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The Journal of Knee Surgery Apr 2023We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal...
We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of knee meniscal tears. Outcome measures included repair failure, repeat knee arthroscopic surgery, and magnetic resonance imaging), visual analog scale for pain, the International Knee Documentation Committee questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Lysholm's Knee Scoring Scale, and the Knee Injury and Osteoarthritis Outcome Score. Study quality was assessed using the modified Coleman methodology score. Nineteen studies reported repair of 1,092 menisci including six studies that investigated fibrin clot augmentation, five studies that investigated PRP augmentation, three studies that investigated bone marrow stimulation augmentation, two studies that used meniscal wrapping augmentation, and three studies that used other techniques. The level of evidence ranged from I to IV and mean modified Coleman methodology score was 43 (range: 17-69), with higher scores noted in studies completed in recent years. PRP and bone marrow stimulation augmentation appear to decrease risk of failure in patients undergoing isolated meniscal repair but do not improve knee symptom scores. Fibrin clot and trephination augmentation techniques do not have sufficient evidence to support decreased failure risk at this time. Meniscal wrapping augmentation and scaffold implantation augmentation appear to be an attractive option to meniscectomy in complicated tears that are not candidates for repair alone, but further confirmatory studies are needed to support initial data. Evidence supporting augmentation of meniscal repair is limited at this time but suggests that the highest likelihood for effectiveness of augmentation is in the settings of isolated meniscal repair or meniscal repairs that would normally not be amenable to repair.
Topics: Humans; Treatment Outcome; Knee Joint; Meniscus; Knee Injuries; Osteoarthritis; Arthroscopy; Biological Products; Menisci, Tibial; Retrospective Studies
PubMed: 34781393
DOI: 10.1055/s-0041-1739198 -
International Orthopaedics Jan 2015The aim of this systematic review was to document the available clinical evidence to support meniscal scaffold implantation, analysing results and indications for the... (Review)
Review
PURPOSE
The aim of this systematic review was to document the available clinical evidence to support meniscal scaffold implantation, analysing results and indications for the treatment of meniscal loss.
METHODS
The systematic review of the literature was performed searching three medical electronic databases: PubMed, Scopus, and the Cochrane Collaboration. The guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) were used. Relevant data were then extracted and collected in a unique database with consensus of two observers. To assess the methodological quality of the collected data, the subscales of a modified Coleman methodology score (CMS) were determined.
RESULTS
A total of 23 studies on two scaffolds (CMI, Ivy Sports Medicine GmbH, Germany; Actifit, Orteq, United Kingdom) met the inclusion criteria and were used for the final analysis, of which more than half have been published in the last three years. Good clinical results have been documented in 613 patients, mainly young men affected by symptomatic chronic lesions, with a cumulative failure rate of 6.1% and presence of newly formed tissue documented both at histological and MRI evaluation in most cases. However, there is a lack of comparative trials and the average study quality is low.
CONCLUSION
An increase in publications regarding this topic has been seen recently, due to the introduction in the clinical practice of the second synthetic scaffold. Safety and positive results have been shown for both scaffolds. Although, literature lacks randomized trials at long-term follow-up to confirm real potential and most appropriate indications of meniscal scaffold implantation.
Topics: Adult; Female; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Menisci, Tibial; Osteoarthritis, Knee; Prosthesis Implantation; Tissue Scaffolds; Treatment Outcome
PubMed: 24973973
DOI: 10.1007/s00264-014-2415-x -
Orthopaedic Journal of Sports Medicine Nov 2020Given the superiority of meniscal repair over partial meniscectomy according to biomechanical data, the clinical outcomes of meniscal repair are likely to be better than... (Review)
Review
BACKGROUND
Given the superiority of meniscal repair over partial meniscectomy according to biomechanical data, the clinical outcomes of meniscal repair are likely to be better than those of partial meniscectomy for a medial meniscus root tear (MMRT).
PURPOSE/HYPOTHESIS
This review was designed to compare the clinical and radiological results between meniscal repair and partial meniscectomy for MMRTs. It was hypothesized that meniscal repair would result in better clinical and radiological results compared with partial meniscectomy.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Studies were included in the review if they (1) included patients with MMRTs who underwent primary arthroscopic meniscal repair or partial meniscectomy and (2) analyzed validated patient-reported outcomes and/or radiological evaluations. Summary odds ratios (ORs) with 95% CIs were calculated to compare partial meniscectomy with meniscal repair for each outcome.
RESULTS
A total of 13 studies were included. The mean duration of follow-up was 33.5 and 47.2 months in the meniscal repair group and partial meniscectomy group, respectively. The change in the Lysholm score from preoperatively to postoperatively was statistically significantly in favor of meniscal repair (OR, 2.20 [95% CI, 1.55-3.12]), while no difference was found with respect to the change in the Tegner score between the 2 surgical approaches (OR, 1.21 [95% CI, 0.65-2.24]). The prevalence of postoperative severe knee osteoarthritis (OR, 0.31 [95% CI, 0.17-0.54]) as well as that of reoperations (OR, 0.05 [95% CI, 0.01-0.19]) were significantly in favor of meniscal repair.
CONCLUSION
Better outcomes were seen after meniscal repair compared with partial meniscectomy for MMRTs, with greater improvements in Lysholm scores, and lower rates of progression to knee osteoarthritis, and lower reoperation rate.
PubMed: 33241058
DOI: 10.1177/2325967120962078 -
Arthroscopy : the Journal of... Sep 2015To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears. (Review)
Review
PURPOSE
To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears.
METHODS
A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures. The methodologic quality of the included studies was assessed with the modified Coleman Methodology Score.
RESULTS
Seven studies with a total of 172 patients met the inclusion criteria. The mean patient age was 55.3 years, and 83% of patients were female patients. Preoperative and postoperative Lysholm scores were reported for all patients. After a mean follow-up period of 30.2 months, the Lysholm score increased from 52.4 preoperatively to 85.9 postoperatively. On conventional radiographs, 64 of 76 patients (84%) showed no progression of Kellgren-Lawrence grading. Magnetic resonance imaging showed no progression of cartilage degeneration in 84 of 103 patients (82%) and showed reduced medial meniscal extrusion in 34 of 61 patients (56%). On the basis of second-look arthroscopy and magnetic resonance imaging in 137 patients, the healing status was rated as complete in 62%, partial in 34%, and failed in 3%. Overall, the methodologic quality of the included studies was fair, with a mean modified Coleman Methodology Score of 63.
CONCLUSIONS
ATPR significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in most patients, at least during a short-term follow-up. Complete healing of the repaired root and reduction of meniscal extrusion seem to be less predictable, being observed in only about 60% of patients. Conclusions about the progression of osteoarthritis and reduction of meniscal extrusion are limited by the small portion of patients undergoing specific evaluation (44% and 35% of the study group, respectively).
LEVEL OF EVIDENCE
Level IV, systematic review of Level III and IV studies.
Topics: Arthroscopy; Humans; Knee Injuries; Magnetic Resonance Imaging; Menisci, Tibial; Outcome Assessment, Health Care; Postoperative Period; Second-Look Surgery; Tibial Meniscus Injuries; Wound Healing
PubMed: 25979687
DOI: 10.1016/j.arthro.2015.03.022 -
Revista Brasileira de Ortopedia Apr 2023To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as...
To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as the evolution of the anatomical knowledge on this structure. An electronic search was conducted in the MEDLINE/PubMed, Google Scholar, EMBASE and Cochrane library databases with no date restrictions. The following index terms were used in the search: AND AND AND . The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included anatomical studies of the knee were included, such as cadaver dissections, histological and/or biological investigations, and/or imaging of the medial MTL anatomy. Eight articles that met the inclusion criteria were selected. The first article was published in 1984 and the last, in 2020. The total sample in the 8 articles was of 96 patients. Most studies are purely descriptive in terms of the macroscopic morphological and microscopic histological findings. Two studies evaluated the biomechanical aspects of the MTL, and one, the anatomical correlation with the magnetic resonance imaging examination. The main function of the medial MTL, a ligament that originates in the tibia and is inserted in the lower meniscus, is to stabilize and maintain the meniscus in its position on the tibial plateau. However, there is a limited amount of information regarding medial MTLs, primarily in terms of anatomy, especially vascularization and innervation.
PubMed: 37252293
DOI: 10.1055/s-0042-1749199 -
The American Journal of Sports Medicine Apr 2015Meniscal allograft transplantation (MAT) was developed as a means of treating the symptoms of compartmental overload after meniscectomy. Despite more than 20 years of... (Review)
Review
BACKGROUND
Meniscal allograft transplantation (MAT) was developed as a means of treating the symptoms of compartmental overload after meniscectomy. Despite more than 20 years of research in this field, many controversies still exist regarding meniscal transplantation.
PURPOSE
The aims of this study were to assess (1) the quality of the published studies on MAT; (2) the indications for this type of surgery; (3) the methods used for preservation, sizing, and fixation of the allograft; and (4) the clinical and radiographic outcomes of this procedure and its role in preventing osteoarthritis.
STUDY DESIGN
Systematic review.
METHODS
Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels 1 to 4, (3) reported clinical and/or radiological outcomes of MAT isolated or combined with other procedures, (4) minimum 12-month follow-up, (5) case series of at least 10 patients, and (6) a follow-up rate of at least 80% (no more than 20% of patients lost to follow-up).
RESULTS
A total of 55 studies matched the inclusion criteria (2 level 2, 7 level 3, and 46 level 4). The average Coleman methodology score was 49.73 ± 12.41 (range, 24-81). There was agreement in the literature regarding the indications for MAT: joint line pain and tenderness correlated with previous meniscectomy, young patients, without diffuse Outerbridge grade III and no grade IV cartilage damage, and a stable and well-aligned knee. Different graft types have been used: viable, fresh frozen, cryopreserved, and lyophilized. The most common method for graft sizing was plain radiography. Different fixation techniques have been described, with only a few studies comparing the clinical results of the different techniques and with no proven superiority of one method over the other. All the studies showed clinical improvement at last follow-up visit compared with preoperatively. The chondroprotective effect of MAT is still unclear.
CONCLUSION
Meniscal allograft transplantation seems to provide good clinical results at short-term and midterm follow-up, with improvement in knee function as well as acceptable complication and failure rates. Higher quality studies are necessary to better assess the potential chondroprotective effect of MAT and to identify differences in terms of outcomes between different surgical techniques.
Topics: Allografts; Arthralgia; Cryopreservation; Humans; Knee Joint; Menisci, Tibial; Transplantation, Homologous
PubMed: 24928760
DOI: 10.1177/0363546514536021 -
The Knee Jan 2023Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aimsto assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants.
METHODS
The study was performedaccording to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcomedata specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data.
RESULTS
Ten studies comprising 568 patients (mean age 29.2-40 years, follow up duration 1-14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51-3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain,Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores.
CONCLUSION
Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.
Topics: Humans; Adult; Menisci, Tibial; Tissue Scaffolds; Knee Joint; Meniscectomy; Osteoarthritis; Pain, Postoperative; Arthroscopy
PubMed: 36512894
DOI: 10.1016/j.knee.2022.11.020 -
BMC Musculoskeletal Disorders Jun 2023Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with...
BACKGROUND
Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear.
PURPOSE
To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings.
STUDY DESIGN
Systematic review.
METHODS
According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057).
RESULTS
Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up.
CONCLUSION
HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions.
LEVEL OF EVIDENCE
III.
Topics: Humans; Knee Joint; Menisci, Tibial; Arthroplasty, Replacement, Knee; Rupture; Osteoarthritis; Knee Injuries; Osteotomy; Arthroscopy; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 37280599
DOI: 10.1186/s12891-023-06520-9 -
Knee Surgery, Sports Traumatology,... Jul 2022Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many... (Meta-Analysis)
Meta-Analysis Review
Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years.
PURPOSE
Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed.
METHODS
PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established.
RESULTS
In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years.
CONCLUSION
The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years.
LEVEL OF EVIDENCE
IV.
Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Follow-Up Studies; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 34671817
DOI: 10.1007/s00167-021-06770-x -
The Knee Dec 2023Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this... (Review)
Review
BACKGROUND
Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this systematic review was to compare diagnostic methods and summarize the data of medial and lateral meniscal extrusion in knees with and without osteoarticular pathology.
METHODS
This systematic review was conducted according to the PRISMA 2020 statement. Searches were conducted on PubMed, EMBASE and Cochrane databases to identify studies that measured meniscal extrusion using magnetic resonance imaging (MRI) or ultrasound (US). Meniscal extrusion data was summarized as weighted mean for medial and lateral meniscus, and stratified according to the method of measurement (MRI or US) and presence of knee osteoarticular pathology.
RESULTS
A total of 26 studies were included in this review. Weighted mean values of meniscal extrusion were always higher for the medial than the lateral meniscus, regardless of the method of measurement. The medial meniscus extrusion was always higher in knees with osteoarticular pathology than those without. For the lateral meniscus extrusion, the mean values were higher in those knees without osteoarticular pathology. When classifying pathological meniscal extrusion with pre-defined cut-off values, the higher the cut-off used, the lower the percentage of knees classified as pathological meniscal extrusion.
CONCLUSIONS
The medial meniscus presents on mean higher extrusion and extrusion is higher in knees with osteoarticular pathology. Based on summary data, the most suitable cut-offs for pathological meniscal extrusion for both MRI and US seem to fall within >2 and >3 mm.
Topics: Humans; Knee Joint; Menisci, Tibial; Magnetic Resonance Imaging; Lower Extremity
PubMed: 37925806
DOI: 10.1016/j.knee.2023.09.010