-
Arthritis Care & Research Sep 2023To systematically review all studies that have evaluated the association between physical activity (PA) levels and features of knee osteoarthritis (OA) on magnetic...
OBJECTIVE
To systematically review all studies that have evaluated the association between physical activity (PA) levels and features of knee osteoarthritis (OA) on magnetic resonance imaging (MRI) for subjects without OA.
METHODS
The inclusion criteria for prospective studies were as follows: 1) subjects without OA; 2) average age 35-80 years; and 3) any self-reported PA or objective measurement of PA. The eligible MRI outcomes were OA-related measures of intraarticular knee joint structures. Exclusion criteria were evaluations of instant associations with transient structural changes after PA.
RESULTS
Two randomized controlled trials and 16 observational studies were included. One of 11 studies found that PA was harmfully related to cartilage volume or thickness, but 4 studies found a significant protective association. Four of 10 studies found that PA was harmfully related to cartilage defects, while others showed no significant associations. Two of 3 studies reported a significantly increased cartilage T2 value in individuals with more PA. All 3 studies reported no significant association between PA and bone marrow lesions. Two studies assessed the association between PA and meniscus pathology, in which only occupational PA involving knee bending was associated with a greater risk of progression.
CONCLUSION
Within the sparse and diverse evidence available, no strong evidence was found for the presence or absence of an association between PA and the presence or progression of features of OA on MRI among subjects without OA. Therefore, more research is required before PA in general and also specific forms of PA can be deemed safe for knee joint structures.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Osteoarthritis, Knee; Prospective Studies; Cartilage, Articular; Knee Joint; Magnetic Resonance Imaging; Exercise
PubMed: 36576386
DOI: 10.1002/acr.25083 -
Arthroscopy : the Journal of... Jun 2024To systematically review the literature regarding the biomechanical properties of different repair techniques and fixation methods for vertically oriented meniscal tears. (Review)
Review
Neither All-Inside, nor Inside-Out, nor Outside-In Repair Demonstrates Superior Biomechanical Properties for Vertical Meniscal Tears: A Systematic Review of Human Cadaveric Studies.
PURPOSE
To systematically review the literature regarding the biomechanical properties of different repair techniques and fixation methods for vertically oriented meniscal tears.
METHODS
Human cadaveric studies evaluating the biomechanical properties of different repair techniques for vertically oriented meniscal tears were identified using the PubMed, EMBASE, and Cumulative Index to Nursing & Allied Health databases. Primary outcomes included load to failure, displacement, stiffness, peak contact pressure, and contact area of repaired menisci. Repair techniques from included studies were reclassified into a total of 19 distinct all-inside (AI), inside-out (IO), or outside-in (OI) techniques.
RESULTS
Sixteen studies were included (420 total menisci). Contact pressure and area were restored to intact-state values across all 5 compressive load studies at low knee flexion angles but not at greater knee flexion angles (i.e., >60°). There were no significant differences in contact pressure or area between AI, IO, and OI techniques across all studies. Some studies demonstrated statistically significant advantages in tensile properties with IO techniques when compared with AI techniques, whereas others found AI techniques to be superior. No studies directly compared tensile properties of OI techniques with those of AI or IO techniques. Vertical mattress suture configurations resulted in significantly greater load to failure and decreased displacement compared with horizontal mattress configurations in 67% of studies comparing the 2 techniques. There was no difference in the rate of tissue failure in AI (66.97%), IO (60.38%), or OI (66.67%, χ = 0.83, P = .66) techniques.
CONCLUSIONS
Contact mechanics are reliably restored after repair of vertical meniscal tears at low flexion angles but inconsistently restored at greater flexion angles, regardless of technique. Vertical mattress configurations outperformed horizontal mattress configurations under tensile load. There are conflicting data regarding the comparison of tensile properties between AI and IO techniques. Ultimately, neither AI, IO, nor OI repair demonstrated superior biomechanical properties in the present literature.
CLINICAL RELEVANCE
Several repair techniques demonstrate favorable biomechanical properties for vertical meniscal tears under tensile and compressive loads. Neither AI, IO, nor OI repair techniques demonstrate superior biomechanical properties at this time.
PubMed: 38880182
DOI: 10.1016/j.arthro.2024.03.049 -
The Journal of Bone and Joint Surgery.... Jun 2024Despite vigorous efforts to delineate the efficacy of magnetic resonance imaging (MRI) for the diagnosis of meniscal ramp lesions, there is still a great deal of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite vigorous efforts to delineate the efficacy of magnetic resonance imaging (MRI) for the diagnosis of meniscal ramp lesions, there is still a great deal of uncertainty regarding its diagnostic performance. Therefore, we conducted a systematic review and meta-analysis to investigate the diagnostic performance of MRI for detecting ramp lesions in anterior cruciate ligament (ACL)-deficient knees.
METHODS
We performed a systematic search of MEDLINE via PubMed, Scopus, Web of Science, and Embase and included all articles, published before October 20, 2022, comparing the accuracy of MRI with that of arthroscopy as the gold standard for diagnosis of ramp lesions. We performed statistical analysis using Stata and Meta-DiSc software. Quality assessment of the included studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool.
RESULTS
This meta-analysis evaluated 21 diagnostic performance comparisons from 19 original research articles (2,149 patients). The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve for diagnosing a ramp lesion were 0.70 (95% confidence interval [Cl], 0.66 to 0.73), 0.88 (95% Cl, 0.86 to 0.89), 6.49 (95% Cl, 4.12 to 10.24), 0.36 (95% Cl, 0.28 to 0.46), 24.33 (95% Cl, 12.81 to 46.19), and 0.88, respectively. Meta-regression using different variables yielded the same results.
CONCLUSIONS
MRI exhibited a DOR of 24.33 and moderate sensitivity, specificity, and accuracy for diagnosing ramp lesions in ACL-deficient knees. However, arthroscopy using a standard anterolateral portal with intercondylar viewing is recommended to confirm a diagnosis of a ramp lesion.
LEVEL OF EVIDENCE
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Magnetic Resonance Imaging; Anterior Cruciate Ligament Injuries; Tibial Meniscus Injuries; Sensitivity and Specificity; Menisci, Tibial; Arthroscopy
PubMed: 38595146
DOI: 10.2106/JBJS.23.00501 -
Physical Therapy in Sport : Official... Jan 2024To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy.
DESIGN
Meta-Analysis.
SETTING
Laboratory.
PARTICIPANTS
332 meniscectomy patients and 137 healthy controls (from 13 qualified studies) MAIN OUTCOME MEASURES: Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs.
RESULTS
When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = -0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = -0.024; P = 0.716) but a significantly lower KFM (ES = -0.422; P < 0.001). High heterogeneity among study ESs was observed in patients' between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics.
CONCLUSION
Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.
Topics: Humans; Biomechanical Phenomena; Gait; Knee; Knee Joint; Meniscectomy; Osteoarthritis, Knee; Walking
PubMed: 37980779
DOI: 10.1016/j.ptsp.2023.10.005 -
Knee Surgery, Sports Traumatology,... Mar 2024To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing...
PURPOSE
To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT).
METHODS
A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status.
RESULTS
Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT.
CONCLUSIONS
Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Cartilage, Articular; Survivorship; Menisci, Tibial; Musculoskeletal Diseases; Osteotomy; Allografts; Follow-Up Studies
PubMed: 38383989
DOI: 10.1002/ksa.12065 -
The American Journal of Sports Medicine Jul 2024Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability....
BACKGROUND
Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability. However, fresh-frozen grafts are associated with several clinical challenges such as graft shrinkage and extrusion, among many others.
PURPOSE
To present the current knowledge on the use of fresh meniscal allografts, presenting whether benefits associated with fresh grafts provide sufficient evidence to support their use in clinical practice.
STUDY DESIGN
Systematic review; Level of evidence, 5.
METHODS
A comprehensive search was conducted with keywords listed below. After an initial screening on title and abstract, full-text articles were assessed with the inclusion criteria.
RESULTS
A total of 78 studies matched the inclusion criteria. Literature and preclinical studies indicated that fresh meniscal allografts are beneficial for maintaining mechanical properties, graft ultrastructure, and matrix metabolism due to the presence of viable cells. Therefore, fresh allografts may address common complications associated with fresh-frozen MAT. To overcome challenges associated with both fresh-frozen and fresh allografts, a group has studied treating fresh-frozen allografts with a cell-based injection therapy.
CONCLUSION
Fresh meniscal allografts pose several challenges including limited availability, demanding preservation procedures, and high costs. Although the role of viable cells within meniscal allografts remains controversial, these cells may be vital for maintaining tissue properties.
Topics: Humans; Menisci, Tibial; Allografts; Transplantation, Homologous; Cryopreservation; Tibial Meniscus Injuries
PubMed: 38282584
DOI: 10.1177/03635465231200236 -
Physical Therapy May 2024This study aimed to synthesize the evidence from randomized clinical trials in people with nontraumatic degenerative meniscal pathology by comparing physical therapist... (Meta-Analysis)
Meta-Analysis
Physical Therapist Interventions Versus or Combined With Surgical Treatment in Nontraumatic Degenerative Meniscal Pathology: A Systematic Review and Network Meta-Analysis.
OBJECTIVE
This study aimed to synthesize the evidence from randomized clinical trials in people with nontraumatic degenerative meniscal pathology by comparing physical therapist interventions versus or combined with arthroscopic partial meniscectomy (APM).
METHODS
Seven electronic databases were searched. Methodological quality was evaluated using the Physiotherapy Evidence Database scale. Data synthesis was performed with random-effects network meta-analysis, and results were summarized using the standardized mean differences.
RESULTS
From 2103 studies, 10 randomized clinical trials comprising 1411 individuals were included. Ninety percent of the selected randomized clinical trials were classified as good quality according to the Physiotherapy Evidence Database scale. All interventions (physical therapist interventions, APM, and APM plus physical therapist interventions) showed reduced pain and physical impairments at 3-month follow-up. However, when a physical therapist intervention was included, greater reductions in pain at rest (APM vs physical therapist interventions: 0.73 [95% CI = 0.20 to 1.26]; APM vs APM plus physical therapist interventions: 0.59 [95% CI = 0.15 to 1.03]) and greater increases in the strength of knee extensor muscles (APM vs physical therapist interventions: 0.44 [95% CI = 0.07 to 0.80]; APM vs APM plus physical therapist interventions: 0.73 [95% CI = 0.29 to 1.16]) were observed at 3 months. By contrast, no differences were found between treatments beyond 3 months.
CONCLUSION
Physical therapist interventions based on exercise programs demonstrate superior short-term outcomes in pain reduction and knee extensor strength compared to surgical treatment.
IMPACT
For nontraumatic degenerative meniscal pathology, conservative treatment utilizing a physical therapist intervention approach should be prioritized as the first choice over surgical treatment. It offers comparable or superior short-term pain reduction and strength improvements, with a lower risk of side effects. In cases where surgery is deemed necessary, including postsurgical, physical therapist interventions are highly recommended to enhance muscle strength and alleviate pain.
Topics: Humans; Meniscectomy; Physical Therapy Modalities; Network Meta-Analysis; Randomized Controlled Trials as Topic; Arthroscopy; Combined Modality Therapy; Muscle Strength; Tibial Meniscus Injuries
PubMed: 38243408
DOI: 10.1093/ptj/pzae007