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Rodríguez-Rodríguez IF, Navarro-Torres-Arpi P, Dryjanski-Lerner A, Gómez-Mont-Landerreche JG, Levy-Holden GA, Gil-Orbezo F. [Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. Acta Ortop Mex 2024; 38:52-56. [PMID: 38657152] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.
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Affiliation(s)
| | - P Navarro-Torres-Arpi
- Servicio de Traumatología y Ortopedia del Hospital Español. Ciudad de México. México
| | - A Dryjanski-Lerner
- Servicio de Traumatología y Ortopedia del Hospital Español. Ciudad de México. México
| | | | - G A Levy-Holden
- Servicio de Traumatología y Ortopedia del Hospital Español. Ciudad de México. México
| | - F Gil-Orbezo
- Servicio de Traumatología y Ortopedia del Hospital Español. Ciudad de México. México
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Adsit E, Albright J, Algan S, Beck J, Bowen RE, Brey J, Marc Cardelia J, Clark C, Coello P, Crepeau A, Edmonds E, Ellington M, Ellis HB, Fabricant PD, Frank JS, Ganley TJ, Green DW, Gupta A, Heyworth B, Kemper WC, Latz K, Mansour A, Mayer S, McKay SD, Milewski MD, Niu E, Pacicca DM, Parikh SN, Pupa L, Rhodes J, Saper M, Schmale GA, Schmitz M, Shea K, Silverstein RS, Storer S, Wilson PL. Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database. Am J Sports Med 2023; 51:3493-3501. [PMID: 37899536 PMCID: PMC10623608 DOI: 10.1177/03635465231206173] [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: 08/18/2022] [Accepted: 07/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
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Affiliation(s)
| | | | - Jay Albright
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sheila Algan
- Department of Orthopedic Surgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma, USA
| | | | - Richard E. Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Department of Orthopedics, Norton Children's Orthopedics of Louisville, Louisville, Kentucky, USA
| | - J. Marc Cardelia
- Department of Orthopedics and Sports Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA)
| | | | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; Division of Sports Medicine, Department of Orthopedics, UConn Health, Farmington, Connecticut, USA
| | - Eric Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Matthew Ellington
- Department of Orthopedics, Central Texas Pediatric Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B. Ellis
- Investigation performed at Scottish Rite for Children, University of Texas Southwestern Medical Center, Dallas, USA
| | - Peter D. Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York
| | - Jeremy S. Frank
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Theodore J. Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Gupta
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Benton Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - W. Craig Kemper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Latz
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Alfred Mansour
- Department of Orthopedic Surgery, UTHealth Houston, McGovern Medical School, Houston, Texas, USA
| | - Stephanie Mayer
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott D. McKay
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Niu
- Department of Orthopedic Surgery and Sports Medicine, Children's National Medical Center, Washington, DC, USA
| | - Donna M. Pacicca
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Shital N. Parikh
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lauren Pupa
- Baylor College of Medicine, Houston, Texas, USA
| | - Jason Rhodes
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Department of Orthopaedics, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel S. Silverstein
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Stephen Storer
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Philip L. Wilson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA; Scottish Rite for Children, Dallas, Texas, USA)
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Al Saedi ZS, Alzubaidi BK, Mirza HA, Alhothali MK, Alhijjy MM, Mirza AA. Medial Discoid Meniscus: A Rare Case Report. Cureus 2023; 15:e39971. [PMID: 37416007 PMCID: PMC10320819 DOI: 10.7759/cureus.39971] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
The meniscus is a glossy white structure found in the knee between the femoral condyle and tibial plateau in the medial and lateral aspects of both knees. The main purposes of the meniscus are to enhance joint congruity and stability, transmit load, and absorb stress. A rare type of anomaly of the meniscus shape is called discoid meniscus, which presents as an atypical shape also known as disk cartilage. This report presents a 13-year-old male with a history of left knee pain after a fall. The pain was stabby in nature with a decrease in range of motion in the left knee and positive McMurray and Apley's tests on examination. The patient was treated by arthroscopic saucerization, and the procedure was successful. The patient had a good postoperative outcome after two months of follow-up.
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Affiliation(s)
| | | | - Hashem A Mirza
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | | | - Amr A Mirza
- Orthopedic Surgery, King Fahad General Hospital, Jeddah, SAU
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Liu Y, Liu Y, Zhu LQ, Zhen YF, Zhang FY, Wang XD. Efficacy of short-term splint immobilization in the treatment of pediatric discoid lateral meniscus after saucerization management. Medicine (Baltimore) 2023; 102:e33553. [PMID: 37058025 PMCID: PMC10101260 DOI: 10.1097/md.0000000000033553] [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: 01/01/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
There are no universal guidelines for rehabilitation after saucerization for children with discoid lateral meniscus. This study determined if short-term knee splint immobilization and delayed rehabilitation produces the same benefit as early rehabilitation after saucerization in children, in terms of knee function and pain intensity. A retrospective review was performed by categorizing patients into 2 groups depending on whether a splint immobilization was adopted postoperatively: for group A, rehabilitation began early without splint immobilization after surgery, and for group B, a knee splint was immobilized for 2 weeks. Numerical rating scale scores were collected in patients 1, 3, and 7 days, Lysholm scores were measured at 4 and 8 weeks postoperatively, and the gradual return to normal activities was documented. Forty-eight patients and 53 knees were included: group A had 30 patients with 31 knees, and group B had 18 patients with 22 knees. There was no improvement in numerical rating scale scores on the 1st (P=.519), 3rd (P=.421), and 7th (P=.295) postoperative days in group B. The Lysholm scores of group A (62.94 ± 8.68) was higher than that of group B (46.68 ± 9.82) measured 4 weeks following surgery, but there was no difference at 8 weeks (P=.237), and both groups had similar time to return to normal activities (P=.363). For discoid lateral meniscus patients who underwent isolated saucerization, short-term splint immobilization did not significantly help relieve postoperative pain. There was a comparable time-course for return to normal activities in both study groups.
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Affiliation(s)
- Yao Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Ya Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lun-Qing Zhu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yun-Fang Zhen
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Fu-Yong Zhang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Anderson KG, Carsen S, Stinson Z, Kushare I, Finlayson CJ, Nault ML, Lee RJ, Haus BM, Schmale GA. Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results. Am J Sports Med 2023; 51:1171-1176. [PMID: 36876853 DOI: 10.1177/03635465231159671] [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] [Indexed: 03/07/2023]
Abstract
BACKGROUND The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series. PURPOSE/HYPOTHESIS Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. We hypothesized that symptoms and signs, arthroscopic findings, surgical treatments, and outcomes are similar to those for symptomatic discoid lateral menisci. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review identified patients with a diagnosed discoid medial meniscus confirmed at surgery across 8 children's hospitals between January 2000 and June 2021. The literature on discoid lateral menisci was reviewed and summarized for comparison. RESULTS A total of 21 patients (9 female, 12 male) with 22 discoid medial menisci were identified. The mean ± SD age at the time of diagnosis was 12.8 ± 3.8 years. The most common symptoms and signs were locking and/or clunking, present in 12 of 22 knees (55%), similar to that reported in patients with discoid lateral menisci. Twelve discoid medial menisci were complete (55%); 8, incomplete (36%); and 2, indeterminate (9%). Tears were present in 13 knees, most commonly horizontal cleavage (54%). Five discoid medial menisci were unstable (23%): 3 for posterior tears and 2 for rim insufficiency. All 22 knees underwent arthroscopic saucerization, and of the 13 torn menisci, 7 (54%) were repaired. The median follow-up was 24 months (range, 2-82 months). Four knees underwent reoperation. All knees that required reoperation had undergone repair for a posteriorly located tear. There was a significant association between operative repair and need for reoperation (P = .0048). High rates of peripheral instability were also noted in case series of patients with discoid lateral menisci. CONCLUSION Patient presentations and treatments for those with discoid medial menisci were similar to those reported for patients with discoid lateral menisci. Knees with discoid medial menisci also demonstrated instability attributed to peripheral insufficiency and posterior tears. Tears were present in over half of knees with discoid medial menisci, and reoperation was more common in knees that underwent repair of tears than those without repair.
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Affiliation(s)
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottowa, Ontario, Canada
| | - Zachary Stinson
- Nemours Children's Health and University of Central Florida School of Medicine, Orlando, Florida, USA
| | - Indranil Kushare
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Craig J Finlayson
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - R Jay Lee
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian M Haus
- University of California Davis Children's Hospital, Sacramento, California, USA
| | | | - Gregory A Schmale
- Seattle Children's and University of Washington School of Medicine, Seattle, Washington, USA
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Trisolino G, Stallone S, Grassi A, Olivotto E, Battistelli M, Zarantonello P, Gallone G, Ferrari D, Di Gennaro GL, Zaffagnini S. The discoid lateral meniscus in children: a narrative review of pathology, diagnosis and treatment. Ann Jt 2022; 7:38. [PMID: 38529145 PMCID: PMC10929324 DOI: 10.21037/aoj-21-31] [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: 11/17/2021] [Accepted: 06/01/2022] [Indexed: 03/27/2024]
Abstract
Background and Objective The discoid lateral meniscus (DLM) is a congenital abnormality of the meniscal shape, characterized by a typical central hypertrophy and a diameter larger than a regular meniscus, potentially leading to knee pain and symptoms, especially in children. The present study provides an update and a general review of this uncommon meniscal pathology. The incidence of discoid meniscus is about 0.4-17% for the lateral and 0.1-0.3% for the medial, although, being often asymptomatic, the true prevalence is unknown. We aim to enhance awareness on this subject to medical care provider. Methods A literature search was performed on PubMed, including articles written in English until October 2021. Key Content and Findings The articles regarding etiology, diagnosis and management of DLM in children or in patients younger than 18 years were reviewed using the narrative approach. Conclusions Recent literature has shown that DLM is one of the most frequent congenital anomalies of the knee encountered during childhood. While asymptomatic children with incidental finding can be managed nonoperatively, symptomatic painful DLM should be addressed surgically, restoring typical anatomy using saucerization, tear repair, and stable fixation of the meniscus. The risk of osteoarthritis progression seems to be higher in children with operated DLM, imposing prolonged follow-up and cartilage preserving strategies for these patients.
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Affiliation(s)
- Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michela Battistelli
- Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, Urbino, Italy
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Gallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniele Ferrari
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Yamasaki S, Hashimoto Y, Takigami J, Terai S, Takahashi S, Nakamura H. Risk Factors Associated With Knee Joint Degeneration After Arthroscopic Reshaping for Juvenile Discoid Lateral Meniscus. Am J Sports Med 2017; 45:570-577. [PMID: 28272930 DOI: 10.1177/0363546516668623] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although arthroscopic meniscal reshaping for discoid lateral meniscus (DLM) has better outcomes than total or subtotal meniscectomy, degenerative changes on radiographs are still seen in some patients with meniscal reshaping. PURPOSE To assess the risk factors associated with knee joint degeneration after reshaping surgery for juvenile DLM. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Forty patients (45 knees) with a mean age of 12.0 years who underwent arthroscopic meniscal reshaping for DLM were enrolled at a mean of 39.6 months after surgery. For all patients, meniscal saucerization was performed first. Then, if the residual meniscus was unstable, stabilization was provided with suture fixation. At final follow-up, we obtained radiographs to assess degenerative changes to the knee joint using the classification by Tapper and Hoover. Residual meniscal width and meniscal extrusion (defined as a relative percentage of extrusion [RPE]) were measured with magnetic resonance imaging (MRI). Then, the correlation between radiographic evidence of degenerative changes (Tapper and Hoover grade), residual meniscal width, and RPE were assessed with Pearson and Spearman correlation analyses. Logistic regression analysis was used to examine whether preoperative characteristics correlated with degeneration and residual meniscal width. RESULTS The mean residual meniscal width was 4.6 mm (range, 3.8-6.0 mm), and the mean ± SD RPE was 25.5% ± 21.8% at the final follow-up. There were 28 knees with Tapper and Hoover grade 0, 10 knees with grade 1, and 7 knees with grade 2. The residual meniscal width and RPE were significantly correlated with Tapper and Hoover grade (ρ = -0.489, P = .0007; ρ = 0.414, P = .005, respectively). The residual meniscal width was also significantly correlated with RPE ( r = -0.416, P = .004). The receiver operating characteristic curve showed that a 5.0-mm residual meniscal width was the cutoff value leading to evidence of degeneration. Multiple logistic regression analysis showed that an anterocentral shift on preoperative MRI was a risk factor for degeneration (odds ratio, 27.2; 95% CI, 1.1-360.5; P = .012) and residual meniscal width less than 5.0 mm (odds ratio, 20.9; 95% CI, 1.5-281; P = .022). CONCLUSION Smaller meniscal width and greater severity of meniscal extrusion correlated with knee joint degeneration. An anterocentral shift on preoperative MRI was a risk factor for degenerative changes and smaller residual meniscal width.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Shozaburo Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Kennedy JA, Dias JJ. Effect of triggering and entrapment on tendon gliding properties following digital flexor tendon laceration: in vitro study on turkey tendon. J Hand Surg Eur Vol 2014; 39:708-13. [PMID: 23735810 DOI: 10.1177/1753193413490898] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The optimal management of partial flexor tendon laceration is controversial and remains a clinical challenge. Abnormal tendon gliding (triggering and entrapment) was assessed at the A2 pulley in 40 turkey tendons in three groups: intact, partially divided (palmar or lateral), and trimmed. Testing was of gliding resistance and friction coefficient at 30° and 70° of flexion, loaded with 2 and 4 N. We observed for triggering and entrapment. The changes in gliding properties were compared and analysed using Wilcoxon matched pair testing. A significant difference was found in the change in gliding properties of intact to lacerated and lacerated to trimmed tendons and between tendons that glided normally compared with those exhibiting triggering or entrapment. This suggests that palmar and lateral lacerations which, through clinical examination and visualization, are found to glide normally should be treated with early mobilization. However, partial lacerations that exhibit triggering or entrapment should be trimmed.
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Affiliation(s)
| | - J J Dias
- Department of Health Sciences, Leicester General Hospital, Leicester, UK
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