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Journal of Digital Imaging Dec 2022Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We...
Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We investigated the correlation between meniscal pathology and anatomic features of pMFL such as attachment type, thickness, and volume. We retrospectively evaluated 191 patients who underwent knee MRI. MR images were reviewed to assess the attachment type of the pMFL on the medial femoral condyle (high vs. low), the thickness of the pMFL, and the presence of a meniscal tear or a discoid meniscus. The pMFL volume was quantified by using three-dimensional (3D) segmentation software. The relationship between the frequency of medial or lateral meniscal tear and anatomic features of pMFL were analyzed using Chi-square, Fisher's exact, or Mann-Whitney U test. High type pMFLs had significantly greater thickness and volume than low type pMFLs (p < 0.001). Patients with degenerative lateral meniscal tear had significantly higher thickness and volume of the pMFL than patients with intact lateral meniscus (p < 0.05). The pMFL thickness and volume were not significantly related to traumatic lateral meniscal tear, medial meniscal tear, and discoid meniscus. High type pMFLs tended to be thicker and larger than low type pMFLs and higher thickness and volume of the pMFL was significantly related to the degenerative lateral meniscal tear. However, the attachment type of the pMFL itself was not significantly related to the lateral meniscal tear as well as the medial meniscal tear.
Topics: Humans; Tibial Meniscus Injuries; Retrospective Studies; Menisci, Tibial; Ligaments, Articular; Knee Joint; Magnetic Resonance Imaging
PubMed: 35668218
DOI: 10.1007/s10278-022-00651-6 -
Knee Surgery, Sports Traumatology,... Jul 2022Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many... (Meta-Analysis)
Meta-Analysis Review
Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years.
PURPOSE
Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed.
METHODS
PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established.
RESULTS
In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years.
CONCLUSION
The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years.
LEVEL OF EVIDENCE
IV.
Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Follow-Up Studies; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 34671817
DOI: 10.1007/s00167-021-06770-x -
Joint Diseases and Related Surgery 2022This study aimed to define the medial meniscus posterior base angle (MMPBA) and the lateral meniscus posterior base angle (LMPBA) measured in the medial and lateral...
OBJECTIVES
This study aimed to define the medial meniscus posterior base angle (MMPBA) and the lateral meniscus posterior base angle (LMPBA) measured in the medial and lateral meniscus posterior horns and examine the biomechanical and morphological relationship between anterior cruciate ligament (ACL) injuries and posterior meniscus horns using these parameters.
PATIENTS AND METHODS
The retrospective study was conducted with 32 patients with ACL rupture and 40 control patients, for a total of 72 patients (40 males, 32 females; mean age: 36.3±9.9 years; range, 18 to 57 years), between January 2016 and January 2018. The posterior tibial slope (PTS) was measured in standard radiographs, and MMPBA and LMPBA values were assessed by standard knee magnetic resonance imaging. The MMPBA was defined as the angle between the line passing through the medial meniscus' tibial side border and the line passing through the capsular side border in the sagittal section's medial meniscus posterior horn. The LMPBA was defined as the angle between the line passing through the lateral meniscus' tibial side border and the line passing through the capsular side border on the sagittal section's lateral meniscus posterior horn. Groups were compared for PTS, MMPBA, and LMPBA.
RESULTS
When both groups were compared in terms of MMPBA and LMPBA, patients with ACL rupture had significantly higher base angles (p<0.001 and p=0.031, respectively). The mean MMPBA was 84.27º±12.59º (range, 62º to 106.1º) in patients with ACL rupture, while it was 70.75º±7.85º (range, 55.1º to 88.6º) in the control group. The mean LMPBA was 83.62º±11.4º (range, 62.3º to 105.9º) in patients with ACL rupture, while it was 76.94º±11.46º (range, 30.8º to 96.5º) in the control group. In the receiver operating characteristics curve analysis, the cut-off value of MMPBA was 84.5, and values above this showed a 58.5% sensitivity and a 97.6% specificity for ACL rupture, whereas for LMPBA, the cut-off value was 93.15, and values above this showed a 27.3% sensitivity and a 95.1% specificity for ACL rupture. The PTS and MMPBA were significantly correlated with each other (p=0.047). The MMPBA and LMPBA were also significantly correlated with each other (p=0.011). However, there was no significant correlation between PTS and LMPBA (p=0.56).
CONCLUSION
Medial meniscus posterior base angle and LMPBA values above 84.5º and 93.15º, respectively, are new indirect magnetic resonance imaging findings of ACL injury.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Female; Humans; Magnetic Resonance Imaging; Male; Menisci, Tibial; Middle Aged; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35852200
DOI: 10.52312/jdrs.2022.653 -
Revista Espanola de Cirugia Ortopedica... 2023Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We...
INTRODUCTION
Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships.
MATERIALS AND METHODS
The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured.
RESULTS
The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament.
CONCLUSIONS
The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
Topics: Humans; Knee Joint; Anterior Cruciate Ligament; Tibia; Menisci, Tibial; Cadaver; Ligaments, Articular
PubMed: 35691577
DOI: 10.1016/j.recot.2022.06.001 -
Revista Espanola de Cirugia Ortopedica... 2023Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We...
INTRODUCTION
Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships.
MATERIALS AND METHODS
The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured.
RESULTS
The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from the tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament.
CONCLUSIONS
The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.
Topics: Humans; Knee Joint; Anterior Cruciate Ligament; Tibia; Menisci, Tibial; Ligaments, Articular; Cadaver
PubMed: 36528296
DOI: 10.1016/j.recot.2022.12.006 -
Arthroscopy : the Journal of... Feb 2021To observe the morphology of the transverse geniculate ligament of the knee (TGL) by magnetic resonance imaging (MRI) and to analyze the cause of the pseudotear sign of...
PURPOSE
To observe the morphology of the transverse geniculate ligament of the knee (TGL) by magnetic resonance imaging (MRI) and to analyze the cause of the pseudotear sign of the anterior horn of the meniscus caused by the TGL.
METHODS
Patients who underwent MRI examination of the knee joint in the orthopaedics department of our hospital from July 2016 to August 2019 were identified. The occurrence rate, length, width, thickness, cross-sectional shape, pattern, appearance, and position relative to the anterior horn of the lateral and medial meniscus and anatomical variations were observed by multiplane and multisequence MRI. The frequency and cause of the pseudotear sign also were observed.
RESULTS
The data of 101 patients were analyzed. Among them, 60 were male, and 41 were female. The average age was 42.01 (18-75) years. The occurrence rate of the TGL was 67.3% (68/101), the average length was 38.75 ± 3.56 mm, the median coronal diameter was 1.79 ± 0.60 mm, the median sagittal diameter was 1.88 ± 0.35 mm, and the cross-sectional morphology was mostly oval and round. There were 5 types of TGL connection to the anterior horn of the medial meniscus: type 1, located at the front edge; type 2, located at the upper front edge; type 3, located at the upper edge; type 4, located at the back upper edge; and type 5, was located at the back edge of the anterior horn of the medial meniscus. There was only one type of TGL insertion into the anterior horn of the lateral meniscus, located at the anterior superior edge of the anterior horn of the lateral meniscus. There were 4 cases of the pseudotear sign in the anterior horn of the meniscus, 3 in the lateral meniscus and 1 in the medial meniscus. The pseudotear sign of the anterior horn of the meniscus caused by the TGL was observed at a rate of 5.88% (4/68).
CONCLUSIONS
In MRI examination of the knee, the anterior horn of the meniscus sometimes shows a pseudotear sign. According to the shape and route of the TGL on MRI and the direction and position of the pseudotear sign of the anterior horn of the meniscus, true and false tears of the anterior horn of the meniscus can be identified.
LEVEL OF EVIDENCE
Level III, diagnostic study (retrospective, noncomparative, observational case series without a consistently applied reference "gold" standard).
Topics: Adolescent; Adult; Aged; Computer Simulation; Cross-Sectional Studies; Female; Humans; Knee Joint; Ligaments; Magnetic Resonance Imaging; Male; Menisci, Tibial; Middle Aged; Retrospective Studies; Tibial Meniscus Injuries; Young Adult
PubMed: 32890637
DOI: 10.1016/j.arthro.2020.08.024 -
Journal of Orthopaedic Research :... Apr 2020Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with...
Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior-inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage-to-bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759-767, 2020.
Topics: Adolescent; Anterior Cruciate Ligament Injuries; Cartilage, Articular; Female; Humans; Magnetic Resonance Imaging; Male; Menisci, Tibial; Prospective Studies; Tibial Meniscus Injuries; Young Adult
PubMed: 31705680
DOI: 10.1002/jor.24519 -
BMC Musculoskeletal Disorders Mar 2021Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in...
Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 - 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 - 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 - 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 - 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. STUDY DESIGN: Case-control study; level of evidence, 3.
Topics: Adolescent; Adult; Aged; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Case-Control Studies; Child; Female; Humans; Male; Menisci, Tibial; Middle Aged; Prevalence; Retrospective Studies; Tibial Meniscus Injuries; Young Adult
PubMed: 33752653
DOI: 10.1186/s12891-021-04107-w -
BMC Musculoskeletal Disorders May 2021Turner's syndrome, discoid meniscus, and Blount's disease have all been studied in isolation, but, to the best of our knowledge, there have been no studies reporting a...
BACKGROUND
Turner's syndrome, discoid meniscus, and Blount's disease have all been studied in isolation, but, to the best of our knowledge, there have been no studies reporting a patient with all three. Thus, the first case of Turner's syndrome with discoid meniscus and Blount's disease is presented.
CASE PRESENTATION
A 5-year-old Japanese girl with a history of Turner's syndrome and Blount's disease complained of pain in her left knee. Magnetic resonance imaging showed a discoid lateral meniscus tear, and arthroscopic partial meniscectomy was performed, providing a good outcome.
CONCLUSIONS
In this report, some possible explanations regarding the concomitant presence of these three diseases are discussed. A possible explanation in this case is that the patient with Turner's syndrome had a discoid lateral meniscus that might have been induced by some genetic factors associated with Turner's syndrome, and then the discoid lateral meniscus might have been the mechanical stress that caused Blount's disease.
Topics: Child, Preschool; Female; Humans; Knee Joint; Meniscectomy; Menisci, Tibial; Tibial Meniscus Injuries; Turner Syndrome
PubMed: 33992118
DOI: 10.1186/s12891-021-04336-z -
Journal of Orthopaedics and... Sep 2023Lateral, All-Round and All-Inside (LARAI) portal is a viewing or working portal for observing and repairing the lesions of the lateral meniscus. However, there are...
BACKGROUND
Lateral, All-Round and All-Inside (LARAI) portal is a viewing or working portal for observing and repairing the lesions of the lateral meniscus. However, there are safety concerns about popliteal artery (PA) injuries during the procedure. This study aimed to assess the safe distance between the trajectory of the LARAI portal and PA.
MATERIALS AND METHODS
Both three-dimensional computed tomography (3D-CT) and cadavers were used to simulate the LARAI portal trajectory. In the 3D-CT study, between January 2020 and September 2020, 45 participants who underwent computed tomography angiography were included in the study. The shortest distance from the PA to the simulated trajectory needle (PS) was measured using 3D-CT. Mean -3SD -2 was calculated to assess the safety of the LARAI portal trajectory. If this value was more than zero, the trajectory was considered "safe." In the cadaveric study, lower limbs from seven fresh-frozen cadavers were used to establish the "safe" trajectories of the LARAI portal, and the PS was measured.
RESULTS
In the 3D-CT study, the longest PS (P < 0.001) was found 20 mm lateral to the edge of the patellar tendon trajectory at 0 mm from the posterior cruciate ligament (PCL). Safe trajectories were also found 10 mm, 15 mm, and 20 mm lateral to the edge of the patellar tendon at 0 mm from the PCL, as well as the 20 mm lateral to the edge of the patellar tendon at 3 mm from the PCL. The cadaveric study showed that the average PS of all safe trajectories closely adjoined to PCL was greater than 14 mm.
CONCLUSIONS
The LARAI portal trajectory in the "figure of four" is safe, and the optimal insertion point is 10-20 mm lateral to the edge of the patellar tendon and closely adjoined to the posterolateral margin of the PCL at knee joint line level.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Menisci, Tibial; Posterior Cruciate Ligament; Vascular System Injuries; Cadaver; Tomography, X-Ray Computed; Tomography; Knee Joint
PubMed: 37775551
DOI: 10.1186/s10195-023-00727-1