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The American Journal of Sports Medicine Jun 2024Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a refixation technique for MMPRT instead of the conventional 2 simple stitches (TSS). This is in view of its superior biomechanical characteristics.
PURPOSE
To perform a systematic review and meta-analysis to compare MMA and TSS configuration techniques for MMPRT repair and identify any differences between the 2 techniques in terms of clinical outcomes, medial meniscal extrusion (MME), and postoperative healing.
STUDY DESIGN
Meta-analysis; Level of evidence, 4.
METHODS
The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase databases were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ("meniscus" OR "meniscal injuries") AND ("Mason-Allen" OR "simple stitch" OR "suture techniques"). Data pertaining to all patient-reported outcome measures, postoperative complications, MME, postoperative healing, cartilage degeneration, and progression of knee osteoarthritis were extracted from each study. The pooled outcome data were analyzed using random- and fixed-effects models.
RESULTS
After abstract and full-text screening, 6 clinical studies were included. In total, there were 291 patients; 160 underwent MMA fixation, and 131 underwent the TSS technique. The majority of studies had similar surgical techniques regarding repair technique, suture material, tibial fixation, and number and position of tibial tunnels. There were no differences between the groups in terms of patient-reported outcome measures at 14.2 months. Both techniques were also similar in the degree of postoperative MME and meniscal healing.
CONCLUSION
Both suture configurations were equivalent in terms of clinical outcomes, the extent of meniscal extrusion, and postoperative healing. The TSS technique may offer advantages in terms of faster learning curve and shorter operative time. However, randomized controlled trials with large sample sizes, longer follow-up and assessment of chondral degeneration, and presence of knee osteoarthritis are required to assess whether a true difference exists, as the majority of included studies were limited by their retrospective design.
Topics: Humans; Tibial Meniscus Injuries; Suture Techniques; Menisci, Tibial; Postoperative Complications
PubMed: 38258492
DOI: 10.1177/03635465231190650 -
The American Journal of Sports Medicine Nov 2021Failure to appropriately identify and repair medial meniscal ramp lesions at the time of anterior cruciate ligament (ACL) reconstruction (ACLR) may result in increased... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Failure to appropriately identify and repair medial meniscal ramp lesions at the time of anterior cruciate ligament (ACL) reconstruction (ACLR) may result in increased anterior tibial translation and internal rotation, increasing the risk for graft failure. Knowledge of the risk factors leading to the development of ramp lesions may enhance clinicians' vigilance in specific ACL-deficient populations and subsequently repair of these lesions at the time of ACLR.
PURPOSE
To perform a systematic review and meta-analysis of factors tested for associations with ramp lesions and to determine which were significantly associated with the presence of ramp lesions.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
PubMed, OVID/Medline, and Cochrane databases were queried in April 2020. Data pertaining to study characteristics and reported risk factors for ramp lesions were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and ramp lesions by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported.
RESULTS
The review included 12 studies with 8410 patients. The overall pooled prevalence of ramp lesions was 21.9% (range, 9.0%-41.7%). A total of 45 risk factors were identified, of which 8 were explored quantitatively. There was strong evidence to support that posteromedial tibial edema on magnetic resonance imaging (MRI) (OR, 2.12; 95% CI, 1.27-3.56; = .004), age <30 years (OR, 2.02; 95% CI, 1.23-3.22; = .002), and complete ACL tears (OR, 3.0; 95% CI, 1.41-6.20; = .004) were risk factors for ramp lesions. There was moderate evidence to support that male sex (OR, 1.58; 95% CI, 1.36-1.83; < .001) and concomitant lateral meniscal tears (OR, 1.54; 95% CI, 1.11-2.13; = .009) were risk factors for ramp lesions. Chronic ACL injury (≥24 months) demonstrated minimal evidence as a risk factor (OR, 1.41; 95% CI, 1.14-1.74; = .001). No significant associations were determined between contact injury or revision ACLR and the presence of ramp lesions.
CONCLUSION
Significant associations between male sex, age <30 years, posteromedial tibial edema on MRI, concomitant lateral meniscal tears, complete ACL tears, injury chronicity, and the presence of ramp lesions were found. Contact injury and revision ACLR were not significantly associated with the presence of ramp lesions.
Topics: Adult; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Male; Menisci, Tibial; Risk Factors; Tibial Meniscus Injuries
PubMed: 33565883
DOI: 10.1177/0363546520986817 -
Journal of Orthopaedic Surgery (Hong... 2023Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature.
METHODS
Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest.
RESULTS
Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7 mm, which was significantly larger than the 0.9 ± 1.2 mm observed after LMPRT repair ( < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair ( < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair ( < 0.001).
CONCLUSIONS
LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.
Topics: Humans; Menisci, Tibial; Retrospective Studies; Knee Joint; Osteoarthritis; Magnetic Resonance Imaging; Arthroscopy; Rupture
PubMed: 37173149
DOI: 10.1177/10225536231175233 -
Knee Surgery, Sports Traumatology,... Nov 2020The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and...
PURPOSE
The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport.
METHODS
Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review.
RESULTS
Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211 months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8.
CONCLUSION
This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Arthroplasty, Replacement, Knee; Arthroscopy; Humans; Knee Injuries; Lysholm Knee Score; Menisci, Tibial; Orthopedics; Patient Safety; Postoperative Period; Reoperation; Rupture; Second-Look Surgery; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 32979079
DOI: 10.1007/s00167-020-06287-9 -
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 -
The Journal of Knee Surgery Apr 2023We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal...
We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of knee meniscal tears. Outcome measures included repair failure, repeat knee arthroscopic surgery, and magnetic resonance imaging), visual analog scale for pain, the International Knee Documentation Committee questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Lysholm's Knee Scoring Scale, and the Knee Injury and Osteoarthritis Outcome Score. Study quality was assessed using the modified Coleman methodology score. Nineteen studies reported repair of 1,092 menisci including six studies that investigated fibrin clot augmentation, five studies that investigated PRP augmentation, three studies that investigated bone marrow stimulation augmentation, two studies that used meniscal wrapping augmentation, and three studies that used other techniques. The level of evidence ranged from I to IV and mean modified Coleman methodology score was 43 (range: 17-69), with higher scores noted in studies completed in recent years. PRP and bone marrow stimulation augmentation appear to decrease risk of failure in patients undergoing isolated meniscal repair but do not improve knee symptom scores. Fibrin clot and trephination augmentation techniques do not have sufficient evidence to support decreased failure risk at this time. Meniscal wrapping augmentation and scaffold implantation augmentation appear to be an attractive option to meniscectomy in complicated tears that are not candidates for repair alone, but further confirmatory studies are needed to support initial data. Evidence supporting augmentation of meniscal repair is limited at this time but suggests that the highest likelihood for effectiveness of augmentation is in the settings of isolated meniscal repair or meniscal repairs that would normally not be amenable to repair.
Topics: Humans; Treatment Outcome; Knee Joint; Meniscus; Knee Injuries; Osteoarthritis; Arthroscopy; Biological Products; Menisci, Tibial; Retrospective Studies
PubMed: 34781393
DOI: 10.1055/s-0041-1739198 -
Orthopaedic Journal of Sports Medicine Nov 2020Given the superiority of meniscal repair over partial meniscectomy according to biomechanical data, the clinical outcomes of meniscal repair are likely to be better than... (Review)
Review
BACKGROUND
Given the superiority of meniscal repair over partial meniscectomy according to biomechanical data, the clinical outcomes of meniscal repair are likely to be better than those of partial meniscectomy for a medial meniscus root tear (MMRT).
PURPOSE/HYPOTHESIS
This review was designed to compare the clinical and radiological results between meniscal repair and partial meniscectomy for MMRTs. It was hypothesized that meniscal repair would result in better clinical and radiological results compared with partial meniscectomy.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Studies were included in the review if they (1) included patients with MMRTs who underwent primary arthroscopic meniscal repair or partial meniscectomy and (2) analyzed validated patient-reported outcomes and/or radiological evaluations. Summary odds ratios (ORs) with 95% CIs were calculated to compare partial meniscectomy with meniscal repair for each outcome.
RESULTS
A total of 13 studies were included. The mean duration of follow-up was 33.5 and 47.2 months in the meniscal repair group and partial meniscectomy group, respectively. The change in the Lysholm score from preoperatively to postoperatively was statistically significantly in favor of meniscal repair (OR, 2.20 [95% CI, 1.55-3.12]), while no difference was found with respect to the change in the Tegner score between the 2 surgical approaches (OR, 1.21 [95% CI, 0.65-2.24]). The prevalence of postoperative severe knee osteoarthritis (OR, 0.31 [95% CI, 0.17-0.54]) as well as that of reoperations (OR, 0.05 [95% CI, 0.01-0.19]) were significantly in favor of meniscal repair.
CONCLUSION
Better outcomes were seen after meniscal repair compared with partial meniscectomy for MMRTs, with greater improvements in Lysholm scores, and lower rates of progression to knee osteoarthritis, and lower reoperation rate.
PubMed: 33241058
DOI: 10.1177/2325967120962078 -
Revista Brasileira de Ortopedia Apr 2023To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as...
To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as the evolution of the anatomical knowledge on this structure. An electronic search was conducted in the MEDLINE/PubMed, Google Scholar, EMBASE and Cochrane library databases with no date restrictions. The following index terms were used in the search: AND AND AND . The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included anatomical studies of the knee were included, such as cadaver dissections, histological and/or biological investigations, and/or imaging of the medial MTL anatomy. Eight articles that met the inclusion criteria were selected. The first article was published in 1984 and the last, in 2020. The total sample in the 8 articles was of 96 patients. Most studies are purely descriptive in terms of the macroscopic morphological and microscopic histological findings. Two studies evaluated the biomechanical aspects of the MTL, and one, the anatomical correlation with the magnetic resonance imaging examination. The main function of the medial MTL, a ligament that originates in the tibia and is inserted in the lower meniscus, is to stabilize and maintain the meniscus in its position on the tibial plateau. However, there is a limited amount of information regarding medial MTLs, primarily in terms of anatomy, especially vascularization and innervation.
PubMed: 37252293
DOI: 10.1055/s-0042-1749199 -
The Knee Jan 2023Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aimsto assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants.
METHODS
The study was performedaccording to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcomedata specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data.
RESULTS
Ten studies comprising 568 patients (mean age 29.2-40 years, follow up duration 1-14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51-3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain,Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores.
CONCLUSION
Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.
Topics: Humans; Adult; Menisci, Tibial; Tissue Scaffolds; Knee Joint; Meniscectomy; Osteoarthritis; Pain, Postoperative; Arthroscopy
PubMed: 36512894
DOI: 10.1016/j.knee.2022.11.020 -
BMC Musculoskeletal Disorders Jun 2023Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with...
BACKGROUND
Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear.
PURPOSE
To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings.
STUDY DESIGN
Systematic review.
METHODS
According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057).
RESULTS
Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up.
CONCLUSION
HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions.
LEVEL OF EVIDENCE
III.
Topics: Humans; Knee Joint; Menisci, Tibial; Arthroplasty, Replacement, Knee; Rupture; Osteoarthritis; Knee Injuries; Osteotomy; Arthroscopy; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 37280599
DOI: 10.1186/s12891-023-06520-9