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Knee Surgery, Sports Traumatology,... Jun 2024To elucidate the features of bone cysts at attachment sites of medial meniscus posterior root tears (MMPRTs).
PURPOSE
To elucidate the features of bone cysts at attachment sites of medial meniscus posterior root tears (MMPRTs).
METHODS
Knees treated using arthroscopic surgery for MMPRT between 2015 and 2022 were retrospectively reviewed. Patients without a memory of onset (painful popping), prior knee surgeries, concomitant ligament or meniscus injuries or fractures were excluded. Duration from onset to magnetic resonance imaging (MRI) and type of tear were evaluated during arthroscopy. On radiography, meniscus signs (cleft/ghost/giraffe neck), bone cysts at the attachment site of the MMPRT and posterior shiny-corner lesions (PSCLs; bone marrow lesions on the meniscal-covered portion of the posterior tibial plateau) were evaluated. The sensitivity and specificity of the bone cysts were assessed by comparison with matched patients who underwent arthroscopic surgery for medial meniscus posterior horn tear. In addition, subgroups (cyst-positive/cyst-negative) among patients with MMPRT were created to assess the features of bone cysts.
RESULTS
A total of 275 patients with MMPRT and 275 matched patients with posterior horn tears were evaluated. The sensitivity and specificity of bone cysts for MMPRT in this study were 22.2% and 98.6%, respectively. Among the 275 knees with MMPRT, compared with the cyst-negative group, the cyst-positive group had a longer duration from onset to MRI (12.9 ± 13.1 vs. 8.3 ± 10.9 weeks, respectively, p = 0.025) and reduced occurrence of PSCLs (18.0% vs. 42.0%, respectively, p = 0.031).
CONCLUSION
The occurrence of bone cysts at the attachment site was helpful for the accurate diagnosis of MMPRT and related to longer duration from onset to MRI and reduced PSCLs.
LEVEL OF EVIDENCE
Level III, cross-sectional study.
PubMed: 38932618
DOI: 10.1002/ksa.12338 -
International Journal of Molecular... Jun 2024Investigate meniscal extracellular matrix degradation. Equine menisci ( = 34 from 17 horses) were studied. Site-matched sections were cut and scored from three regions...
Investigate meniscal extracellular matrix degradation. Equine menisci ( = 34 from 17 horses) were studied. Site-matched sections were cut and scored from three regions (ROIs; = 102) and stained for histology, proteoglycan (safranin O and fast green), aggrecan, and collagen cleavage (NITEGE, DIPEN, and C1,2C antibodies, respectively). Picrosirius red and second harmonic generation microscopy were performed to investigate collagen ultrastructure. A total of 42 ROIs met the inclusion criteria and were included in the final analysis. The median (range) ROI histological score was 3 (0-9), providing a large spectrum of pathology. The median (range) proteoglycan score was 1 (0-3), representing superficial and central meniscal loss. The median (range) of DIPEN, NITEGE, and C1,2C scores was 1 (0-3), revealing immunostaining of the femoral and tibial surfaces. The proteoglycan scores exhibited significant positive associations with both histologic evaluation ( = 0.03) and DIPEN scores ( = 0.02). Additionally, a robust positive association ( = 0.007) was observed between the two aggrecanolysis indicators, NITEGE and DIPEN scores. A negative association ( = 0.008) was identified between NITEGE and histological scores. The C1,2C scores were not associated with any other scores. Picrosirius red and second harmonic generation microscopy (SHGM) illustrated the loss of the collagen matrix and structure centrally. Proteoglycan and collagen degradation commonly occur superficially in menisci and less frequently centrally. The identification of central meniscal proteoglycan and collagen degradation provides novel insight into central meniscal degeneration. However, further research is needed to elucidate the etiology and sequence of degradative events.
Topics: Animals; Horses; Proteoglycans; Collagen; Meniscus; Aggrecans; Extracellular Matrix; Proteolysis; Menisci, Tibial
PubMed: 38928148
DOI: 10.3390/ijms25126439 -
BMC Musculoskeletal Disorders Jun 2024While risk factors for osteoarthritis (OA) are well known, it is not well understood why certain individuals maintain high mobility and joint health throughout their...
OBJECTIVE
While risk factors for osteoarthritis (OA) are well known, it is not well understood why certain individuals maintain high mobility and joint health throughout their life while others demonstrate OA at older ages. The purpose of this study was to assess which demographic, clinical and MRI quantitative and semi-quantitative factors are associated with preserving healthy knees in older individuals.
METHODS
This study analyzed data from the OA Initiative (OAI) cohort of individuals at the age of 65 years or above. Participants without OA at baseline (BL) (Kellgren-Lawrence (KL) ≤ 1) were followed and classified as incident cases (KL ≥ 2 during follow-up; n = 115) and as non-incident (KL ≤ 1 over 96-month; n = 391). Associations between the predictor-variables sex, age, BMI, race, clinical scoring systems, T relaxation times and Whole-Organ Magnetic Resonance Imaging-Score (WORMS) readings at BL and the preservation of healthy knees (KL ≤ 1) during a 96-month follow-up period were assessed using logistic regression models.
RESULTS
Obesity and presence of pain showed a significant inverse association with maintaining radiographically normal joints in patients aged 65 and above. T relaxation times of the lateral femur and tibia as well as the medial femur were also significantly associated with maintaining radiographically normal knee joints. Additionally, absence of lesions of the lateral meniscus and absence of cartilage lesions in the medial and patellofemoral compartments were significantly associated with maintaining healthy knee joints.
CONCLUSION
Overall, this study provides protective clinical parameters as well as quantitative and semi-quantitative MR-imaging parameters associated with maintaining radiographically normal knee joints in an older population over 8 years.
Topics: Humans; Male; Aged; Female; Magnetic Resonance Imaging; Knee Joint; Osteoarthritis, Knee; Follow-Up Studies; Risk Factors; Aged, 80 and over; Obesity
PubMed: 38926717
DOI: 10.1186/s12891-024-07590-z -
European Journal of Trauma and... Jun 2024Tibial plateau fractures (TPFs) are usually associated with ligamentous or meniscal injuries that could remain misdiagnosed. An appropriate and early recognition may...
BACKGROUND
Tibial plateau fractures (TPFs) are usually associated with ligamentous or meniscal injuries that could remain misdiagnosed. An appropriate and early recognition may change the surgical management of these soft tissue injuries (STIs) that could be addressed concomitantly with TPF treatment. Magnetic resonance imaging (MRI) is an efficient diagnostic test to identify all associated STIs in TPFs. This study aims to analyze the MRI impact in identifying and guiding the STIs treatment in TPFs.
MATERIAL/METHODS
This retrospective study included a consecutive series of 57 patients with TPFs treated between January 1st, 2022, and December 31st, 2022. All fracture patterns were classified according to the AO/OTA and Schatzker classification. The prevalence of STIs, including medial meniscus (MM), lateral meniscus (LM), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) injuries, was assessed through the MRI evaluation.
RESULTS
A statistical significance was found regarding the MRI detection of LM, ACL, PCL and MCL injuries that led to additional surgical procedures at the same time as the TPFs treatment (p < 0.05). In contrast, the amount of additional MM and LCL injuries identified by MRI, which resulted in other surgical procedures, was not statistically significant (p > 0.05).
CONCLUSIONS
Preoperative MRI has been demonstrated to be an effective procedure for diagnosing STIs in TPFs, significantly influencing and changing the surgical treatment.
LEVEL OF EVIDENCE
IV.
PubMed: 38926170
DOI: 10.1007/s00068-024-02581-0 -
Knee Surgery, Sports Traumatology,... Jun 2024To evaluate long-term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to...
PURPOSE
To evaluate long-term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to identify patient surgical and magnetic resonance imaging (MRI) characteristics associated with improved outcomes.
METHODS
This was a single-centre, retrospective study evaluating patients who had undergone a PMMR repair using a transtibial suture pullout technique with two locking cinch sutures. This was performed as a follow-up to previously published 2-year and 5-year outcome studies, using the same cohort. All patients from the prior short-term and midterm studies were invited to participate. Patient-reported outcome (PROs) scores, including the International Knee Documentation Committee (IKDC) and Lysholm scores, were collected. Previously collected demographic data were updated based on review of the electronic medical record. Patient outcomes were assessed preoperatively, as well as at 2-year, 5-year and 8-year postoperatively. MRI outcome measurements were assessed at 2-year and 5-year follow-ups. All statistical analysis was performed using SPSS version 26.
RESULTS
Seventeen patients of the original 18 patients (94.4%) were included in the final analysis. Additionally, three patients who had additional ipsilateral surgery were excluded from the analysis of PROs. The IKDC score significantly increased from 44.7 ± 11.6 at preoperative baseline to 71.2 ± 21.3 at 8-year post-operation (p = 0.001). There were no significant differences in IKDC score between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). The Lysholm score significantly increased from 49.6 ± 7.3 at preoperative baseline to 76.4 ± 17.2 at 8-year follow-up (p < 0.001). There was no significant difference in Lysholm scores between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). A linear regression analysis found that 5-year IKDC scores were significantly correlated with 8-year IKDC scores (β = 0.681, p = 0.038). At 8-year follow-up, four (23.5%) patients required additional procedures on their operative knee (one total knee arthroplasty conversion).
CONCLUSION
Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long-term follow-up despite worsening MRI outcomes at short-term and medium-term follow-ups. While a high proportion of patients required additional procedures on their operative knee at 8-year follow-up, few of these patient's additional procedures were related to failure of their primary surgery. Providers and patients may expect durable clinical outcomes following the repair of PMMRT, irrespective of radiographic appearance.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38923098
DOI: 10.1002/ksa.12321 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2024To investigate the construction of a novel tissue engineered meniscus scaffold based on low temperature deposition three-dimenisonal (3D) printing technology and...
OBJECTIVE
To investigate the construction of a novel tissue engineered meniscus scaffold based on low temperature deposition three-dimenisonal (3D) printing technology and evaluate its biocompatibility.
METHODS
The fresh pig meniscus was decellularized by improved physicochemical method to obtain decellularized meniscus matrix homogenate. Gross observation, HE staining, and DAPI staining were used to observe the decellularization effect. Toluidine blue staining, safranin O staining, and sirius red staining were used to evaluate the retention of mucopolysaccharide and collagen. Then, the decellularized meniscus matrix bioink was prepared, and the new tissue engineered meniscus scaffold was prepared by low temperature deposition 3D printing technology. Scanning electron microscopy was used to observe the microstructure. After co-culture with adipose-derived stem cells, the cell compatibility of the scaffolds was observed by cell counting kit 8 (CCK-8), and the cell activity and morphology were observed by dead/live cell staining and cytoskeleton staining. The inflammatory cell infiltration and degradation of the scaffolds were evaluated by subcutaneous experiment in rats.
RESULTS
The decellularized meniscus matrix homogenate appeared as a transparent gel. DAPI and histological staining showed that the immunogenic nucleic acids were effectively removed and the active components of mucopolysaccharide and collagen were remained. The new tissue engineered meniscus scaffolds was constructed by low temperature deposition 3D printing technology and it had macroporous-microporous microstructures under scanning electron microscopy. CCK-8 test showed that the scaffolds had good cell compatibility. Dead/live cell staining showed that the scaffold could effectively maintain cell viability (>90%). Cytoskeleton staining showed that the scaffolds were benefit for cell adhesion and spreading. After 1 week of subcutaneous implantation of the scaffolds in rats, there was a mild inflammatory response, but no significant inflammatory response was observed after 3 weeks, and the scaffolds gradually degraded.
CONCLUSION
The novel tissue engineered meniscus scaffold constructed by low temperature deposition 3D printing technology has a graded macroporous-microporous microstructure and good cytocompatibility, which is conducive to cell adhesion and growth, laying the foundation for the research of tissue engineered meniscus scaffolds in the next step.
Topics: Animals; Tissue Engineering; Tissue Scaffolds; Swine; Rats; Printing, Three-Dimensional; Meniscus; Biocompatible Materials; Rats, Sprague-Dawley; Cells, Cultured; Menisci, Tibial; Microscopy, Electron, Scanning
PubMed: 38918198
DOI: 10.7507/1002-1892.202402063 -
Skeletal Radiology Jun 2024(I) Characterize the demographics and clinical features of patients with meniscal root tears (MRT); (II) analyze the morphology, extent, and grade of MRT on MRI; (III)...
PURPOSE
(I) Characterize the demographics and clinical features of patients with meniscal root tears (MRT); (II) analyze the morphology, extent, and grade of MRT on MRI; (III) evaluate associated abnormalities on imaging; and (IV) evaluate the associations between imaging findings, demographics, clinical features, and joint structural abnormalities.
MATERIAL AND METHODS
A search was performed to identify meniscal root tears. Age, sex, BMI, and pain were recorded. Knee radiographs and MRI were reviewed. Presence, grade and morphology of MRT, meniscal extrusion, insufficiency fractures, as well as joint structural abnormalities were scored. For goals (I), (II), and (III), tabulations for categorical variables and mean for continuous variables were computed. MRT findings variables were described using percentages. For goal (IV), adjusted linear and logistic regression were employed.
RESULTS
Ninety-six patients with a mean age of 56.6 years (69 females) and mean BMI of 28.9 kg/m were included; 88 of the MRT were located at the posterior horn of the medial meniscus (PHMM), and 82% were radial tear. The mean tear diameter was 3.8 mm, and 78/96 tears presented with meniscal extrusion. Nineteen patients presented with subchondral insufficiency fracture (SIF), which was significantly associated with the gap of the tear (p = 0.001) and grade of the meniscal root lesion (p = 0.005).
CONCLUSION
MRT typically found in middle-aged to older overweight and obese women. Lesions were mostly radial tears and located at PHMM and were frequently associated with meniscal extrusion and SIF. Moreover, the presence of SIF was significantly associated with the gap width and grade of root tear.
PubMed: 38916756
DOI: 10.1007/s00256-024-04724-1 -
Folia Histochemica Et Cytobiologica Jun 2024Osteoarthritis (OA) is a prevailing degenerative disease in elderly population and can lead to severe joint dysfunction. Studies have revealed various pharmacological...
Diosmetin ameliorates osteoarthritic inflammation in vivo and ECM macromolecules degradation in interleukin-1β-stimulated murine chondrocytes through the Nrf2/NF-κB pathway.
INTRODUCTION
Osteoarthritis (OA) is a prevailing degenerative disease in elderly population and can lead to severe joint dysfunction. Studies have revealed various pharmacological activities of diosmetin, including the anti-OA efficacy. The present study further investigated its effect on interleukin (IL)-1β-induced OA in chondrocytes.
MATERIAL AND METHODS
Primary chondrocytes were isolated from young mice, stimulated with IL-1β (10 ng/mL), and pretreated with diosmetin (10 and 20 μM) to conduct the in vitro assays. CCK-8 assay assessed the cytotoxicity of diosmetin whereas the levels of inflammatory factors (PGE2, nitrite, TNF-α, and IL-6) in homogenized cells were evaluated by ELISA. The levels of inflammatory cytokines, content of extracellular matrix (ECM), and signaling-related proteins (Nrf2, HO-1, and NF-κB p65) were assessed by western blotting. Expression of collagen II, p65, and Nrf2 in the chondrocytes was confirmed by immunofluorescence staining. The chondrocytes treated with IL-1β and diosmetin were transfected with Nrf2 knockdown plasmid (si-Nrf2) to investigate the role of Nrf2. In vivo OA mouse model was induced by surgically destabilizing the medial meniscus (DMM). Safranin O staining was conducted to assess the OA severity in the knee-joint tissue.
RESULTS
Diosmetin suppressed the expression of iNOS, COX-2, PGE2, nitrite, TNF-α, IL-6, MMP-13, and ADAMTS-5 induced by IL-1β in chondrocytes. The expression of p-p65, p-IκBα, and nuclear p65 was decreased whereas that of Nrf2 and HO-1 increased by diosmetin treatment in IL-1β-treated chondrocytes. Nrf2 knockdown by siRNA reversed the inhibitory effect of diosmetin on IL-1β-induced degradation of ECM proteins and inflammatory factors in cultured chondrocytes. In the DMM-induced model of OA, diosmetin alleviated cartilage degeneration and decreased the Osteoarthritis Research Society International score. C: ONCLUSIONS: Diosmetin ameliorates expression of inflammation biomarkers and ECM macromolecules degradation in cultured murine chondrocytes via inactivation of NF-κB signaling by activating Nrf2/HO-1 signaling pathway.
PubMed: 38912570
DOI: 10.5603/fhc.100071 -
Medical Engineering & Physics Jul 2024Biomechanical modeling of the knee during motion is a pivotal component in disease treatment, implant designs, and rehabilitation strategies. Historically, dynamic...
Biomechanical modeling of the knee during motion is a pivotal component in disease treatment, implant designs, and rehabilitation strategies. Historically, dynamic simulations of the knee have been scant. This study uniquely integrates a dual fluoroscopic imaging system (DFIS) to investigate the in vivo dynamic behavior of the meniscus during functional activities using a finite element (FE) model. The model was subsequently validated through experiments. Motion capture of a single-leg lunge was executed by DFIS. The motion model was reconstructed using 2D-to-3D registration in conjunction with computed tomography (CT) scans. Both CT and magnetic resonance imaging (MRI) data facilitated the development of the knee FE model. In vivo knee displacements and rotations were utilized as driving conditions for the FE model. Moreover, a 3D-printed model, accompanied with digital imaging correlation (DIC), was used to evaluate the accuracy of the FE model. To a better inner view of knees during the DIC analysis, tibia and femur were crafted by transparent resin. The availability of the FE model was guaranteed by the similar strain distribution of the DIC and FE simulation. Subsequent modeling revealed that the compressive stress distribution between the medial and lateral menisci was balanced in the standing posture. As the flexion angle increased, the medial meniscus bore the primary compressive load, with peak stresses occurring between 60 and 80° of flexion. The simulation of a healthy knee provides a critical theoretical foundation for addressing knee pathologies and advancing prosthetic designs.
Topics: Biomechanical Phenomena; Finite Element Analysis; Humans; Knee; Mechanical Phenomena; Tomography, X-Ray Computed; Movement; Knee Joint
PubMed: 38906571
DOI: 10.1016/j.medengphy.2024.104183 -
Clinical Orthopaedics and Related... May 2024In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial...
Arthroscopic Partial Meniscectomy for a Degenerative Meniscus Tear Is Not Cost Effective Compared With Placebo Surgery: An Economic Evaluation Based on the FIDELITY Trial Data.
BACKGROUND
In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial meniscectomy (APM) over conservative treatment or placebo surgery. Yet, advocates of APM still argue that APM is cost effective. Giving advocates of APM their due, we note that there is evidence from the treatment of other musculoskeletal complaints to suggest that a treatment may prove cost effective even in the absence of improvements in efficacy outcomes, as it may lead to other benefits, such as diminished productivity loss and reduced costs, and so the question of cost effectiveness needs to be answered for APM.
QUESTIONS/PURPOSES
(1) Does APM result in lower postoperative costs compared with placebo surgery? (2) Is APM cost-effective compared with placebo surgery?
METHODS
One hundred forty-six adults aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis according to the American College of Rheumatology clinical criteria were randomized to APM (n = 70) or placebo surgery (n = 76). In the APM and placebo surgery groups, mean age was 52 ± 7 years and 52 ± 7 years, and 60% (42 of 70) and 62% (47 of 76) of participants were men, respectively. There were no between-group differences in baseline characteristics. In both groups, a standard diagnostic arthroscopy was first performed. Thereafter, in the APM group, the torn meniscus was trimmed to solid meniscus tissue, whereas in the placebo surgery group, APM was carefully mimicked but no resection of meniscal tissue was performed; as such, surgical costs were the same in both arms and were not included in the analyses. All patients received identical postoperative care including a graduated home-based exercise program. At the 2-year follow-up, two patients were lost to follow-up, both in the placebo surgery group. Cost effectiveness over the 2-year trial period was computed as incremental net monetary benefit (INMB) for improvements in quality-adjusted life years (QALY), using both the societal (primary) and healthcare system (secondary) perspectives. To be able to consider APM cost effective, the CEA analysis should yield a positive INMB value. Nonparametric bootstrapping was used to assess uncertainty. Several one-way sensitivity analyses were also performed.
RESULTS
APM did not deliver lower postoperative costs, nor did it convincingly improve quality of life scores when compared with placebo surgery. From a societal perspective, APM was associated with € 971 (95% CI -2013 to 4017) higher costs and 0.015 (95% CI -0.011 to 0.041) improved QALYs over 2-year follow-up compared with placebo surgery. Both differences were statistically inconclusive (a wide 95% CI that crossed the line of no difference). Using the conventional willingness to pay (WTP) threshold of € 35,000 per QALY, APM resulted in a negative INMB of € -460 (95% CI -3757 to 2698). In our analysis, APM would result in a positive INMB only when the WTP threshold rises to about € 65,000 per QALY. The wide 95% CIs suggests uncertain cost effectiveness irrespective of chosen WTP threshold.
CONCLUSION
The results of this study lend further support to clinical practice guidelines recommending against the use of APM in patients with a degenerative meniscus tear. Given the robustness of existing evidence demonstrating no benefit or cost effectiveness of APM over nonsurgical treatment or placebo surgery, future research is unlikely to alter this conclusion.Level of Evidence Level III, economic analysis.
PubMed: 38905520
DOI: 10.1097/CORR.0000000000003094