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Arthroscopy : the Journal of... Dec 2023To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomical transtibial pull-out root repair in a porcine medial...
Augmentation of a Nonanatomical Repair of a Medial Meniscus Posterior Root Tear With Centralization Using Three Knotless Anchors May Be Associated With Less Meniscal Extrusion and Better Compressive Load Distribution in Mid-Flexion Compared With Non-Anatomical Root Repair Alone in a Porcine Knee...
PURPOSE
To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomical transtibial pull-out root repair in a porcine medial meniscus posterior root tear (MMPRT) model.
METHODS
Porcine knee joints (N = 10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) nonanatomical root repair; (4) nonanatomical root repair with centralization using 2 anchors: anchors were inserted at the posterior medial collateral ligament (MCL) border and 10 mm anterior to the posterior MCL border; and (5) nonanatomical root repair with centralization using 3 anchors: another anchor was placed 10 mm posterior to the posterior MCL border. Contact area on the medial meniscus (MM), contact pressure in the MM and tibial cartilage, and MM extrusion were evaluated at 30°, 45°, 60°, and 90° knee flexions under 200 N compressive force.
RESULTS
MM extrusion at the posterior MCL border was significantly reduced after root repair with centralization using 3 anchors than after root repair alone at 30° (-0.063 mm vs 1.5 mm, P = .017), 45° (0.21 mm vs 1.7 mm, P = .018), and 60° (0.78 mm vs 2.3 mm, P = .019). There were no significant differences in MM extrusion between the root repair alone and root repair with centralization using 2 anchors at all flexion angles. The contact area in the middle and posterior MM was significantly greater after centralization with 3 anchors than after root repair alone at all flexion angles (except the posterior MM at 90°). The mean contact pressure in the tibial cartilage was significantly lower after centralization with 3 anchors than after root repair at all angles.
CONCLUSIONS
Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution between 30° and 60° flexion compared with nonanatomical root repair alone in a porcine model.
CLINICAL RELEVANCE
This biomechanical study at time zero suggests that the addition of centralization using 3 knotless anchors may reduce MM extrusion and restore the load-distributing function of the MM.
Topics: Swine; Animals; Menisci, Tibial; Knee Joint; Tibia; Rupture; Lacerations; Biomechanical Phenomena
PubMed: 37142135
DOI: 10.1016/j.arthro.2023.04.009 -
International Immunopharmacology Nov 2023Osteoarthritis (OA) is a serious orthopedic disease that affects people's quality of life. Although there are many treatment methods, the treatment effect is still not...
Osteoarthritis (OA) is a serious orthopedic disease that affects people's quality of life. Although there are many treatment methods, the treatment effect is still not good. Brevilin A is a bioactive compound isolated from the medicinal herbCentipeda minima. The potential efficacy of brevilin A on OA was explored in this study. Mouse chondrocytes were isolated and stimulated by IL-1β and mouse OA model was induced by destabilization of the medial meniscus (DMM). The results demonstrated that brevilin A markedly inhibited IL-1β-induced MMP1 and MMP3 production. IL-1β-induced PGE, NO, MDA, and iron production were alleviated by brevilin A. The production of GSH and the expression of SIRT1, Nrf2, HO-1, GPX4, and Ferritin were increased by brevilin A. Furthermore, the inhibition of brevilin A on IL-1β-induced inflammation and ferroptosis were prevented by SIRT1 inhibitor. In vivo, the results showed brevilin A markedly attenuated OA progression in DMM-induced mouse OA model. Also, brevilin A could alleviate MMP1, MMP3, iNOS, and COX2 expression in OA mice. In conclusion, brevilin A protected mice against OA via suppressing inflammatory response and ferroptosis by regulating SIRT1/Nrf2/GPX4 signaling.
Topics: Humans; Mice; Animals; NF-E2-Related Factor 2; Matrix Metalloproteinase 3; Matrix Metalloproteinase 1; Ferroptosis; Sirtuin 1; Quality of Life; Inflammation; Osteoarthritis; Signal Transduction; Disease Models, Animal; Menisci, Tibial; Chondrocytes; Interleukin-1beta
PubMed: 37717314
DOI: 10.1016/j.intimp.2023.110924 -
Orthopaedics & Traumatology, Surgery &... Jun 2024It is nowadays recommended to "Save the meniscus". This paradigm is based on the affirmation that an extended meniscectomy exposes to the risk of long-term secondary...
BACKGROUND
It is nowadays recommended to "Save the meniscus". This paradigm is based on the affirmation that an extended meniscectomy exposes to the risk of long-term secondary osteoarthritis and the global failure rate of a longitudinal tear repair remains low, whether it is the medial or lateral meniscus, with or without anterior cruciate ligament (ACL) reconstruction. However, each kind of lesion has to be studied separate.
PURPOSE
The study aimed to focus on a homogeneous population of isolated repair of the bucket handle tear (BHT) of the medial meniscus (MM) in patients with stable knees to evaluate failure rate at a minimum of three years of follow-up. The secondary objectives were to evaluate any risk factors or protective factors of failure, clinical outcomes, and secondary amount of meniscectomy in failure cases compared to the amount of meniscus fixed in the first surgery.
METHODS
All patients who underwent arthroscopic repair of a BHT of the MM situated in the red-on-red or red-on white (RW) zone on a stable knee between January 2010 and December 2018 were evaluated retrospectively. Failure was defined as a need for reoperation for recurrence of meniscal symptoms (pain, locking) on the medial side with per-operative confirmation of the absence of healing. The following parameters were studied: demographics (age, gender, BMI), time from injury to surgery, clinical scores (Tegner, Lysholm, International Knee Documentation Committee [IKDC]), surgical findings (extent and zone of the tear), surgical management (number and type of suture).
RESULTS
Thirty-nine patients were included. The mean follow-up was 77.2±24.4 [36-141] months. Twenty-seven (69%) failures were recorded. In 56% (15/27) of the reoperations, the meniscectomy amount was smaller than what it would have been done in the first surgery. All clinical scores improved significantly from pre- to post-operatively; all patients met minimal clinically important differences for all the scores. No risk factors were found significant in the multivariate analysis.
CONCLUSION
Repairing an isolated BHT of the MM is associated with a high failure rate. Despite the failure, we observed that the meniscectomy area was smaller than documented in the primary surgery in most of the cases and repair must still be considered as the first option.
LEVEL OF EVIDENCE
IV; retrospective cohort series.
Topics: Humans; Tibial Meniscus Injuries; Male; Female; Retrospective Studies; Adult; Treatment Failure; Middle Aged; Arthroscopy; Reoperation; Meniscectomy; Menisci, Tibial; Young Adult; Risk Factors
PubMed: 37898297
DOI: 10.1016/j.otsr.2023.103737 -
Cureus Jul 2023Ramp lesions are a common occurrence in patients with anterior cruciate ligament (ACL) tears. These lesions can be difficult to diagnose due to their concealed nature,... (Review)
Review
Ramp lesions are a common occurrence in patients with anterior cruciate ligament (ACL) tears. These lesions can be difficult to diagnose due to their concealed nature, and their treatment is crucial due to the stabilizing function of the medial meniscocapsular region. The optimal treatment option for ramp lesions varies depending on the size and stability of the lesion. The purpose of this study was to evaluate the best treatment option for ramp lesions based on the stability of the lesion, including no treatment, biological treatment, and arthroscopic repair. We hypothesize that stable lesions have a favorable prognosis with techniques that do not require the use of meniscal sutures. In contrast, unstable lesions require appropriate fixation, either through an anterior or posteromedial portal. This study is a systematic review and meta-analysis with a level of evidence IV. The study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for a systematic review of clinical studies reporting outcomes of ramp lesion treatment. The PubMed/MEDLINE database was searched using Mesh and non-Mesh terms related to ramp lesions, medial meniscus ramp lesions, and meniscocapsular injuries. The inclusion criteria encompassed clinical studies in English or Spanish that reported the treatment of ramp meniscal lesions, with a follow-up of at least six months and inclusion of functional results, clinical stability tests, radiological evaluation, or arthroscopic second look. The analysis included 13 studies with 1614 patients. Five studies distinguished between stable and unstable ramp lesions using different criteria (displacement or size) for assessment. Of the stable lesions, 90 cases received no treatment, 64 cases were treated biologically (debridement, edge-curettage, or trephination), and 728 lesions were repaired. There were 221 repaired unstable lesions. All different methods of repair were registered. In stable lesions, three studies were included in a network meta-analysis. The best-estimated treatment for stable lesions was biological (SUCRA 0.9), followed by repair (SUCRA 0.6), and no treatment (SUCRA 0). In unstable lesions, seven studies using International Knee Documentation Committee Subjective Knee Form (IKDC) and 10 studies using Lysholm for functional outcomes showed significant improvement from preoperative to postoperative scores after repair, with no differences between repairing methods. We recommend simplifying the classification of ramp lesions as stable or unstable to determine treatment. Biological treatment is preferred for stable lesions rather than leaving them in situ. Unstable lesions, on the other hand, require repair, which has been associated with excellent functional outcomes and healing rates.
PubMed: 37435014
DOI: 10.7759/cureus.41651 -
Osteoarthritis and Cartilage Dec 2023To explore factors that were associated with meniscus volume in knees free of radiographic osteoarthritis (OA) features and symptoms of OA.
OBJECTIVES
To explore factors that were associated with meniscus volume in knees free of radiographic osteoarthritis (OA) features and symptoms of OA.
METHODS
In the third Rotterdam Study cohort, clinical, radiographic, and magnetic resonance data were obtained at baseline (BL) and after 5 years of follow-up. Meniscus volumes and their change over time were calculated after semi-automatic segmentation on Magnetic Resonance Imaging. Knees with radiographic OA features (Kellgren and Lawrence>0) or clinical diagnosis of OA (American College of Rheumatology) at BL were excluded. Ten OA risk factors were adjusted in the multivariable analysis (generalized estimating equations), treating two knees within subjects as repeated measurements.
RESULTS
From 1065 knees (570 subjects), the average (standard deviation) age and Body mass index (BMI) of included subjects were 54.3 (3.7) years and 26.5 (4.4) kg/m. At BL, nine factors (varus alignment, higher BMI, meniscus pathologies, meniscus extrusion, cartilage lesions, injury, greater physical activity level, quadriceps muscle strength, and higher age) were significantly associated with greater meniscus volume. Five factors (injury, meniscus pathologies, meniscus extrusion, higher age, and change of BMI) were significantly associated with meniscus volume loss.
CONCLUSIONS
Modifiable factors (varus alignment, BMI, physical activity level, and quadriceps muscle strength) and non-modifiable factors (higher age, injury, meniscus pathologies, meniscus extrusion, and cartilage lesions) were all associated with meniscus volume or meniscus volume loss over time.
Topics: Humans; Osteoarthritis, Knee; Radiography; Knee; Knee Joint; Magnetic Resonance Imaging; Menisci, Tibial; Meniscus
PubMed: 37598744
DOI: 10.1016/j.joca.2023.08.003 -
Knee Surgery, Sports Traumatology,... Sep 2023To investigate whether knee morphological features, patient characteristics, and intraoperative findings are associated with a lateral meniscus (LM) posterior root tear...
Lateral-medial asymmetry of posterior tibial slope and small lateral tibial plateau articular surface depth are morphological factors of lateral meniscus posterior root tears in ACL-injured patients.
PURPOSE
To investigate whether knee morphological features, patient characteristics, and intraoperative findings are associated with a lateral meniscus (LM) posterior root tear (LMPRT) in anterior cruciate ligament (ACL) injuries with the integrated data from two academic centres.
METHODS
This retrospective study used registry data acquired prospectively at two academic centres. Patients with ACL reconstruction (ACLR) with LMPRT and no other LM injury were selected (LMPRT group) from each database. The control group included patients who underwent ACLR without LM tears. Patients were matched to the LMPRT group according to age and gender (1:1). Morphological factors evaluated on preoperative magnetic resonance image scans included lateral femoral condyle (LFC) anterior-posterior diameter, height, and depth; lateral tibial plateau (LTP) articular surface (AS) depth and sagittal plane depth; and lateral and medial posterior tibial slopes (PTSs). LFC height and depth ratios, LTP AS depth and sagittal plane depth ratios, and lateral-to-medial slope asymmetry were computed from previous measurements. Patient characteristics and intraoperative findings were extracted and compared between both groups.
RESULTS
The study included 252 patients (126 in each group). The lateral-medial asymmetry of PTS was greater in the LMPRT group (1.2° vs 0.3°, p < 0.05), and the LTP AS depth was smaller in the LMPRT group (31.4 mm vs 33.2 mm, p < 0.01). There were no differences in LFC morphology between the control and LMPRT groups. Pivot shift grade (p < 0.05), percentage of complete ACL tears (p < 0.05), and medial meniscus ramp lesions (p < 0.05) were significantly higher in the LMPRT group.
CONCLUSION
LMPRT was associated with significantly increased lateral-medial asymmetry of PTS and significantly smaller LTP AS depth. LMPRT was also associated with an increase in the preoperative pivot shift grade and the presence of a medial meniscus ramp lesion. These morphological characteristics are rather simple to measure and would serve as helpful indicators to preoperatively detect LMPRT, which is frequently challenging to diagnose preoperatively.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Menisci, Tibial; Retrospective Studies; Tibial Meniscus Injuries; Knee Joint; Tibia; Anterior Cruciate Ligament Injuries; Magnetic Resonance Imaging
PubMed: 36656347
DOI: 10.1007/s00167-023-07317-y -
Scientific Reports Nov 2023The associations among Kellgren-Lawrence (KL) grade, medial meniscus extrusion (MME), and cartilage thickness in knee osteoarthritis (OA) remain insufficiently...
The associations among Kellgren-Lawrence (KL) grade, medial meniscus extrusion (MME), and cartilage thickness in knee osteoarthritis (OA) remain insufficiently understood. Our aim was to determine these associations in early to moderate medial tibiofemoral knee OA. We included 469 subjects with no lateral OA from the Kanagawa Knee Study. KL grade was assessed using artificial intelligence (AI) software. The MME was measured by MRI, and the cartilage thickness was evaluated in 18 subregions of the medial femorotibial joint by another AI system. The median MME width was 1.4 mm in KL0, 1.5 mm in KL1, 2.4 mm in KL2, and 6.0 mm in KL3. Cartilage thinning in the medial femur occurred in the anterior central subregion in KL1, expanded inwardly in KL2, and further expanded in KL3. Cartilage thinning in the medial tibia occurred in the anterior and middle external subregions in KL1, expanded into the anterior and middle central subregions in KL2, and further expanded in KL3. The absolute correlation coefficient between MME width and cartilage thickness increased as the KL grade increased in some subregions. This study provides novel insights into the early stages of knee OA and potentially has implications for the development of early intervention strategies.
Topics: Humans; Menisci, Tibial; Osteoarthritis, Knee; Artificial Intelligence; Knee Joint; Magnetic Resonance Imaging; Cartilage, Articular
PubMed: 37973855
DOI: 10.1038/s41598-023-46953-9 -
International Orthopaedics Oct 2023Untreated or overlooked medial meniscus posterior root tears (MMPRTs) induce sequential knee joint degradation. We evaluated epidemiological features of acute MMPRT for...
PURPOSE
Untreated or overlooked medial meniscus posterior root tears (MMPRTs) induce sequential knee joint degradation. We evaluated epidemiological features of acute MMPRT for its early detection and accurate diagnosis.
METHODS
Among 330 MMPRT patients from 2018 to 2020, those who underwent arthroscopic pullout repairs were enrolled. Patients who underwent non-operative treatment or knee arthroplasty, those with a cruciate ligament-deficient knee or advanced osteoarthritis of the knee, and those with insufficient data were excluded. Finally, we retrospectively evaluated data from 234 MMPRTs (female: 79.9%, complete tears: 92.7%, mean age: 65 years). Welch's t-test and Chi-squared test were used for pairwise comparisons. Spearman's rank correlation analysis was performed between age at surgery and body mass index (BMI). Multivariable logistic regression analysis with stepwise backward elimination was applied to the values as risk factors for painful popping events.
RESULTS
In both sexes, there were significant differences in height, weight, and BMI. In all patients, there was a significant negative correlation between BMI and age (ρ = - 0.36, p < 0.001). The BMI cutoff value of 27.7 kg/m had a 79.2% sensitivity and a 76.9% specificity for detecting MMPRT patients aged < 50 years. A painful popping event was confirmed in 187 knees (79.9%), and the frequency was significantly reduced in partial tears as compared to complete tears (odds ratio: 0.080, p < 0.001).
CONCLUSION
Higher BMI was associated with a significantly younger age of MMPRT onset. Partial MMPRTs had a low frequency of painful popping events (43.8%).
PubMed: 37329453
DOI: 10.1007/s00264-023-05848-0 -
Knee Surgery, Sports Traumatology,... Oct 2023The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears....
PURPOSE
The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender.
METHODS
Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%).
RESULTS
Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001).
CONCLUSION
Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Male; Adult; Retrospective Studies; Anterior Cruciate Ligament Reconstruction; Tibial Meniscus Injuries; Anterior Cruciate Ligament; Knee Injuries; Anterior Cruciate Ligament Injuries; Menisci, Tibial
PubMed: 37486367
DOI: 10.1007/s00167-023-07516-7 -
Anatomia, Histologia, Embryologia Sep 2023The knee joint capsules composed of a fibrous layer and a synovial layer. The knee meniscus consists of the superficial network, lamellar layer, tie fibre and...
The knee joint capsules composed of a fibrous layer and a synovial layer. The knee meniscus consists of the superficial network, lamellar layer, tie fibre and circumferential bundles. However, the continuous structure of the knee joint capsule and meniscus has not been reported. Fetal and adult pigs were used to investigate the structural relationship between the stifle joint capsule and meniscus based on the gross anatomy and histological findings. In the gross anatomical examination, the joint capsule appeared to have separated attachments to the meniscus, except for the lower aspect of the popliteal hiatus. Histologically, the lower half of the popliteal hiatus was found to have separated attachments, with vessels running between the attachments of the joint capsules. The synovial layer of the joint capsule continued to the superficial network, and the fibrous layer of the joint capsule continued to the lamellar layer and tie fibres. There were two routes of arterial entry into the meniscus: intracapsular and intercapsular. It appeared that the presence of separated attachments of the joint capsule was necessary to allow the intercapsular route. This study clarified for the first time the routes of feeding vessels entering the meniscus and proposed to call this entry point the meniscus hilum. We consider that this detailed anatomical information is important for understanding the continuation between the joint capsule and the meniscus.
Topics: Animals; Swine; Knee Joint; Meniscus; Synovial Membrane; Fetus; Menisci, Tibial
PubMed: 37306076
DOI: 10.1111/ahe.12938