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Skeletal Radiology Jul 2022Running is among the most popular recreational activities; nonetheless, the acute post-race changes of cartilage or meniscus have rarely been determined. The current... (Review)
Review
Acute changes in knee cartilage and meniscus following long-distance running in habituate runners: a systematic review on studies using quantitative magnetic resonance imaging.
OBJECTIVE
Running is among the most popular recreational activities; nonetheless, the acute post-race changes of cartilage or meniscus have rarely been determined. The current study aimed to review the acute changes in knee cartilage and meniscus among habituate runners following long-distance running detected by using quantitative magnetic resonance imaging (MRI).
MATERIALS AND METHODS
Systematic literature search was performed on those dominate clinical databases which including MEDLINE, Cochrane, Embase, ScienceDirect, and Web of Science. Included studies should be conducted on healthy marathon runners, and the participants should be examined before and after running by using MRI. Intervention studies were excluded.
RESULTS
A total number of 14 studies were finally included in this review which all examined the cartilage or meniscus by using MRI functional sequences. Among them, six studies quantitatively measured the changes regarding volume of the knee cartilage or/and meniscus. Five studies found that the volume would decrease initially after running. Ten studies reported T2 (T2*) would decrease after running and returned to the baseline in a short term, while T1ρ may remain increased in months. Five studies measured subareas for T2 (T2*) value, and found that the superficial and medial subarea changed more vastly than other regions after running.
CONCLUSION
Runners experience transient changes in the volume and signals of knee cartilage and meniscus after long-distance running. A liquid exchange and material interaction in cartilage and meniscus was observed after running. Superficial and medial areas of knee cartilage and meniscus might be more susceptible to mechanical loading.
Topics: Cartilage, Articular; Humans; Knee; Knee Joint; Magnetic Resonance Imaging; Meniscus
PubMed: 34854970
DOI: 10.1007/s00256-021-03943-0 -
Knee Surgery, Sports Traumatology,... Jun 2022Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is... (Review)
Review
PURPOSE
Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re-operation rates of biologically augmented meniscal repairs.
METHODS
PubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post-operative rehabilitation, patient reported outcome measures, and length of follow-up were recorded, reviewed, and analyzed by two independent reviewers.
RESULTS
Of 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8-27.0% with PRP augmentation, 0.0-28.5% with fibrin clot augmentation, 0.0-12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post-operative rehabilitation protocols.
CONCLUSION
Patients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair.
LEVEL OF EVIDENCE
IV.
Topics: Arthroscopy; Biological Products; Humans; Knee Injuries; Menisci, Tibial; Tibial Meniscus Injuries
PubMed: 35258647
DOI: 10.1007/s00167-021-06849-5 -
Arthroscopy, Sports Medicine, and... Apr 2024To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP). (Review)
Review
PURPOSE
To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP).
METHODS
A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP.
RESULTS
A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment.
CONCLUSIONS
The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
PubMed: 38525288
DOI: 10.1016/j.asmr.2024.100916 -
Arthroscopy : the Journal of... May 2015The purpose of this study was to evaluate the clinical and structural outcomes after resorbable collagen meniscus scaffold implantation through a systematic review of... (Review)
Review
PURPOSE
The purpose of this study was to evaluate the clinical and structural outcomes after resorbable collagen meniscus scaffold implantation through a systematic review of the published literature.
METHODS
A systematic search of both the PubMed and Embase databases was undertaken to identify all studies that reported clinical and/or structural outcomes after resorbable collagen meniscus scaffold implantation for the treatment of defects involving either the medial or lateral meniscus. Extracted data included study characteristics; surgical methods and rehabilitation protocols; objective outcomes; and preoperative and postoperative subjective outcome scores including Lysholm, Tegner, International Knee Documentation Committee, and visual analog scale scores.
RESULTS
Thirteen studies were included in this review. There were 10 Level IV studies, 2 Level II studies, and 1 Level I study with follow-up intervals ranging from 3 months to 12.5 years. With a few exceptions, the study designs used in each study generally followed those which had been previously performed. Substantial differences in rehabilitation protocols and concomitant procedures were noted that may have had an effect on overall clinical outcomes. Objective findings were mostly consistent and typically showed minimal degenerative changes on postoperative radiographs, decreased signal intensity of the scaffold over time on magnetic resonance imaging, the presence of meniscus-like tissue at second-look arthroscopy, and good integration of new tissue as evidenced by histologic analysis of biopsy specimens. Most studies reported satisfactory clinical outcomes, and most patients showed substantial improvements in comparison with mean preoperative baseline values.
CONCLUSIONS
On the basis of this systematic review, implantation of resorbable collagen scaffolds for the treatment of meniscus defects provides satisfactory clinical and structural outcomes in most cases. There is evidence that collagen meniscus scaffold implantation provides superior clinical outcomes when compared with partial meniscectomy alone.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I, II, and IV studies.
Topics: Absorbable Implants; Collagen Type I; Humans; Lysholm Knee Score; Menisci, Tibial; Patient Outcome Assessment; Regeneration; Tissue Scaffolds; Visual Analog Scale
PubMed: 25595693
DOI: 10.1016/j.arthro.2014.11.019 -
Arthroscopy : the Journal of... Feb 2024To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature. (Review)
Review
Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review.
PURPOSE
To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature.
METHODS
A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means.
RESULTS
The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from -2.4 to -0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and -0.9 to -0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from -0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias.
CONCLUSIONS
The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II-IV studies.
PubMed: 38401664
DOI: 10.1016/j.arthro.2024.02.017 -
CMAJ : Canadian Medical Association... Oct 2014Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This systematic review and meta-analysis evaluates the efficacy of arthroscopic meniscal débridement in patients with knee pain in the setting of mild or no concurrent osteoarthritis of the knee in comparison with nonoperative or sham treatments.
METHODS
We searched MEDLINE, Embase and the Cochrane databases for randomized controlled trials (RCTs) published from 1946 to Jan. 20, 2014. Two reviewers independently screened all titles and abstracts for eligibility. We assessed risk of bias for all included studies and pooled outcomes using a random-effects model. Outcomes (i.e., function and pain relief) were dichotomized to short-term (< 6 mo) and long-term (< 2 yr) data.
RESULTS
Seven RCTs (n = 805 patients) were included in this review. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference (MID) between treatment arms for long-term functional outcomes (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] -0.10 to 0.23). Short-term functional outcomes between groups were significant but did not exceed the threshold for MID (SMD 0.25, 95% CI 0.02 to 0.48). Arthroscopic surgery did not result in a significant improvement in pain scores in the short term (mean difference [MD] 0.20, 95% CI -0.67 to 0.26) or in the long term (MD -0.06, 95% CI -0.28 to 0.15). Statistical heterogeneity was low to moderate for the outcomes.
INTERPRETATION
There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears in comparison with nonoperative or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. A trial of nonoperative management should be the first-line treatment for such patients.
Topics: Arthroscopy; Humans; Menisci, Tibial; Osteoarthritis, Knee; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 25157057
DOI: 10.1503/cmaj.140433 -
Sports Medicine and Arthroscopy Review Dec 2019The important medial patellar ligamentous restraints to lateral dislocation are the proximal group (the medial quadriceps tendon femoral ligament and the medial...
The important medial patellar ligamentous restraints to lateral dislocation are the proximal group (the medial quadriceps tendon femoral ligament and the medial patellofemoral ligament) and the distal group [medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML)]. The MPTL patellar insertion is at inferomedial border of patella and tibial insertion is in the anteromedial tibia. The MPML originates in the inferomedial patella, right proximal to the MPTL, inserting in the medial meniscus. On the basis of anatomy and biomechanical studies, the MPTL and MPML are more important in 2 moments during knee range of motion: terminal extension, when it directly counteracts quadriceps contraction. In a systematic review on MPTL reconstructions 19 articles were included detailing the clinical outcomes of 403 knees. All were case series. Overall, good and excellent outcomes were achieved in >75% of cohorts in most studies and redislocations were <10%, with or without the association of the medial patellofemoral ligament. The MPTL is a relevant additional tool to proximal restraint reconstruction in select patient profiles; however, more definitive clinical studies are necessary to better define surgical indications.
Topics: Biomechanical Phenomena; Humans; Ligaments, Articular; Patella; Patellar Dislocation; Patellofemoral Joint; Range of Motion, Articular; Plastic Surgery Procedures
PubMed: 31688532
DOI: 10.1097/JSA.0000000000000269 -
The American Journal of Sports Medicine Jun 2022Previous meta-analyses have demonstrated superior outcomes in patients undergoing arthroscopic repair of medial meniscus posterior root tears (MMPRTs) compared with... (Meta-Analysis)
Meta-Analysis
Comparison of Long-term Radiographic Outcomes and Rate and Time for Conversion to Total Knee Arthroplasty Between Repair and Meniscectomy for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis.
BACKGROUND
Previous meta-analyses have demonstrated superior outcomes in patients undergoing arthroscopic repair of medial meniscus posterior root tears (MMPRTs) compared with meniscectomy. However, these analyses have considered only short- or midterm outcomes and low-quality evidence.
PURPOSE
To compare the mid- to long-term rates of radiographic osteoarthritis (OA) between repair and meniscectomy for MMPRT.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
PubMed, EMBASE, Ovid/MEDLINE, and Cochrane Central Register of Controlled Trials databases were queried for articles evaluating repair and meniscectomy for MMPRT. Articles were eligible if they had a minimum mean 4-year follow-up for radiographic OA or conversion to total knee arthroplasty (TKA) and were at least level 3 evidence. Radiographic OA was assessed using Kellgren-Lawrence (KL) progression. Rates of conversion to TKA and International Knee Documentation Committee (IKDC) scores were also extracted. DerSimonian-Laird binary random-effects models were created to evaluate differences in radiographic OA and TKA conversion rates, with odds ratios (ORs) representing pooled estimates. Continuous random-effects models with standardized mean differences (SMDs) were used to compare postoperative IKDC scores.
RESULTS
Repair and meniscectomy cohorts were followed for a mean of 64.8 months and 62.5 months, respectively, for KL progression; and 82.8 months and 73.8 months, respectively, for TKA rates and IKDC scores. Overall, 59 of 144 (41%) patients undergoing surgical intervention for MMPRT demonstrated OA progression; 18 of 82 (22%) who underwent repair for MMPRT exhibited OA progression compared with 41 of 62 (66%) who underwent meniscectomy (OR, 0.17; 95% CI, 0.03-0.83; = .029). Overall, 30 of 143 (21%) patients converted to TKA; 9.8% (8/82) of patients who underwent repair converted to TKA (range, 47-131 months), while 36% (22/61) who underwent meniscectomy converted to TKA (range, 17.8-101 months) (OR, 0.15; 95% CI, 0.05-0.44; < .001). No significant differences between postoperative IKDC scores were observed (SMD, 0.51; 95% CI, -0.02 to 1.05; = .06).
CONCLUSION
Medial meniscus posterior root repair results in significantly lower rates of radiographic OA progression and conversion to TKA at >60-month follow-up. On the basis of these findings, we recommend consideration of repair of MMPRTs when degenerative changes are not severe, as it can yield improved outcomes.
Topics: Arthroplasty, Replacement, Knee; Arthroscopy; Humans; Meniscectomy; Menisci, Tibial; Osteoarthritis; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 34251898
DOI: 10.1177/03635465211017514 -
Knee Surgery, Sports Traumatology,... Jan 2023To evaluate the prevalence of and factors associated with meniscal ramp lesions on magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL)...
PURPOSE
To evaluate the prevalence of and factors associated with meniscal ramp lesions on magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) injuries.
METHODS
Data from the Natural Corollaries and Recovery after ACL injury multicentre longitudinal cohort study (NACOX) were analysed. Only patients who underwent MRI were included in this study. All MRI scans were reviewed by an orthopaedic knee surgeon and a musculoskeletal radiologist. The patients were divided into two groups, those with and without ramp lesions according to MRI findings. Univariable and stepwise forward multiple logistic regression analyses were used to evaluate patient characteristics (age, gender, body mass index, pre-injury Tegner activity level, activity at injury) and concomitant injuries on MRI (lateral meniscus, medial collateral ligament [MCL], isolated deep MCL, lateral collateral ligament, pivot-shift-type bone bruising, posteromedial tibial [PMT] bone bruising, medial femoral condyle bone bruising, lateral femoral condyle [LFC] impaction and a Segond fracture) associated with the presence of meniscal ramp lesions.
RESULTS
A total of 253 patients (52.2% males) with a mean age of 25.4 ± 7.1 years were included. The overall prevalence of meniscal ramp lesions was 39.5% (100/253). Univariate analyses showed that contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising, LFC impaction and the presence of a Segond fracture increased the odds of having a meniscal ramp lesion. Stepwise forward multiple logistic regression analysis revealed that the presence of a meniscal ramp lesion was associated with contact sports at ACL injury [odds ratio (OR) 2.50; 95% confidence intervals (CI) 1.32-4.72; P = 0.005], pivot-shift-type bone bruising (OR 1.29; 95% CI 1.01-1.67; P = 0.04), PMT bone bruising (OR 4.62; 95% CI 2.61-8.19; P < 0.001) and the presence of a Segond fracture (OR 4.38; 95% CI 1.40-13.68; P = 0.001).
CONCLUSION
The overall prevalence of meniscal ramp lesions in patients with ACL injuries was high (39.5%). Contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising and the presence of a Segond fracture on MRI were associated with meniscal ramp lesions. Given their high prevalence, meniscal ramp lesions should be systematically searched for on MRI in patients with ACL injuries. Knowledge of the factors associated with meniscal ramp lesions may facilitate their diagnosis, raising surgeons' and radiologists' suspicion of these tears.
LEVEL OF EVIDENCE
III.
Topics: Male; Humans; Adolescent; Young Adult; Adult; Female; Anterior Cruciate Ligament Injuries; Prevalence; Longitudinal Studies; Tibial Meniscus Injuries; Anterior Cruciate Ligament Reconstruction; Menisci, Tibial; Tibial Fractures; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 36045182
DOI: 10.1007/s00167-022-07135-8 -
Technology and Health Care : Official... 2015Tissue engineering has provided the orthopedic surgeon with a vast portfolio of methods for replacement or regeneration of articular cartilage or meniscal tissue. On the... (Review)
Review
BACKGROUND
Tissue engineering has provided the orthopedic surgeon with a vast portfolio of methods for replacement or regeneration of articular cartilage or meniscal tissue. On the one hand cell based techniques such as autologous chondrocyte transplantation (ACT) are a main focus of interest. On the other hand cell free techniques are rapidly evolving and gaining more interest. The European Union regulation of November 2007, demanding proof of efficacy in cases of autologous cell transplantation, additionally increased the interest in cell-free techniques.
OBJECTIVE
The aim of this review was to discuss the advantages and disadvantages of cell-based and cell-free procedures and to summarize the clinical evidence for cell-free, tissue engineering procedures in orthopedic surgery for meniscal and cartilage defects.
METHODS
A systematic review was performed searching for clinical human studies evaluating cell-free repair procedures for cartilage and meniscus defects. All human study reports with English or German language abstracts were included.
RESULTS
The search revealed 82 studies of which only 12 met the inclusion criteria. Overall good clinical results for the use of cell-free meniscal and cartilage scaffolds were reported.
CONCLUSION
With improved understanding of the healing process in cartilage- and meniscal-defects, acellular, off the shelf products might gain more importance.
Topics: Cartilage, Articular; Clinical Trials as Topic; Humans; Menisci, Tibial; Orthopedic Procedures; Tissue Engineering; Tissue Scaffolds
PubMed: 26409907
DOI: 10.3233/THC-150917