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Arthroscopy Techniques Feb 2024Treatment of meniscal tears has evolved over the last few decades, and preservation has now become the gold standard of treatment. Advancements in repair technique have...
Treatment of meniscal tears has evolved over the last few decades, and preservation has now become the gold standard of treatment. Advancements in repair technique have extended the indication of repair. However, meniscectomy has to be performed in some situations. In these situations, meniscal allograft transplantation is considered the gold standard. But allografts are not available in every part of the world. Collagen implants and synthetic polymers are also advocated. But again, its limited research, availability, and high cost have restricted its widespread use. Many authors have advocated autograft transplantation, but there are no long-term results, and there is a lack of uniform surgical techniques. There is a technique described for lateral meniscus, but a medial meniscus autograft transplant technique is not very well elaborated. In this report, we aimed to describe a medial meniscus replacement technique using a hamstring autograft.
PubMed: 38435257
DOI: 10.1016/j.eats.2023.10.005 -
Knee Surgery, Sports Traumatology,... Oct 2023To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for...
Subchondral insufficiency fracture is a predictive factor of osteoarthritis progression and conversion to arthroplasty in non-surgically treated medial meniscus root tear.
PURPOSE
To investigate the radiographic and clinical outcomes of non-surgical treatment for medial meniscus posterior root tear (MMPRT), and prognostic factors for osteoarthritis (OA) progression and clinical failure.
METHODS
A prospectively collected database was retrospectively reviewed for patients who were diagnosed with acute medial meniscus posterior root tear (MMPRT) between 2013 and 2021 and treated non-surgically for more than 2 years. Patient demographic characteristics and clinical outcomes including pain numeric rating scale (NRS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee radiographs were obtained to assess the angle of knee alignment and Kellgren-Lawrence (K-L) grade during the first and annually follow-up visits. Baseline magnetic resonance (MR) images were reviewed for the presence of medial meniscus extrusion, bone marrow edema, subchondral insufficiency fracture of medial femoral condyle, and cartilage lesion. The OA progression group was defined as patients who experienced a worsening of one or more grades in the K-L classification system. Prognostic factors were evaluated for OA progression and conversion to total knee arthroplasty (TKA).
RESULTS
Ninety-four patients (90 female and 4 male) with a mean age of 67.0 ± 7.3 years (range, 53-83 years) were followed for a mean of 46.1 ± 22.1 months (range, 24.1-170.5). During the follow-up period, no significant differences in clinical scores were observed, and there were also no significant differences between the groups with and without OA progression. Overall, 12 patients (13%) underwent TKA at a mean of 20.7 ± 16.5 months (range, 8-69 months) and 34 patients (36%) demonstrated OA progression at a mean time of 24 ± 15 months (range, 12-62). The subchondral insufficiency fracture was a prognostic factor for OA progression (p = 0.045 for knee radiograph and p = 0.019 for MR) and conversion to TKA (RR, 4.08 [95% CI 1.23-13.57]; p = 0.022).
CONCLUSIONS
Non-surgical treatment for acute medial meniscus posterior root tear did not result in any significant change in clinical outcomes from the initial to the final follow-up. The rate of conversion to arthroplasty was 13%, and the rate of osteoarthritis progression was 36%. Furthermore, subchondral insufficiency fracture was found to be a concomitant prognostic factor correlated with OA progression and conversion to arthroplasty. This information can provide insights for physicians when discussing treatment options with patients, particularly regarding the use of non-surgical treatment and may contribute as a source for future studies of medial meniscus posterior root tear.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Male; Female; Middle Aged; Aged; Menisci, Tibial; Retrospective Studies; Fractures, Stress; Osteoarthritis; Rupture; Arthroplasty, Replacement, Knee; Magnetic Resonance Imaging; Knee Dislocation; Arthroscopy
PubMed: 37195475
DOI: 10.1007/s00167-023-07444-6 -
Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear.International Orthopaedics Oct 2023The extent to which arthropathic changes progress after medial meniscus posterior root tear (MMPRT) repair remains controversial. This retrospective study assessed...
PURPOSE
The extent to which arthropathic changes progress after medial meniscus posterior root tear (MMPRT) repair remains controversial. This retrospective study assessed medial joint space (MJS) narrowing progression after pullout repair for MMPRT and identified the correlating factors.
METHODS
We included 56 patients who underwent pullout repair for MMPRT. The MJS of the bilateral knees was assessed with radiography using the fixed-flexion view. A second-look arthroscopy was performed one year post-operatively for all patients. The baseline characteristics, clinical scores, Kellgren-Lawrence (KL) grade, and medial meniscus extrusion (MME) were identified. Statistical comparisons and correlation analyses were conducted.
RESULTS
The MJS narrowing width was significantly larger in MMPRT knees than in contralateral knees (0.51 ± 0.85 mm vs. 0.09 ± 0.49 mm, p < 0.001). KL grade progression was observed in 23.2% (13/56) of patients. There was a significant difference between pre- and post-operative MME values, indicating MME progression (p < 0.001). Each clinical score showed significant improvement one year post-operatively (p < 0.001). Positive correlations were found between MJS narrowing and pre-operative MJS (coefficient = 0.510, p < 0.001), rate of change in MJS (coefficient = 0.929, p < 0.001), and increase in MME (ΔMME) (coefficient = 0.506, p < 0.001).
CONCLUSION
Knees that underwent pullout repair for MMPRT showed progression of MJS narrowing by 0.51 mm at one year post-operatively, although clinical scores markedly improved. Correlating factors for MJS narrowing were pre-operative MJS, rate of change in MJS, and ΔMME. Preventing MME progression is essential for preventing arthropathic changes.
PubMed: 36715713
DOI: 10.1007/s00264-023-05701-4 -
Scientific Reports Dec 2023We reported that the full-length width of medial tibial osteophytes comprising cartilage and bone parts correlates with medial meniscus extrusion (MME) in early-stage...
We reported that the full-length width of medial tibial osteophytes comprising cartilage and bone parts correlates with medial meniscus extrusion (MME) in early-stage knee osteoarthritis (OA). However, no data exist on the prevalence of MME and its relationship with osteophytes in the elderly population. 1191 elderly individuals (females 57%; 72.9 years old on average) in the Bunkyo Health Study underwent standing plain radiograph and proton density-weighted MRI on knee joints. MRI-detected OA changes were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. A new method of assessing the cartilage and bone parts of osteophytes was developed using pseudo-coloring images of proton density-weighted fat-suppressed MRI. Most subjects showed Kellgren-Lawrence grade 1 or 2 radiographic medial knee OA (88.1%), MME (98.7%, 3.90 ± 2.01 mm), and medial tibial osteophytes (99.3%, 3.27 ± 1.50 mm). Regarding OA changes, MME was closely associated with the full-length width of medial tibial osteophytes (β = 1.114; 95% CI 1.069-1.159; p < 0.001) in line with osteophyte width (intraclass correlation coefficient, 0.804; 95% CI 0.783-0.823). Our data revealed that MME and medial tibial osteophytes are observed in the elderly and demonstrate that the degree of MME is consistent with the full-length width of medial tibial osteophytes, suggesting that osteophytes might be implicated in MME.
Topics: Female; Humans; Aged; Menisci, Tibial; Osteophyte; Protons; Knee Joint; Osteoarthritis, Knee; Magnetic Resonance Imaging
PubMed: 38129496
DOI: 10.1038/s41598-023-49868-7 -
BMC Musculoskeletal Disorders Nov 2023Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is...
BACKGROUND
Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them.
STUDY DESIGN
Retrospective study.
METHODS
Patients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour's classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated.
RESULTS
The prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P < 0.001). The DM group has a higher percentage of all types of FTD except type D (P < 0.05), and a higher percentage of both low- and high-grade FTD (P < 0.001). There were 633 cases of type I DM and 370 cases of type II DM. The overall percentage of FTD was not significantly different between the two types (P = 0.106). No significant difference was detected for all types of FTD except type B (P < 0.05). The Type I DM group has a significant higher percentage of high-grade FTD than Type II group (P < 0.05).
CONCLUSION
Patients with a DM are more likely to have FTD regardless of the type of DM, while those with a type I DM are more prone to have a high grade FTD.
Topics: Humans; Retrospective Studies; Femur; Prevalence; Frontotemporal Dementia; Joint Instability; Knee Joint; Magnetic Resonance Imaging; Bone Diseases; Lower Extremity Deformities, Congenital; Meniscus; Menisci, Tibial
PubMed: 38037030
DOI: 10.1186/s12891-023-06958-x -
The American Journal of Sports Medicine Oct 2023Posterior medial meniscus root (PMMR) tears have been associated with increased posterior tibial slope, but this has not been fully evaluated biomechanically. In...
BACKGROUND
Posterior medial meniscus root (PMMR) tears have been associated with increased posterior tibial slope, but this has not been fully evaluated biomechanically. In addition, the effects of knee flexion and rotation on the PMMR are not well understood biomechanically because of technological testing limitations. A novel multiaxial force sensor has made it possible to elucidate answers to these questions.
PURPOSE
(1) To determine if increased posterior tibial slope results in increased posterior shear force and compression on the PMMR, (2) to evaluate how knee flexion angle affects PMMR forces, and (3) to assess how internal and external rotation affects force at the PMMR.
STUDY DESIGN
Controlled laboratory study.
METHODS
Ten fresh-frozen cadaveric knees were tested in all combinations of 3 posterior tibial slopes and 4 flexion angles. A multiaxial force sensor was connected to the PMMR and installed below the posterior tibial plateau maintaining anatomic position. The specimen underwent a 500-N compression load followed by a 5-N·m internal torque and a 5-N·m external torque. The magnitude and direction of the forces acting on the PMMR were measured.
RESULTS
Under joint compression, an increased tibial slope significantly reduced the tension on the PMMR between 5° and 10° (from 13.5 N to 6.4 N), after which it transitioned to a significant increase in PMMR compression, reaching 7.6 N at 15°. Under internal torque, increased tibial slope resulted in 4.7 N of posterior shear at 5° significantly changed to 2.0 N of anterior shear at 10° and then 8.2 N of anterior shear at 15°. Under external torque, increased tibial slope significantly decreased PMMR compression (5°: 8.9 N; 10°: 4.3 N; 15°: 1.1 N). Under joint compression, increased flexion angle significantly increased medial shear forces of the PMMR (0°, 3.8 N; 30°, 6.2 N; 60°, 7.3 N; 90°, 8.4 N). Under internal torque, 90° of flexion significantly increased PMMR tension from 2.3 N to 7.5 N. Under external torque, 30° of flexion significantly increased PMMR compression from 4.7 N to 12.2 N.
CONCLUSION
An increased posterior tibial slope affects compression and anterior shear forces at the PMMR. An increased flexion angle affects compression, tension, and medial shear forces at the PMMR.
CLINICAL RELEVANCE
The increase in compression and posterior shear force when the knee is loaded in compression may place the PMMR under increased stress and risk potential failure after repair. This study provides clinicians with information to create safer protocols and improve repair techniques to minimize the forces experienced at the PMMR.
Topics: Humans; Menisci, Tibial; Biomechanical Phenomena; Cadaver; Knee Joint; Tibia; Range of Motion, Articular; Anterior Cruciate Ligament Injuries
PubMed: 37715505
DOI: 10.1177/03635465231195841 -
Knee Surgery, Sports Traumatology,... Sep 2023To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. (Review)
Review
PURPOSE
To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment.
METHODS
Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable.
RESULTS
Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures.
CONCLUSION
Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale.
LEVEL OF EVIDENCE
Systematic review of level IV studies.
Topics: Humans; Cost-Benefit Analysis; Meniscectomy; Osteoarthritis, Knee; Meniscus; Arthroscopy; Menisci, Tibial
PubMed: 36637478
DOI: 10.1007/s00167-022-07278-8 -
IScience Oct 2023Mitophagy is critical for maintaining proper cellular functions, and it contributes to the onset and progression of osteoarthritis (OA). A recent study showed that...
Mitophagy is critical for maintaining proper cellular functions, and it contributes to the onset and progression of osteoarthritis (OA). A recent study showed that focused low-intensity pulsed ultrasound (FLIPUS) could activate mitophagy, but the molecular mechanism remains unclear. This study aimed to elucidate the chondroprotective effects of FLIPUS in OA and the regulatory effects on FUN14-domain containing 1 (FUNDC1-mediated mitophagy. , FLIPUS improved inflammatory response, anabolism, and catabolism in interleukin (IL)-1β-induced OA chondrocytes. The chondroprotective effects of FLIPUS were attributed to promoting the expression of phosphoglycerate mutase 5 (PGAM5) and the dephosphorylation of FUNDC1 at serine 13 (Ser13), as well as promoting the mitophagy process. , FLIPUS reduced the cartilage degeneration and apoptosis and reversed the change of anabolic- and catabolic-related proteins in destabilized medial meniscus (DMM)-induced mouse model. Thus, the study indicates that FLIPUS exhibits a chondroprotective effect via activating impaired FUNDC1-mediated mitophagy.
PubMed: 37720103
DOI: 10.1016/j.isci.2023.107772 -
Arthroscopy : the Journal of... Aug 2023To evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) with or without concomitant posterior medial meniscal root (PMMR) tears and to describe...
Medial Meniscal Extrusion of Greater Than 3 Millimeters on Ultrasound Suggests Combined Medial Meniscotibial Ligament and Posterior Medial Meniscal Root Tears: A Cadaveric Analysis.
PURPOSE
To evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) with or without concomitant posterior medial meniscal root (PMMR) tears and to describe how ME varied along the length of meniscus.
METHODS
ME was measured using ultrasonography in 10 human cadaveric knees in conditions: (1) control, either (2a) isolated MTL sectioning, or (2b) isolated PMMR tear, (3) combined PMMR+MTL sectioning, and (4) PMMR repair. Measurements were obtained 1 cm anterior to the MCL (anterior), over the MCL (middle), and 1 cm posterior to the MCL (posterior) with or without 1,000 N axial loads in 0° and 30° flexion.
RESULTS
At 0°, MTL sectioning demonstrated greater middle than anterior (P < .001) and posterior (P < .001) ME, whereas PMMR (P = .0042) and PMMR+MTL (P < .001) sectioning demonstrated greater posterior than anterior ME. At 30°, PMMR (P < .001) and PMMR+MTL (P < .001) sectioning demonstrated greater posterior than anterior ME, and PMMR (P = .0012) and PMMR+MTL (P = .0058) sectioning demonstrated greater posterior than anterior ME. PMMR+MTL sectioning demonstrated greater posterior ME at 30° compared with 0° (P = .0320). MTL sectioning always resulted in greater middle ME (P < .001), in contrast with no middle ME changes following PMMR sectioning. At 0°, PMMR sectioning resulted in greater posterior ME (P < .001), but at 30°, both PMMR and MTL sectioning resulted in greater posterior ME (P < .001). Total ME surpassed 3 mm only when both the MTL and PMMR were sectioned.
CONCLUSIONS
The MTL and PMMR contribute most to ME when measured posterior to the MCL at 30° of flexion. ME greater than 3 mm is suggestive of combined PMMR + MTL lesions.
CLINICAL RELEVANCE
Overlooked MTL pathology may contribute to persistent ME following PMMR repair. We found isolated MTL tears able to cause 2 to 2.99 mm of ME, but the clinical significance of these magnitudes of extrusion is unclear. The use of ME measurement guidelines with ultrasound may allow for practical MTL and PMMR pathology screening and pre-operative planning.
Topics: Humans; Tibial Meniscus Injuries; Biomechanical Phenomena; Cadaver; Knee Joint; Menisci, Tibial; Anterior Cruciate Ligament; Knee Injuries; Cartilage Diseases; Ultrasonography; Anterior Cruciate Ligament Injuries
PubMed: 36813009
DOI: 10.1016/j.arthro.2023.01.104 -
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