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Journal of Experimental Orthopaedics Jul 2024It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between...
PURPOSE
It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between bone bruise (BB) distribution or depth and ACL tear location.
METHODS
A retrospective analysis of 446 consecutive patients with acute non-contact ACL injury was performed. Only patients with complete ACL tears verified during subsequent arthroscopy were included. Magnetic resonance imaging (MRI) was used to classify BB location, BB depth, ACL tear location and concomitant injuries (medial/lateral meniscus and medial/lateral collateral ligament). Demographic characteristics included age, gender, body mass index (BMI), type of sport and time between injury and MRI. Multiple linear regression analysis was used to identify independent predictors of ACL tear location.
RESULTS
One hundred and fifty-eight skeletally mature patients met the inclusion criteria. The presence of BB in the lateral tibial plateau was associated with a more distal ACL tear location ( = -0.27, < 0.001). Less BB depth in the lateral femoral condyle showed a tendency towards more proximal ACL tears ( = -0.14; = 0.054). Older age predicted a more proximal ACL tear location ( = 0.31, < 0.001). No significant relationship was found between ACL tear location and gender, BMI, type of sport, concomitant injuries and time between injury and MRI.
CONCLUSION
ACL tear location after an acute non-contact injury is associated with distinct patterns of BB distribution, particularly involving the lateral compartment, indicating that different injury mechanisms may lead to different ACL tear locations.
LEVEL OF EVIDENCE
Level III.
PubMed: 38741902
DOI: 10.1002/jeo2.12034 -
Scientific Reports May 2024Three-dimensional information is essential for a proper understanding of the healing potential of the menisci and their overall role in the knee joint. However, to date,...
Three-dimensional information is essential for a proper understanding of the healing potential of the menisci and their overall role in the knee joint. However, to date, the study of meniscal vascularity has relied primarily on two-dimensional imaging techniques. Here we present a method to elucidate the intricate 3D meniscal vascular network, revealing its spatial arrangement, connectivity and density. A polymerizing contrast agent was injected into the femoral artery of human cadaver legs, and the meniscal microvasculature was examined using micro-computed tomography at different levels of detail and resolution. The 3D vascular network was quantitatively assessed in a zone-base analysis using parameters such as diameter, length, tortuosity, and branching patterns. The results of this study revealed distinct vascular patterns within the meniscus, with the highest vascular volume found in the outer perimeniscal zone. Variations in vascular parameters were found between the different circumferential and radial meniscal zones. Moreover, through state-of-the-art 3D visualization using micro-CT, this study highlighted the importance of spatial resolution in accurately characterizing the vascular network. These findings, both from this study and from future research using this technique, improve our understanding of microvascular distribution, which may lead to improved therapeutic strategies.
Topics: Humans; Imaging, Three-Dimensional; Microvessels; X-Ray Microtomography; Menisci, Tibial; Meniscus; Male; Cadaver; Female
PubMed: 38740845
DOI: 10.1038/s41598-024-61497-2 -
BMC Musculoskeletal Disorders May 2024Synovitis, characterized by inflammation of the synovial membrane, is commonly induced by meniscus tears. However, significant differences in inflammatory responses and...
BACKGROUND
Synovitis, characterized by inflammation of the synovial membrane, is commonly induced by meniscus tears. However, significant differences in inflammatory responses and the key inflammatory mediators of synovium induced by different types of meniscal tears remain unclear.
METHODS
Magnetic resonance imaging (MRI) was employed to identify the type of meniscus tear, and the quantification of synovial inflammation was assessed through H&E staining assay. Transcription and expression levels of IL-1β and IL-6 were evaluated using bioinformatics, ELISA, RT-qPCR, and IHC of CD68 staining assays. The therapeutic potential of Docosapentaenoic Acid (DPA) was determined through network pharmacology, ELISA, and RT-qPCR assays. The safety of DPA was assessed using colony formation and EdU staining assays.
RESULTS
The results indicate that both IL-1β and IL-6 play pivotal roles in synovitis pathogenesis, with distinct expression levels across various subtypes. Among tested meniscus tears, oblique tear and bucket handle tear induced the most severe inflammation, followed by radial tear and longitudinal tear, while horizontal tear resulted in the least inflammation. Furthermore, in synovial inflammation induced by specific meniscus tears, the anterior medial tissues exhibited significantly higher local inflammation than the anterior lateral and suprapatellar regions, highlighting the clinical relevance and practical guidance of anterior medial tissues' inflammatory levels. Additionally, we identified the essential omega-3 fatty acid DPA as a potential therapeutic agent for synovitis, demonstrating efficacy in blocking the transcription and expression of IL-1β and IL-6 with minimal side effects.
CONCLUSION
These findings provide valuable insights into the nuanced nature of synovial inflammation induced by various meniscal tear classifications and contribute to the development of new adjunctive therapeutic agents in the management of synovitis.
Topics: Tibial Meniscus Injuries; Synovitis; Magnetic Resonance Imaging; Synovial Membrane; Humans; Fatty Acids, Unsaturated; Male; Interleukin-1beta; Animals; Interleukin-6; Female; Menisci, Tibial; Mice; Disease Models, Animal
PubMed: 38734632
DOI: 10.1186/s12891-024-07491-1 -
Immune Network Apr 2024We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus...
We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus tear (MT) and proposed this as a mechanism for a greater post-injury prevalence of post traumatic osteoarthritis (PTOA). To explore additional roles of complement proteins and regulators, we determined the presence of decay-accelerating factor (DAF), C5b, and membrane attack complexes (MACs, C5b-9) in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy, osteoarthritis (OA)-related knee replacement surgery and normal controls. Multiplexed immunohistochemistry was used to detect and quantify complement proteins. To explore the involvement of body mass index (BMI), after these 2 injuries, we examined correlations among DAF, C5b, MAC and BMI. Using these approaches, we found that synovial cells after ACL injury expressed a significantly lower level of DAF as compared to MT (p<0.049). In contrast, C5b staining synovial cells were significantly higher after ACL injury (p<0.0009) and in OA DSST (p<0.039) compared to MT. Interestingly, there were significantly positive correlations between DAF & C5b (r=0.75, p<0.018) and DAF & C5b (r=0.64 p<0.022) after ACL injury and MT, respectively. The data support that DAF, which should normally dampen C5b deposition due to its regulatory activities on C3/C5 convertases, does not appear to exhibit that function in inflamed synovia following either ACL injury or MT. Ineffective DAF regulation may be an additional mechanism by which relatively uncontrolled complement activation damages tissue in these injury states.
PubMed: 38725672
DOI: 10.4110/in.2024.24.e17 -
F1000Research 2022The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and... (Observational Study)
Observational Study
BACKGROUND
The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens.
METHODS
The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper.
RESULTS
The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively.
CONCLUSION
It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.
Topics: Humans; Cross-Sectional Studies; Knee Joint; Menisci, Tibial; Cadaver; Male; Female; Adult; Middle Aged; Aged; Meniscus
PubMed: 38725543
DOI: 10.12688/f1000research.128395.2 -
Cureus Apr 2024The meniscus of the knee serves as a crucial load-bearing structure, and its damage can significantly impact weight distribution. In addressing focal meniscal defects,...
A Rare Case of Arthroscopic Lateral Segmental Meniscal Allograft Transplantation (SMALT) and Osteochondral Allograft Transplantation (OCA) of the Lateral Femoral Condyle Augmented With Bone Marrow Aspirate Concentrate (BMAC).
The meniscus of the knee serves as a crucial load-bearing structure, and its damage can significantly impact weight distribution. In addressing focal meniscal defects, segmental meniscal allograft transplantation (SMALT) emerges as an innovative solution. Here, we detail a case involving a young, active female who underwent SMALT augmented with osteochondral allograft transplantation (OCA) and bone marrow aspirate concentration (BMAC). The patient, a 40-year-old former Division I volleyball player, previously underwent arthroscopic procedures and presented with knee pain alongside complex lateral meniscus tear evident in magnetic resonance imaging (MRI) findings. Initial arthroscopy revealed multiple tears, including segmental deficiency at the posterior horn-body junction and a horizontal cleavage tear. Despite failed attempts at repair due to the meniscal gap, a second-stage lateral SMALT was performed, with the allograft soaked in the patient's BMAC, supplemented with OCA to the lateral femoral condyle. Rehabilitation protocols tailored to both SMALT and OCA were implemented. This represents the first documented instance of lateral SMALT, extending the scope of viable solutions for segmental meniscal deficiencies, and marking a significant milestone in orthopedic practice.
PubMed: 38721181
DOI: 10.7759/cureus.57843 -
The Archives of Bone and Joint Surgery 2024Discoid lateral meniscus (DLM) is the most frequent congenital variant of the lateral meniscus, which is prone to degeneration and tears, and frequently causes knee...
Discoid lateral meniscus (DLM) is the most frequent congenital variant of the lateral meniscus, which is prone to degeneration and tears, and frequently causes knee osteoarthritis. The purpose of this article has been to analyze the publications made during 2023 on DLM. The main conclusions of the analysis were as follows: MRI assessment might be helpful to diagnose DLM and detect the presence of instability: two main factors in the decision to perform surgery. Arthroscopic assessment should be utilized in conjunction with MRI findings for complete DLM diagnosis. Restoring the normal shape, retaining adequate width and thickness, and ensuring the stability of the remnant DLM is essential to sustaining the physiological function of the meniscus and preserving the knee. Partial meniscectomy with or without repair should be the first-line treatment when feasible, given that the clinical and radiological long-run results of total or subtotal meniscectomy are worse.
PubMed: 38716174
DOI: 10.22038/ABJS.2023.73940.3422 -
A New Entity of Ramp Lesion Combined with Posterior Root Tear of the Medial Meniscus: A Case Report.JBJS Case Connector Apr 2024This report describes a new pattern of meniscal tear in an 18-year-old man after a knee sprain; he had undergone anterior cruciate ligament revision (ACL-R) 3 years...
CASE
This report describes a new pattern of meniscal tear in an 18-year-old man after a knee sprain; he had undergone anterior cruciate ligament revision (ACL-R) 3 years earlier. He was diagnosed with an anterior cruciate ligament (ACL) graft rupture, a ramp lesion (Thaunat type 4), and a posterior root avulsion fracture of the medial meniscus (MM) (LaPrade type 5). He was treated successfully with an all-inside repair of the ramp lesion, a transtibial pull-out repair of the root tear, and ACL graft revision and anterolateral stabilization.
CONCLUSION
This specific meniscal injury pattern should be recognized and documented, potentially warranting consideration as a new addition to Thaunat and LaPrade classifications as type 6.
Topics: Humans; Male; Adolescent; Tibial Meniscus Injuries; Knee Injuries; Menisci, Tibial; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries
PubMed: 38704648
DOI: 10.2106/JBJS.CC.23.00439 -
Arthroscopy Techniques Apr 2024Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament....
Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament. Such lateral meniscus posterior horn lesions have been termed zip lesions. The lateral meniscus posterior horn is the major restraint for the pivot shift maneuver. Considering the morphology of condyles, lateral meniscus preservation and repair of unstable meniscocapsular posterior tear are needed to prevent future osteoarthritis. In this Technical Note, we aim to classify zip lesions of the posterior horn of the lateral meniscus. Zip lesions are located posteriorly and often are missed on magnetic resonance imaging and routine diagnostic arthroscopy. We recommend looking from the anteromedial portal and exploring the posterolateral compartment to identify hidden zip lesions, equivalent to medial-sided ramp lesions. We describe various all-inside techniques to repair these inaccessible tears.
PubMed: 38690337
DOI: 10.1016/j.eats.2024.102911 -
Medicina (Kaunas, Lithuania) Mar 2024This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial...
This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.
Topics: Humans; Meniscectomy; Menisci, Tibial; Osteoarthritis, Knee; Quality of Life; Tibial Meniscus Injuries
PubMed: 38674215
DOI: 10.3390/medicina60040569