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The American Journal of Sports Medicine Feb 2021
Topics: Humans; Knee Injuries; Meniscectomy; Menisci, Tibial; Rupture; Tibial Meniscus Injuries
PubMed: 33523754
DOI: 10.1177/0363546520979962 -
Archives of Orthopaedic and Trauma... Nov 2022Meniscal allografts are a preferred alternative to menisectomy in cases of irrepairable meniscal tears in young patients. Biological meniscal allograft transplantation...
PURPOSE
Meniscal allografts are a preferred alternative to menisectomy in cases of irrepairable meniscal tears in young patients. Biological meniscal allograft transplantation requires a cadaveric donor, limiting its availability for transplantation. We are exploring the possibility of using contralateral lateral meniscus for medial meniscal allograft transplantation, as it can be easily procured from proximal tibial cuts from total knee replacement.
METHODS
Ten paired knees from five formalin-fixed Indian male cadavers were dissected. Outer and inner circumferences of the medial and meniscus, area of the articular surface of the medial tibial plateau covered by the native medial meniscus and transplanted lateral meniscus were noted. Measurements were taken using software ImageJ (National Institute of Health). The mean of the recordings from two independent observers was taken as the final value. Inter-observer and intra-observer reliability were also calculated.
RESULTS
The mean inner circumference of the medial meniscus was significantly larger than the lateral meniscus (p < 0.0001). However, outer circumferences were not significantly different from each other (p = 0.1). Area of the tibial plateau covered by the native medial meniscus was smaller than the area covered by the transplanted lateral meniscus, though the difference was not statistically significant. Inter-observer reliability and intra-observer reliability were good (ICC 0.904 and 0.927, respectively).
CONCLUSION
Based on measurements of the outer circumference of medial and lateral menisci, lateral meniscal allograft can be matched for transplantation on the contralateral medial side from the donor with same dimensions of the tibial plateau. Further clinical studies are necessary to prove the clinical significance of this cadaveric study.
LEVEL OF EVIDENCE
Diagnostic study.
Topics: Allografts; Cadaver; Formaldehyde; Humans; Male; Menisci, Tibial; Reproducibility of Results
PubMed: 33890130
DOI: 10.1007/s00402-021-03910-3 -
The American Journal of Sports Medicine Dec 2014Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint... (Review)
Review
Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments.
Topics: Algorithms; Arthroscopy; Biomechanical Phenomena; Decision Making; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Menisci, Tibial; Patient Outcome Assessment; Physical Examination; Postoperative Care; Postoperative Complications; Suture Anchors; Suture Techniques; Tibial Meniscus Injuries
PubMed: 24623276
DOI: 10.1177/0363546514524162 -
Sports Medicine and Arthroscopy Review Jun 2012Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as... (Review)
Review
Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes.
Topics: Arthroscopy; Humans; Menisci, Tibial; Patient Selection; Postoperative Care; Radiography; Tibial Meniscus Injuries
PubMed: 22555205
DOI: 10.1097/JSA.0b013e31825186ca -
The American Journal of Sports Medicine Apr 2023The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series.
BACKGROUND
The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series.
PURPOSE/HYPOTHESIS
Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. We hypothesized that symptoms and signs, arthroscopic findings, surgical treatments, and outcomes are similar to those for symptomatic discoid lateral menisci.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A retrospective review identified patients with a diagnosed discoid medial meniscus confirmed at surgery across 8 children's hospitals between January 2000 and June 2021. The literature on discoid lateral menisci was reviewed and summarized for comparison.
RESULTS
A total of 21 patients (9 female, 12 male) with 22 discoid medial menisci were identified. The mean ± SD age at the time of diagnosis was 12.8 ± 3.8 years. The most common symptoms and signs were locking and/or clunking, present in 12 of 22 knees (55%), similar to that reported in patients with discoid lateral menisci. Twelve discoid medial menisci were complete (55%); 8, incomplete (36%); and 2, indeterminate (9%). Tears were present in 13 knees, most commonly horizontal cleavage (54%). Five discoid medial menisci were unstable (23%): 3 for posterior tears and 2 for rim insufficiency. All 22 knees underwent arthroscopic saucerization, and of the 13 torn menisci, 7 (54%) were repaired. The median follow-up was 24 months (range, 2-82 months). Four knees underwent reoperation. All knees that required reoperation had undergone repair for a posteriorly located tear. There was a significant association between operative repair and need for reoperation ( = .0048). High rates of peripheral instability were also noted in case series of patients with discoid lateral menisci.
CONCLUSION
Patient presentations and treatments for those with discoid medial menisci were similar to those reported for patients with discoid lateral menisci. Knees with discoid medial menisci also demonstrated instability attributed to peripheral insufficiency and posterior tears. Tears were present in over half of knees with discoid medial menisci, and reoperation was more common in knees that underwent repair of tears than those without repair.
Topics: Humans; Child; Male; Female; Adolescent; Menisci, Tibial; Arthroscopy; Knee Joint; Joint Diseases; Rupture; Retrospective Studies
PubMed: 36876853
DOI: 10.1177/03635465231159671 -
BMC Musculoskeletal Disorders Dec 2022Many surgeries have not reversed or prevented progressive symptomatic knee arthritis, and there is no consensus regarding the ideal repair or reconstruction technique...
BACKGROUND
Many surgeries have not reversed or prevented progressive symptomatic knee arthritis, and there is no consensus regarding the ideal repair or reconstruction technique for meniscal root treatment. Additionally, there is a lack of studies comparing the clinical efficacy evaluation of different repair techniques. The aim of the present study is to compare the clinical efficacy and healing rates of meniscus root in the treatment of medial meniscus posterior root tear (MMPRT) with the arthroscopically assisted meniscus root reconstruction with gracilis autograft and transtibial pull-out technique.
METHODS
Patients with MMPRT (type II) who received treatment of posterior meniscus root attachment point through the tibial tunnel between January 2018 and April 2019 were included in this study. Patients were divided into 2 groups (arthroscopically assisted gracilis autograft reconstruction technique: 29 cases; transtibial pull-out technique group: 35 cases) according to the different treatment methods. The mean follow-up period was 26.9 ± 2.3 months. The demographics, functional recovery of the knee, and meniscus root healing rates (assessed using knee magnetic resonance imaging (MRI) at the final follow-up) were compared between the two groups.
RESULTS
There was a statistically significant improvement in the Lysholm score, international knee documentation committee (IKDC) score, and visual analogue scale (VAS) score (P < 0.001 in both groups). Additionally, compared with the transtibial pull-out repair group, the arthroscopically assisted reconstruction with gracilis autograft showed significant improvement in the meniscus root healing rates, Lysholm score, and IKDC score at the end of follow-up (P < 0.05).
CONCLUSIONS
Compared with the transtibial pull-out technique, the arthroscopically assisted meniscus root reconstruction with gracilis autograft was advantageous for treating these patients with superior clinical outcome and higher meniscus root healing rates.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Menisci, Tibial; Tibial Meniscus Injuries; Autografts; Arthroscopy; Retrospective Studies; Rupture; Patient Reported Outcome Measures; Magnetic Resonance Imaging
PubMed: 36517773
DOI: 10.1186/s12891-022-06067-1 -
The Knee Aug 2021Risk factors for the progression of spontaneous osteonecrosis of the knee (SONK) remain unclear. The purpose of this study was to investigate the association between...
BACKGROUND
Risk factors for the progression of spontaneous osteonecrosis of the knee (SONK) remain unclear. The purpose of this study was to investigate the association between magnetic resonance imaging (MRI) findings of the meniscus and the prognosis of SONK.
METHODS
A total of 78 consecutive patients (female 85%; mean age 75.6 ± 7.2 years old) diagnosed with SONK were included. Of these, 30 patients did not receive surgery within 1 year from the onset of SONK (conservative group), while the remaining 48 patients underwent unicompartmental knee arthroplasty due to worsening of symptoms (UKA group). Using MRI findings obtained within 3 months of the onset, we compared the types of meniscus tear and medial meniscus extrusion between the conservative group and UKA group. We performed a receiver operating characteristics (ROC) analysis to estimate the cut-off value.
RESULTS
Patients in the UKA group showed greater medial meniscus extrusion (absolute value, 4.2 mm ± 1.9 vs. 2.8 mm ± 1.2, P = 0.001; relative percentage of extrusion (RPE), 45.7% ± 21.5 vs. 30.7% ± 12.9, P = 0.001) and a higher prevalence of radial tear (P = 0.021) than those in the conservative group. In the multivariate analysis, RPE remained a relevant independent factor (P = 0.035) for future UKA. An ROC analysis found that the cut-off point of RPE was 33% (sensitivity, 81.2%; specificity, 63.3%).
CONCLUSION
RPE was a predictor of the prognosis of patients who underwent UKA within 1 year after the onset of SONK. Our results suggest that patients with RPE ≥ 33% are at high risk for progression.
Topics: Aged; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Menisci, Tibial; Osteonecrosis; Prognosis; Retrospective Studies
PubMed: 34214956
DOI: 10.1016/j.knee.2021.06.003 -
Radiologie (Heidelberg, Germany) Apr 2024Meniscus tears are classified as horizontal, longitudinal, radial, and complex tears. Flap tears are a specific form in which a portion of the meniscus is displaced... (Review)
Review
Meniscus tears are classified as horizontal, longitudinal, radial, and complex tears. Flap tears are a specific form in which a portion of the meniscus is displaced from a horizontal or longitudinal tear. The question of whether it is possible to preserve the meniscus by meniscus repair is of crucial therapeutic importance. It is therefore important to specify not only the configuration of the tear but also its extent and location as precisely as possible. Cooper's zonal classification should also be used for this purpose. Lesions of the meniscus roots are of high clinical relevance. On the posterior horn of the medial meniscus, root lesions are usually degenerative; on the posterior horn of the lateral meniscus, they are often traumatic. It is important to familiarize oneself with the normal appearance and anatomical location of the meniscal roots. Ramp lesions have received particular attention in recent years, especially in patients with anterior cruciate ligament tears. Therefore, particularly the integrity of the attachment of the posterior horn of the medial meniscus to the tibial plateau must be analyzed. If the meniscotibial ligament tears along its course or at the insertion to the meniscus or if it avulses with a meniscus fragment, this is a ramp lesion.
Topics: Humans; Arthroscopy; Menisci, Tibial; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia
PubMed: 38519603
DOI: 10.1007/s00117-024-01294-0 -
JBJS Case Connector 2019A 21-year-old college soccer player suffered from knee joint pain, but neither preoperative clinical examination nor magnetic resonance imaging could detect a precise...
CASE
A 21-year-old college soccer player suffered from knee joint pain, but neither preoperative clinical examination nor magnetic resonance imaging could detect a precise diagnosis. Arthroscopy showed that medial meniscus hypermobility led to impingement of the femorotibial joint surface. After inside-to-outside meniscus suture, the abnormal hypermobility could no longer be observed. The player returned to sports without any previously experienced symptoms.
CONCLUSIONS
We present a case report of the hypermobile medial meniscus without substantial tear treated by meniscal suture. A careful arthroscopy inspection was the key element of the diagnosis and subsequent successful surgical treatment.
Topics: Arthroscopy; Humans; Joint Instability; Male; Menisci, Tibial; Young Adult
PubMed: 31339865
DOI: 10.2106/JBJS.CC.18.00216 -
Biomechanics and Modeling in... Dec 2020The altered biomechanical function of the knee following partial meniscectomy results in ongoing articular cartilage overload, which may lead to progressive...
The altered biomechanical function of the knee following partial meniscectomy results in ongoing articular cartilage overload, which may lead to progressive osteoarthritis (OA). An artificial medial meniscus implant (NUsurface Meniscus Implant, Active Implants LLC., Memphis, TN, USA) was developed to mimic the native meniscus and may provide an effective long-term solution for OA patients, alleviate pain, and restore joint function. The goal of the current study was to investigate the potential effect of an artificial medial meniscus implant on the function of the lateral compartment of the knee and on the potential alterations in load distribution between the two compartments under static axial loading, using advanced piezo-resistive sensors. We used an integrated in situ/in vivo experimental approach combining contact pressure measurements of cadaveric knees with MRI joint space measurements of 72 mild OA patients. We employed this integrated approach to evaluate the mechanical consequences in both the medial (treated) and lateral knee compartments of two levels of meniscectomy and implantation of an artificial meniscus implant. Partial and subtotal meniscectomies of the medial meniscus resulted in statistically significant decrease in contact areas (p = 0.008 and p < 0.0001, respectively) and increased contact pressures in the medial compartment; however, implantation of the artificial meniscus implant restored the average contact pressure to 93 ± 14% of its pre-meniscectomy, intact value. Additionally, we found that neither the two different grades of medial meniscectomies, nor implantation of the artificial medial meniscus implant affected the lateral compartment of the knee. The MRI data from the patient cohort facilitated the integration of real-life clinical results together with the laboratory measurements from our cadaveric study, as these two approaches complement each other. We conclude that the use of the artificial medial meniscus implant may re-establish normal load distribution across the articulating surfaces of the medial compartment and not increase loading across the lateral knee compartment.
Topics: Adult; Biomechanical Phenomena; Cadaver; Cartilage, Articular; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Meniscectomy; Menisci, Tibial; Middle Aged; Osteoarthritis, Knee; Pressure; Prostheses and Implants; Prosthesis Design; Range of Motion, Articular; Stress, Mechanical; Tibia; Weight-Bearing
PubMed: 32236747
DOI: 10.1007/s10237-020-01323-6