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Arthroscopy, Sports Medicine, and... Apr 2024To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP). (Review)
Review
PURPOSE
To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP).
METHODS
A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP.
RESULTS
A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment.
CONCLUSIONS
The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
PubMed: 38525288
DOI: 10.1016/j.asmr.2024.100916 -
Arthroscopy : the Journal of... Mar 2024To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects. (Review)
Review
PURPOSE
To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects.
METHODS
A search was performed by 3 independent reviewers on PubMed, MEDLINE, EMBASE, and Cochrane from 2016 to June 18, 2023, with the term "meniscus" with all the following terms: "scaffolds," "constructs," "implant," and "tissue engineering." Inclusion criteria included "Clinical trials" and "English language articles" that involved isolated meniscus tissue engineering strategies for meniscus injuries. Only Level I to IV clinical studies were considered. The modified Coleman Methodology score was used for quality analysis of included clinical trials. The Methodological Index for Non-Randomized Studies was employed for analysis of the risk of study bias and methodological quality.
RESULTS
The search identified 2,280 articles, and finally 19 original clinical trials meeting the inclusion criteria were included. Three types of tissue-engineered meniscus implants (CMI-Menaflex, Actifit, and NUsurface) have been clinically evaluated for meniscus reconstruction. Lack of standardized outcome measures and imaging protocols limits comparison between studies.
CONCLUSIONS
Tissue-engineered meniscus implants can provide short-term knee symptom and function improvements, but no implants have been shown to propose significant long-term benefits for meniscus defects.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I to IV studies.
Topics: Humans; Tissue Engineering; Menisci, Tibial; Meniscus; Knee Joint; Prostheses and Implants
PubMed: 37414105
DOI: 10.1016/j.arthro.2023.06.043 -
The Knee Oct 2023To critically evaluate the efficacy and safety of early versus delayed anterior cruciate ligament reconstruction (ACLR) for anterior cruciate ligament (ACL) injuries... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To critically evaluate the efficacy and safety of early versus delayed anterior cruciate ligament reconstruction (ACLR) for anterior cruciate ligament (ACL) injuries based on the different cut-off values of the timing of operation.
METHODS
PubMed, Medline, Embase, Cochrane library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang Digital Periodical database were searched from inception to November 2022 without language restrictions. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing early ACLR with delayed ACLR for ACL injuries were included.
RESULTS
Twenty-four studies (10 RCTs and 14 CSs) were included. According to the information from included studies, 3 weeks, 4 weeks, 6 weeks, 6 months, and 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR. When 4 weeks were considered as the cut-off value, early ACLR could significantly improve Lysholm score, IKDC score and VAS score at 6 and 12 months postoperatively and decrease the incidence of adverse events compared with delayed ACLR (P < 0.05). However, no statistically significant difference in positive rate of Lachman test and incidence of meniscus injuries and chondral lesions between the two groups when 3 weeks, 6 weeks, 6 months or 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR (P > 0.05).
CONCLUSION
The present study suggests that early ACLR, especially conducted within 3-4 weeks after ACL injuries, may be more effective for improving knee function and relieving pain compared with delayed ACLR. More high-quality RCTs are warranted.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Knee Joint; Meniscus; Randomized Controlled Trials as Topic
PubMed: 37517167
DOI: 10.1016/j.knee.2023.07.008 -
The Journal of Bone and Joint Surgery.... Jul 2022The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.
METHODS
We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.
RESULTS
A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).
CONCLUSIONS
Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35856932
DOI: 10.2106/JBJS.21.01303 -
The Knee Jun 2021Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more...
BACKGROUND
Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role.
METHODS
A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation.
RESULTS
Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week.
CONCLUSION
Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
Topics: Bibliometrics; Female; Humans; Male; Menisci, Tibial; Tibia
PubMed: 33945980
DOI: 10.1016/j.knee.2021.04.006 -
Arthroscopy : the Journal of... May 2015The purpose of this study was to evaluate the clinical and structural outcomes after resorbable collagen meniscus scaffold implantation through a systematic review of... (Review)
Review
PURPOSE
The purpose of this study was to evaluate the clinical and structural outcomes after resorbable collagen meniscus scaffold implantation through a systematic review of the published literature.
METHODS
A systematic search of both the PubMed and Embase databases was undertaken to identify all studies that reported clinical and/or structural outcomes after resorbable collagen meniscus scaffold implantation for the treatment of defects involving either the medial or lateral meniscus. Extracted data included study characteristics; surgical methods and rehabilitation protocols; objective outcomes; and preoperative and postoperative subjective outcome scores including Lysholm, Tegner, International Knee Documentation Committee, and visual analog scale scores.
RESULTS
Thirteen studies were included in this review. There were 10 Level IV studies, 2 Level II studies, and 1 Level I study with follow-up intervals ranging from 3 months to 12.5 years. With a few exceptions, the study designs used in each study generally followed those which had been previously performed. Substantial differences in rehabilitation protocols and concomitant procedures were noted that may have had an effect on overall clinical outcomes. Objective findings were mostly consistent and typically showed minimal degenerative changes on postoperative radiographs, decreased signal intensity of the scaffold over time on magnetic resonance imaging, the presence of meniscus-like tissue at second-look arthroscopy, and good integration of new tissue as evidenced by histologic analysis of biopsy specimens. Most studies reported satisfactory clinical outcomes, and most patients showed substantial improvements in comparison with mean preoperative baseline values.
CONCLUSIONS
On the basis of this systematic review, implantation of resorbable collagen scaffolds for the treatment of meniscus defects provides satisfactory clinical and structural outcomes in most cases. There is evidence that collagen meniscus scaffold implantation provides superior clinical outcomes when compared with partial meniscectomy alone.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I, II, and IV studies.
Topics: Absorbable Implants; Collagen Type I; Humans; Lysholm Knee Score; Menisci, Tibial; Patient Outcome Assessment; Regeneration; Tissue Scaffolds; Visual Analog Scale
PubMed: 25595693
DOI: 10.1016/j.arthro.2014.11.019 -
Knee Surgery, Sports Traumatology,... Jul 2018To determine sports activities achieved after meniscus transplantation and if associations exist between sports activity levels and transplant failure or progression of... (Review)
Review
PURPOSE
To determine sports activities achieved after meniscus transplantation and if associations exist between sports activity levels and transplant failure or progression of tibiofemoral osteoarthritis (OA).
METHODS
A systematic search was performed using PubMed and Cochrane online databases. Inclusionary criteria were English language, clinical trials published from 1996 through May 2017, minimum 2 years of follow-up, and sports activity data reported.
RESULTS
Twenty-eight studies were included in which 1521 menisci were implanted into 1497 patients. The mean age was 34.3 ± 6.7 years, and the mean follow-up was 5.0 ± 3.7 years. Details on sports activities were provided in 7 studies (285 patients) that reported 70-92% of patients returned to a wide variety of sports activities. Mean Tegner activity scores were reported in 24 investigations. The mean score was <5 in 58% of these studies, indicating many patients were participating in light recreational activities. There was no association between mean Tegner scores and transplant failure rates. A moderate correlation was found between failure rates and mean follow-up time (R = 0.63). The effect of sports activity levels on progression of tibiofemoral OA could not be determined because of limited data. Only two studies determined whether symptoms occurred during sports activities; these reported 1/38 (3%) and 5/69 (7%) patients had knee-related problems.
CONCLUSIONS
It appeared that the majority of individuals returned to low-impact athletic activities after meniscus transplantation. The short-term follow-up did not allow for an analysis on the effect of return to high-impact activities on transplant failure rates or progression of OA.
LEVEL OF EVIDENCE
IV.
Topics: Follow-Up Studies; Humans; Menisci, Tibial; Meniscus; Return to Sport; Sports; Tibial Meniscus Injuries
PubMed: 28752186
DOI: 10.1007/s00167-017-4658-8 -
Journal of Orthopaedic Surgery (Hong... 2021To report of efficacy repair treatment for meniscus posterior root tears repair. (Meta-Analysis)
Meta-Analysis
PURPOSE
To report of efficacy repair treatment for meniscus posterior root tears repair.
METHODS
We systematically searched databases including PubMed, Embase, and Cochrane Library for relevant articles. Coleman Methodology Score was used for a quality assessment of the included studies. A meta-analysis was performed to analyze for efficacy of MMPRTs repair.
RESULTS
Twenty-two studies, 14 level III and 8 level IV, were included in this systematic review, with a total of 926 cases. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower progression of Kellgrene-Lawrence grade with meniscal repair. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. As treatment efficacy, the Lysholm score increased 28.87 (P < 0.001), IKDC score increased 31.73. The overall pooled event rates of progression of K-L grade is 0.200. Difference of Lysholm score and IKDC score between repair and meniscectomy were 8.72 and 9.67.
CONCLUSIONS
The clinical subjective score after MMPRT repair was significantly improved compared with the preoperative status. Considering the progression of joint K-L grade, it can prevent the progression of arthrosis to some extent, but not completely. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. Based on these results, MMPRTs repair cloud result favorable outcomes.
Topics: Arthroscopy; Humans; Joint Diseases; Meniscectomy; Meniscus; Osteoarthritis; Prognosis; Plastic Surgery Procedures; Retrospective Studies; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 33832364
DOI: 10.1177/23094990211003350 -
Clinical Orthopaedics and Related... Feb 2007Magnetic resonance imaging (MRI) and clinical examination are tools commonly used in the diagnosis of meniscus tears. It has been suggested routine MRI before... (Review)
Review
Magnetic resonance imaging (MRI) and clinical examination are tools commonly used in the diagnosis of meniscus tears. It has been suggested routine MRI before therapeutic arthroscopy for clinically diagnosed meniscus tears will reduce the number and cost of unnecessary invasive procedures. We designed a systematic review of prospective cohort studies comparing MRI and clinical examination to arthroscopy to diagnosis meniscus tears. Thirty-two relevant studies were identified by a literature review. Careful evaluation by an experienced examiner identifies patients with surgically treatable meniscus lesions with equal or better reliability than MRI. MRI is superior when indications for arthroscopy are solely diagnostic. However, the methods by which such a clinician arrives at a conclusion have not been identified. To create an evidence-based algorithm for the diagnosis of a meniscus tear future investigations should prospectively assess the value of commonly used aspects of the patient history and meniscus tests. MRI is useful, but should be reserved for situations in which an experienced clinician requires further information before arriving at a diagnosis. Indications for arthroscopy should be therapeutic, not diagnostic in nature.
Topics: Arthroscopy; Humans; Knee Injuries; Magnetic Resonance Imaging; Physical Examination; Sensitivity and Specificity; Tibial Meniscus Injuries
PubMed: 17279041
DOI: 10.1097/BLO.0b013e31802fb9f3 -
Archives of Orthopaedic and Trauma... Jun 2019The purpose of this systematic review and meta-analysis was to analyze and compare the rate of secondary meniscus and cartilage lesions diagnosed at different time... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The purpose of this systematic review and meta-analysis was to analyze and compare the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction.
MATERIALS AND METHODS
A systematic search for articles comparing the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction was performed. PubMed central was the database used for the literature review.
RESULTS
Forty articles out of 1836 were included. In 35 trials (88%), there was evidence of a positive correlation between the rate of meniscus and/or cartilage lesions and the time since ACL injury. This correlation was more evident for the medial meniscus in comparison with the lateral meniscus. In particular, a delay of more than 6 months was critical for secondary medial meniscus injuries [risk ratio 0.58 (95% CI 0.44-0.79)] and a delay of more than 12 months was critical for cartilage injuries [risk ratio 0.42 (95% CI 0.29-0.59)]. Additionally, there is evidence that the chance for meniscal repair decreases as the time since ACL rupture increases.
CONCLUSION
Chronic instability in the ACL-deficient knee is associated with a significant increase of medial meniscus injuries after 6 months followed by a significant increase of cartilage lesions after 12 months.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Reconstruction; Cartilage Diseases; Humans; Menisci, Tibial; Postoperative Complications; Prevalence; Tibial Meniscus Injuries
PubMed: 30758661
DOI: 10.1007/s00402-019-03128-4