-
Journal of Ultrasound in Medicine :... Dec 2023The aim of this study was to explore the application value of shear wave elastography in healthy adults with knee meniscus.
OBJECTIVES
The aim of this study was to explore the application value of shear wave elastography in healthy adults with knee meniscus.
METHODS
One hundred adult subjects who underwent health checkups at our hospital from December 2022 to February 2023 were selected as research participants. Shear wave elastography was used to evaluate the periphery of the lateral and medial meniscus in both knees. To assess the mean differences in Young's modulus values between male and female groups, a one-way analysis of variance (ANOVA) and independent samples t-test were conducted. In addition, a Pearson correlation coefficient test was used to analyze the correlation between the elastic values of the meniscus and age, height, weight, and body mass index (BMI).
RESULTS
There were no significant differences in elastic values between the lateral meniscus of the left and right sides or between the medial meniscus of the left and right sides within the same gender group (P > .05). Stiffness values of the medial meniscus were higher in each gender group than those of the lateral meniscus (P < .01). Additionally, males demonstrated higher stiffness values than females (P < .01). As age increased, the Young's modulus of the meniscus increased significantly (r > .75, P < .01).
CONCLUSION
Shear wave elastography can serve as an adjunctive tool to aid in the assessment of knee meniscal elasticity.
Topics: Humans; Adult; Male; Female; Elasticity Imaging Techniques; Knee Joint; Menisci, Tibial; Body Mass Index; Elastic Modulus
PubMed: 37661827
DOI: 10.1002/jum.16326 -
Orthopaedics & Traumatology, Surgery &... Oct 2023
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Knee Injuries; Meniscus; Menisci, Tibial
PubMed: 37527774
DOI: 10.1016/j.otsr.2023.103672 -
Journal of Medical Ultrasonics (2001) Oct 2023Medial meniscus extrusion is one of the risk factors for knee osteoarthritis (OA). However, lateral meniscus extrusion has not been discussed, and detailed information...
PURPOSE
Medial meniscus extrusion is one of the risk factors for knee osteoarthritis (OA). However, lateral meniscus extrusion has not been discussed, and detailed information remains unknown. In particular, the lateral meniscus has high mobility and is expected to be difficult to evaluate in terms of its behavior under static conditions. Dynamic ultrasonographic evaluation was introduced to detect the dynamic behavior of the meniscus during walking. In this study, we aimed to investigate the behavior of the lateral meniscus during walking using dynamic ultrasonographic evaluation.
METHODS
Sixteen participants with knee OA were recruited in this study. The change of lateral meniscus extrusion during walking was recorded using ultrasonography. Medial and lateral meniscal extrusion during the stance phase was measured, and meniscal mobility was defined as the difference in meniscal extrusion between minimum and maximum values (mm), medial meniscal extrusion (∆MME), and lateral meniscal extrusion (∆LME), respectively. The walking cycle and gait forms of lateral thrust were also evaluated using three-dimensional motion analysis systems and analyzed in terms of the correlation with ∆MME and ∆LME.
RESULTS
The lateral meniscus was depicted in the articular plane, and extrusion decreased during the stance phase of the gait cycle. The ∆LME was significantly higher than the ∆MME (p < 0.01). There was a significant positive correlation between ∆LME and lateral thrust (r = 0.62, p < 0.05).
CONCLUSIONS
We found that dynamic ultrasonographic evaluation can be used to visualize lateral meniscus extrusion during walking, and that its behavior is correlated to the degree of lateral thrust.
Topics: Humans; Menisci, Tibial; Magnetic Resonance Imaging; Osteoarthritis, Knee; Gait; Ultrasonography
PubMed: 37286813
DOI: 10.1007/s10396-023-01330-x -
Cell Communication and Signaling : CCS Aug 2023The study was design to investigate the functional roles of Wilms tumor 1-associated protein (WTAP), an enzyme catalyzes m6A modification, in the pathogenesis of...
The study was design to investigate the functional roles of Wilms tumor 1-associated protein (WTAP), an enzyme catalyzes m6A modification, in the pathogenesis of osteoarthritis (OA) and further elucidate its possible regulatory mechanism. Herein, we discovered that WTAP was outstandingly upregulated in chondrocyte stimulated with Lipopolysaccharide (LPS) and cartilage tissue of patients with OA. Functional studies have demonstrated that WTAP knockdown enhances proliferation ability, suppresses apoptosis, and reduces extracellular matrix (ECM) degradation in an LPS-induced OA chondrocyte injury model and ameliorates cartilage damage in a destabilizing the medial meniscus (DMM)-induced OA mice model. Conversely, overexpression of WTAP contributes to the opposite effects. Mechanistically, our data has demonstrated that mA modification mediated by WTAP promotes the maturation of pri-miR-92b to miR-92b-5p, thereby enhancing the targeted inhibitory function of miR-92b-5p on TIMP4. Furthermore, we have discovered that WTAP can directly facilitate the degradation of TIMP4 mRNAs in a YTHDF2-dependent manner. In a nutshell, our findings suggested that WTAP knockdown alleviated OA progression by modulating the miR-92b-5p/TIMP4 axis in an m6A-dependent manner. Our study disclosed that WTAP-mediated m6A modification displayed a crucial role in OA development and suggested that targeting WTAP could be a promising preventive and therapeutic target for patients with OA. Video Abstract.
Topics: Animals; Mice; Apoptosis; Chondrocytes; Lipopolysaccharides; Methyltransferases; MicroRNAs; Osteoarthritis; Humans
PubMed: 37563688
DOI: 10.1186/s12964-023-01228-8 -
International Orthopaedics Oct 2023The functional outcomes of arthroscopic matrix-based meniscus repair (AMMR) in patients two and five years after the treatment clearly show that the use of the collagen...
PURPOSE
The functional outcomes of arthroscopic matrix-based meniscus repair (AMMR) in patients two and five years after the treatment clearly show that the use of the collagen matrix and bone marrow aspirate creates favorable biological conditions for meniscus healing. This study not only provides ten follow-up results but also investigates biomolecular mechanisms governing the regenerative process.
METHODS
Case series was based on data collected from patients who underwent AMMR procedure, starting with preoperatively through two-year and five-year till ten-year follow-up. The outcomes are presented as IKDC and the Lysholm subjective scores as well as the imaging results. Biomolecular investigation of the membranes utilized in the AMMR procedure include DNA content analysis, cell viability and proliferation study of bone marrow and bone marrow concentrate-derived cells, and cytokine array performed on monocytes cultured on the membranes.
CONCLUSION
Data collected from patients who underwent AMMR procedure, starting with pre-operatively through two year and five year till ten year follow-up, indicate the possibility for long-term, stable meniscus preservation. Outcomes are manifested with a visible improvement of the IKDC and the Lysholm subjective scores as well as in the imaging results. The type of the meniscal tear or complexity of the knee injury (isolated AMMR vs. AMMR + ACL) did not affect the clinical outcomes. The study highlighted the role of the membrane in facilitating cell adhesion and proliferation. Additionally, several cytokines were selected as potentially crucial products of the membrane vs. monocyte interactions, driving the tissue regeneration and remodeling. Interestingly, thresholds of what constitutes a safe and well-decellularized membrane according to relevant literature have been significantly breached, but ultimately did not elicit detrimental side effects.
Topics: Humans; Treatment Outcome; Bone Marrow; Follow-Up Studies; Collagen; Knee Injuries; Arthroscopy; Meniscus; Menisci, Tibial
PubMed: 36764942
DOI: 10.1007/s00264-023-05711-2 -
Knee Surgery, Sports Traumatology,... Nov 2023The current study aimed to evaluate the effect of medial meniscus posterior root tear (MMPRT) on radiological and clinical outcomes after medial opening-wedge high...
PURPOSE
The current study aimed to evaluate the effect of medial meniscus posterior root tear (MMPRT) on radiological and clinical outcomes after medial opening-wedge high tibial osteotomy (MOWHTO).
METHODS
This retrospective cohort study included patients who underwent MOWHTO (113 knees) at our hospital between September 2012 and June 2020 and who were followed up for > 2 years. The radiological and clinical outcomes were compared between the MMPRT group (52 knees), who included patients with MMPRT, and the non-MMPRT group (61 knees), who comprised patients without meniscal tear or with any type of meniscal tear other than MMPRT. Logistic regression analysis was performed to evaluate factors affecting osteoarthritis (OA) progression after MOWHTO.
RESULTS
The mean follow-up period was 40.6 ± 14.2 months. The mean ages of the MMPRT and non-MMPRT groups were 56.9 ± 6.4 and 54.4 ± 6.1 years, respectively (p = 0.031). There was no significant difference in the last follow-up radiological and clinical outcomes between the two groups. In the logistic regression analysis, the postoperative hip-knee-ankle angle was a risk factor of OA progression after MOWHTO (odds ratio 0.7; 95% confidence interval 0.5-0.9; p = 0.006), and the type of medial meniscus tear was not associated with OA progression (p = n.s.).
CONCLUSIONS
In the short- to mid-term follow-up of MOWHTO, the radiological or clinical outcomes of patients with MMPRT were not inferior to those of patients without MMPRT. Postoperative lower extremity alignment, but not MMPRT, was a factor influencing MOWHTO prognosis. Concurrent root repair in HTO will restore the anatomy better; however, its effect on progression of OA is yet to be proven.
LEVEL OF EVIDENCE
IV.
PubMed: 37676499
DOI: 10.1007/s00167-023-07542-5 -
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 -
Arthroscopy : the Journal of... Mar 2024Arthroscopic access to the posterior root of the medial meniscus is often difficult in a tight medial compartment. To facilitate ease of access, partial lengthening of...
Arthroscopic access to the posterior root of the medial meniscus is often difficult in a tight medial compartment. To facilitate ease of access, partial lengthening of the medial collateral ligament (MCL) "pie-crusting" has been advocated to increase the working space of the medial compartment during arthroscopy. Purported benefits of MCL include increased visualization and decreased misdiagnosis during diagnostic arthroscopy, decreased iatrogenic chondral injuries with instrumentation, and postoperative medial compartment off-loading. Several techniques of MCL lengthening have been described including percutaneous lengthening, transportal lengthening, and mini-open lengthening. The safety of MCL lengthening has been demonstrated. Patients receiving MCL lengthening have no difference in postoperative laxity, postoperative pain, nor damage to surrounding structures. MCL lengthening also shows improved patient outcome scores and decreased rates of retear of medial meniscal root tear repair.
Topics: Humans; Menisci, Tibial; Arthroplasty, Replacement, Knee; Knee Injuries; Arthroscopy; Rupture
PubMed: 38219116
DOI: 10.1016/j.arthro.2023.08.066 -
Current Reviews in Musculoskeletal... Jun 2024The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies.
RECENT FINDINGS
Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.
PubMed: 38822979
DOI: 10.1007/s12178-024-09906-x -
Knee Surgery, Sports Traumatology,... Nov 2023The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely...
PURPOSE
The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely understood. Thus, the aim of this study was to investigate the effects of transtibial pullout repair on MMPRTs and whether the effects would be sustained.
METHODS
Nineteen knees with MMPRTs that were treated by trans-tibial pullout repair were enrolled in this study. Medial meniscus extrusion (MME) was measured by ultrasonography during knee extension (no weight-bearing with the knee at 0° extension: NW0°) and 90° flexion (no weight-bearing with the knee at 90° flexion: NW90°) with the patient in the supine position and with full weight-bearing (FW0°) preoperatively and at 3 and 12 months postoperatively. The clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and International Knee Documentation Committee score.
RESULTS
The difference in MME with NW0° was not statistically significant between the preoperative (3.4 ± 1.0 mm) and 12-month postoperative (3.7 ± 0.6 mm) time points. The MME with NW90° at 3 (2.1 ± 0.7 mm) and 12 months (2.9 ± 0.6 mm) postoperatively were significantly lower than the preoperative values (3.4 ± 0.8 mm) (P < 0.05). However, the value significantly increased from 3 to 12 months postoperatively (P < 0.05). The MME with FW0° at 12 months postoperatively (4.3 ± 0.6 mm) was significantly larger than that at pre-operatively (3.6 ± 0.9 mm) (P < 0.05). All the patients' clinical conditions were significantly improved at 12 months postoperatively when compared to their preoperative clinical conditions.
CONCLUSION
Surgery did not reduce the extrusion in the no weight-bearing and weight-bearing positions at knee extension, and these values increased in the postoperative period. In addition, while the surgery reduced the extrusion in the knee flexion position, the restoration achieved by the surgery was not sustained in the long term.
LEVEL OF EVIDENCE
Level IV.
PubMed: 37573532
DOI: 10.1007/s00167-023-07528-3