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Cartilage Dec 2021Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity...
Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity for regeneration. Loss of meniscus tissue has been associated with early-onset knee osteoarthritis due to an increase in joint contact pressures in meniscectomized knees. Clinically available replacement strategies range from allograft transplantation to synthetic implants, including the collagen meniscus implant, ACTIfit, and NUSurface. Although short-term efficacy has been demonstrated with some of these treatments, factors such as long-term durability, chondroprotective efficacy, and return to sport activities in young patients remain unpredictable. Investigations of cell-based and tissue-engineered strategies to treat meniscus tissue deficiency are ongoing.
Topics: Allografts; Collagen; Humans; Knee Joint; Meniscectomy; Menisci, Tibial; Meniscus; Osteoarthritis, Knee; Postoperative Complications; Tibial Meniscus Injuries; Tissue Engineering; Transplantation
PubMed: 34802295
DOI: 10.1177/19476035211060512 -
The Knee Aug 2022This study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus. (Review)
Review
AIM
This study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus.
METHODS
Preoperative and postoperative full-length weight-bearing radiographs of the lower limb were obtained from a total of 161 patients with lateral menisci tears from September 2018 to September 2020 who underwent partial meniscal resection. The patients were divided into discoid meniscus group (DMG) and ordinary meniscus group (OMG). The measured mechanical axis deviation (MAD), proximal tibia angle (PTA), and distal femoral angle (DFA) in the axial alignment of the lower limb were determined before and after surgery. Knee joint function on the affected side was determined using the International Knee Documentation Committee (IKDC) subjective scale and the Lysholm knee scoring scale before surgery and at one, six, 12, and 24 months after surgery.
RESULTS
For MAD and DFA, there were statistically significant differences between the preoperative and postoperative findings within each group (P < 0.01); the MAD and DFA were smaller after surgery. The difference in preoperative and postoperative PTA of the DMG was statistically significant (P < 0.01), meaning that the PTA becomes larger after surgery. The differences in preoperative and postoperative PTA of the OMG, preoperative PTA between the two groups, and postoperative PTA between the two groups were not statistically significant (P > 0.05). Intragroup comparisons of the IKDC subjective scale and the Lysholm knee scoring scale before and after surgery revealed significant differences (P < 0.05).
CONCLUSION
Arthroscopic partial resection of the discoid lateral meniscus is a safe and effective surgical method that can significantly improve knee joint function. Although the axial arrangement of the lower limbs will be slightly changed in the early stage, it will still be within the normal range after surgery in patients with normal lower limb axial alignment. For patients with varus or valgus before surgery, this procedure should be applied with caution.
Topics: Arthroscopy; Humans; Knee Joint; Lower Extremity; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35809449
DOI: 10.1016/j.knee.2022.06.010 -
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 -
Cartilage Dec 2021The aim of this study was to investigate the roles of SMURF1 and SMURF2 in progenitor cells from the human knee in late-stage osteoarthritis (OA).
OBJECTIVE
The aim of this study was to investigate the roles of SMURF1 and SMURF2 in progenitor cells from the human knee in late-stage osteoarthritis (OA).
DESIGN
We applied immunohistochemistry, immunocytochemistry, RNAi, lentiviral transfection, and Western blot analysis. We obtained chondrogenic progenitor cells (CPCs) from the articular cartilage and meniscus progenitor cells (MPCs) from the nonvascularized part of the meniscus.
RESULTS
SMURF1 and SMURF2 appeared in both osteoarthritic tissues. CPCs and MPCs exhibited comparable amounts of these proteins, which influence the balance between RUNX2 and SOX9. The overexpression of SMURF1 reduced the levels of RUNX2, SOX9, and TGFBR1. The overexpression of SMURF2 also reduced the levels of RUNX2 and TGFBR1, while SOX9 levels were not affected. The knockdown of SMURF1 had no effect on RUNX2, SOX9, or TGFBR1. The knockdown of SMURF2 enhanced RUNX2 and SOX9 levels in CPCs. The respective protein levels in MPCs were not affected.
CONCLUSIONS
This study shows that SMURF1 and SMURF2 are regulatory players for the expression of the major regulator transcription factors RUNX2 and SOX9 in CPCs and MPCs. Our novel findings may help elucidate new treatment strategies for cartilage regeneration.
Topics: Cartilage, Articular; Chondrogenesis; Humans; Meniscus; Osteoarthritis; Stem Cells; Ubiquitin-Protein Ligases
PubMed: 33090007
DOI: 10.1177/1947603520967069 -
Journal of Sport Rehabilitation Mar 2023Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan... (Meta-Analysis)
Meta-Analysis
CONTEXT
Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial.
OBJECTIVE
To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR).
EVIDENCE ACQUISITION
Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR.
EVIDENCE SYNTHESIS
Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = -4.66; 95% confidence interval, -8.6 to -0.73; P = .02; I2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior-posterior view (mean difference = -7.08; 95% confidence interval, -10.92 to -3.24; P = .0003; I2 = 0%) and lateral view (mean difference = -10.33; 95% confidence interval, -16.9 to -3.75; P = .002; I2 = 17%).
CONCLUSION
This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.
Topics: Humans; Menisci, Tibial; Arthroscopy; Meniscus; Knee Injuries; Tibia; Anterior Cruciate Ligament Injuries
PubMed: 36476967
DOI: 10.1123/jsr.2022-0069 -
Journal of Orthopaedic Research :... Sep 2020Injury to any individual structure in the knee interrupts the overall function of the joint and initiates a cascade of biological and biomechanical changes whose... (Review)
Review
Injury to any individual structure in the knee interrupts the overall function of the joint and initiates a cascade of biological and biomechanical changes whose endpoint is often osteoarthritis (OA). The knee meniscus is an integral component of knee biomechanics and may also contribute to the biological homeostasis of the joint. Meniscus injury altering knee function is associated with a high risk of OA progression, and may also be involved in the initiation of OA. As the relationship between meniscus injury and OA is very complex; despite the availability of transcript level data on human meniscus injury and meniscus mediated OA, mechanistic studies are lacking, and available human data are difficult to validate in the absence of patient-matched noninjured control tissues. As similarities exist between human and mouse knee joint structure and function, investigators have begun to use cutting-edge genetic and genomic tools to examine the usefulness of the mouse as a model to study the intricate relationship between meniscus injury and OA. In this review, we use evidence from human meniscus research to identify critical barriers hampering our understanding of meniscus injury induced OA and discuss strategies to overcome these barriers, including those that can be examined in a mouse model of injury-mediated OA.
Topics: Animals; Humans; Menisci, Tibial; Mice; Models, Animal; Osteoarthritis, Knee; Tibial Meniscus Injuries
PubMed: 32068295
DOI: 10.1002/jor.24630 -
Biomacromolecules Jan 2020Rapid adhesion between tissue and synthetic materials is relevant to accelerate wound healing and to facilitate the integration of implantable medical devices. Most...
Rapid adhesion between tissue and synthetic materials is relevant to accelerate wound healing and to facilitate the integration of implantable medical devices. Most frequently, tissue adhesives are applied as a gel or a liquid formulation. This manuscript presents an alternative approach to mediate adhesion between synthetic surfaces and tissue. The strategy presented here is based on the modification of the surface of interest with a thin polymer film that can be transformed on-demand, using UV-light as a trigger, from a nonadhesive into a reactive and tissue adhesive state. As a first proof-of-concept, the feasibility of two photoreactive, thin polymer film platforms has been explored. Both of these films, colloquially referred to as polymer brushes, have been prepared using surface-initiated atom transfer radical polymerization (SI-ATRP) of 2-hydroxyethyl methacrylate (HEMA). In the first part of this study, it is shown that direct UV-light irradiation of PHEMA brushes generates tissue-reactive aldehyde groups and facilitates adhesion to meniscus tissue. While this strategy is very straightforward from an experimental point of view, a main drawback is that the generation of the tissue reactive aldehyde groups uses the 250 nm wavelength region of the UV spectrum, which simultaneously leads to extensive photodegradation of the polymer brush. The second part of this report outlines the synthesis of PHEMA brushes that are modified with 4-[3-(trifluoromethyl)-3-diazirin-3-yl]benzoic acid (TFMDA) moieties. UV-irradiation of the TFMDA containing brushes transforms the diazirine moieties into reactive carbenes that can insert into C-H, N-H, and O-H bonds and mediate the formation of covalent bonds between the brush surface and meniscus tissue. The advantage of the TFMDA-modified polymer brushes is that these can be activated with 365 nm wavelength UV light, which does not cause photodegradation of the polymer films. While the work presented in this manuscript has used silicon wafers and fused silica substrates as a first proof-of-concept, the versatility of SI-ATRP should enable the application of this strategy to a broad range of biomedically relevant surfaces.
Topics: Animals; Azirines; Benzoates; Cattle; Meniscus; Methacrylates; Methane; Photochemical Processes; Polymerization; Silicon Dioxide; Surface Properties; Tissue Adhesives; Ultraviolet Rays
PubMed: 31596075
DOI: 10.1021/acs.biomac.9b01196 -
International Journal of Molecular... Apr 2022A relationship between an acidic pH in the joints, osteoarthritis (OA), and pain has been previously demonstrated. Acidosis Chemical Exchange Saturation Transfer...
A relationship between an acidic pH in the joints, osteoarthritis (OA), and pain has been previously demonstrated. Acidosis Chemical Exchange Saturation Transfer (acidoCEST) indirectly measures the extracellular pH through the assessment of the exchange of protons between amide groups on iodinated contrast agents and bulk water. It is possible to estimate the extracellular pH in the osteoarthritic joint using acidoCEST MRI. However, conventional MR sequences cannot image deep layers of cartilage, meniscus, ligaments, and other musculoskeletal tissues that present with short echo time and fast signal decay. Ultrashort echo time (UTE) MRI, on the other hand, has been used successfully to image those joint tissues. Here, our goal is to compare the pH measured in the knee joints of volunteers without OA and patients with severe OA using acidoCEST-UTE MRI. Patients without knee OA and patients with severe OA were examined using acidoCEST-UTE MRI and the mean pH of cartilage, meniscus, and fluid was calculated. Additionally, the relationship between the pH measurements and the Knee Injury and Osteoarthritis Outcome Score (KOOS) was investigated. AcidoCEST-UTE MRI can detect significant differences in the pH of knee cartilage, meniscus, and fluid between joints without and with OA, with OA showing lower pH values. In addition, symptoms and knee-joint function become worse at lower pH measurements.
Topics: Cartilage; Humans; Knee Joint; Magnetic Resonance Imaging; Meniscus; Osteoarthritis, Knee
PubMed: 35457284
DOI: 10.3390/ijms23084466 -
International Journal of Molecular... May 2022The beginning of meniscal surgery was attributed to Annadale at the end of the 19th century: interestingly, he performed the first documented surgical repair of the...
The beginning of meniscal surgery was attributed to Annadale at the end of the 19th century: interestingly, he performed the first documented surgical repair of the meniscus [...].
Topics: Humans; Male; Menisci, Tibial; Meniscus; Tibial Meniscus Injuries
PubMed: 35682735
DOI: 10.3390/ijms23116057