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The Journal of Bone and Joint Surgery.... Jul 2023➤ Clinicians should be careful to assess for associated injuries including anterolateral complex and medial meniscal ramp lesions or lateral meniscal posterior root...
➤ Clinicians should be careful to assess for associated injuries including anterolateral complex and medial meniscal ramp lesions or lateral meniscal posterior root tears.➤ Consideration of lateral extra-articular augmentation should be given for patients with >12° of posterior tibial slope.➤ Patients with preoperative knee hyperextension (>5°) or other nonmodifiable risk factors, including high-risk osseous geometry, may benefit from a concomitant anterolateral augmentation procedure to improve rotational stability.➤ Meniscal lesions should be addressed at the time of anterior cruciate ligament reconstruction with meniscal root or ramp repair.
Topics: Humans; Anterior Cruciate Ligament Injuries; Tibial Meniscus Injuries; Menisci, Tibial; Tibia; Knee Injuries; Knee Joint
PubMed: 37205735
DOI: 10.2106/JBJS.22.01079 -
Orthopaedic Journal of Sports Medicine Jul 2023Medial meniscus posterior root tears (MMPRTs) disrupt the integrity and hoop tension of the meniscus, leading to cartilage degeneration and accelerated osteoarthritis...
Clinical, Radiographic, and MRI Evaluation of All-Inside Medial Meniscus Posterior Root Repair via Suture Fixation to the Posterior Cruciate Ligament Versus Partial Meniscectomy: Results at 3-Year Follow-up.
BACKGROUND
Medial meniscus posterior root tears (MMPRTs) disrupt the integrity and hoop tension of the meniscus, leading to cartilage degeneration and accelerated osteoarthritis (OA) progression. The management of patients with MMPRT is controversial, and the efficacy of different treatment options is unclear.
PURPOSE
To compare the clinical, radiographic, and magnetic resonance imaging (MRI) outcomes of patients with MMPRT between trans-posterior cruciate ligament (trans-PCL) all-inside repair and partial meniscectomy.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
We identified patients with MMPRT who underwent trans-PCL all-inside repair (group AR) or partial meniscectomy (group PM) between 2015 and 2019 at a single institution. The trans-PCL all-inside repair was performed by suturing the torn meniscus root to the PCL fibers. Patient-reported outcomes as well as radiographic and MRI outcomes were collected at baseline and final follow-up. Clinical failure was defined as conversion to total knee arthroplasty (TKA), and Kaplan-Meier survival analysis was used to investigate the survival rates of patients with different surgical procedures.
RESULTS
Included were 29 patients in group AR and 31 patients in group PM (mean age, 62.69 and 60.68 years, respectively; mean follow-up, 2.91 ± 1.33 and 3.45 ± 1.50 years, respectively). There were no differences in baseline patient characteristics between the groups. All patient-reported outcome scores improved significantly in both groups at the final follow-up. When we compared final outcomes between the groups, group AR had less joint space narrowing ( = .010), less Kellgren-Lawrence OA grade progression ( = .002), and less medial meniscal extrusion (MME; = .002) than group PM. In addition, group AR showed less progression of bone marrow lesions and cartilage lesions ( < .05) than group PM. The rate of conversion to TKA was 6.90% in group AR and 29.0% in group PM. The 5-year survival rates in the AR and PM groups were 82.6% and 59.8%, respectively ( = .153).
CONCLUSION
Trans-PCL all-inside repair for MMPRTs was associated with greater improvement in clinical function, better radiographic results, less MME and cartilage degeneration, and a lower rate of subsequent TKA compared with partial meniscectomy.
PubMed: 37435421
DOI: 10.1177/23259671231180545 -
Experimental & Molecular Medicine Dec 2023Osteoarthritis (OA) is a degenerative joint disease. While it is classically characterized by articular cartilage destruction, OA affects all tissues in the joints and...
Osteoarthritis (OA) is a degenerative joint disease. While it is classically characterized by articular cartilage destruction, OA affects all tissues in the joints and is thus also accompanied by local inflammation, subchondral bone changes, and persistent pain. However, our understanding of the underlying subchondral bone dynamics during OA progression is poor. Here, we demonstrate the contribution of immunoglobulin superfamily 11 (IgSF11) to OA subchondral bone remodeling by using a murine model. In particular, IgSF11 was quickly expressed by differentiating osteoclasts and upregulated in subchondral bone soon after destabilization-of-the-medial-meniscus (DMM)-induced OA. In mice, IgSF11 deficiency not only suppressed subchondral bone changes in OA but also blocked cartilage destruction. The IgSF11-expressing cells in OA subchondral bone were found to be involved in osteoclast maturation and bone resorption and colocalized with receptor-activator of nuclear-factor κ-B (RANK), the key osteoclast differentiation factor. Thus, our study shows that blocking early subchondral bone changes in OA can ameliorate articular cartilage destruction in OA.
Topics: Animals; Mice; Bone and Bones; Bone Resorption; Cartilage, Articular; Disease Models, Animal; Osteoarthritis; Osteoclasts
PubMed: 38036734
DOI: 10.1038/s12276-023-01126-6 -
Annals of Anatomy = Anatomischer... Oct 2023This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential...
This study evaluates the morpho-functional modifications that characterize meniscal development from neonatal to adult dogs. Even if menisci are recognized as essential structures for the knee joint, poor information is available about their morphogenesis, in particular in dog models. Menisci from a group of Dobermann Pinchers aged 0, 10, 30 days, and 4 years (T0, T10, T30, adult, respectively) were analyzed by SEM, histochemistry (Safranin O and Picro Sirius Red Staining analyzed under a polarized light microscope), immunofluorescences (collagen type I and II), biomechanical (compression) and biochemical analyses (glycosaminoglycans, GAGs, and DNA content). SEM analyses revealed that the T0 meniscus is a bulgy structure that during growth tends to flatten, firstly in the inner zone (T10) and then even in the outer zone (T30), until the achievement of the completely smooth adult final shape. These results were further supported by the histochemistry analyses in which the deposition of GAGs started from T30, and the presence of type I birefringent collagen fibers was observed from T0 to T30, while poorly refringent type III collagen fibers were observed in the adult dogs. Double immunofluorescence analyses also evidenced that the neonatal meniscus contains mainly type I collagen fibers, as well as the T10 meniscus, and demonstrated a more evident regionalization and crimping in the T30 and adult meniscus. Young's elastic modulus of the meniscus in T0 and T10 animals was lower than the T30 animals, and this last group was also lower than adult ones (T0-T10 vs T30 vs adult). Biochemical analysis confirmed that cellularity decreases over time from neonatal to adult (p < 0.01). The same decreasing trend was observed in GAGs deposition. These results may suggest that the postnatal development of canine meniscus may be related to the progressive functional locomotory development: after birth, the meniscus acquires its functionality over time, through movement, load, and growth itself.
Topics: Dogs; Animals; Menisci, Tibial; Knee Joint; Meniscus; Collagen Type I; Glycosaminoglycans
PubMed: 37499701
DOI: 10.1016/j.aanat.2023.152141 -
The American Journal of Sports Medicine Nov 2023Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and,...
BACKGROUND
Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy.
PURPOSE
To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete).
RESULTS
In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus ( < .001), peripheral rim instability ( = .005), and longitudinal tears ( = .015) and require a meniscal repair ( < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear ( = .015) and require additional debridement beyond the physiologic rim ( = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair.
CONCLUSION
To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
Topics: Humans; Child; Adolescent; Menisci, Tibial; Cohort Studies; Arthroscopy; Tibial Meniscus Injuries; Joint Diseases; Cartilage Diseases; Retrospective Studies
PubMed: 37899536
DOI: 10.1177/03635465231206173 -
Arthroscopy : the Journal of... Oct 2023To investigate the correlation between nontraumatic medial meniscus posterior root tear (MMPRT) and bone morphology of the knee with a particular emphasis on MMPR...
PURPOSE
To investigate the correlation between nontraumatic medial meniscus posterior root tear (MMPRT) and bone morphology of the knee with a particular emphasis on MMPR impingement.
METHODS
Magnetic resonance imaging (MRI) findings were examined between January 2018 and December 2020. MRI findings of patients with traumatic MMPRT, Kellgren Lawrence stage 3-4 arthropathy on radiographs, single- or multiple-ligament injuries and/or those who underwent treatment for these diseases, and surgery in and around the knee were excluded from the study. MRI measurements included medial femoral condylar angle (MFCA), intercondylar distance (ICD), and intercondylar notch width (ICNW), distal/posterior medial femoral condylar offset ratio, notch shape, medial tibial slope (MTS) angle, and medial proximal tibial angle (MPTA) measurements and spur presence and were compared between groups. All measurements were performed by two board-certified orthopedic surgeons on a best agreement basis.
RESULTS
MRI examinations of patients aged 40-60 were analyzed. MRI findings were divided into two groups: the study group of MRI findings of patients with MMPRT (n = 100) and the control group of MRI findings of patients without MMPRT (n = 100). MFCA was found to be significantly higher in the study group (mean: 46.5 ± 3.58) than in the control group (mean: 40.04 ± 4.61) (P < .001). In the study group, the ICD (study group mean: 76.26 ± 4.89; control group mean: 78.18 ± 6.1) was significantly narrower (P = .018), and the ICNW (study group mean: 17.19 ± 2.23; control group mean: 20.48 ± 2.13) was significantly shorter (P < .001). The ICNW/ICD ratio was significantly lower in patients in the study group (0.22 ± 0.02) than in the control group (0.25 ± 0.02) (P < .001). Bone spurs were present in 84% of the study group and only in 28% of those in the control group. In the study group, the most common notch type was A-type with 78%, while the least common was the U-type notch with 10%. However, in the control group, the most common notch type was A-type with 43%, and the least common was the W-type notch with 22%. The distal/posterior medial femoral condylar offset ratio was statistically lower in the study group (0.72 ± 0.07) than in the control group 0.78 ± 0.07) (P < .001). No significant intergroup differences were found in MTS (study group mean: 7.51 ±2.59; control group mean: 7.83 ± 2.57) (P = .390) and MPTA (study group mean: 86.92 ±2.15; control group mean: 87.48 ±1.8) measurements (P = .67).
CONCLUSIONS
Increased medial femoral condylar angle, low distal/posterior femoral offset ratio, narrow intercondylar distance and intercondylar notch width, A-type notch shape, and spur presence are associated with MMPRT.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
Topics: Humans; Menisci, Tibial; Retrospective Studies; Knee Joint; Femur; Rupture; Lacerations; Magnetic Resonance Imaging; Epiphyses
PubMed: 36868529
DOI: 10.1016/j.arthro.2023.02.020 -
Chemico-biological Interactions Jan 2024Osteoarthritis (OA) is a common joint degenerative disease, and chondrocyte injury is the main pathological and physiological change. Ruscogenin (Rus), a bioactive...
Osteoarthritis (OA) is a common joint degenerative disease, and chondrocyte injury is the main pathological and physiological change. Ruscogenin (Rus), a bioactive compound isolated from Radix Ophiopogon japonicus, exhibits various pharmacological effects. The aim of this research was to test the role and mechanism of Rus on OA both in vivo and in vitro. Destabilized medial meniscus (DMM)-induced OA model was established in vivo and IL-1β-stimulated mouse chondrocytes was used to explore the role of Rus on OA in vitro. In vivo, Rus exhibited protective effects against DMM-induced OA model. Rus could inhibit MMP1 and MMP3 expression in OA mice. In vitro, IL-1β-induced inflammation and degradation of extracellular matrix were inhibited by Rus, as confirmed by the inhibition of PGE2, NO, MMP1, and MMP3 by Rus. Also, IL-1β-induced ferroptosis was suppressed by Rus, as confirmed by the inhibition of MDA, iron, and ROS, as well as the upregulation of GSH, GPX4, Ferritin, Nrf2, and SLC7A11 expression induced by Rus. Furthermore, the suppression of Rus on IL-1β-induced inflammation, MMPs production, and ferroptosis were reversed when Nrf2 was knockdown. In conclusion, Rus attenuated OA progression through inhibiting chondrocyte ferroptosis via Nrf2/SLC7A11/GPX4 signaling pathway.
Topics: Animals; Mice; Cartilage; Chondrocytes; Ferroptosis; Inflammation; Interleukin-1beta; Matrix Metalloproteinase 1; Matrix Metalloproteinase 3; NF-E2-Related Factor 2; Osteoarthritis; Signal Transduction; Spirostans
PubMed: 38122922
DOI: 10.1016/j.cbi.2023.110835 -
Knee Surgery, Sports Traumatology,... Oct 2023In adolescent patients, meniscal tear injury can occur either in isolation (e.g., discoid lateral meniscus tears) or in association with other traumatic injuries...
PURPOSE
In adolescent patients, meniscal tear injury can occur either in isolation (e.g., discoid lateral meniscus tears) or in association with other traumatic injuries including tibial eminence fracture or ACL tear. Damage to meniscal integrity has been shown to increase contact pressure in articular cartilage, increasing risk of early onset osteoarthritis. In symptomatic patients failing conservative management, surgical intervention via meniscus repair or meniscus transplant is indicated. The purpose of this study was to evaluate the radial dimensions of pediatric menisci throughout development. The hypothesis was that the average radial meniscus dimensions will increase as specimen age increases, and mean medial and lateral region measurements will increase at a linear rate.
METHODS
Seventy-eight skeletally immature knee cadaver specimens under age 12 years were included in this study. The meniscal specimens were photographed in the axial view with ruler in the plane of the tibial plateau and analyzed using computer-aided design (CAD) software (Autodesk Fusion 360). Measurements were taken from inner to outer meniscus rims at five 45 degree intervals using the clockface as a reference (12:00, 1:30, 3:00, 4:30, 6:00), and total area of meniscus and tibial plateau was recorded. Generalized linear models were used to evaluate the associations of radial width measurements with age, tibial coverage, and lateral vs. medial meniscus widths.
RESULTS
All radial width measurements increased significantly with specimen age (p ≤ 0.002), and all lateral-medial meniscal widths increased (p < 0.001). The anterior zones of the meniscus were found to increase at the slowest rate compared to other regions. Tibial plateau coverage was found to not significantly vary with age.
CONCLUSIONS
Meniscus radial width and lateral-medial meniscus width are related to age. The anterior width of the meniscus varied least with age. Improved anatomic understanding may help surgeons more effectively plan for meniscus repair, discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation.
Topics: Humans; Child; Adolescent; Tibial Meniscus Injuries; Knee Joint; Menisci, Tibial; Tibia; Anterior Cruciate Ligament Injuries; Cartilage Diseases; Cadaver; Retrospective Studies
PubMed: 37178242
DOI: 10.1007/s00167-023-07447-3 -
Arthroscopy : the Journal of... May 2024To describe the patient-reported clinical outcomes following medial meniscus root repair with meniscus centralization and to identify common complications and detail...
Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up.
PURPOSE
To describe the patient-reported clinical outcomes following medial meniscus root repair with meniscus centralization and to identify common complications and detail provisional results.
METHODS
Patients undergoing medial meniscus root repair with meniscus centralization from 2020 to 2022 were identified using an institutional database. Patients were followed prospectively using postoperative Tegner Activity Scale, visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, International Knee Documentation Committee score, and a Likert score for improvement, surgery satisfaction, and subsequent surgeries at minimum 1-year follow-up with mean 2-year follow-up. Demographics, injury characteristics, and surgical details were also collected.
RESULTS
Twenty-five patients (age: 50 ± 11 years; sex: 76% female; body mass index: 33 ± 8) were included in this study. Postoperative Tegner score was maintained at preoperative levels (P = .233), and VAS at rest, VAS with use, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and International Knee Documentation Committee improved significantly postoperatively (P = .003; P < .001, P < .001, P = .023, respectively). Eighty-eight percent of patients reported subjective improvement in their knee at final follow-up. Postoperative radiographs did not show any significant osteoarthritis progression, and no patients had undergone a revision meniscus surgery or total knee arthroplasty at the time of follow-up.
CONCLUSIONS
At minimum 1-year follow-up and mean 2-year follow-up, patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant postoperative improvements in pain, function, and quality of life and reported high rates of surgery satisfaction. There was no evidence of significant arthritic progression on postoperative imaging, and no patients underwent revision meniscus surgery or total knee arthroplasty.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Humans; Female; Middle Aged; Male; Menisci, Tibial; Follow-Up Studies; Tibial Meniscus Injuries; Treatment Outcome; Patient Satisfaction; Postoperative Complications; Arthroscopy; Adult; Patient Reported Outcome Measures
PubMed: 37832745
DOI: 10.1016/j.arthro.2023.10.003 -
Research (Washington, D.C.) 2024Transient receptor potential vanilloid family member 1 (TRPV1) has been revealed as a therapeutic target of osteoarthritis (OA), the most common deteriorating whole...
Transient receptor potential vanilloid family member 1 (TRPV1) has been revealed as a therapeutic target of osteoarthritis (OA), the most common deteriorating whole joint disease, by impeding macrophagic inflammation and chondrocytes ferroptosis. However, the clinical application for capsaicin as the TRPV1 agonist is largely limited by its chronic toxicity. To address this issue, we developed a bifunctional controllable magnetothermal switch targeting TRPV1 for the alleviation of OA progression by coupling of magnetic nanoparticles (MNPs) to TRPV1 monoclonal antibodies (MNPs-TRPV1). Under the alternating magnetic field (AMF) stimulation, MNPs-TRPV1 locally dissipated heat, which was sufficient to trigger the opening and activation of TRPV1, and effectively impeded macrophagic inflammation and chondrocyte ferroptosis. This magnetothermal modulation of TRPV1 simultaneously attenuated synovitis and cartilage degeneration in mice incurred by destabilization of medial meniscus surgery, indicating the delayed OA progression. Furthermore, MNPs-TRPV1 with AMF exposure remarkably reduced knee pain sensitivity, alleviated the crippled gait, and improved spontaneous ambulatory activity performance in the mice OA model. Overall, this work provides a potential pathogenesis-based precise OA therapy with temporally and spatially magnetothermal modulation of TRPV1 in a controllable manner.
PubMed: 38371274
DOI: 10.34133/research.0316