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Sports Medicine (Auckland, N.Z.) Feb 2021Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction.
OBJECTIVE
To identify how peri-articular neuromuscular function changes over time after knee injury and surgery.
DESIGN
Systematic review with meta-analyses.
DATA SOURCES
PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes.
RESULTS
A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries.
CONCLUSIONS
Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42019141850.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Knee Injuries; Knee Joint; Muscle Strength
PubMed: 33247378
DOI: 10.1007/s40279-020-01386-6 -
Knee Surgery, Sports Traumatology,... Jan 2012To determine collagen meniscus implant (CMI) efficacy for improving patient function, symptoms, and activity level. Study methodologies, rehabilitation, and return to... (Review)
Review
PURPOSE
To determine collagen meniscus implant (CMI) efficacy for improving patient function, symptoms, and activity level. Study methodologies, rehabilitation, and return to sports guidelines were also reviewed.
METHODS
MedLine, EMBASE, CINAHL, Life Science Citations, and Cochrane Central Register of Controlled Trials databases were searched from January 1995-May 2011 using the term collagen meniscal or meniscus implant. Only human studies with English language abstracts that reported patient outcomes were included. Modified Coleman Methodology criteria were used to score research quality.
RESULTS
Eleven studies with 520 subjects (men = 428; women = 92; 17.7% women) of 38.2 ± 3.7 years of age met the inclusion criteria. Of these subjects, 321 (men = 263, women = 58; 18.1% women) received a CMI. Based primarily on Lysholm Knee Score, Tegner Activity Scale, pain scales and self-assessment measurements knee function, symptoms, and activity level generally improved by 46.6 ± 39.9 months post-surgery. Rehabilitation was described in 9/11 (81.8%) studies and four released patients to full activities at 6 months post-surgery. No study described how advanced rehabilitation or function testing contributed to return to activity decision-making. Research quality was generally low (67.1 ± 18.6) with widely ranging (29-97) scores. Reduced CMI size at last follow-up was reported in 6/11 (54.5%) studies, but the significance of this finding is unknown.
CONCLUSIONS
Knee function, symptoms, and activity level generally improved following CMI use, but poor research report quality was common. Additional well-designed long-term prospective studies are needed to better determine knee osteoarthrosis prevention efficacy and appropriate patient selection.
Topics: Arthroplasty; Athletic Injuries; Collagen Type I; Guided Tissue Regeneration; Humans; Knee Injuries; Menisci, Tibial; Practice Guidelines as Topic; Recovery of Function; Surgical Mesh; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 21695465
DOI: 10.1007/s00167-011-1579-9 -
CMAJ : Canadian Medical Association... Oct 2014Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arthroscopic surgery for degenerative meniscal tears is a commonly performed procedure, yet the role of conservative treatment for these patients is unclear. This systematic review and meta-analysis evaluates the efficacy of arthroscopic meniscal débridement in patients with knee pain in the setting of mild or no concurrent osteoarthritis of the knee in comparison with nonoperative or sham treatments.
METHODS
We searched MEDLINE, Embase and the Cochrane databases for randomized controlled trials (RCTs) published from 1946 to Jan. 20, 2014. Two reviewers independently screened all titles and abstracts for eligibility. We assessed risk of bias for all included studies and pooled outcomes using a random-effects model. Outcomes (i.e., function and pain relief) were dichotomized to short-term (< 6 mo) and long-term (< 2 yr) data.
RESULTS
Seven RCTs (n = 805 patients) were included in this review. The pooled treatment effect of arthroscopic surgery did not show a significant or minimally important difference (MID) between treatment arms for long-term functional outcomes (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] -0.10 to 0.23). Short-term functional outcomes between groups were significant but did not exceed the threshold for MID (SMD 0.25, 95% CI 0.02 to 0.48). Arthroscopic surgery did not result in a significant improvement in pain scores in the short term (mean difference [MD] 0.20, 95% CI -0.67 to 0.26) or in the long term (MD -0.06, 95% CI -0.28 to 0.15). Statistical heterogeneity was low to moderate for the outcomes.
INTERPRETATION
There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears in comparison with nonoperative or sham treatments in middle-aged patients with mild or no concomitant osteoarthritis. A trial of nonoperative management should be the first-line treatment for such patients.
Topics: Arthroscopy; Humans; Menisci, Tibial; Osteoarthritis, Knee; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 25157057
DOI: 10.1503/cmaj.140433 -
Orthopaedic Journal of Sports Medicine Feb 2017Meniscus damage can be caused by trauma or degeneration and is therefore common among patients of all ages. Repair or regeneration of the menisci could be of great...
BACKGROUND
Meniscus damage can be caused by trauma or degeneration and is therefore common among patients of all ages. Repair or regeneration of the menisci could be of great importance not only for pain relief or regaining function but also to prevent degenerative disease and osteoarthritis. Current treatment does not offer consistent long-term improvement. Although preclinical research focusing on augmentation of meniscal tear repair and regeneration after meniscectomy is encouraging, clinical translation remains difficult.
PURPOSE
To systematically evaluate the literature on in vivo meniscus regeneration and explore the optimal cell sources and conditions for clinical translation. We aimed at thorough evaluation of current evidence as well as clarifying the challenges for future preclinical and clinical studies.
STUDY DESIGN
Systematic review.
METHODS
A search was conducted using the electronic databases of MEDLINE, Embase, and the Cochrane Collaboration. Search terms included , , and .
RESULTS
After screening 81 articles based on title and abstract, 51 articles on in vivo meniscus regeneration could be included; 2 additional articles were identified from the references. Repair and regeneration of the meniscus has been described by intra-articular injection of multipotent mesenchymal stromal (stem) cells from adipose tissue, bone marrow, synovium, or meniscus or the use of these cell types in combination with implantable or injectable scaffolds. The use of fibrochondrocytes, chondrocytes, and transfected myoblasts for meniscus repair and regeneration is limited to the combination with different scaffolds. The comparative in vitro and in vivo studies mentioned in this review indicate that the use of allogeneic cells is as successful as the use of autologous cells. In addition, the implantation or injection of cell-seeded scaffolds increased tissue regeneration and led to better structural organization compared with scaffold implantation or injection of a scaffold alone. None of the studies mentioned in this review compare the effectiveness of different (cell-seeded) scaffolds.
CONCLUSION
There is heterogeneity in animal models, cell types, and scaffolds used, and limited comparative studies are available. The comparative in vivo research that is currently available is insufficient to draw strong conclusions as to which cell type is the most promising. However, there is a vast amount of in vivo research on the use of different types of multipotent mesenchymal stromal (stem) cells in different experimental settings, and good results are reported in terms of tissue formation. None of these studies compare the effectiveness of different cell-scaffold combinations, making it hard to conclude which scaffold has the greatest potential.
PubMed: 28321424
DOI: 10.1177/2325967117690131 -
The Knee Dec 2023Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this... (Review)
Review
BACKGROUND
Meniscus extrusion is crucial for the diagnosis and treatment of meniscal injury, but the literature on this topic has not yet been systematized. The purpose of this systematic review was to compare diagnostic methods and summarize the data of medial and lateral meniscal extrusion in knees with and without osteoarticular pathology.
METHODS
This systematic review was conducted according to the PRISMA 2020 statement. Searches were conducted on PubMed, EMBASE and Cochrane databases to identify studies that measured meniscal extrusion using magnetic resonance imaging (MRI) or ultrasound (US). Meniscal extrusion data was summarized as weighted mean for medial and lateral meniscus, and stratified according to the method of measurement (MRI or US) and presence of knee osteoarticular pathology.
RESULTS
A total of 26 studies were included in this review. Weighted mean values of meniscal extrusion were always higher for the medial than the lateral meniscus, regardless of the method of measurement. The medial meniscus extrusion was always higher in knees with osteoarticular pathology than those without. For the lateral meniscus extrusion, the mean values were higher in those knees without osteoarticular pathology. When classifying pathological meniscal extrusion with pre-defined cut-off values, the higher the cut-off used, the lower the percentage of knees classified as pathological meniscal extrusion.
CONCLUSIONS
The medial meniscus presents on mean higher extrusion and extrusion is higher in knees with osteoarticular pathology. Based on summary data, the most suitable cut-offs for pathological meniscal extrusion for both MRI and US seem to fall within >2 and >3 mm.
Topics: Humans; Knee Joint; Menisci, Tibial; Magnetic Resonance Imaging; Lower Extremity
PubMed: 37925806
DOI: 10.1016/j.knee.2023.09.010 -
The Knee Oct 2022Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics... (Review)
Review
BACKGROUND
Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics affect meniscal microvascularization and provide a structured overview of angiogenic therapies that influence meniscal neovascularization.
METHODS
A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane library and Emcare from inception to November 2021. Studies reporting on (1) Patient characteristics that affect meniscal microvascularization, or (2) Therapies that induce neovascularization in meniscal tissue were included. Studies were graded in quality using the Anatomical Quality Assessment (AQUA) tool. The study was registered with PROSPERO(ID:CRD42021242479).
RESULTS
Thirteen studies reported on patient characteristics and eleven on angiogenic therapies. The influence of Age, Degenerative knee, Gender, and Race was reported. Age is the most studied factor. The entire meniscus is vascularized around birth. With increasing age, vascularization decreases from the inner to the peripheral margin. Around 11 years, blood vessels are primarily located in the peripheral third of the menisci. There seems to be a further decrease in vascularization with increasing age in adults, yet conflicting literature exists. Degenerative changes of the knee also seem to influence meniscal vascularization, but evidence is limited. Angiogenic therapies to improve meniscal vascularization have only been studied in preclinical setting. The use of synovial flap transplantation, stem cell therapy, vascular endothelial growth factor, and angiogenin has shown promising results.
CONCLUSION
To decrease failure rates of meniscal repair, a better understanding of patient-specific vascular anatomy is essential. Translational clinical research is needed to investigate the clinical value of angiogenic therapies.
Topics: Adult; Humans; Meniscectomy; Menisci, Tibial; Meniscus; Microvessels; Tibial Meniscus Injuries; Vascular Endothelial Growth Factor A
PubMed: 35964436
DOI: 10.1016/j.knee.2022.07.007 -
Current Stem Cell Research & Therapy May 2013Meniscal injuries are among the common sports injuries and their natural healing is limited. Removal of injured meniscus impairs normal knee function and predisposes... (Meta-Analysis)
Meta-Analysis Review
Meniscal injuries are among the common sports injuries and their natural healing is limited. Removal of injured meniscus impairs normal knee function and predisposes patients to osteoarthritis. Tissue engineering and replacement strategies provide a novel approach for the treatment of severe meniscus injury. The aim of this article is to review preclinical studies that used approaches for meniscal replacement including growth factors, synthetic and tissue engineered scaffolds and non-meniscal autografts. Medline, EMBASE and UK PubMed search was performed and articles were assessed for inclusion. Included articles were summarised and categorised. Forty seven articles matched the inclusion criteria.The studies were classified according to the approaches used for meniscus replacement. Overall most experiments have shown good tissue integration and biochemical properties of the regenerated tissues. However, only few approaches have demonstrated satisfactory chondroprotective function.
Topics: Humans; Menisci, Tibial; Models, Biological; Tissue Engineering; Tissue Scaffolds; Transplantation, Autologous
PubMed: 23317472
DOI: 10.2174/1574888x11308030008 -
Arthroscopy : the Journal of... Nov 2014Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty... (Review)
Review
PURPOSE
Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty performing the repair, potential suture failure due to mechanical stresses, and poor healing rates. In addition, many surgeons have the perception that debriding the tear until the superior and inferior laminae are stable results in a good clinical outcome. Furthermore, many of the tears occur in patients who are older than the generally accepted indicated age for repair and may also have a degenerative component, making them potentially less likely to benefit from repair. This review was performed to evaluate the published outcomes of HCT repairs and test the hypothesis that surgically repaired HCTs have an unacceptably low rate of success.
METHODS
A systematic search of the PubMed and Embase databases was performed in December 2013 to identify studies in which meniscal HCTs were repaired. Inclusion criteria for the analysis were English language, reference to a patient with an HCT repaired by any method, and a report of at least 1 postoperative outcome. For the purposes of this review, a failed outcome was defined as the need for reoperation.
RESULTS
More than 16,000 abstracts were returned in the search. From these abstracts, we identified 210 articles for further review, of which 9 met the inclusion criteria. A total of 98 repairs of horizontal tears were evaluated in these studies. By use of reoperation as the criterion for treatment failure, 77 of the repairs were successful, for an overall success rate of 77.8%.
CONCLUSIONS
The literature does not support the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. Rather, our results show that existing studies of repaired HCTs show a comparable success rate to repairs of other types of meniscal tears.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
Topics: Adult; Age Factors; Aged; Arthroscopy; Female; Humans; Male; Middle Aged; Reoperation; Rupture; Sutures; Tibial Meniscus Injuries; Treatment Outcome; Wound Healing
PubMed: 25108905
DOI: 10.1016/j.arthro.2014.05.038 -
Sports Health 2018With the rise in sports participation and increased athleticism in the adolescent population, there is an ever-growing need to better understand adolescent meniscus... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
With the rise in sports participation and increased athleticism in the adolescent population, there is an ever-growing need to better understand adolescent meniscus pathology and treatment.
OBJECTIVE
To better understand the operative management of meniscus tears in the adolescent population.
DATA SOURCES
A systematic review of PubMed (MEDLINE) and Google Scholar was performed for all archived years.
STUDY SELECTION
Studies that reported on isolated meniscus tears in adolescent patients (age, 10-19 years) were included.
STUDY DESIGN
Systematic review and meta-analysis.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Two authors reviewed and extracted data from studies that fulfilled all inclusion criteria.
RESULTS
Nine studies on isolated meniscus tears in adolescent patients were found, with level of evidence ranging from 3 to 4. These studies evaluated a total of 373 patients (248 males, 125 females) and 390 knees. Seven studies were published between 1979 and 2000, all of which discuss meniscectomy as the primary treatment. Two studies were published after 2000 and report on meniscus repair surgery. The mean patient age was 14.4 years. A total of 308 meniscectomies and 64 meniscus repairs were performed. Follow-up ranged from 1.8 to 30 years (mean, 10.8 years). A 37% retear rate was reported for patients undergoing meniscus repair. Different outcome measures were used for meniscectomy versus meniscus repair. Three studies evaluating meniscectomy reported Tapper-Hoover scores, showing 54 patients with an excellent result, 58 with good, 57 with fair, and 23 with poor results.
CONCLUSION
A shift in the management of isolated adolescent meniscal tears is reflected in the literature, with a recent increase in operative repair. This is likely secondary to poor outcomes after meniscectomy reflected in long-term follow-up studies. The current literature highlights the need for improved description of tear patterns, standardized reporting of outcome measures, and improved study methodologies to help guide orthopaedic surgeons on operative treatment of meniscal tears in adolescent patients.
Topics: Adolescent; Athletic Injuries; Child; Female; Humans; Male; Meniscectomy; Tibial Meniscus Injuries; Treatment Outcome; Young Adult
PubMed: 29648924
DOI: 10.1177/1941738118768201 -
Arthroscopy : the Journal of... Feb 2024To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature. (Review)
Review
Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review.
PURPOSE
To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature.
METHODS
A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means.
RESULTS
The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from -2.4 to -0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and -0.9 to -0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from -0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias.
CONCLUSIONS
The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II-IV studies.
PubMed: 38401664
DOI: 10.1016/j.arthro.2024.02.017