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Clinics in Sports Medicine Jan 2020The menisci are 2 fibrocartilaginous crescents anchored via bony and ligamentous attachments to surrounding structures. Their biochemical composition and multilayered... (Review)
Review
The menisci are 2 fibrocartilaginous crescents anchored via bony and ligamentous attachments to surrounding structures. Their biochemical composition and multilayered structure make them ideal for converting compressive forces to tensile forces in addition to improving joint congruity and providing shock absorption to weight bearing. The medial meniscus maintains more attachments at both the horns and the midbody than the lateral meniscus, making it more susceptible to injury. Understanding of the gross anatomy, vascular anatomy, biochemical composition, and microstructure is key to understanding causes of meniscal pathology as well as treatment options for restoring its primary functions.
Topics: Body Water; Collagen Type I; Collagen Type II; Glycosaminoglycans; Humans; Knee Joint; Menisci, Tibial; Proprioception; Proteoglycans; Synovial Fluid; Tibial Meniscus Injuries; Weight-Bearing
PubMed: 31767101
DOI: 10.1016/j.csm.2019.08.007 -
Medicina (Kaunas, Lithuania) Jun 2023Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead... (Review)
Review
Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author's treatment strategies.
Topics: Humans; Menisci, Tibial; Knee Joint; Tibia; Rupture
PubMed: 37511993
DOI: 10.3390/medicina59071181 -
The American Journal of Sports Medicine Dec 2014Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint... (Review)
Review
Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments.
Topics: Algorithms; Arthroscopy; Biomechanical Phenomena; Decision Making; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Menisci, Tibial; Patient Outcome Assessment; Physical Examination; Postoperative Care; Postoperative Complications; Suture Anchors; Suture Techniques; Tibial Meniscus Injuries
PubMed: 24623276
DOI: 10.1177/0363546514524162 -
Clinics in Orthopedic Surgery Oct 2023There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply...
BACKGROUND
There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS.
METHODS
A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded.
RESULTS
Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application. Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study.
CONCLUSIONS
This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.
Topics: Humans; Menisci, Tibial; Return to Sport; Rupture; Arthroplasty, Replacement, Knee; Weight-Bearing
PubMed: 37811518
DOI: 10.4055/cios21231 -
Radiologie (Heidelberg, Germany) Apr 2024Meniscus tears are classified as horizontal, longitudinal, radial, and complex tears. Flap tears are a specific form in which a portion of the meniscus is displaced... (Review)
Review
Meniscus tears are classified as horizontal, longitudinal, radial, and complex tears. Flap tears are a specific form in which a portion of the meniscus is displaced from a horizontal or longitudinal tear. The question of whether it is possible to preserve the meniscus by meniscus repair is of crucial therapeutic importance. It is therefore important to specify not only the configuration of the tear but also its extent and location as precisely as possible. Cooper's zonal classification should also be used for this purpose. Lesions of the meniscus roots are of high clinical relevance. On the posterior horn of the medial meniscus, root lesions are usually degenerative; on the posterior horn of the lateral meniscus, they are often traumatic. It is important to familiarize oneself with the normal appearance and anatomical location of the meniscal roots. Ramp lesions have received particular attention in recent years, especially in patients with anterior cruciate ligament tears. Therefore, particularly the integrity of the attachment of the posterior horn of the medial meniscus to the tibial plateau must be analyzed. If the meniscotibial ligament tears along its course or at the insertion to the meniscus or if it avulses with a meniscus fragment, this is a ramp lesion.
Topics: Humans; Arthroscopy; Menisci, Tibial; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia
PubMed: 38519603
DOI: 10.1007/s00117-024-01294-0 -
Clinics in Sports Medicine Jul 2019Concomitant high tibial osteotomy and meniscal allograft transplant is indicated in patients with medial meniscus deficiency and varus deformity. A synergistic... (Review)
Review
Concomitant high tibial osteotomy and meniscal allograft transplant is indicated in patients with medial meniscus deficiency and varus deformity. A synergistic relationship likely exists between knee realignment and restoration of meniscal and chondral tissue. Therefore, it is important to address all sources of pathology, such as meniscal or chondral defects, when addressing axis malalignment. In this article, we review the indications, preoperative considerations, technique, postoperative rehabilitative protocol, and outcomes in patients undergoing high tibial osteotomy with medial meniscal allograft transplant.
Topics: Humans; Knee Joint; Menisci, Tibial; Osteotomy; Physical Examination; Preoperative Period; Radiography; Tibia
PubMed: 31079771
DOI: 10.1016/j.csm.2019.02.006 -
Orthopaedics & Traumatology, Surgery &... Feb 2021The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and... (Review)
Review
The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and adolescents. In normal menisci, lesions are traumatic in origin. They are often vertical, in the posterior segment, associated with anterior cruciate ligament tear. In abnormal menisci, lesions are much more specific to children, occurring atraumatically, mainly in discoid menisci. Clinical signs of traumatic meniscal lesion are minimal, and associated ligament involvement should be systematically screened for. In contrast, clinical findings are rich and specific in discoid malformative pathology, sometimes showing the typical "clunk" sign highly suggestive of a detachment. The complementary examination of choice is MRI. In children more than in adults, lesions need screening for in apparently normal menisci. This particularly concerns ramp lesions of the medial meniscus. It is important also to be aware of false signs, and notably linear hypersignal of vascular origin in the posterior segment of the medial meniscus. MRI is essential in determining type of tear and guiding surgery in discoid meniscal pathology. Indications for meniscal repair in children are maximal, even in lesions extending into the white zone, and the risk of failure needs to be assumed. All meniscal suture techniques - all-inside, in-out and out-in - need to be acquired. Meniscectomy, even partial, should be exceptional. Treatment of symptomatic discoid meniscus usually involves minimal central meniscoplasty and suture of the discovered lesion. Results of meniscal repair in children are generally very satisfactory, whatever the type or site of lesion. Vertical suture is to be preferred; suture failure is often only partial. In all, optimal treatment of meniscal pathology in children and adolescents requires perfect knowledge of pediatric specificities and above all mastery of repair techniques to restore meniscal tissue as fully as possible so as to conserve future knee function.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Arthroscopy; Cartilage Diseases; Child; Humans; Meniscectomy; Menisci, Tibial
PubMed: 33321242
DOI: 10.1016/j.otsr.2020.102775 -
Bioscience Reports Jan 2019The morphology and histology changes in the medial meniscus after posterior cruciate ligament (PCL) rupture are poorly understood. Forty-eight rabbits were divided into...
The morphology and histology changes in the medial meniscus after posterior cruciate ligament (PCL) rupture are poorly understood. Forty-eight rabbits were divided into matched mode pairs; each rabbit had an experimental side, in which the PCL was transacted, and a control side. At the 4, 8, 16 and 24 weeks after the PCL transection, each of the 12 rabbits was killed. Histology was performed to detect the expression of the tissue inhibitors of metalloproteinases-1 (TIMP-1), matrix metalloproteinase (MMP)-1 and MMP-13 in the medial meniscus. We found that medial meniscus displayed significant degenerative characteristics in morphology. The histological evaluation of the degeneration found that the expression levels of TIMP-1, MMP-1 and MMP-13 in the medial meniscus were higher in the experiment side than those in the control side (<0.05). The expression of both TIMP-1 and MMP-13 was initially elevated and then decreased. The MMP-1 expression reached its peak swiftly and then maintained a relatively high level. There were clear time-dependent degenerative changes in the histology of the medial meniscus after PCL rupture. The high expression of TIMP-1, MMP-1 and MMP-13 in the cartilage may be responsible for the degeneration, and PCL rupture may trigger meniscus degradation and ultimately osteoarthritis.
Topics: Animals; Disease Models, Animal; Gene Expression Regulation; Humans; Knee Injuries; Matrix Metalloproteinase 1; Matrix Metalloproteinase 13; Menisci, Tibial; Osteoarthritis; Posterior Cruciate Ligament; Rabbits; Tissue Inhibitor of Metalloproteinase-1
PubMed: 30626725
DOI: 10.1042/BSR20181843 -
The Journal of Knee Surgery Dec 2014There are two scaffold products designed for meniscal reconstruction or substitution of partial meniscal defects that are currently available in the Europe: the collagen...
There are two scaffold products designed for meniscal reconstruction or substitution of partial meniscal defects that are currently available in the Europe: the collagen meniscal implant (CMI; Ivy Sports Medicine, Gräfelfing, Germany) and the polymer scaffold (PS; Actifit, Orteq Bioengineering, London, United Kingdom). The CMI has demonstrated improved clinical outcomes compared with baseline in patients with chronic postmeniscectomy symptoms with follow-up ranging from 5 to more than 10 years. There are also several comparative studies that report improved clinical scores in patients with chronic medial meniscus symptoms treated with CMI versus repeat partial meniscectomy, and a lower reoperation rate. Recently, PS insertion was shown to result in improved clinical outcomes in patients with chronic postmeniscectomy symptoms of the medial or lateral meniscus at short-term follow-up. However, there is currently no medium- or long-term data available for the PS. The use of meniscal scaffolds in the acute setting has not been found to result in improved outcomes in most studies. The authors' surgical indications for meniscal scaffold implantation, preferred surgical technique, and postoperative rehabilitation protocol are described.
Topics: Arthroscopy; Biocompatible Materials; Collagen; Humans; Knee Injuries; Knee Joint; Menisci, Tibial; Polymers; Prostheses and Implants; Prosthesis Implantation; Tibial Meniscus Injuries; Tissue Scaffolds
PubMed: 25172967
DOI: 10.1055/s-0034-1388656 -
The American Journal of Sports Medicine Oct 2023Meniscal extrusion has become increasingly utilized when evaluating meniscus root abnormalities. However, no consensus definition or approach exists on how to measure... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Meniscal extrusion has become increasingly utilized when evaluating meniscus root abnormalities. However, no consensus definition or approach exists on how to measure extrusion.
PURPOSE/HYPOTHESIS
The purpose of this study was to evaluate the extent of heterogeneity in meniscal extrusion measurement techniques and reported extrusion values in knees with posterior medial meniscus root tears (PMMRTs). We hypothesized that meniscal extrusion measurement techniques would vary considerably throughout reported studies, with resultant wide-ranging published extrusion values.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The inclusion criteria consisted of all clinical and cadaveric studies reporting on meniscal extrusion after PMMRTs, excluding studies lacking data in full extension, those presenting only semiquantitative analyses, articles reporting only differences in meniscal extrusion, and review articles.
RESULTS
A total of 45 studies were included. Imaging modality types included magnetic resonance imaging (89%), 3-dimensional reconstruction with computed tomography (7%), linear displacement transducers (2%), and a combination of magnetic resonance imaging and ultrasound (2%). The 3 most commonly used landmarks to acquire coronal images for meniscal extrusion measurements were the medial collateral ligament (38%), the midpoint of the anterior-posterior length of the medial meniscus (23%), and the middle of the medial femoral condyle (19%). The pooled mean extrusion values according to the measurement location were 3.5 ± 0.7 mm, 3.9 ± 0.8 mm, and 4.5 ± 2.1 mm, respectively, with no significant differences noted between the modality types ( = .23). The pooled mean meniscal extrusion from all included studies was 3.2 ± 2.0 mm.
CONCLUSION
Substantial variation exists in measurement techniques for meniscal extrusion, particularly as it relates to the coronal cross-sectional reference location. Further studies should aim to provide clear descriptions of the measurement method and have uniform measurement methodology to allow comparisons and pooling between studies.
Topics: Humans; Menisci, Tibial; Cross-Sectional Studies; Tibial Meniscus Injuries; Knee Joint; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 36541434
DOI: 10.1177/03635465221131005