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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 -
European Journal of Radiology May 2018The menisci play an important role in knee kinematics. Their unique anatomy allows them to channel forces generated during knee movements through the larger... (Review)
Review
The menisci play an important role in knee kinematics. Their unique anatomy allows them to channel forces generated during knee movements through the larger tibio-femoral condylar surfaces while simultaneously resisting deleterious hoop stresses. Although physiologic meniscal extrusion occurs with every knee joint movement, pathologic meniscal extrusion subjects the knee to persistent and excessive load transmission. This renders the knee structures susceptible to injury or exacerbates worsening of existing knee joint internal derangement. Detection and quantification of meniscus extrusion is important given its association with underlying pathological processes and internal derangements such as cartilage loss, osteoarthritis and meniscal tears. The medial and lateral menisci vary in size, attachments and load transmission, and the medial meniscus is more susceptible to injury. In this article, the authors illustrate the role of meniscus kinematics, and the identification and quantification of medial meniscal extrusion. Multimodality imaging appearances and implications of presence of medial meniscal extrusion in different knee joint pathologies are discussed with review of the relevant literature.
Topics: Cartilage Diseases; Female; Humans; Magnetic Resonance Imaging; Male; Menisci, Tibial; Middle Aged; Multimodal Imaging; Osteoarthritis; Radiography; Tibial Meniscus Injuries
PubMed: 29685524
DOI: 10.1016/j.ejrad.2018.03.007 -
Clinical Anatomy (New York, N.Y.) Jul 2022Medial knee pain is commonplace in clinical practice and ultrasound assessment of the tibial collateral ligament-medial meniscus complex is increasingly becoming a... (Review)
Review
Medial knee pain is commonplace in clinical practice and ultrasound assessment of the tibial collateral ligament-medial meniscus complex is increasingly becoming a valuable examination tool in the outpatient setting. In the pertinent literature, basic sonographic protocols have been proposed to evaluate the medial compartment of the knee joint. Using high-frequency ultrasound probes and high-level ultrasound machines; we matched the histo-anatomical features of the tibial collateral ligament-medial meniscus complex and its different sonographic patterns in physiological/pathological conditions to define a standardized (layer-by-layer) sonographic approach. Moreover, high-sensitive power Doppler assessments have also been performed to evaluate the nearby microcirculation. Modern ultrasound equipment appears to provide optimal "sonographic dissection" of the tibial collateral ligament-medial meniscus complex for its various physiological/pathological patterns. Likewise, high-sensitive power Doppler allows clear visualization of the microcirculation as regards the local ligamentous and capsular structures. In clinical practice, using adequate technological equipment, a detailed sonographic assessment of the tibial collateral ligament-medial meniscus complex can be performed. High-frequency B-mode ultrasound imaging and high-sensitive power Doppler perfusion patterns can be matched/integrated with the clinical findings to optimize the management of patients with medial knee pain.
Topics: Humans; Knee Joint; Medial Collateral Ligament, Knee; Menisci, Tibial; Pain; Ultrasonography
PubMed: 35368125
DOI: 10.1002/ca.23864 -
Calcified Tissue International Jan 2023Medial meniscus posterior root tears (MMPRT) are often associated with osteoarthritis (OA) progression and subchondral bone insufficiency fractures. This study aimed to...
Medial meniscus posterior root tears (MMPRT) are often associated with osteoarthritis (OA) progression and subchondral bone insufficiency fractures. This study aimed to develop the first MMPRT mouse model. The MMPRT model was created by sectioning the medial meniscus posterior root of 12-week-old CL57BL/6J male mice under stereomicroscopic observation. The sham operation and the destabilization of the medial meniscus (DMM) model groups were also created. OA progression and subchondral bone changes were evaluated histologically using the Osteoarthritis Research Society International (OARSI) subchondral bone scoring system at 2, 4, 8, and 12 weeks after surgery. Microcomputed tomography (µCT) was performed to evaluate the presence of insufficient fractures. OA progression and medial meniscus extrusion were observed in the MMPRT and DMM models 12 weeks after surgery. OA progressed in both models during the time course, without a significant difference in the OARSI score between the two groups. The subchondral bone score was significantly higher at 12 weeks than at 2 and 4 weeks in the MMPRT group, while no significant difference was found between the two groups. In the µCT analysis, destruction of the medial tibial plateau was observed in 4/40 knees, while none were observed in the DMM group. Of the four knees, destruction of the medial femoral condyle was also observed in three knees. Characteristic pathological changes were observed in the mouse MMPRT model. The mouse MMPRT model may be useful for investigating pathological changes after MMPRT.
Topics: Male; Mice; Animals; Menisci, Tibial; Retrospective Studies; X-Ray Microtomography; Tibial Meniscus Injuries; Magnetic Resonance Imaging; Osteoarthritis; Disease Models, Animal
PubMed: 36242608
DOI: 10.1007/s00223-022-01028-1 -
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 -
Scientific Reports Aug 2023Medial meniscus extrusion (MME) is exacerbated by repeated mechanical stress. Various factors would affect MME; however, there is limited information about the behaviour...
Medial meniscus extrusion (MME) is exacerbated by repeated mechanical stress. Various factors would affect MME; however, there is limited information about the behaviour of the medial meniscus during walking in patients with knee osteoarthritis (KOA). This study aimed to investigate the pattern of MME during walking and its association with limb biomechanics in patients with KOA. Fifty-five patients with KOA and ten older adult volunteers as a control group were involved in this study. The MME and limb biomechanics during walking were evaluated simultaneously by ultrasound and a motion analysis system, respectively. The waveform was constructed from the values of MME, and the point showing the highest value of MME was identified during the gait cycle. According to the peak timing of MME in the waveform, the pattern of the waveform was evaluated and compared to the control group. Lateral thrust, knee adduction moment (KAM), and flexion moment were obtained from motion analysis, and their association with the MME was evaluated. The patients with KOA demonstrated unique peak timing during walking. Compared to the control group, there were three groups of MME waveforms, early (< 59%), normal (60-83%), and late (> 84%) from the peak timing in the gait cycle. The pattern of MME waveform in early, normal, and late groups was correlated with the first KAM and lateral thrust, second KAM, and knee flexion moment, respectively. A unique MME pattern during walking was demonstrated, and these patterns were associated with limb biomechanics in patients with KOA.
Topics: Humans; Aged; Osteoarthritis, Knee; Menisci, Tibial; Biomechanical Phenomena; Knee Joint; Walking; Gait
PubMed: 37532866
DOI: 10.1038/s41598-023-39715-0 -
The Journal of the American Academy of... Feb 2022Performing medial meniscus allograft transplantation in combination with anterior cruciate ligament (ACL) reconstruction is technically demanding. Medial meniscus...
Performing medial meniscus allograft transplantation in combination with anterior cruciate ligament (ACL) reconstruction is technically demanding. Medial meniscus allograft transplantation in combination with ACL reconstruction may be indicated for patients with meniscal deficiency in whom ACL reconstruction has failed and patients with medial-sided knee pain secondary to meniscal deficiency in combination with ACL deficiency. Despite the complex nature of this combined surgical procedure, numerous studies have reported considerable clinical improvements at midterm and long-term follow-up. This technique article describes the indications, preoperative considerations, surgical technique, postoperative rehabilitation, and outcomes of medial meniscus allograft transplantation in combination with ACL reconstruction.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Menisci, Tibial; Tendons; Tibial Meniscus Injuries
PubMed: 34242205
DOI: 10.5435/JAAOS-D-20-00363 -
Skeletal Radiology Mar 2022To assess the diagnostic accuracy of MRI in diagnosing ramp lesions in patients with an acute lesion of the anterior cruciate ligament (ACL).
OBJECTIVES
To assess the diagnostic accuracy of MRI in diagnosing ramp lesions in patients with an acute lesion of the anterior cruciate ligament (ACL).
MATERIALS AND METHODS
All consecutive patients over 15 years of age who underwent surgical repair of the ACL at a single hospital between January and May 2019, with MRI data available, were included in this retrospective study, except patients who had previous knee surgery. The gold standard was arthroscopic evaluation. Two trained radiologists with 5 and 14 years of experience did a blinded review of the MRIs. The following pathological signs were studied: complete fluid filling between the capsule and the posterior horn of the medial meniscus, irregular appearance of the posterior wall of the medial meniscus, oedema of the capsule, fluid hyperintensity in contact with the medial meniscus and anterior subluxation of the medial meniscus. Logistic regressions in univariate then multivariate analysis were carried out and measures of diagnostic accuracy and interobserver agreement were calculated with R software (version 3.6).
RESULTS
Fifty-seven patients were included. Twelve had a ramp lesion diagnosed by arthroscopy (21%). Only complete fluid hyperintensity between the posterior horn of the medial meniscus and the capsule was significantly associated with ramp lesions (P value < 0.01). The diagnostic accuracy of this specific sign was moderate, with a specificity of 84%, sensitivity of 75%, PPV of 56%, NPV of 93% and a good level of inter-observer agreement (k = 0.79).
CONCLUSION
The complete fluid filling is the only significant pathological MRI sign for ramp lesions, with moderate accuracy.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Magnetic Resonance Imaging; Menisci, Tibial; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 34216246
DOI: 10.1007/s00256-021-03858-w -
Operative Orthopadie Und Traumatologie Dec 2021Replacement of the lateral or medial meniscus with an allogeneic graft. (Review)
Review
OBJECTIVE
Replacement of the lateral or medial meniscus with an allogeneic graft.
INDICATIONS
Complete loss of inner or outer meniscus.
CONTRAINDICATIONS
Grade 3 to 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities > 5°, symptomatic instabilities.
SURGICAL TECHNIQUE
Knee joint arthroscopy via the high anterolateral standard portal and checking the indication. Thaw the allogeneic meniscus graft in NaCl at room temperature and incubate in vancomycin solution. Refreshment of the capsule and resection of remnants of the meniscus. Search for the insertion zones on the tibial plateau, debridement, insert a transtibial targeting device and drill target wires in the middle of the insertion zones. Overdrill the target wires with a 4.5 mm drill. Short medial or lateral arthrotomy (approx. 2 cm). Reinforcement of the anterior and posterior horns of the meniscus graft with nonresorbable suture material (e.g. "fiber wire" size 5). Insertion of K‑wires with thread loops into the tibial bone tunnel. The reinforcement threads of the meniscus transplant are drawn into the bone tunnel via the thread loops, and the meniscus transplant is drawn into the joint. Reduction of the meniscus base to the capsule and refixation of the meniscus to the capsule with "inside out" or "all inside" sutures.
POSTOPERATIVE MANAGEMENT
Six weeks partial weight-bearing using a hinged brace, then gradually increased load. Range of motion: 4 weeks 0‑0-60°, then 2 weeks 0‑0-90°, followed by no restrictions.
RESULTS
In our hospital, 15 patients (6 × medial, 9 × lateral) were treated using the described surgical technique. After a minimum period of 1 year (mean = 14.2 months), meniscus extrusion-measured in the MRI-averaged 2.7 mm. The Lysholm score rose from an average of 70.2 (±7.4) to 90.1 points (±10.6). In one case, due to an early reruption, revision with renewed meniscus refixation had to be performed 10 days after the operation. In another case, meniscus resection was performed 6 months after the meniscus transplant due to a reruption. Thrombosis, infection and arthrofibrosis were not observed.
Topics: Arthroscopy; Humans; Knee Injuries; Menisci, Tibial; Meniscus; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 34519837
DOI: 10.1007/s00064-021-00731-w -
Knee Surgery, Sports Traumatology,... May 2022Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid... (Review)
Review
Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid not only to the pathology, but also to a player's contract status, time in the season, specific demands of his/her sport and position on the field, and future consequences. Successful treatment requires the clinician to understand the player's goals and needs, communicate effectively between all stakeholders, and a have knowledge of the challenges posed by the different types of meniscal tear seen in this population. Paramount is the distinction between injuries to the medial and lateral meniscus. Deficiency of the lateral meniscus, as a result of a tear or a meniscectomy, leads to frequent early problems and inexorably to chondral degeneration thereby affecting an athlete's ability to perform. Therefore, it is strongly recommended to repair the majority of lateral meniscal tears. Medial meniscal tears pose a more challenging treatment dilemma, as the success of partial meniscectomy in achieving reproducible, early return to play must be balanced against the long-term degenerative consequences. Many meniscal tears are correctly treated non-operatively.Level of evidence V.
Topics: Arthroscopy; Athletes; Female; Humans; Knee Injuries; Male; Meniscectomy; Menisci, Tibial; Tibial Meniscus Injuries
PubMed: 34415368
DOI: 10.1007/s00167-021-06694-6