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Ugeskrift For Laeger Sep 2017The menisci play a major role in knee function regarding joint movement, stability, load distribution and load transmission. Injuries to the menisci cause pain, and... (Review)
Review
The menisci play a major role in knee function regarding joint movement, stability, load distribution and load transmission. Injuries to the menisci cause pain, and meniscal tears are a common reason for patient referral. In Denmark, partial meniscectomy increased significantly until 2010, and several studies have questioned the long-term effect of meniscectomy as an overall procedure. A Danish national clinical guideline on knee meniscal pathology was published in May 2016, and this article is a short summary of updated knowledge on meniscal pathology and relevant conclusions from the guideline.
Topics: Algorithms; Arthroscopy; Denmark; Humans; Meniscectomy; Menisci, Tibial; Osteoarthritis, Knee; Practice Guidelines as Topic; Range of Motion, Articular; Tibial Meniscus Injuries
PubMed: 28918786
DOI: No ID Found -
BMC Musculoskeletal Disorders Aug 2016Discoid lateral meniscus (DLM) is relatively common in East Asia..Symptomatic discoid lateral meniscus (SDLM) is an important indication for knee arthroscopic surgery.... (Comparative Study)
Comparative Study
BACKGROUND
Discoid lateral meniscus (DLM) is relatively common in East Asia..Symptomatic discoid lateral meniscus (SDLM) is an important indication for knee arthroscopic surgery. However, studies investigating SDLM are rare. The purpose of this study was to evaluate the clinical characteristics and intra-articular variants of SDLM in a Chinese population.
METHODS
We retrospectively reviewed all patients with SDLM from January 2005 to December 2014 in our hospital. Clinical variables included gender, age, duration, age of onset, affected side, symptoms and trauma history as well as arthroscopic findings: DLM types, tear patterns and concomitant medial meniscus tear, which were evaluated and compared statistically.
RESULTS
Of the 496 consecutive participants with SDLM, females outnumbered males (69.6 % vs. 30.4 %). The age of onset ranged from 3 to 80 years (median, 31 years), and was significantly higher in females than in males (p < 0.0001). Trauma history in males was significantly higher than in females (45 % vs. 35.1 %, p = 0.0356). Males showed a higher incidence of popping and snapping, while females manifested higher range-of-motion (ROM) limitations (p = 0.0179, and p = 0.0392, respectively). No significant difference in intra-articular variants was observed between genders. The complete type was the most frequent (344, 69.4 %), followed by the incomplete type (149, 30 %), and the Wrisberg type (3, 0.6 %). Significant difference in tear patterns was found between complete and incomplete types (p < 0.0001). Few patients showed medial meniscus tear (11, 2.2 %), at a significantly higher age compared with patients without tear (median, 57 years vs. 33 years, p < 0.0001).
CONCLUSIONS
The majority of Chinese patients with SDLM are young and middle-aged females. Female patients had an older age of onset, higher incidence of ROM limitation and limited trauma history. The complete type is the most common, with tear patterns varying between complete and incomplete types. The SDLM does not significantly affect the medial meniscus.
Topics: Adolescent; Adult; Age Factors; Anatomic Variation; Arthroscopy; Child; China; Female; Humans; Incidence; Knee Joint; Male; Menisci, Tibial; Middle Aged; Range of Motion, Articular; Retrospective Studies; Sex Factors; Tibial Meniscus Injuries; Young Adult
PubMed: 27494952
DOI: 10.1186/s12891-016-1188-3 -
Journal of Orthopaedic Research :... Jun 2018The dog has been used extensively as an experimental model to study meniscal treatments such as meniscectomy, meniscal repair, transplantation, and regeneration....
The dog has been used extensively as an experimental model to study meniscal treatments such as meniscectomy, meniscal repair, transplantation, and regeneration. However, there is very little information on meniscal kinematics in the dog. This study used MR imaging to quantify in vitro meniscal kinematics in loaded dog knees in four distinct poses: extension, flexion, internal, and external rotation. A new method was used to track the meniscal poses along the convex and posteriorly tilted tibial plateau. Meniscal displacements were large, displacing 13.5 and 13.7 mm posteriorly on average for the lateral and medial menisci during flexion (p = 0.90). The medial anterior horn and lateral posterior horns were the most mobile structures, showing average translations of 15.9 and 15.1 mm, respectively. Canine menisci are highly mobile and exhibit movements that correlate closely with the relative tibiofemoral positions. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1710-1716, 2018.
Topics: Animals; Biomechanical Phenomena; Dogs; Magnetic Resonance Imaging; Menisci, Tibial; Movement
PubMed: 29106743
DOI: 10.1002/jor.23800 -
Osteoarthritis and Cartilage Apr 2022The human meniscus is essential in maintaining proper knee joint function. The meniscus absorbs shock, distributes loads, and stabilizes the knee joint to prevent the...
OBJECTIVE
The human meniscus is essential in maintaining proper knee joint function. The meniscus absorbs shock, distributes loads, and stabilizes the knee joint to prevent the onset of osteoarthritis. The extent of its shock-absorbing role can be estimated by measuring the energy dissipated by the meniscus during cyclic mechanical loading.
METHODS
Samples were prepared from the central and horn regions of medial and lateral human menisci from 8 donors (both knees for total of 16 samples). Cyclic compression tests at several compression strains and frequencies yielded the energy dissipated per tissue volume. A GEE regression model was used to investigate the effects of compression, meniscal side and region, and water content on energy dissipation in order to account for repeated measures within samples.
RESULTS
Energy dissipation by the meniscus increased with compressive strain from ∼0.1 kJ/m (at 10% strain) to ∼10 kJ/m (at 20% strain) and decreased with loading frequency. Samples from the anterior region provided the largest energy dissipation when compared to central and posterior samples (P < 0.05). Water content for the 16 meniscal tissues was 77.9 (C.I. 72.0-83.8%) of the total tissue mass. A negative correlation was found between energy dissipation and water content (P < 0.05).
CONCLUSION
The extent of energy dissipated by the meniscus is inversely related to loading frequency and meniscal water content.
Topics: Humans; Knee; Knee Joint; Menisci, Tibial; Meniscus; Water
PubMed: 35032627
DOI: 10.1016/j.joca.2022.01.001 -
BMJ Open May 2023Although ultrasound can reportedly diagnose discoid lateral meniscus (DLM) in children, its widespread application is challenging because the diagnostic criteria are...
Feasibility and efficacy of ultrasound in the diagnosis of discoid lateral meniscus and its classification in children: protocol for a prospective, multicentre, diagnostic test study.
INTRODUCTION
Although ultrasound can reportedly diagnose discoid lateral meniscus (DLM) in children, its widespread application is challenging because the diagnostic criteria are based on qualitative descriptions of DLM morphology rather than quantitative parameters. Additionally, no studies have applied ultrasound in classifying DLM. Therefore, this study aims to establish the quantitative ultrasound parameters that reflect DLM morphology, evaluate the feasibility and validity of these parameters for identifying DLM and their classification, and develop the quantitative ultrasound diagnostic criteria for DLM and their classification in children.
METHODS AND ANALYSIS
Patients will be recruited from the outpatient clinics of the orthopaedics department at West China Hospital, Sichuan University, the Fourth Medical Center of the Chinese People's Liberation Army General Hospital, Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Yibin Hospital affiliated with West China Hospital Sichuan University, Suining Central Hospital and the Third Hospital of Mianyang from August 2022 to July 2024. Eligible patients are those aged ≤14 years, with knee symptoms such as pain, locking and limited extension, and who planned to undergo arthroscopic surgery. Exclusion criteria are patients with contraindications to ultrasound examination, such as severe skin damage or fracture around the knee. The sample size is estimated to be 576 cases with a power of 0.9 for hypothesis testing, a two-sided α of 0.05, and an expected sensitivity and specificity of 95%. Three days before surgery, ultrasound will be used to observe the morphology of the lateral meniscus and measure its width, angle α formed by the chord of upper and lower arc-shaped articular surface at the free edge, and the movement distance of the peripheral rim. Participants will be categorised according to the arthroscopy results for the DLM and its classification. The diagnostic performance of each parameter will be assessed and compared in terms of the area under the curve, sensitivity, specificity, and positive and negative predictive values.
ETHICS AND DISSEMINATION
This study was approved by the Ethics Committee of West China Hospital, Sichuan University (approval no. 2022-923), and this approval covers all study hospitals. Written informed consent is required from all participants before enrolment in the study. The study's findings will be disseminated through peer-reviewed publications and conference presentations.
TRIAL REGISTRATION NUMBER
Chinese Clinical Trial Registry (ChiCTR2200062000).
Topics: Humans; Child; Menisci, Tibial; Prospective Studies; Feasibility Studies; China; Diagnostic Tests, Routine; Multicenter Studies as Topic
PubMed: 37164464
DOI: 10.1136/bmjopen-2022-069527 -
Archives of Orthopaedic and Trauma... Feb 2021Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based...
INTRODUCTION
Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol.
MATERIALS AND METHODS
A group consisting of 11 healthy volunteers (Group I, male and female, 18-45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23-43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II).
RESULTS
A total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average.
CONCLUSIONS
Ultrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI.
TRIAL REGISTRATION
The study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24).
Topics: Adult; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Menisci, Tibial; Prospective Studies; Reproducibility of Results; Tibial Meniscus Injuries; Ultrasonography
PubMed: 33215303
DOI: 10.1007/s00402-020-03683-1 -
Journal of Orthopaedic Research :... Feb 2022The objective of this study was to evaluate histologic and molecular features of meniscus degeneration in cohorts of patients with and without osteoarthritis (OA) of the...
The objective of this study was to evaluate histologic and molecular features of meniscus degeneration in cohorts of patients with and without osteoarthritis (OA) of the knee. Menisci were obtained from patients undergoing total knee arthroplasty for OA (TKA) or arthroscopic partial meniscectomy (APM) for a torn knee meniscus. Degenerative meniscal tears were among the most common tear type in the APM group based on the pattern. Using an integrative workflow for molecular evaluation of formalin-fixed and paraffin-embedded tissues, human menisci underwent blinded histologic evaluation and NanoString gene expression analyses. Histology revealed increased proteoglycan content in TKA menisci compared to APM menisci, but otherwise no significant differences in the total pathology score or sub-scores between patients based on age or cohort. NanoString analyses revealed differential expression of genes primarily associated with the PI3K-AKT signaling pathway, cell cycle, and apoptosis. These data provide new insights into histological and molecular features of meniscus degeneration in patients with and without knee OA. Histologic assessment of menisci showed similar severity of overall degeneration between cohorts, but there were differences at the molecular level. The dysregulated pathways identified in this study could contribute to early-onset meniscus degeneration, or to a predisposition to meniscus tears and subsequent knee OA. Further studies that validate genes and pathways uncovered in this study will allow us to evaluate novel approaches to assess and treat meniscal degeneration.
Topics: Arthroscopy; Humans; Knee Injuries; Meniscectomy; Menisci, Tibial; Meniscus; Osteoarthritis, Knee; Phosphatidylinositol 3-Kinases
PubMed: 33792974
DOI: 10.1002/jor.25047 -
[Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears].Beijing Da Xue Xue Bao. Yi Xue Ban =... Oct 2021To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair...
OBJECTIVE
To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries.
METHODS
This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears.
RESULTS
A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; =86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; =36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; =24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (=53, 61.6%), type Ⅰb: horizontal tear (=27, 31.4%), and type Ⅰc: radial tear (=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (=20, 55.6%), and type Ⅱc: both tears (=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (=9, 37.5%), type Ⅲb: radial tear (=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores ( > 0.01).
CONCLUSION
We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.
Topics: Adult; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Female; Humans; Male; Menisci, Tibial; Tibial Meniscus Injuries
PubMed: 34650290
DOI: 10.19723/j.issn.1671-167X.2021.05.013 -
Anatomical Record (Hoboken, N.J. : 2007) May 2022The lateral and medial menisci are fibrocartilaginous structures in the knee that play a crucial role in normal knee biomechanics. However, one commonly cited role of... (Review)
Review
The lateral and medial menisci are fibrocartilaginous structures in the knee that play a crucial role in normal knee biomechanics. However, one commonly cited role of the menisci is that they function as "shock absorbers." Here we provide a critique of this notion, drawing upon a review of comparative anatomical and biomechanical data from humans and other tetrapods. We first review those commonly, and often exclusively, cited studies in support of a shock absorption function and show that evidence for a shock absorptive function is dubious. We then review the evolutionary and comparative evidence to show that (1) the human menisci are unremarkable in morphology compared with most other tetrapods, and (2) "shock" during locomotion is uncommon, with humans standing out as one of the only tetrapods that regularly experiences high levels of shock during locomotion. A shock-absorption function does not explain the origin of menisci, nor are human menisci specialized in any way that would explain a unique shock-absorbing function during human gait. Finally, we show that (3) the material properties of menisci are distinctly poorly suited for energy dissipation and that (4) estimations of meniscal energy absorption based on published data are negligible, both in their absolute amount and in comparison to other well-accepted structures which mitigate shock during locomotion. The menisci are evolutionarily ancient structures crucial for joint congruity, load distribution, and stress reduction, among a number of other functions. However, the menisci are not meaningful shock absorbers, neither in tetrapods broadly, nor in humans.
Topics: Biomechanical Phenomena; Gait; Humans; Knee Joint; Locomotion; Menisci, Tibial
PubMed: 34486236
DOI: 10.1002/ar.24752 -
Skeletal Radiology May 2022To explore whether and which quantitative 3D measures of medial and/or lateral meniscus position and size are associated with subsequent medial femorotibial structural...
OBJECTIVE
To explore whether and which quantitative 3D measures of medial and/or lateral meniscus position and size are associated with subsequent medial femorotibial structural progression of knee osteoarthritis and to determine the correlation between central slice and total meniscus measures.
MATERIALS AND METHODS
Knees with radiographic osteoarthritis from Osteoarthritis Initiative participants with longitudinal medial MRI-based cartilage thickness and radiographic joint space width (JSW) loss over 12 months were selected. These 37 structural progressor knees (64.7 ± 8.0y, 30.2 ± 4.6 kg/m, 35% men) were matched 1:1 to 37 non-progressor knees (64.6 ± 9.8y, 30.2 ± 4.4 kg/m, 35% men) without cartilage thickness or JSW loss. Quantitative measures of meniscus position and size were computed from manual segmentations of coronal baseline MRIs. Cohen's D was used as measure of effect size.
RESULTS
Maximum extrusion distance of the total medial meniscus and mean extrusion in the central 5 and in the central slice were greater for progressor than non-progressor knees (Cohen's D 0.58-0.66). No significant differences were observed for medial tibial coverage or mean extrusion (entire meniscus). Among medial meniscus morphology measures, only mean height differed between progressor vs non-progressor knees (Cohen's D 0.40). Among lateral meniscus measures, height and volume were greater in progressor vs. non-progressor knees (Cohen's D 0.46-0.83). Mean extrusion measures were highly correlated between the entire meniscus and the central (r = 0.88) or the central 5 (r = 0.93) slices.
CONCLUSIONS
3D maximum and central medial meniscus extrusion may serve as predictors for subsequent structural progression. Central meniscus extrusion measures could substitute 3D extrusion measurement across the entire meniscus.
Topics: Disease Progression; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Menisci, Tibial; Meniscus; Osteoarthritis, Knee; Tibia
PubMed: 34591163
DOI: 10.1007/s00256-021-03911-8