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Ontario Health Technology Assessment... 2014Patients with knee pain as a result of osteoarthritis or degenerative meniscal injury may seek treatment through arthroscopic surgery. How effective arthroscopic... (Review)
Review
BACKGROUND
Patients with knee pain as a result of osteoarthritis or degenerative meniscal injury may seek treatment through arthroscopic surgery. How effective arthroscopic debridement with or without meniscectomy is for relieving pain and improving patients' functional outcomes is uncertain.
OBJECTIVES
To conduct an evidence update of an evidence-based analysis (EBA) conducted in 2005 to determine if arthroscopic debridement for osteoarthritis of the knee or for meniscal injury from degenerative causes improve patient outcomes.
DATA SOURCES
A literature search was performed using Ovid MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, and all EBM databases, for studies published from January 1, 2005, to February 4, 2014.
REVIEW METHODS
A systematic review of the literature was conducted, limited to randomized controlled trials (RCTs) that examined the effectiveness of arthroscopic debridement with or without meniscectomy. Quality assessment of the body of literature was conducted using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
RESULTS
A total of 8 RCTs were identified, 2 from the original EBA plus 6 that were published since that time. The studies included patients with a range of indications for treatment and severity of osteoarthritis. Moderate-quality evidence showed no statistically significant difference in pain or functional status between patients who received arthroscopic treatment versus placebo (e.g., sham surgery). Low-quality evidence showed no statistically significant difference in pain or functional status between patients who received arthroscopic treatment versus usual care (e.g., physical therapy).
LIMITATIONS
Heterogeneity across the study populations, interventions, and reported measures limited the ability to calculate a summary effect estimate; however, all studies demonstrated consistency in their findings.
CONCLUSIONS
The evidence does not show the superiority of arthroscopic debridement with or without meniscectomy in patients with osteoarthritis of the knee or with meniscal injury from degenerative causes.
Topics: Arthralgia; Arthroscopy; Debridement; Humans; Menisci, Tibial; Osteoarthritis, Knee; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 26330895
DOI: No ID Found -
Journal of Experimental Orthopaedics Jul 2024to provide a comprehensive overview of all the surgical techniques published in the literature for repairing meniscal ramp lesions focusing on the technical aspects and... (Review)
Review
PURPOSE
to provide a comprehensive overview of all the surgical techniques published in the literature for repairing meniscal ramp lesions focusing on the technical aspects and the pros and cons of every procedure. Such lesions can be managed using various approaches, each of this with its specific advantages and disadvantages.
METHODS
Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines for studies on surgical techniques for repairing meniscal ramp lesions through May 2023. Overall, 32 articles matched the selection criteria and were included in the study.
RESULTS
Debridement alone may be sufficient for small stable meniscal ramp lesions but, for tears in the menisco-capsular junction that affect the stability of the medial meniscus, it seems reasonable to repair it, even though the clinical results available in literature are contrasting. All-inside sutures through anterior portals seems to be an effective solution for meniscal ramp lesions with MTL tears. All-inside sutures through posteromedial portals are particularly useful for large meniscal ramp lesions, in which an inside-out suture can also be performed.
CONCLUSION
Meniscal ramp lesions can be managed using various approaches, each of this with its specific advantages and disadvantages. Further research is required to determine the optimal technique that can be considered as the gold standard and can provide the better results.
LEVEL OF EVIDENCE
Level III, systematic review.
PubMed: 38887657
DOI: 10.1002/jeo2.12037 -
The Libyan Journal of Medicine Dec 2022The meniscus is a relatively avascular fibrocartilaginous structure that provides a key role in shock absorption and load transmission. However, accurate diagnosis of...
The meniscus is a relatively avascular fibrocartilaginous structure that provides a key role in shock absorption and load transmission. However, accurate diagnosis of meniscal retear can present a clinical challenge. The purpose of this study was to conduct a systematic review on the available literature, which compare the sensitivities, specificities, and accuracies of different diagnostic modalities of diagnosing knee meniscal retears in patients who have undergone surgical meniscal repair, such as Magnetic Resonance Imaging (MRI), Magnetic Resonance Arthrography with intraarticular contrast (direct MRA), and a combination of MRI and direct MRA. Two authors independently searched two databases (PubMed and Scopus) for literature related to knee meniscus retear according to the PRISMA guidelines. Four studies were found, which resulted in 291 patients with 293 menisci. All studies were published in 2008 and 2014. In our analysis, we calculated sensitivity to be 78.79% (95% CI, 64.07-93.51), specificity to be 56.58% (95% CI, 20.21-92.94), and overall accuracy to be 66.25% (95% CI, 54.29-78.22) for MRI and sensitivity to be 87.84% (95% CI, 83.93-91.74), specificity to be 88.68% (95% CI, 81.93-95.43), and overall accuracy to be 87.22% (95% CI, 82.22-91.62) for direct MRA. We recommend the use of direct MRA for the diagnosis of meniscal retears due to its higher sensitivity, specificity, and accuracy as compared to MRI and its reduced cost and invasive nature as compared to second-look arthroscopy. However, our review is limited by the number of studies available on this topic. More studies using study designs such as randomized controlled trials, involving MRI, direct MRA, and combinations of such techniques, should be performed to accurately assess the different techniques and aid in designing guidelines to guide the diagnosis of meniscal retears following meniscal repair.
Topics: Humans; Magnetic Resonance Imaging; Menisci, Tibial; Meniscus; Sensitivity and Specificity; Tibial Meniscus Injuries
PubMed: 35048785
DOI: 10.1080/19932820.2022.2030024 -
Arthritis Care & Research Sep 2015People with meniscal tears are at high risk to develop or progress to knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
People with meniscal tears are at high risk to develop or progress to knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these individuals. The purpose of this systematic review and meta-analysis was to investigate knee extensor strength in people undergoing an arthroscopic partial meniscectomy (APM).
METHODS
Six databases (Medline, CINAHL, SPORTDiscus, Embase, PEDro, and AMED) were searched up to June 22, 2014. Studies that measured knee extensor muscle strength in people age ≥30 years undergoing APM for a meniscal tear and used either a healthy control group or the contralateral leg to compare knee extensor muscle strength were included. Methodological quality was assessed using guidelines from the Centre for Reviews and Dissemination.
RESULTS
Eleven studies, in which participants were predominantly male, were included (n = 596). A moderate reduction in muscle strength was observed prior to APM compared to controls (standardized mean difference [SMD] 0.58, 95% confidence interval [95% CI] 0.04, 1.13) and continued up to 6 months postsurgery (SMD range -2.42 to -0.47). There was no difference in muscle strength at 2 years post-APM (SMD -0.01 [95% CI -0.36, 0.35]), while a moderate reduction was again apparent at 4 years post-APM (SMD -0.56, [95% CI -1.20, 0.08]) compared to controls.
CONCLUSION
Our findings suggest that middle-aged and older individuals undergoing APM have reduced knee extensor muscle strength in the operated leg compared to control data. As meniscus pathology and knee extensor muscle weakness are risk factors for osteoarthritis, these results highlight the clinical importance of addressing muscle weakness in these individuals.
Topics: Aged; Arthroscopy; Humans; Menisci, Tibial; Middle Aged; Muscle Strength
PubMed: 25776139
DOI: 10.1002/acr.22581 -
Musculoskeletal Surgery Jun 2023Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often... (Review)
Review
BACKGROUND
Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs).
METHODS
Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included.
RESULTS
A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as "moderate," four obtained a "low" grade while the remaining two were evaluated as "critically low." SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo.
CONCLUSIONS
Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.
Topics: Humans; Middle Aged; Arthroscopy; Exercise Therapy; Menisci, Tibial; Osteoarthritis, Knee; Pain; Systematic Reviews as Topic; Tibial Meniscus Injuries
PubMed: 36057031
DOI: 10.1007/s12306-022-00760-z -
Knee Surgery, Sports Traumatology,... Jan 2023This study aimed to systematically evaluate the clinical, functional, and radiological outcomes, complications, and rate of return to sports among patients with RAMP... (Review)
Review
PURPOSE
This study aimed to systematically evaluate the clinical, functional, and radiological outcomes, complications, and rate of return to sports among patients with RAMP lesion of the medial meniscus encountered during anterior cruciate ligament (ACL) reconstruction.
METHODS
A systematic review was conducted based on the PRISMA guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "ACL" or "anterior cruciate ligament," and "RAMP lesion." The outcome measures extracted from the studies were the Short Form-12 (SF-12) in its mental and physical component (MCS and PCS), Lysholm score, Subjective IKDC, Marx Score, WOMAC Score, Tegner, Radiological changes, complications, failures and/or revision surgery, and rate of return to sports.
RESULTS
The cohort of patients consisted of 1,243 participants with a mean age of 28.6 ± 2.6. The mean postoperative follow-up was 40.9 ± 6.3 months. A total of 1145 (92.1%) RAMP lesions were repaired with concomitant ACL reconstruction, while only 98 (7.9%) lesions were left untreated (or treated with abrasion only). The Lysholm score was used in 6 studies (in one only at final follow-up), with a significant improvement in all the studies (Lysholm 60.03 ± 6.12; Lysholm 89.9 ± 5.0). Eight studies out of nine reported Subjective IKDC score, and a significant improvement was noted in all cases (IKDC 56.2 ± 5.8. IKDC 84.9 ± 3.7). Of 18 (1.4%) complications reported, 15 (1.2%) were related to RAMP/ACL surgery, and of the remaining three (0.2%) two (0.2%) were hematomas and one (0.1%) a contralateral ACL lesion. Of the 106 (8.5%) revision surgeries required, 5 (0.4%) were in non-treated lesions [two (0.2%) ACL re-ruptures and three (0.2%) medial meniscus re-injury]. In treated patients, the revision occurred for the following reasons: 75 (6.0%) meniscectomy, 14 (1.1%) meniscal suture revisions, 11 (0.9%) ACL failures and one (0.1%) arthrolysis.
CONCLUSIONS
It is not yet clear if, in all cases of ACL reconstruction in which a medial meniscal RAMP lesion is encountered, the lesion needs to undergo surgical repair. Accordingly, it is recommended that in the repair of all unstable medial meniscal RAMP lesions during an ACL reconstruction in cases associated with a stable RAMP lesion, the surgeon may decide on repair based on the patient profile.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Adult; Menisci, Tibial; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Meniscectomy; Anterior Cruciate Ligament Reconstruction
PubMed: 35869982
DOI: 10.1007/s00167-022-07067-3 -
Orthopaedic Journal of Sports Medicine Feb 2021The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial... (Review)
Review
BACKGROUND
The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial femoral condyle and passes posteriorly to the posterior cruciate ligament (PCL). The pMFL plays a role in recovery after PCL injuries and offers stability to the lateral meniscus, promoting normal knee function.
PURPOSE/HYPOTHESIS
The aim of the magnetic resonance imaging (MRI) arm of this study was to evaluate the prevalence of the pMFL in Polish patients. The purpose of the systematic review and meta-analysis was to evaluate the clinical relevance of the pMFL in knee surgery. It was hypothesized that extensive variability exists in reports on the prevalence, function, and clinical significance of the pMFL.
STUDY DESIGN
Cross-sectional study and systematic review; Level of evidence, 3.
METHODS
A retrospective MRI investigation was conducted on 100 randomly selected lower limbs of Polish patients (56 male, 44 female) performed in 2019 to determine the prevalence of the pMFL. Additionally, an extensive literature search of major online databases was performed to evaluate all reported data on the pMFL. Assessments of article eligibility and data extraction were completed independently by 2 reviewers, and all disagreements were resolved via a consensus. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool.
RESULTS
In the MRI arm of this study, the pMFL was observed in 73 of the 100 limbs. In the meta-analysis, 47 studies were included, totaling 4940 lower limbs. The pooled prevalence of the pMFL was found to be 70.4% (95% CI, 63.4%-76.9%); the mean length was 27.7 mm (95% CI, 24.8-30.5 mm) and the mean widths were 4.5, 6.1, and 4.1 mm for the meniscal and femoral attachments and midportion, respectively. The mean pMFL thickness was 2.3 mm (95% CI, 1.8-2.7 mm).
CONCLUSION
Despite the variability in the literature, the pMFL was found to be a prevalent and large anatomic structure in the knee joint. The shared features of this ligament with the PCL necessitate the consideration of its value in planning and performing arthroscopic procedures of the knee.
PubMed: 33748297
DOI: 10.1177/2325967120973195 -
Medical Ultrasonography May 2018To evaluate the diagnostic accuracy of meniscal tears using B-mode ultrasound and high-frequency linear probe by conducting a systematic review and pooled meta-analysis. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the diagnostic accuracy of meniscal tears using B-mode ultrasound and high-frequency linear probe by conducting a systematic review and pooled meta-analysis.
MATERIAL AND METHODS
The Cochrane library, Embase, and Pubmed were searched for relevant studies up to 29 July 2017. The arthroscopy was used as the reference standard. The results were estimated by pooled sensitivity, specificity, diagnostic odds ratio, likelihood ratio, and the area under the summary receiver operating characteristic (SROC).
RESULTS
Seven prospective studies met the selection criteria, comprising 321meniscal tears from 472 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the SROC curve were 88.80% (95%CI: 82.83-92.87), 84.66% (95%CI: 75.89-90.64), 5.79(95%CI: 3.66-9.15), 0.13 (95%CI: 0.09-0.20), and 43.74 (95%CI: 24.01-79.68), respectively. The area under the SROC curve was 93% (95%CI: 91-95).
CONCLUSIONS
This meta-analysis indicates that 2-dimensional ultrasound is useful, and could be routinely used for estimating meniscal injuries in the human knee joint.
Topics: Humans; Menisci, Tibial; Reproducibility of Results; Sensitivity and Specificity; Tibial Meniscus Injuries; Ultrasonography
PubMed: 29730682
DOI: 10.11152/mu-1252 -
Orthopaedic Journal of Sports Medicine Jul 2018Delayed anterior cruciate ligament (ACL) reconstruction may be associated with increased risk of subsequent knee joint damage and osteoarthritis (OA). The relationship... (Review)
Review
BACKGROUND
Delayed anterior cruciate ligament (ACL) reconstruction may be associated with increased risk of subsequent knee joint damage and osteoarthritis (OA). The relationship between recurrent instability episodes and meniscal or cartilage damage after first-time ACL injury is unknown.
PURPOSE
To assess the association between recurrent knee instability episodes and prevalence of meniscal lesions, cartilage damage, and OA after first-time ACL injury.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Six electronic databases were systematically searched using keywords and Medical Subject Heading terms. Studies selected were of English language, included original data, had a prospective design, and provided an outcome of recurrent instability and meniscal lesions, cartilage damage, or OA after first-time ACL injury. Adjusted odds ratios (ORs) were extracted or unadjusted ORs (95% CI) were calculated. PRISMA guidelines were followed, and 2 independent raters assessed study quality using Downs and Black criteria.
RESULTS
Of 905 potentially relevant studies, 7 were included. Sample sizes ranged from 43 to 541, and Downs and Black scores ranged from 2 to 12. Clinical and methodological heterogeneity precluded meta-analysis. Six studies reported a positive association between recurrent instability episodes and medial meniscal damage (OR range, 3.46 [95% CI, 1.24-9.99] to 11.56 [1.37-521.06]). The association between instability episodes and lateral meniscal or cartilage damage was inconsistent. No studies examined the association between instability episodes and OA.
CONCLUSION
This systematic review provides preliminary evidence that recurrent instability episodes after first-time ACL injury may be associated with increased odds of medial meniscal damage. This highlights the importance of early diagnosis, education, and treatment for individuals with ACL injury, all of which must include a specific focus on the prevention and management of instability episodes. High-quality, prospective cohort studies are needed that assess the effects of diagnostic and treatment delay, recurrent instability episodes on secondary meniscal and cartilage damage, and OA after an initial ACL injury.
PubMed: 30057927
DOI: 10.1177/2325967118786507 -
The Knee Oct 2022Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics... (Review)
Review
BACKGROUND
Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics affect meniscal microvascularization and provide a structured overview of angiogenic therapies that influence meniscal neovascularization.
METHODS
A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane library and Emcare from inception to November 2021. Studies reporting on (1) Patient characteristics that affect meniscal microvascularization, or (2) Therapies that induce neovascularization in meniscal tissue were included. Studies were graded in quality using the Anatomical Quality Assessment (AQUA) tool. The study was registered with PROSPERO(ID:CRD42021242479).
RESULTS
Thirteen studies reported on patient characteristics and eleven on angiogenic therapies. The influence of Age, Degenerative knee, Gender, and Race was reported. Age is the most studied factor. The entire meniscus is vascularized around birth. With increasing age, vascularization decreases from the inner to the peripheral margin. Around 11 years, blood vessels are primarily located in the peripheral third of the menisci. There seems to be a further decrease in vascularization with increasing age in adults, yet conflicting literature exists. Degenerative changes of the knee also seem to influence meniscal vascularization, but evidence is limited. Angiogenic therapies to improve meniscal vascularization have only been studied in preclinical setting. The use of synovial flap transplantation, stem cell therapy, vascular endothelial growth factor, and angiogenin has shown promising results.
CONCLUSION
To decrease failure rates of meniscal repair, a better understanding of patient-specific vascular anatomy is essential. Translational clinical research is needed to investigate the clinical value of angiogenic therapies.
Topics: Adult; Humans; Meniscectomy; Menisci, Tibial; Meniscus; Microvessels; Tibial Meniscus Injuries; Vascular Endothelial Growth Factor A
PubMed: 35964436
DOI: 10.1016/j.knee.2022.07.007