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Knee Surgery & Related Research Mar 2017The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal... (Review)
Review
The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison.
PubMed: 28231642
DOI: 10.5792/ksrr.16.059 -
The Journal of Knee Surgery Nov 2017Partial and total meniscectomies are the most common treatments for patients with discoid lateral meniscus (DLM). We conducted this study to quantitatively assess and... (Meta-Analysis)
Meta-Analysis Review
Partial and total meniscectomies are the most common treatments for patients with discoid lateral meniscus (DLM). We conducted this study to quantitatively assess and compare the outcomes of partial and total meniscectomies for DLM. We also assessed whether the outcomes differed by the type of DLM, duration of follow-up, and age of patients. We searched PubMed, Embase, and the Cochrane database to identify relevant studies that reported outcomes, including Ikeuchi grade, the International Knee Documentation Committee (IKDC) Subjective Knee score, Lysholm score, or failure rate, in patients who underwent partial and total meniscectomies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, whereas mean difference and 95% CIs were calculated for continuous outcomes. Fifteen studies met the inclusion criteria. The overall rate of excellent (E) or good (G) postoperatively was 85.5% (95% CI: 79.5-91.5%). The E or G rate of partial meniscectomy was significantly higher than that of total meniscectomy (OR= 1.97, 95% CI: 1.03-3.75, = 0.038). Besides, patients younger than 20 years had a significantly higher E or G rate than those older than 20 years. (OR = 3.12, 95% CI: 1.18-8.23, = 0.022). We also found the E or G rate tended to decrease from short- to long-term follow-up. Our systematic review and meta-analysis showed that that partial meniscectomy could achieve better outcomes compared with total meniscectomy for DLM patients.
Topics: Humans; Meniscectomy; Menisci, Tibial
PubMed: 28114702
DOI: 10.1055/s-0036-1598021 -
Orthopaedic Journal of Sports Medicine Mar 2023Medial meniscal extrusion (MME) has received significant interest because of its correlation with medial meniscus root tears (MMRTs), its potential as a diagnostic tool,... (Review)
Review
BACKGROUND
Medial meniscal extrusion (MME) has received significant interest because of its correlation with medial meniscus root tears (MMRTs), its potential as a diagnostic tool, and its significance in the progression of knee osteoarthritis (OA).
PURPOSE
To (1) evaluate if MMRTs significantly increase MME compared with nonroot tears (NRTs) and no tears and (2) determine the clinical outcomes of increased MME.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Electronic database searches of PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were conducted on June 6, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist criteria. The searches were conducted using the keywords "meniscus tear" and "extrusion." No restrictions were placed on the date of publication. Quality and sensitivity assessments were conducted on included studies. Major MME was defined as an extrusion ≥3 mm.
RESULTS
Twenty-two studies involving 7882 knees were included. Compared with patients with NRTs, those with MMRTs had a 1.12-mm greater mean absolute meniscal extrusion (AME) and were 3.45 times more likely to have major MME ( < .001 for both). Compared with patients with no tears, those with MMRTs had a 2.13-mm greater AME ( < .001). Within patients with MMRT, those with widely displaced MMRT had a 1.01-mm greater AME compared with nondisplaced MMRT ( < .001). Patients with OA had a 0.73-mm greater AME and were 3.86 times more likely to have major MME compared with patients without OA ( < .001 for both). Within patients who were not stratified according to MMRT, NRT, or no tears, those who eventually developed OA had a 0.79-mm greater AME than those who did not have OA ( = .02).
CONCLUSION
Patients with MMRTs had higher MME values compared with those with other types of meniscal tears and those without any meniscal tears. Patients with knee OA were more likely to have higher MME compared with those without OA.
PubMed: 36909671
DOI: 10.1177/23259671231151698 -
Knee Surgery, Sports Traumatology,... Aug 2023Medial meniscus extrusion (MME) refers to the protrusion of the medial meniscus beyond the tibial edge by more than 3 mm, leading to a deficiency of the hoop strain.... (Meta-Analysis)
Meta-Analysis Review
Radiographic OA, bone marrow lesions, higher body mass index and medial meniscal root tears are significantly associated with medial meniscus extrusion with OA or medial meniscal tears: a systematic review and meta-analysis.
PURPOSE
Medial meniscus extrusion (MME) refers to the protrusion of the medial meniscus beyond the tibial edge by more than 3 mm, leading to a deficiency of the hoop strain. MME commonly occurs in conjunction with osteoarthritis (OA) or medial meniscal tears (MMT). However, factors associated with concomitant MME in patients with OA or MMT have not been systematically reviewed. This study aims to perform a systematic review and meta-analysis to identify factors associated with concomitant MME in OA or MMT.
METHODS
The systematic review of the literature was performed according to PRISMA. A literature search was conducted in 4 databases. All original human studies that reported the available evidence on factors associated with concomitant MME in patients with OA or MMT were included. Pooled binary variables were analyzed by odds ratios (OR) and 95% CIs, and pooled continuous variables were evaluated by mean difference (MD) and 95% CIs.
RESULTS
Ten studies on OA (5993 patients) and eight studies on MMT (872 patients) met the inclusion criteria. The overall pooled incidence of MME was 43% (95% CI, 37-50%) for OA, 61% (95% CI 43-77%) for MMT, and 85% (95% CI 72-94%) for medial meniscal root tears (MMRT). For the population with OA, Factors significantly associated with MME included radiographic OA [OR 4.24; 95% CI 3.07-5.84; P < 0.0001], bone marrow lesions [OR, 3.35; 95% CI 1.61-6.99; P = 0.0013], cartilage damage [OR, 3.25; 95% CI 1.60-6.61; P = 0.0011], and higher body mass index (BMI) [MD, 1.81; 95% CI 1.15-2.48; P < 0.0001]. Factors strongly associated with increased risk of MME for MMT included medial meniscal root [OR, 8.39; 95% CI 2.84-24.82; P < 0.0001] and radial tears [OR, 2.64; 95% CI 1.18-5.92; P < 0.0001].
CONCLUSION
Radiographic OA, bone marrow lesions, cartilage damage, and higher BMI were significantly associated with concomitant MME with OA. Furthermore, medial meniscal root and radial tears were significantly associated with an increased risk of MME in patients with MMT.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Menisci, Tibial; Body Mass Index; Bone Marrow; Retrospective Studies; Magnetic Resonance Imaging; Osteoarthritis; Cartilage Diseases; Bone Diseases
PubMed: 37099153
DOI: 10.1007/s00167-023-07418-8 -
Knee Surgery, Sports Traumatology,... May 2016To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
METHODS
MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
RESULTS
There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77-94 %) and 93 % (95 % CI 91-96 %), respectively, for ACL tears; 89 % (95 % CI 83-94 %) and 88 % (95 % CI 82-93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66-87 %) and 95 % (95 % CI 91-97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
CONCLUSION
This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
LEVEL OF EVIDENCE
III.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Arthroscopy; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Menisci, Tibial; Middle Aged; Tibial Meniscus Injuries; Young Adult
PubMed: 26614425
DOI: 10.1007/s00167-015-3861-8 -
Osteoarthritis and Cartilage May 2023To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy... (Meta-Analysis)
Meta-Analysis Review
Arthroscopic partial meniscectomy vs non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears: a systematic review and meta-analysis with individual participant data from 605 randomised patients.
OBJECTIVE
To identify subgroups of patients with magnetic resonance imaging (MRI)-confirmed degenerative meniscus tears who may benefit from arthroscopic partial meniscectomy (APM) in comparison with non-surgical or sham treatment.
METHODS
Individual participant data (IPD) from four RCTs were pooled (605 patients, mean age: 55 (SD: 7.5), 52.4% female) as to investigate the effectiveness of APM in patients with MRI-confirmed degenerative meniscus tears compared to non-surgical or sham treatment. Primary outcomes were knee pain, overall knee function, and health-related quality of life, at 24 months follow-up (0-100). The IPD were analysed in a one- and two-stage meta-analyses. Identification of potential subgroups was performed by testing interaction effects of predefined patient characteristics (e.g., age, gender, mechanical symptoms) and APM for each outcome. Additionally, generalized linear mixed-model trees were used for subgroup detection.
RESULTS
The APM group showed a small improvement over the non-surgical or sham group on knee pain at 24 months follow-up (2.5 points (95% CI: 0.8-4.2) and 2.2 points (95% CI: 0.9-3.6), one- and two-stage analysis, respectively). Overall knee function and health-related quality of life did not differ between the two groups. Across all outcomes, no relevant subgroup of patients who benefitted from APM was detected. The generalized linear mixed-model trees did also not identify a subgroup.
CONCLUSIONS
No relevant subgroup of patients was identified that benefitted from APM compared to non-surgical or sham treatment. Since we were not able to identify any subgroup that benefitted from APM, we recommend a restrained policy regarding meniscectomy in patients with degenerative meniscus tears.
Topics: Humans; Middle Aged; Meniscectomy; Quality of Life; Magnetic Resonance Imaging; Pain; Arthroscopy; Meniscus; Osteoarthritis, Knee
PubMed: 36646304
DOI: 10.1016/j.joca.2023.01.002 -
Arthroscopy : the Journal of... Mar 2015The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee. (Review)
Review
PURPOSE
The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee.
METHODS
The Medline, Embase, and Cochrane databases were screened for all studies related to the ALL of the knee. Two reviewers independently reviewed all eligible articles and the references of these articles. Inclusion and exclusion criteria were applied to all searched studies. Quality assessment was completed for the included studies.
RESULTS
Nineteen studies were identified for final analysis. Pooled analysis identified the ALL in 430 of 449 knees (96%) examined. The ligament was found to originate from the region of the lateral femoral epicondyle and insert on the proximal tibia midway between the Gerdy tubercle and the fibular head. The ALL was found to be 34.1 to 41.5 mm in length, 5.1 to 8.3 mm in width above the lateral meniscus, and 8.9 to 11.2 mm in width below the lateral meniscus. By use of magnetic resonance imaging, the ALL was identified in 93% of knees examined (clinical, 64 of 70; cadaveric, 16 of 16). In one case study the ligament was clearly visualized by ultrasound examination. Histologic analysis across 3 studies showed characteristics consistent with ligamentous tissue. Though not shown in biomechanical studies, it is hypothesized that the ALL provides anterolateral stability to the knee, preventing anterolateral subluxation of the proximal tibia on the femur. One study identified a network of peripheral nerves, suggesting a proprioceptive function of the ALL.
CONCLUSIONS
This systematic review shows the ALL to be a distinct structure with a consistent origin and insertion sites. The ALL is an extra-articular structure with a clear course from the lateral femoral epicondyle region, running anteroinferiorly, to the proximal tibia at a site midway between the Gerdy tubercle and the head of the fibula. The function of this ligament is theorized to provide anterolateral knee stability.
LEVEL OF EVIDENCE
Level IV, systematic review of cadaveric and imaging studies.
Topics: Femur; Humans; Knee Joint; Ligaments, Articular; Tibia
PubMed: 25744324
DOI: 10.1016/j.arthro.2014.12.015 -
Indian Journal of Orthopaedics Jun 2024This study aimed to reach a consensus for ideal surgical treatment of discoid lateral meniscus (DLM) and to evaluate its long term surgical and radiological outcome. (Review)
Review
PURPOSE OF THE STUDY
This study aimed to reach a consensus for ideal surgical treatment of discoid lateral meniscus (DLM) and to evaluate its long term surgical and radiological outcome.
METHODS
All authors independently searched for peer reviewed publications with keywords like discoid lateral meniscus, tibial menisci abnormalities, tibial menisci surgery and clinical outcome and their representative Medical Subjects Headings (MeSH) in databases of PubMed, EBSCO, Cochrane Central Register of Controlled Trials, from inception to December 2022. Original articles in English language on discoid lateral meniscus reporting clinical, surgical, or radiological outcomes with five or more years of follow-up were included in this systematic review. Study details and outcome data were analysed according to the age, follow-up period, kind of surgery, DLM type, and alignment.
RESULTS
Our search strategy yielded 654 articles in PubMed, 222 articles in EBSCO and 5 articles in CENTRAL i.e. a total of 881 articles. After detailed assessment and screening, 12 articles were included in the final analysis, which included 444 DLM cases. The mean patient age at surgery ranged from 9.9 to 35.9 years, and the mean follow-up period ranged from 5.2 to 16 years. Partial meniscectomy and meniscoplasty are the recommended treatment because of the concerns of degenerative arthritis development after the total and subtotal meniscectomies. Two studies have documented better results with meniscal allograft transplantation.
CONCLUSION
Satisfactory clinico-radiological outcome can be obtained after surgical treatment of discoid lateral meniscus with meniscus reshaping and repair of peripheral unstable part. Meniscal allograft transplantation (MAT) is gaining popularity in patients with total meniscectomy with satisfactory long term functional outcome.
PubMed: 38812876
DOI: 10.1007/s43465-024-01137-z -
The Journal of Knee Surgery Jun 2019Although the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young...
Although the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young population. Better evidence regarding the outcomes following traumatic meniscal tears in children would improve our understanding of this increasing pathology and help define important factors in deciding the best treatment option. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines using the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, and MEDLINE PubMed databases. Inclusion criteria were as follows: studies reporting the outcomes of meniscal repair in patients 18 years old or younger, with a minimum mean follow-up of 12 months, Portuguese, Spanish, or English languages, and human studies including 10 or more patients. Our search identified 2,534 individual titles. After application of the inclusion and exclusion criteria, 8 studies were included, evaluating 287 patients with repaired meniscal tears. All eight studies were classified as level of evidence IV. The mean methodological index for nonrandomized studies score was 8.6 ± 1.4. Meniscal repair included all meniscal zones and tear patterns. Anterior cruciate ligament tear was the most common associated injury. The all-inside and inside-out techniques were predominantly reported. The majority of the patients reported good to excellent outcomes and had clinical signals of meniscal healing; meniscectomies following meniscal repair were performed in just 44 cases. In conclusion, meniscal tears in pediatrics are not uncommon. Repairs of this injury were associated with good to excellent outcomes in most patients, regardless of the injury pattern, zone, or technique. Reported complications were minimal; however, higher quality studies are needed to confirm the findings of this systematic review. This is a systematic review study with Level IV.
Topics: Adolescent; Anterior Cruciate Ligament Injuries; Arthroscopy; Child; Humans; Meniscectomy; Patient Outcome Assessment; Tibial Meniscus Injuries; Wound Healing
PubMed: 29791926
DOI: 10.1055/s-0038-1653943 -
Skeletal Radiology Jul 2022Running is among the most popular recreational activities; nonetheless, the acute post-race changes of cartilage or meniscus have rarely been determined. The current... (Review)
Review
Acute changes in knee cartilage and meniscus following long-distance running in habituate runners: a systematic review on studies using quantitative magnetic resonance imaging.
OBJECTIVE
Running is among the most popular recreational activities; nonetheless, the acute post-race changes of cartilage or meniscus have rarely been determined. The current study aimed to review the acute changes in knee cartilage and meniscus among habituate runners following long-distance running detected by using quantitative magnetic resonance imaging (MRI).
MATERIALS AND METHODS
Systematic literature search was performed on those dominate clinical databases which including MEDLINE, Cochrane, Embase, ScienceDirect, and Web of Science. Included studies should be conducted on healthy marathon runners, and the participants should be examined before and after running by using MRI. Intervention studies were excluded.
RESULTS
A total number of 14 studies were finally included in this review which all examined the cartilage or meniscus by using MRI functional sequences. Among them, six studies quantitatively measured the changes regarding volume of the knee cartilage or/and meniscus. Five studies found that the volume would decrease initially after running. Ten studies reported T2 (T2*) would decrease after running and returned to the baseline in a short term, while T1ρ may remain increased in months. Five studies measured subareas for T2 (T2*) value, and found that the superficial and medial subarea changed more vastly than other regions after running.
CONCLUSION
Runners experience transient changes in the volume and signals of knee cartilage and meniscus after long-distance running. A liquid exchange and material interaction in cartilage and meniscus was observed after running. Superficial and medial areas of knee cartilage and meniscus might be more susceptible to mechanical loading.
Topics: Cartilage, Articular; Humans; Knee; Knee Joint; Magnetic Resonance Imaging; Meniscus
PubMed: 34854970
DOI: 10.1007/s00256-021-03943-0