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Clinics in Orthopedic Surgery Oct 2023There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply...
BACKGROUND
There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS.
METHODS
A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded.
RESULTS
Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application. Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study.
CONCLUSIONS
This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.
Topics: Humans; Menisci, Tibial; Return to Sport; Rupture; Arthroplasty, Replacement, Knee; Weight-Bearing
PubMed: 37811518
DOI: 10.4055/cios21231 -
Knee Surgery, Sports Traumatology,... Jun 2023This study aimed to evaluate and compare the time required to return to sports (RTS) after surgery, the rate of revision surgery and the time required for RTS after... (Review)
Review
PURPOSE
This study aimed to evaluate and compare the time required to return to sports (RTS) after surgery, the rate of revision surgery and the time required for RTS after revision surgery in elite athletes undergoing meniscal repair or partial meniscectomy, particularly analysing the difference between medial and lateral menisci. It was hypothesised that both procedures would entail similar, high rates of RTS, with the lateral meniscus exhibiting higher potential healing postprocedure compared to the medial meniscus.
METHODS
A systematic review was conducted based on the PRISMA guidelines. Quality assessment of the systematic review was performed using the AMSTAR-2 checklist. The following search terms were browsed in the title, abstract and keyword fields: 'meniscus' or 'meniscal' AND 'tear,' 'injury' or 'lesion' AND 'professional,' 'elite' or 'high-level' AND 'athletes,' 'sports,' 'sportsman,' 'soccer,' 'basketball,' 'football' or 'handball'. The resulting measures extracted from the studies were the rate of RTS, level of RTS, complications, revision surgery and subsequent RTS, Tegner, International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS).
RESULTS
In this study, the cohort consisted of 421 patients [415 (98.6%) men and 6 (1.4%) women] with a mean age of 23.0 ± 3.0 years. All patients were elite athletes in wrestling, baseball, soccer, rugby or handball. While 327 (77.7%) patients received partial meniscectomy at a mean age of 23.3 ± 2.6 years, 94 (22.3%) patients received meniscal repair at a mean age of 22.1 ± 4.0 years. After partial meniscectomy, 277 patients (84.7%) returned to their competitive sports activity and 256 (78.3%) returned to their pre-injury activity levels. A total of 12 (3.7%) patients required revision surgery because of persistent pain [5 (1.5%) patients], chondrolysis [2 (0.7%) patients] or both chondrolysis and lateral instability [5 (1.5%) patients]. Ten (83.3%) of the twelve patients had involvement of the lateral meniscus, whereas the location of injury was not specified in the remaining two patients. After revision surgery, all patients (100%) resumed sports activity. However, after meniscal repair, 80 (85.1%) athletes returned to their competitive sports activity and 71 (75.5%) returned to their pre-injury activity levels. A total of 16 (17.0%) patients required partial meniscectomy in cases of persistent pain or suture failure. Of these, 4 (25%) patients involved lateral and medial menisci each and 8 (50%) patients were not specified. After revision surgery, more than 80.0% of the patients (13) resumed sports activity.
CONCLUSIONS
In elite athletes with isolated meniscal injury, partial meniscectomy and meniscal suture exhibited similar rates of RTS and return to pre-injury levels. Nonetheless, athletes required more time for RTS after meniscal repair and exhibited an increased rate of revision surgery associated with a reduced rate of RTS after the subsequent surgery. For lateral meniscus tears, meniscectomy was associated with a high rate of revision surgery and risk of chondrolysis, whereas partial medial meniscectomy allowed for rapid RTS but with the potential risk of developing knee osteoarthritis over the years. The findings of this systematic review suggested a suture on the lateral meniscus in elite athletes because of the high healing potential after the procedure, the reduced risk of developing chondrolysis and the high risk of revision surgery after partial meniscectomy. Furthermore, it is important to evaluate several factors while dealing with the medial meniscus. If rapid RTS activity is needed, a hyperselective meniscectomy is recommended; otherwise, a meniscal suture is recommended to avoid accelerated osteoarthritis.
LEVEL OF EVIDENCE
Level IV.
STUDY REGISTRATION
PROSPERO-CRD42022351979 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351979 ).
Topics: Male; Humans; Female; Young Adult; Adult; Adolescent; Menisci, Tibial; Meniscectomy; Knee Joint; Soccer; Cartilage Diseases; Athletes; Retrospective Studies; Arthroscopy
PubMed: 36319751
DOI: 10.1007/s00167-022-07208-8 -
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 -
Tissue Engineering. Part C, Methods Nov 2017Injury to the meniscus is common, but few viable strategies exist for its repair or regeneration. To address this, animal models have been developed to translate new... (Meta-Analysis)
Meta-Analysis Review
Injury to the meniscus is common, but few viable strategies exist for its repair or regeneration. To address this, animal models have been developed to translate new treatment strategies toward the clinic. However, there is not yet a regulatory document guiding such studies. The purpose of this study was to carry out a systematic review of the literature on meniscus treatment methods and outcomes to define the state of the field. Public databases were queried by using search terms related to animal models and meniscus injury and/or repair over the years 1980-2015. Identified peer-reviewed manuscripts were screened by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One of nine reviewers read each manuscript and scored them based on whether the publication described a series of predefined study descriptors and outcome measures. Additional data were extracted to identify common assays used. A total of 128 full-length peer-reviewed manuscripts were identified. The number of publications increased over the time frame analyzed, with 48% focused on augmented repair. Rabbit was, by far, the most prevalent species utilized (46%), with dog (21%) and sheep (20%) being the next most common. Analysis of study descriptors revealed that most studies appropriately documented details of the animal used, the surgical approach, and defect and implant characteristics (e.g., 63% of studies identified clearly the defect size). In terms of outcome parameters, most studies carried out macroscopic (85%), histologic (90%), and healing/integration (83%) analyses of the meniscus. However, many studies did not provide further analysis beyond these fundamental measures, and less than 40% reported on the adjacent cartilage and synovium, as well as joint function. There is intense interest in the field of meniscus repair. However, given the current lack of guidance documentation in this area, preclinical animal models are not performed in a standardized fashion. The development of a "Best Practices" document would increase reproducibility and external validity of experiments, while accelerating advancements in translational research. Advancement is of paramount importance given the high prevalence of meniscal injuries and the paucity of effective repair or regenerative strategies.
Topics: Animals; Menisci, Tibial; Outcome Assessment, Health Care; Regeneration; Species Specificity; Wound Healing
PubMed: 28622089
DOI: 10.1089/ten.TEC.2017.0080 -
British Journal of Sports Medicine Oct 2019Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees.
METHODS
We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity.
RESULTS
We included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias.
CONCLUSIONS
Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%-14% in adults aged <40 years to 19%-43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.
Topics: Bone Marrow; Cartilage Diseases; Humans; Knee Injuries; Magnetic Resonance Imaging; Menisci, Tibial; Osteoarthritis, Knee; Prevalence
PubMed: 29886437
DOI: 10.1136/bjsports-2018-099257 -
Knee Surgery, Sports Traumatology,... Nov 2020The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and...
PURPOSE
The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport.
METHODS
Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review.
RESULTS
Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211 months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8.
CONCLUSION
This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Arthroplasty, Replacement, Knee; Arthroscopy; Humans; Knee Injuries; Lysholm Knee Score; Menisci, Tibial; Orthopedics; Patient Safety; Postoperative Period; Reoperation; Rupture; Second-Look Surgery; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 32979079
DOI: 10.1007/s00167-020-06287-9 -
Orthopaedic Journal of Sports Medicine Jul 2020Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is... (Review)
Review
BACKGROUND
Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is not clear. Critical literature review can support or change clinical strategies and identify gaps in the available evidence.
PURPOSE
To assess the protective effect of ACLR on the meniscus and provide clinical guidelines for managing ACL tears and subsequent meniscal injury. We aimed to answer the following questions: (1) Does ACLR protect the meniscus from subsequent injury? (2) Does early ACLR reduce secondary meniscal injury compared with delayed ACLR? (3) Does ACLR protect the repaired meniscus?
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review was performed through use of MEDLINE and Embase electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included , , and . Studies describing primary ACLR and nonoperative treatment in adult patients were included, as well as studies indicating timing of ACLR. The included articles were assessed individually for risk of bias through use of the modified Cochrane Risk of Bias and MINORS (Methodological Index for Nonrandomized Studies) tools.
RESULTS
One level 2 randomized controlled trial and several level 3 and 4 studies indicated a protective effect of ACLR on meniscal injury compared with nonoperative treatment. There was weak (level 3) evidence of the protective effect of early ACLR on the meniscus. Meniscal repair failure was less frequent in patients with ACL reconstruction than in patients with ACL deficiency (level 4).
CONCLUSION
The evidence collected in this review suggests a protective effect of ACLR for subsequent meniscal injury (level 2 evidence). ACLR should be performed within 3 months of injury (level 3 evidence). Meniscal injury requiring surgical repair in the ACL-deficient knee should be treated with repair accompanied by ACLR (level 3 evidence). The paucity of level 2 studies prevents the formation of guidelines based on level 1 evidence. There is a strong clinical need for randomized or prospective trials to provide guidelines on timing of ACLR and meniscal repair.
PubMed: 32782901
DOI: 10.1177/2325967120933895 -
Bioengineering (Basel, Switzerland) May 2024(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage.... (Review)
Review
(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage. Despite the frequent occurrence of associated injuries including bone bruises, meniscus, and cartilage damage in patients with ACL injuries, a systematic review of the relationships between the presence of bone bruises and the extent of meniscus and cartilage injuries has yet to be conducted. (2) Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the relationship between bone bruises and meniscus or cartilage injuries following ACL injuries. Study selection, data extraction, and meta-analysis were performed. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessments, and Review Manager 5.3 was used for data analysis. (3) Results: Data were extracted from 22 studies encompassing a total of 2891 patients with ACL injuries. Among the included studies, six studies investigated the relationships between bone bruises and medial meniscus (MM) or lateral meniscus (LM) injuries, while three studies investigated the relationships between bone bruises and cartilage injuries. There were no significant correlations between the presence of bone bruises and MM injuries (relative risk (RR) = 1.32; = 0.61). A quantitative analysis indicated that individuals with bone bruises had a 2.71-fold higher likelihood of sustaining LM injuries than those without bone bruises (RR = 2.71; = 0.0003). The analysis confirmed a significant relationship between bone bruises and cartilage injuries (RR = 6.18; = 0.003). (4) Conclusions: Bone bruises occur most frequently in the lateral compartment. Bone bruises resulting from ACL injuries are related to accompanying LM injuries and cartilage injuries. Knowing these associations and the frequency of injuries may allow orthopedic surgeons to promptly address ACL-related meniscus and cartilage injuries on MRI results and in future clinical practice.
PubMed: 38790382
DOI: 10.3390/bioengineering11050515 -
BMC Musculoskeletal Disorders Sep 2023To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing.
METHODS
This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
INCLUSION CRITERIA
(1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described.
EXCLUSION CRITERIA
(1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1.
RESULTS
Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)].
CONCLUSION
In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing.
TRIAL REGISTRATION
The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).
Topics: Arthroscopy; Cohort Studies; Knee Injuries; Meniscus; Sutures; Humans
PubMed: 37684657
DOI: 10.1186/s12891-023-06602-8 -
Life (Basel, Switzerland) Apr 2024Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study... (Review)
Review
Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies ( = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies ( = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure ( = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.
PubMed: 38792605
DOI: 10.3390/life14050584