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Orthopaedic Journal of Sports Medicine May 2019Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group. (Review)
Review
BACKGROUND
Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group.
PURPOSE
To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes of meniscal tears in the pediatric population (<18 years old) with a follow-up of more than 12 months. Clinical outcome scores were reviewed.
RESULTS
A total of 1003 total studies were initially retrieved, with 8 meeting the inclusion criteria. The review included 287 patients (165 male, 122 female), mean age 15.1 years (range, 4-18 years), with 301 meniscal tears (reported: 134 medial, 127 lateral, and 32 both medial and lateral, 8 location unspecified). Concomitant anterior cruciate ligament reconstruction was performed in 52% (158/301) of meniscal repairs. The average reported postoperative Lysholm scores ranged from 85.4 to 96.3, and the average reported postoperative Tegner activity scores ranged from 6.2 to 8.
CONCLUSION
Arthroscopic repair of a meniscal tear in the pediatric and adolescent population is an effective treatment option that has a low failure rate, enhances postoperative clinical outcomes, and preserves meniscal tissues.
PubMed: 31205961
DOI: 10.1177/2325967119843355 -
Knee Surgery, Sports Traumatology,... Oct 2023To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament...
Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes.
PURPOSE
To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament reconstruction (ACLR).
METHODS
A literature search was performed systematically using PubMed, Embase, and Medline databases in April 2022. The search included the following terms combined with Boolean operators: 'Meniscus repairs', 'Meniscal Repair', 'Posterior Horn', 'Root', 'Radial'. Inclusion criteria consisted of level I-IV human clinical and biomechanical studies reporting biomechanical data and/or outcomes following LMPR repair in the setting of ACLR.
RESULTS
Three biomechanical studies, all utilizing a transtibial pullout technique, were identified, all of which reported significant improvement in joint contact pressures and mechanics and 3/4 of which reported significant improvement in anterior or rotational stability with LMPR repair. Five clinical studies, consisting of 146 patients (mean age 28.5 ± 1.1 years) undergoing LMPR repair, were identified with an average follow-up of 19.1 months (range 6.2-46 months). Across all clinical studies, Lysholm and International Knee Documentation Committee (IKDC) scores were found to improve postoperatively, with 3/4 reporting significant improvement in Lysholm (all, p ≤ 0.001) scores and 3/5 reporting significant improvement in IKDC scores when compared to preoperative values (all, p ≥ 0.004). Meniscal extrusion decreased significantly following repair in 2/4 studies (all, p ≤ 0.001).
CONCLUSIONS
Biomechanically, transtibial pullout repair of the LMPR restored joint contact pressures and joint mechanics to intact levels when performed with concomitant ACLR. Clinically, LMPR repair with concurrent ACLR resulted in improved Lysholm and IKDC scores. These findings enable surgeons to determine optimal treatment plans and discuss realistic outcomes with patients when encountering LMPR injuries.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Infant; Child, Preschool; Menisci, Tibial; Anterior Cruciate Ligament Injuries; Knee Joint; Arthroplasty, Replacement, Knee; Anterior Cruciate Ligament Reconstruction
PubMed: 37516986
DOI: 10.1007/s00167-023-07461-5 -
Arthroscopy : the Journal of... Mar 2024To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects. (Review)
Review
PURPOSE
To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects.
METHODS
A search was performed by 3 independent reviewers on PubMed, MEDLINE, EMBASE, and Cochrane from 2016 to June 18, 2023, with the term "meniscus" with all the following terms: "scaffolds," "constructs," "implant," and "tissue engineering." Inclusion criteria included "Clinical trials" and "English language articles" that involved isolated meniscus tissue engineering strategies for meniscus injuries. Only Level I to IV clinical studies were considered. The modified Coleman Methodology score was used for quality analysis of included clinical trials. The Methodological Index for Non-Randomized Studies was employed for analysis of the risk of study bias and methodological quality.
RESULTS
The search identified 2,280 articles, and finally 19 original clinical trials meeting the inclusion criteria were included. Three types of tissue-engineered meniscus implants (CMI-Menaflex, Actifit, and NUsurface) have been clinically evaluated for meniscus reconstruction. Lack of standardized outcome measures and imaging protocols limits comparison between studies.
CONCLUSIONS
Tissue-engineered meniscus implants can provide short-term knee symptom and function improvements, but no implants have been shown to propose significant long-term benefits for meniscus defects.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
Topics: Humans; Tissue Engineering; Menisci, Tibial; Meniscus; Knee Joint; Prostheses and Implants
PubMed: 37414105
DOI: 10.1016/j.arthro.2023.06.043 -
Journal of Orthopaedic Surgery (Hong... 2021To report of efficacy repair treatment for meniscus posterior root tears repair. (Meta-Analysis)
Meta-Analysis
PURPOSE
To report of efficacy repair treatment for meniscus posterior root tears repair.
METHODS
We systematically searched databases including PubMed, Embase, and Cochrane Library for relevant articles. Coleman Methodology Score was used for a quality assessment of the included studies. A meta-analysis was performed to analyze for efficacy of MMPRTs repair.
RESULTS
Twenty-two studies, 14 level III and 8 level IV, were included in this systematic review, with a total of 926 cases. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower progression of Kellgrene-Lawrence grade with meniscal repair. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. As treatment efficacy, the Lysholm score increased 28.87 (P < 0.001), IKDC score increased 31.73. The overall pooled event rates of progression of K-L grade is 0.200. Difference of Lysholm score and IKDC score between repair and meniscectomy were 8.72 and 9.67.
CONCLUSIONS
The clinical subjective score after MMPRT repair was significantly improved compared with the preoperative status. Considering the progression of joint K-L grade, it can prevent the progression of arthrosis to some extent, but not completely. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. Based on these results, MMPRTs repair cloud result favorable outcomes.
Topics: Arthroscopy; Humans; Joint Diseases; Meniscectomy; Meniscus; Osteoarthritis; Prognosis; Plastic Surgery Procedures; Retrospective Studies; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 33832364
DOI: 10.1177/23094990211003350 -
The Journal of Bone and Joint Surgery.... Jul 2022The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.
METHODS
We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.
RESULTS
A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).
CONCLUSIONS
Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35856932
DOI: 10.2106/JBJS.21.01303 -
Knee Surgery, Sports Traumatology,... Jul 2018To determine sports activities achieved after meniscus transplantation and if associations exist between sports activity levels and transplant failure or progression of... (Review)
Review
PURPOSE
To determine sports activities achieved after meniscus transplantation and if associations exist between sports activity levels and transplant failure or progression of tibiofemoral osteoarthritis (OA).
METHODS
A systematic search was performed using PubMed and Cochrane online databases. Inclusionary criteria were English language, clinical trials published from 1996 through May 2017, minimum 2 years of follow-up, and sports activity data reported.
RESULTS
Twenty-eight studies were included in which 1521 menisci were implanted into 1497 patients. The mean age was 34.3 ± 6.7 years, and the mean follow-up was 5.0 ± 3.7 years. Details on sports activities were provided in 7 studies (285 patients) that reported 70-92% of patients returned to a wide variety of sports activities. Mean Tegner activity scores were reported in 24 investigations. The mean score was <5 in 58% of these studies, indicating many patients were participating in light recreational activities. There was no association between mean Tegner scores and transplant failure rates. A moderate correlation was found between failure rates and mean follow-up time (R = 0.63). The effect of sports activity levels on progression of tibiofemoral OA could not be determined because of limited data. Only two studies determined whether symptoms occurred during sports activities; these reported 1/38 (3%) and 5/69 (7%) patients had knee-related problems.
CONCLUSIONS
It appeared that the majority of individuals returned to low-impact athletic activities after meniscus transplantation. The short-term follow-up did not allow for an analysis on the effect of return to high-impact activities on transplant failure rates or progression of OA.
LEVEL OF EVIDENCE
IV.
Topics: Follow-Up Studies; Humans; Menisci, Tibial; Meniscus; Return to Sport; Sports; Tibial Meniscus Injuries
PubMed: 28752186
DOI: 10.1007/s00167-017-4658-8 -
Arthroscopy : the Journal of... Aug 2022To compare biomechanical properties of various radial tear repair techniques in the medial and lateral menisci. (Review)
Review
PURPOSE
To compare biomechanical properties of various radial tear repair techniques in the medial and lateral menisci.
METHODS
A search was performed for key words regarding mechanical properties of repair of radial meniscal tears in PubMed, Embase, CINAHL, Scopus, and Cochrane databases, yielding 1791 articles. Articles were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines against inclusion criteria and underwent Methodological Index for Non-Randomized Studies (MINORS) methodologic quality assessment. Repair constructs evaluated were classified based on repair technique, use of a transtibial augmentation, and the number, orientation, and pattern of stitches. Results published across different studies were compared but not subjected to meta-analysis due to variability in testing procedures and heterogeneity of repair methods.
RESULTS
We identified 20 studies that performed mechanical testing on 21 different radial meniscal tear repair techniques. The greatest reported mean load-to-failure (LtF) were the transtibial 2-tunnel + 4 horizontal inside-out sutures (191.2 N ± 17.3, cadaver) and all-inside double vertical repair (146.3 N ± 36.2, porcine). The transtibial technique improved LtF and displacement of an inside-out (IO) horizontal repair. All-inside vertical repairs demonstrated greater LtF, stiffness, and displacement compared with IO horizontal repairs in 2 studies. Compared with IO double horizontal repairs, all-inside double vertical or IO double horizontal repairs with reinforcing stitches parallel to the tear exhibited greater LtF in 3 studies and stiffness in 2 studies. Two studies reported that parallel reinforcing stitches significantly reduced suture tear-through compared with similar, nonreinforced repairs. Mean MINORS score for all studies analyzed was 19.88 ± 1.47 points.
CONCLUSIONS
A systematic review demonstrated that there may be alternatives to traditional IO horizontal repairs for radial meniscus tears. Less-invasive all-inside vertical techniques reinforced with suture parallel to the tear instead of standard IO horizontal sutures may improve strength of repair. In addition, transtibial 2-tunnel augmentation may also increase strength of radial meniscus tear repairs.
CLINICAL RELEVANCE
There may be alternatives to IO horizontal repairs for radial meniscus tears.
Topics: Animals; Biomechanical Phenomena; Cartilage Diseases; Knee Injuries; Lacerations; Menisci, Tibial; Meniscus; Rupture; Suture Techniques; Sutures; Swine; Tibial Meniscus Injuries
PubMed: 35189305
DOI: 10.1016/j.arthro.2022.02.010 -
Arthroscopy : the Journal of... Sep 2017To evaluate the surgical outcomes of symptomatic discoid menisci after total meniscectomy, saucerization, and suture repair of tears of a discoid meniscus at short- and... (Review)
Review
PURPOSE
To evaluate the surgical outcomes of symptomatic discoid menisci after total meniscectomy, saucerization, and suture repair of tears of a discoid meniscus at short- and long-term follow-up.
METHODS
A systematic review was conducted using the Pubmed and ScienceDirect databases in adherence with Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Short- and long-term follow-up were defined as an average follow-up of <4 years and >4 years, respectively. Pooled quantitative synthesis was performed on studies that reported results of total meniscectomy and saucerization in the same study. A systematic review was performed on studies that reported data on saucerization, total meniscectomy, and/or repair.
RESULTS
A total of 19 studies for the short term and 22 for the long term were identified that met inclusion criteria for qualitative review. Of these, 4 short-term and 5 long-term studies were included in the quantitative synthesis. No significant differences in Ikeuchi scores are seen in the short-term studies between saucerization and total meniscectomy; however, the long-term studies did find a statistical difference favoring saucerization (P < .001). The differences noted between the preoperative and postoperative Lysholm scores in the short term were 24.1 (95% conflict of interest: 10.25-37.95) in 3 studies and 22.38 (95% conflict of interest: 17.68-27.07) in the 4 long-term studies for saucerization. Suture repair with saucerization versus saucerization without suture repair revealed a statistical difference in only 1 of 5 studies.
CONCLUSIONS
Long-term data demonstrate significantly improved patient reported outcomes in favor of saucerization over total meniscectomy. Suture repair of tears of a lateral discoid meniscus does not demonstrate improved outcomes over partial meniscectomy without repair. Considering the cost of repair and lack of demonstrated improvement, based on the limited available data, we do not recommend repair of the abnormal anatomy in a torn lateral discoid meniscus.
LEVEL OF EVIDENCE
Level IV, systematic review.
Topics: Arthroscopy; Follow-Up Studies; Humans; Joint Diseases; Knee Joint; Meniscectomy; Menisci, Tibial; Patient Reported Outcome Measures
PubMed: 28865577
DOI: 10.1016/j.arthro.2017.03.028 -
Sports Medicine (Auckland, N.Z.) Oct 2016Meniscal pathology is a commonly seen orthopedic condition that can affect a wide age range of patients. Athletes subject their menisci to an increased amount of stress... (Review)
Review
BACKGROUND
Meniscal pathology is a commonly seen orthopedic condition that can affect a wide age range of patients. Athletes subject their menisci to an increased amount of stress during their careers and may increase their risk of meniscal pathology.
OBJECTIVE
The purpose of this systematic review is to evaluate the prevalence of isolated meniscal pathology in asymptomatic athletes.
METHODS
A systematic review was undertaken to determine the prevalence of meniscal pathology in asymptomatic athletes. A search of multiple databases was conducted. Recreational and higher-level athletes were included. Fourteen articles including 295 athletes (208 male, 87 female) were identified for inclusion (age range 14-66 years, mean 31.2 years). Meniscal pathology was visualized with magnetic resonance imaging and graded on a 1-4 scale (grades 1 and 2 indicating intrasubstance damage, grades 3 and 4 indicating a tear).
RESULTS
There was an overall prevalence of 27.2 % (105/386) of knees with intrasubstance meniscal damage (grades 1 and 2), and 3.9 % (15/386) of knees with a tear (grades 3 and 4). When athletes were split into those who participate in pivoting sports versus non-pivoting sports, pivoting athletes showed an overall prevalence of 15.3 % (31/202) of knees with intrasubstance meniscal pathology and 2.5 % (5/202) of knees with a tear. Non-pivoting athletes showed a prevalence of 54.5 % (61/112) of knees with intrasubstance meniscal pathology and 5.4 % (6/112) of knees with a tear.
CONCLUSION
The overall prevalence of isolated meniscal pathology in asymptomatic athletes was 31.1 % (27.2 % with intrasubstance meniscal damage and 3.9 % with a meniscal tear). More studies of age-comparable, non-athletic populations are necessary for direct comparison with these groups.
Topics: Asymptomatic Diseases; Athletic Injuries; Humans; Magnetic Resonance Imaging; Prevalence; Tibial Meniscus Injuries
PubMed: 27075327
DOI: 10.1007/s40279-016-0540-y -
Indian Journal of Orthopaedics Jun 2024This study aimed to reach a consensus for ideal surgical treatment of discoid lateral meniscus (DLM) and to evaluate its long term surgical and radiological outcome. (Review)
Review
PURPOSE OF THE STUDY
This study aimed to reach a consensus for ideal surgical treatment of discoid lateral meniscus (DLM) and to evaluate its long term surgical and radiological outcome.
METHODS
All authors independently searched for peer reviewed publications with keywords like discoid lateral meniscus, tibial menisci abnormalities, tibial menisci surgery and clinical outcome and their representative Medical Subjects Headings (MeSH) in databases of PubMed, EBSCO, Cochrane Central Register of Controlled Trials, from inception to December 2022. Original articles in English language on discoid lateral meniscus reporting clinical, surgical, or radiological outcomes with five or more years of follow-up were included in this systematic review. Study details and outcome data were analysed according to the age, follow-up period, kind of surgery, DLM type, and alignment.
RESULTS
Our search strategy yielded 654 articles in PubMed, 222 articles in EBSCO and 5 articles in CENTRAL i.e. a total of 881 articles. After detailed assessment and screening, 12 articles were included in the final analysis, which included 444 DLM cases. The mean patient age at surgery ranged from 9.9 to 35.9 years, and the mean follow-up period ranged from 5.2 to 16 years. Partial meniscectomy and meniscoplasty are the recommended treatment because of the concerns of degenerative arthritis development after the total and subtotal meniscectomies. Two studies have documented better results with meniscal allograft transplantation.
CONCLUSION
Satisfactory clinico-radiological outcome can be obtained after surgical treatment of discoid lateral meniscus with meniscus reshaping and repair of peripheral unstable part. Meniscal allograft transplantation (MAT) is gaining popularity in patients with total meniscectomy with satisfactory long term functional outcome.
PubMed: 38812876
DOI: 10.1007/s43465-024-01137-z