-
International Journal of Surgery Case... Jun 2024Meniscal root tears are defined as soft-tissue and/or osseous injuries that rip or avulse within one centimeter of the meniscal insertion to the tibial plateau. These...
INTRODUCTION AND IMPORTANCE
Meniscal root tears are defined as soft-tissue and/or osseous injuries that rip or avulse within one centimeter of the meniscal insertion to the tibial plateau. These injuries impact around 100,000 patients a year and make up 10 % to 21 % of all meniscal tears. Meniscal extrusion frequently happens when there are root rips, and the transmission of circumferential hoop loads is hampered.
CASE PRESENTATION
We present one case of a 28-year-old male who complained of pain and stiffness in his left knee since 2 years after undergoing ACL reconstruction using a hamstring autograft. His examination revealed joint line tenderness on both the medial and lateral sides of the left knee. Further investigations involving X-ray and MRI established the diagnosis of both medial and lateral meniscal root tears, which were surgically managed using the transtibial pullout technique.
DISCUSSION
The biomechanical implications of meniscal root tears, such as loss of hoop forces and increased tibiofemoral contact pressures, underscore the importance of timely diagnosis and management. The literature advocates surgical treatment for managing root tears, as leaving them without surgical intervention can lead to functional outcomes similar to those of total meniscectomy.
CONCLUSION
This case report presents both menisci posterior root tears with an intact ACL graft which is unique in that they commonly tear in conjuction with ACL. These kind of injuries necessitates prompt diagnosis and surgical intervention to protect the knee from early arthritic changes.
PubMed: 38954967
DOI: 10.1016/j.ijscr.2024.109971 -
World Journal of Orthopedics Jun 2024Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis....
BACKGROUND
Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis. However, there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.
AIM
To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.
METHODS
We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018. All patients were under the age of 18 at the time of surgery. Procedures were all performed by a single surgeon. Information was gathered from our hospital Electronic Patient Records system. The primary outcome measure was re-operation rate (need for further surgery on the same meniscus). Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee (IKDC), Tegner and Lysholm scores.
RESULTS
We identified 59 patients who underwent 66 All-inside meniscal repairs (32 medial meniscus and 34 Lateral meniscus). Meniscal repairs were performed utilizing FasT-Fix (Smith and Nephew) implants. There were 37 males and 22 females with an average age of 14 years (range 6-16). The average follow-up time was 53 months (range 26-140). Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair. There were no intra-operative complications. The re-operation rate for meniscal repairs was 16.6% (11 cases) with 2 patients requiring further meniscal repairs and 9 patients underwent partial meniscectomies. The mean postoperative IKDC score was 88 (44-100), Tegner score was 7(2-10) and Lysholm score was 94 (57-100).
CONCLUSION
Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.
PubMed: 38947260
DOI: 10.5312/wjo.v15.i6.547 -
Journal of Cell Communication and... Jun 2024Inflammation promotes the degradation of the extracellular matrix, which contributes to the development of osteoarthritis (OA). Adipocyte enhancer binding protein 1...
Adipocyte enhancer binding protein 1 knockdown alleviates osteoarthritis through inhibiting NF-κB signaling pathway-mediated inflammation and extracellular matrix degradation.
Inflammation promotes the degradation of the extracellular matrix, which contributes to the development of osteoarthritis (OA). Adipocyte enhancer binding protein 1 (AEBP1) participates in multiple pathological processes related to inflammatory diseases. However, the role of AEBP1 in OA development is unknown. We found a higher AEBP1 expression in articular cartilage of OA patients ( = 20) compared to their normal controls ( = 10). Thus, we inferred that AEBP1 might affect OA progression. Then mice with destabilization of the medial meniscus (DMM) surgery and chondrocytes with IL-1β treatment (10 ng/mL) were used to mimic OA. The increased AEBP1 expression was observed in models of OA. AEBP1 knockdown in chondrocytes reversed IL-1β-induced inflammation and extracellular matrix degradation, which was mediated by the inactivation of NF-κB signaling pathway and the increased IκBα activity. Co-immunoprecipitation assay indicated the interaction between AEBP1 and IκBα. Importantly, IκBα knockdown depleted the protective role of AEBP1 knockdown in OA. Moreover, AEBP1 knockdown in mice with OA showed similar results to those in chondrocytes. Collectively, our findings suggest that AEBP1 knockdown alleviates the development of OA, providing a novel strategy for OA treatment.
PubMed: 38946719
DOI: 10.1002/ccs3.12022 -
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 -
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 -
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 -
International Journal of Biological... Jun 2024Polygonatum sibiricum polysaccharides (PSP), the primary constituent of Polygonatum sibiricum, have been shown to exhibit a wide range of pharmacological effects, but...
Polygonatum sibiricum polysaccharides (PSP), the primary constituent of Polygonatum sibiricum, have been shown to exhibit a wide range of pharmacological effects, but their impact on osteoarthritis (OA) remains unclear. The objective of this study was to investigate the protective effects of PSP against OA and to elucidate its underlying molecular mechanism. In our in vitro experiments, PSP not only inhibited the IL-1β-induced inflammatory responses and the nuclear factor kappa-B (NF-κB) signaling pathway in chondrocytes but also regulated the cartilage matrix metabolism. In addition, we detected 394 significantly differentially expressed genes through RNA-seq analysis on PSP-intervened chondrocytes, and the toll-like receptor 2 (TLR2) was identified as the most important feature by functional network analysis and qRT-PCR. It was also revealed that PSP treatment significantly reversed the IL-1-induced up-regulation of TLR2 expression in chondrocytes, while TLR2 overexpression partially inhibited the regulatory effects of PSP on inflammation, NF-κB signaling pathway and matrix metabolism. In our in vivo experiments, PSP treatment alleviated the development of destabilization of medial meniscus (DMM)-induced OA in mouse knee joints, inhibited the DMM-induced activation of the TLR2/NF-κB signaling pathway in mouse knee joint cartilage, and reduced the serum levels of inflammatory cytokines. In conclusion, PSP exerts its anti-inflammatory, matrix synthesis-promoting and matrix catabolism-suppressing effects in knee OA by inhibiting the TLR2/NF-κB signaling pathway, suggesting that PSP may be potentially targeted as a novel all-natural, low-toxicity drug for OA prevention and treatment.
PubMed: 38901508
DOI: 10.1016/j.ijbiomac.2024.133137 -
Cureus May 2024Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients....
INTRODUCTION
Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients. However, the usefulness of PSCLs in outpatients, particularly regarding the optimal timing of magnetic resonance imaging (MRI) examinations after injury, remains unknown. We hypothesized that PSCLs would normally be observed in patients with MMPRTs within one month of injury.
MATERIALS AND METHODS
This study included 144 patients with knee pain who visited our hospital between January 2021 and May 2023. MRI findings within and after one month were examined. Fisher's exact test was performed for PSCLs, cleft signs, ghost signs, radial tear signs, bone cysts, and medial meniscus extrusion (MME), which are findings used for the diagnosis of MMPRTs. Time-dependent receiver operating characteristic (ROC) curve analysis was performed for each MRI finding. A binomial logistic regression analysis was performed for age, sex, PSCL, ghost sign, and MME.
RESULTS
PSCLs were observed on 82.6% of the MRI scans within one month, but the positivity rate decreased after one month. After one month, a high percentage of patients had cleft signs and ghost signs. The results of a time-dependent ROC curve analysis showed that the PSCL had better diagnostic ability than the cleft sign, ghost sign, radial tear sign, and MME at a relatively early stage. Additionally, the area under the curve (AUC) of PSCL peaks around 35 days and then declines, reaching 0.8 or less around 40 days. On the other hand, the AUC of the cleft sign and ghost sign began to increase around 30 days after injury, and it exceeded 0.8 after approximately 100 days. The results of the binomial logistic regression analysis revealed significant PSCLs and ghost signs. Independent associations between the PSCL, or ghost sign, and the MMPRT were demonstrated.
CONCLUSION
This study suggests that PSCLs have a superior diagnostic capability for MMPRT during the early stages of injury compared with other MRI findings in outpatients. In particular, PSCLs have a high positivity rate within one month after injury and a high diagnostic capacity up to 40 days after injury.
PubMed: 38894800
DOI: 10.7759/cureus.60605 -
Diagnostics (Basel, Switzerland) May 2024This study delves into the cutting-edge field of deep learning techniques, particularly deep convolutional neural networks (DCNNs), which have demonstrated unprecedented... (Review)
Review
OBJECTIVES
This study delves into the cutting-edge field of deep learning techniques, particularly deep convolutional neural networks (DCNNs), which have demonstrated unprecedented potential in assisting radiologists and orthopedic surgeons in precisely identifying meniscal tears. This research aims to evaluate the effectiveness of deep learning models in recognizing, localizing, describing, and categorizing meniscal tears in magnetic resonance images (MRIs).
MATERIALS AND METHODS
This systematic review was rigorously conducted, strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extensive searches were conducted on MEDLINE (PubMed), Web of Science, Cochrane Library, and Google Scholar. All identified articles underwent a comprehensive risk of bias analysis. Predictive performance values were either extracted or calculated for quantitative analysis, including sensitivity and specificity. The meta-analysis was performed for all prediction models that identified the presence and location of meniscus tears.
RESULTS
This study's findings underscore that a range of deep learning models exhibit robust performance in detecting and classifying meniscal tears, in one case surpassing the expertise of musculoskeletal radiologists. Most studies in this review concentrated on identifying tears in the medial or lateral meniscus and even precisely locating tears-whether in the anterior or posterior horn-with exceptional accuracy, as demonstrated by AUC values ranging from 0.83 to 0.94.
CONCLUSIONS
Based on these findings, deep learning models have showcased significant potential in analyzing knee MR images by learning intricate details within images. They offer precise outcomes across diverse tasks, including segmenting specific anatomical structures and identifying pathological regions. Contributions: This study focused exclusively on DL models for identifying and localizing meniscus tears. It presents a meta-analysis that includes eight studies for detecting the presence of a torn meniscus and a meta-analysis of three studies with low heterogeneity that localize and classify the menisci. Another novelty is the analysis of arthroscopic surgery as ground truth. The quality of the studies was assessed against the CLAIM checklist, and the risk of bias was determined using the QUADAS-2 tool.
PubMed: 38893617
DOI: 10.3390/diagnostics14111090