Brazil; Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, Lyon 69008, France
| | - Rodrigo A Goes
- Instituto Nacional de Traumatologia e Ortopedia, 500 Avendia Brasil, Caju, Rio de Janeiro, 20940-070, Brazil
| | - Adnan Saithna
- Sano Orthopedics, 2000 SE Blue Pkwy, Kansas City, MO 64063, USA; Department of Specialty Medicine (Trauma & Orthopedic Surgery), Kansas City University, Kansas City, MO, USA
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Abstract
BACKGROUND The meniscus plays a vital role in the normal biomechanics of the knee. However, it is not well studied at the molecular level. The purpose of this study was to determine whether molecular and pathological changes in the meniscal tissue vary depending on the presence or absence of meniscal and/or anterior cruciate ligament tear (ACL). METHODS Six normal menisci (group A), seven simple torn menisci (group B) and seven torn menisci with concomitant anterior cruciate ligament tears (group C) were collected. We observed the pathological changes in the menisci and used real-time polymerase chain reaction along with immunohistochemistry and in situ hybridisation to examine the levels of ACAN, ADAMTS5, COL10A1, CEBPβ, MMP13 and miR-381-3p, miR-455-3p, miR-193b-3p, miR-92a-3p, respectively. Patients were scored preoperatively and postoperatively using the Lysholm Knee Scoring Scale and International Knee Documentation Committee Subjective Knee Evaluation Form. RESULTS Compared with group A, the expression levels of ADAMTS5, COL10A1, CEBPβ, and MMP13 and all the miRNAs were increased while ACAN was down-regulated in groups B and C. Additionally, the gene expression and miRNA levels were higher in group C than that in group B, except for ACAN, which was lower. Several fibrochondrocytes strongly expressed ADAMTS5, CEBPβ, and MMP13 in groups B and C and had high levels of miR-381-3p and miR-455-3p than that in group A. Postoperative Lysholm and IKDC scores were higher in group B than in group C. CONCLUSIONS Our findings suggest that the meniscus tended to degenerate after it was injured, especially when combined with a torn ACL. The miRNAs investigated in this study might also contribute to meniscus degeneration. Patients with a combined injury patterns might have relatively worse joint function.
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Affiliation(s)
- Yi Long
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
- Department of Orthopedics, The Central Hospital of Shao Yang, Shaoyang, 422000, Hunan, China
| | - Jingping Xie
- Department of Orthopedics, The Central Hospital of Shao Yang, Shaoyang, 422000, Hunan, China
| | - Zhi-Qi Zhang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Ziji Zhang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Fangang Meng
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
| | - Aishan He
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Katagiri H, Miyatake K, Nakagawa Y, Otabe K, Ohara T, Shioda M, Sekiya I, Koga H. The effect of a longitudinal tear of the medial meniscus on medial meniscal extrusion in anterior cruciate ligament injury patients. Knee 2019; 26:1292-1298. [PMID: 31519329 DOI: 10.1016/j.knee.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effect of a longitudinal tear of the medial meniscus (MM) and its meniscal repair on MM extrusion in anterior cruciate ligament (ACL)-injured patients. The hypothesis underlying this study was that a longitudinal tear of the MM is correlated with MM extrusion, and that the extrusion would persist after ACL reconstruction with concomitant MM repair. METHODS Forty-three ACL-injured patients with a concomitant MM longitudinal tear were included in the MM tear group. Thirty-four solely ACL-injured patients without any meniscal injuries were included in the Control group. Medial meniscus extrusion width (MEW) was measured pre-operatively and three months after surgery on magnetic resonance imaging. RESULTS Pre-operative MEW in the MM tear group was significantly larger than that in the Control group (MM tear group: 1.5 mm, Control: 0.3 mm, P < 0.001). The MEW change in the MM tear group was significantly greater than that in the Control group three months after operation (MM tear group: 0.8 mm, Control: -0.2 mm, P < 0.001). The number of sutures required for repair was correlated with MEW both pre-operatively and postoperatively in the MM tear group (pre-operative: P = 0.005, R = 0.42, postoperative: P < 0.001, R = 0.54). CONCLUSION Longitudinal tear of the MM was correlated with MM extrusion and the MM extrusion persisted after ACL reconstruction with concomitant MM repair in the MM tear group. The initial meniscal tear size was directly correlated with the pre-operative MEW. Therefore, meniscal extrusion after longitudinal tears of the medial meniscus should be taken into careful consideration.
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Affiliation(s)
- Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshiyuki Ohara
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan
| | - Mikio Shioda
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Tokyo, Japan.
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Guenoun D, Magalon J, de Torquemada I, Vandeville C, Sabatier F, Champsaur P, Jacquet C, Ollivier M. Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma. Diagn Interv Imaging 2019; 101:169-176. [PMID: 31727602 DOI: 10.1016/j.diii.2019.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this retrospective study was to describe our preliminary results of intra-meniscal administration of platelet rich plasma (PRP) in patients with degenerative meniscal tears of the knee. MATERIAL AND METHOD Ten patients with degenerative meniscal tears according to the Stoller classification and without knee osteoarthritis were included. There were 7 men and 3 women with a mean age of 40.4±13.6 [SD] years (range: 18-59 years). Patients were prospectively assessed at baseline and 3- and 6-months after intra meniscal PRP administration. Evaluation included the knee injury and osteoarthritis outcome score (KOOS), pain visual analog scale, and return to competition and training. MRI follow-up was performed 6 months after PRP administration. Adverse events were recorded. RESULTS Volume of injected PRP was standardized to 4.0mL. Adverse events during PRP administration was moderate pain in 8 patients (8/10; 80%). Mean KOOS total score significantly improved from 56.6±15.7 (SD) to 72.7±18.5 (SD) (P=0.0007). All six patients practicing sports regularly were able to recover competition or training. In seven patients who underwent MRI follow-up at 6 months, MRI showed stability of the meniscal tears and similar Stoller grades. CONCLUSION Intra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe. Further randomized controlled studies are needed to definitely confirm the effectiveness of this procedure.
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Affiliation(s)
- D Guenoun
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France.
| | - J Magalon
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - I de Torquemada
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - C Vandeville
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - F Sabatier
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - P Champsaur
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France
| | - C Jacquet
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
| | - M Ollivier
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
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Safran-Norton CE, Sullivan JK, Irrgang JJ, Kerman HM, Bennell KL, Calabrese G, Dechaves L, Deluca B, Gil AB, Kale M, Luc-Harkey B, Selzer F, Sople D, Tonsoline P, Losina E, Katz JN. A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program. BMC Musculoskelet Disord 2019; 20:514. [PMID: 31684921 PMCID: PMC6830005 DOI: 10.1186/s12891-019-2872-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence–based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. Methods This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. Results The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. Discussion This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial. Trial registration The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women’s Hospital.
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Affiliation(s)
- Clare E Safran-Norton
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA.,Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA
| | - James K Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA
| | - James J Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah M Kerman
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Gary Calabrese
- Department of Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, OH, USA
| | - Leigh Dechaves
- Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Deluca
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Alexandra B Gil
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Madhuri Kale
- Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA
| | - Brittney Luc-Harkey
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Derek Sople
- Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Tonsoline
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, United States of America, Boston, MA, USA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA. .,Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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Calvo-Gurry M, Hurley ET, Withers D, Vioreanu M, Moran R. Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2019; 27:3633-7. [PMID: 30915511 DOI: 10.1007/s00167-019-05490-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/18/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL). METHODS A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative findings, two groups were identified: Group A (N = 75) had no postero-medial meniscal tear associated with the acute ACL rupture and Group B (N = 75) had a postero-medial meniscal tear found at time of reconstruction. All patients' pre-operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). RESULTS MTP bone bruising was found to be more prevalent in cases that had a postero-medial meniscal tear in the setting of an acute ACL injury (p = 0.046). MTP Grade 2 or 3 bone bruising was more common in patients that had a postero-medial meniscal tear (p = 0.046). There was a slightly higher incidence of grade 2 or 3 MTP bone bruising in cases with a postero-medial meniscal tear, although this did not reach statistical significance (n.s.) There was no difference in LFC, LTP or MFC bone bruising in patients with or without a postero-medial meniscal tear (n.s) for all. CONCLUSIONS Medial-sided bone bruising; especially present on the posterior tibial plateau may result from a higher injury force during the injury to the ACL. The identification of medial bone bruising on pre-operative MRI imaging following an acute ACL rupture should raise the suspicion of an associated postero-medial meniscal tear. LEVEL OF EVIDENCE III.
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Gaillard R, Magnussen R, Batailler C, Neyret P, Lustig S, Servien E. Anatomic risk factor for meniscal lesion in association with ACL rupture. J Orthop Surg Res 2019; 14:242. [PMID: 31362758 PMCID: PMC6664740 DOI: 10.1186/s13018-019-1281-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/15/2019] [Indexed: 01/25/2023] Open
Abstract
Background To assess anatomic risk factors for meniscal lesions in association with acute ACL rupture. The primary hypothesis was that tibiofemoral anatomic measures will be different in those with and without concomitant meniscus tears. Methods A retrospective review of patients who underwent acute ACL reconstruction in the department was performed. All patients underwent a postoperative CT scan. The concavity and/or convexity on the femur and the tibia were measured by two blinded observers on the sagittal plane with different ratios, and these measures were compared in patients with and without meniscus tears in each compartment. Intra- and inter-rater reliabilities were assessed. Results Four hundred twelve patients (268 males and 144 females) were included from October 2012 to February 2015. One hundred sixty-seven patients had a medial meniscal tear (119 males/48 females), and 100 had a lateral meniscal tear (80 males/20 females). The mean time from injury to surgery was 3 months. The average ICC for all measurements was 0.87 (range 0.82–0.98) indicating good reliability. The medial femoral condyle was noted to be significantly longer than the medial tibial plateau in the sagittal plane in patients with a medial meniscal tear (p = 0.04), and the lateral femoral condyle was noted to be significantly longer than the lateral tibial plateau in the sagittal plane in patients with a lateral meniscal tear (p < 0.001). In addition, a less convex lateral tibial plateau was statistically correlated with a higher risk of lateral meniscal tear (p = 0.001). Conclusions A greater anteroposterior length of the medial/lateral femoral condyle relative to the medial/lateral tibial plateau is associated with an increased risk of meniscal lesions in association with acute ACL rupture. The lateral compartment in the male population appears to be the most at risk. Trial registration Retrospectively registered on May 12, 2016 (CPP sud-est II CAL n°2016-037)
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Affiliation(s)
- Romain Gaillard
- Department of Orthopaedics, Groupement Hospitalier Nord, Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.
| | - Robert Magnussen
- Department of Orthopaedics, The Ohio State University, 2050 Kenny Rd #3100, Columbus, OH, 43210, USA.,OSU Sports Medicine Research Institute, The Ohio State University, 2050 Kenny Rd #3100, Columbus, OH, 43210, USA
| | - Cecile Batailler
- Department of Orthopaedics, Groupement Hospitalier Nord, Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Philippe Neyret
- Department of Orthopaedics, Groupement Hospitalier Nord, Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Sebastien Lustig
- Department of Orthopaedics, Groupement Hospitalier Nord, Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Department of Orthopaedics, Groupement Hospitalier Nord, Université Lyon 1, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, LIBM, Villeurbanne, 69100, France
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Barnds B, Morris B, Mullen S, Schroeppel JP, Tarakemeh A, Vopat BG. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc 2019; 27:2316-2321. [PMID: 30941471 DOI: 10.1007/s00167-019-05481-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/06/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to determine the cost of arthroscopic partial meniscectomy (APM), one of the most common surgeries performed by orthopaedic surgeons, and the associated rate of progression to knee arthroplasty (KA) compared to patients treated non-operatively after diagnosis of meniscal tear. METHODS Utilizing data mining software (PearlDiver, Colorado Springs, CO), a national insurance database of approximately 23.5 million orthopaedic patients was queried for patients diagnosed with a meniscal tear. Patients were classified by treatment: non-operative and arthroscopic partial meniscectomy and were followed after initial diagnosis for cost and progression to knee arthroplasty. RESULTS There were 176,407 subjects in the non-op group and 114,194 subjects in the arthroscopic partial meniscectomy group. Arthroscopic partial meniscectomy generated more cost than non-operative ($3842.57 versus $411.05, P < 0.001). Arthroscopic partial meniscectomy demonstrated greater propensity to need future knee arthroplasty (11.4% at 676 days) than those treated non-operatively (9.5% at 402 days) (P < 0.001). Female patients demonstrated a higher rate of progression to knee arthroplasty in the arthroscopic partial meniscectomy and non-operative groups (P < 0.001). CONCLUSION Compared to non-operative treatment for meniscal tears, arthroscopic partial meniscectomy is more expensive and does not appear to decrease the rate of progression to knee arthroplasty. Patients undergoing arthroscopic partial meniscectomy yielded on average a delay of only 9 months (274 days) before undergoing knee arthroplasty. Female patients experienced a significantly higher rate of progression to knee arthroplasty. The authors recognize the limitations of this type of study including its retrospective nature, reliance upon accurate coding and billing information, and the inability to determine whether symptoms including mechanical locking played a role in the decision to perform an APM. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brandon Barnds
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Brandon Morris
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Scott Mullen
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - John Paul Schroeppel
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Armin Tarakemeh
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Bryan G Vopat
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
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Abstract
AIMS The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee. MATERIALS AND METHODS A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group. RESULTS A total of 45 simulated clinical scenarios were refined to five common clinical presentations and six corresponding treatment recommendations. The final guideline stratifies patients based upon a new, standardized classification of symptoms, signs, radiological findings, duration of symptoms, and previous treatment. CONCLUSION The 2018 BASK Arthroscopic Meniscal Surgery Treatment Guidance will facilitate the consistent identification and treatment of patients with meniscal lesions. It is hoped that this guidance will be adopted nationally by surgeons and help inform healthcare commissioning guidance. Validation in clinical practice is now required and several areas of uncertainty in relation to treatment should be a priority for future high-quality prospective studies. Cite this article: Bone Joint J 2019;101-B:652-659.
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Affiliation(s)
- S G F Abram
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - D J Beard
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - A J Price
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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