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Medicina (Kaunas, Lithuania) Jun 2023Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead... (Review)
Review
Medial meniscus posterior root tears (MMRTs), defined as tears or avulsions that occur within 1 cm of the tibial attachment of the medial meniscus posterior root, lead to biomechanically detrimental knee conditions by creating a functionally meniscal-deficient status. Given their biomechanical significance, MMRTs have recently been gaining increasing interest. Accordingly, numerous studies have been conducted on the anatomy, biomechanics, clinical features, diagnosis, and treatment of MMRTs, and extensive knowledge has been accumulated. Although a consensus has not yet been reached on several issues, such as surgical indications, surgical techniques, and rehabilitation protocols, this article aimed to comprehensively review the current knowledge on MMRTs and to introduce the author's treatment strategies.
Topics: Humans; Menisci, Tibial; Knee Joint; Tibia; Rupture
PubMed: 37511993
DOI: 10.3390/medicina59071181 -
Knee Surgery, Sports Traumatology,... Apr 2020The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA... (Review)
Review
PURPOSE
The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts.
METHODS
Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied.
RESULTS
The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair.
DISCUSSION
The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc. LEVEL OF EVIDENCE: II.
Topics: Arthroscopy; Consensus; Humans; Magnetic Resonance Imaging; Meniscectomy; Menisci, Tibial; Rupture; Tibial Meniscus Injuries
PubMed: 32052121
DOI: 10.1007/s00167-020-05847-3 -
Journal of ISAKOS : Joint Disorders &... Jan 2021The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is... (Review)
Review
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
Topics: Arthroscopy; Cartilage Diseases; Female; Humans; Joint Diseases; Knee Joint; Male; Meniscectomy; Menisci, Tibial; Pain; Return to Sport; Rupture; Tibial Meniscus Injuries
PubMed: 33833041
DOI: 10.1136/jisakos-2017-000162 -
Osteoarthritis and Cartilage Sep 2007To evaluate anterior cruciate ligament transection (ACLT) and destabilization of the medial meniscus (DMM) surgical instability models of osteoarthritis (OA) in the...
OBJECTIVE
To evaluate anterior cruciate ligament transection (ACLT) and destabilization of the medial meniscus (DMM) surgical instability models of osteoarthritis (OA) in the 129/SvEv mouse knee joint.
DESIGN
Micro-surgical techniques were used to perform ACLT or DMM under direct visualization. Histological scoring was performed on multiple sections to assess cartilage damage across the entire joint.
RESULTS
The ACLT model gave severe OA, chondrogenesis of the joint capsule and, in some cases, severe subchondral erosion of the posterior tibial plateau. Surgical DMM was less invasive than the ACLT procedure and resulted in lesions primarily on the central weight-bearing region of the medial tibial plateau and medial femoral condyles. Lesions in the DMM model progressed from mild-to-moderate OA at 4 weeks, to moderate-to-severe OA at 8 weeks post-surgery. Destruction of the subchondral bone was never observed in the DMM model.
CONCLUSIONS
ACLT is not recommended in the mouse due to the high surgical proficiency required and the development of severe OA that may involve subchondral bone erosion. The severity and location of lesions following DMM are consistent with lesions observed in aged spontaneous mouse models of OA. The DMM model has sufficient sensitivity to show disease modification, as observed with the ADAMTS-5 knock out (KO) mouse. The DMM model should be a first choice to challenge mice with gene deletions of potential targets in OA.
Topics: Animals; Anterior Cruciate Ligament; Disease Models, Animal; Disease Progression; Feasibility Studies; Menisci, Tibial; Mice; Mice, Mutant Strains; Osteoarthritis
PubMed: 17470400
DOI: 10.1016/j.joca.2007.03.006 -
Osteoarthritis and Cartilage Oct 2022We conducted a systematic review in order to understand the relationship between imaging-visualised meniscus pathologies, hyaline cartilage, joint replacement and pain... (Review)
Review
OBJECTIVE
We conducted a systematic review in order to understand the relationship between imaging-visualised meniscus pathologies, hyaline cartilage, joint replacement and pain in knee osteoarthritis (OA).
DESIGN
A search of the Medline, Excerpta Medica database (EMBASE) and Cochrane library databases was performed for original publications reporting association between imaging-detected meniscal pathology (extrusion or tear/damage) and longitudinal and cross-sectional assessments of hyaline articular cartilage loss [assessed on magnetic resonance imaging (MRI)], incident joint replacement and pain (longitudinal and cross-sectional) in knee OA. Each association was qualitatively characterised by a synthesis of data from each analysis, based upon study design and quality scoring (including risk of bias assessment and adequacy of covariate adjustment using Cochrane recommended methodology).
RESULTS
In total 4,878 abstracts were screened and 82 publications were included (comprising 72 longitudinal analyses and 49 cross-sectional). Using high quality, well-adjusted data, meniscal extrusion and meniscal tear/damage were associated with longitudinal progression of cartilage loss, cross-sectional cartilage loss severity and joint replacement, independently of age, sex and body mass index (BMI). Medial and lateral meniscal tears were associated with cartilage loss when they occurred in the body and posterior horns, but not the anterior horns. There was a lack of high quality, well-adjusted meniscal pathology and pain publications and no clear independent association between meniscal extrusion or tear/damage with pain severity, progression in pain or incident frequent knee symptoms.
CONCLUSION
Meniscal features have strong associations with cartilage loss and joint replacement in knee OA, but weak associations with knee pain. Systematic review PROSPERO registration number: CRD 42020210910.
Topics: Arthroplasty, Replacement; Cartilage, Articular; Cross-Sectional Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Menisci, Tibial; Osteoarthritis, Knee; Pain
PubMed: 35963512
DOI: 10.1016/j.joca.2022.08.002 -
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 -
Autophagy Jul 2020Synovitis is implicated in the pathology of osteoarthritis (OA) and significantly contributes to the development of OA. As a noninvasive physical therapy, low-intensity...
UNLABELLED
Synovitis is implicated in the pathology of osteoarthritis (OA) and significantly contributes to the development of OA. As a noninvasive physical therapy, low-intensity pulsed ultrasound (LIPUS) has been reported to possess anti-inflammatory effect in recent years. However, the role of LIPUS on synovitis of OA and the underlying mechanisms are little known. The present study showed that LIPUS ameliorated synovial inflammation in destabilization of the medial meniscus (DMM) mouse model and air pouch model, and alleviated pain gait patterns of DMM mouse. LIPUS dramatically inhibited the production of mature IL1B/IL-1β (interleukin 1 beta) and . In addition, LIPUS upregulated the macroautophagy/autophagy level as well as accelerated the formation of an SQSTM1 (sequestosome1)-PKM (pyruvate kinase, muscle) complex in the lipopolysaccharide (LPS)-adenosine triphosphate (ATP)-treated macrophages. Besides, LIPUS downregulated the level of PKM2 in LPS-ATP-treated macrophages, which could be reversed by SQSTM1 knockdown. In brief, the present study for the first time demonstrates that LIPUS inhibits the production of mature IL1B partially via SQSTM1-dependent autophagic degradation of PKM2 in LPS-ATP-treated macrophages, which may further ameliorate the synovial inflammation and gait patterns in animal models. Our data provide new clues for the treatments of synovitis and other inflammatory diseases using LIPUS.
ABBREVIATIONS
3-MA: 3-methyladenene; ATG7: autophagy-related 7; ATP: adenosine triphosphate; BafA1: bafilomycin A; BMDMs: bone marrow derived macrophages; CHX: cycloheximide; DMM: destabilization of the medial meniscus; ELISA: enzyme-linked immunosorbent assay; GFP: green fluorescent protein; IL1B/IL-1β: interleukin 1 beta; LIPUS: low-intensity pulsed ultrasound; LIR: LC3-interacting region; LPS: lipopolysaccharide; MAP1LC3B/LC3B: microtubule associated protein 1 light chain 3 beta; MDP: muramyl dipeptide; NFKB/NF-κB: nuclear factor kappa B; NLRP3: NLR family, pyrin domain containing 3; OA: osteoarthritis; PKM/PKM2: pyruvate kinase M1/2; PMA: phorbol-12-myristate-13-acetate; PYCARD/ASC; PYD and CARD domain containing; RFP: red fluorescent protein; siRNAs: small interfering RNAs; SQSTM1: sequestosome 1; TEM: transmission electron microscopy.
Topics: Adenosine Triphosphate; Animals; Anti-Inflammatory Agents; Autophagy; Disease Models, Animal; Gait; Humans; Inflammation; Interleukin-1beta; Lipopolysaccharides; Macrophages; Menisci, Tibial; Mice; Mice, Inbred C57BL; Models, Biological; Pain; Proteolysis; Pyruvate Kinase; RAW 264.7 Cells; Sequestosome-1 Protein; Synovial Membrane; THP-1 Cells; Ultrasonic Waves
PubMed: 31500508
DOI: 10.1080/15548627.2019.1664705 -
Orthopaedics & Traumatology, Surgery &... Feb 2021The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and... (Review)
Review
The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and adolescents. In normal menisci, lesions are traumatic in origin. They are often vertical, in the posterior segment, associated with anterior cruciate ligament tear. In abnormal menisci, lesions are much more specific to children, occurring atraumatically, mainly in discoid menisci. Clinical signs of traumatic meniscal lesion are minimal, and associated ligament involvement should be systematically screened for. In contrast, clinical findings are rich and specific in discoid malformative pathology, sometimes showing the typical "clunk" sign highly suggestive of a detachment. The complementary examination of choice is MRI. In children more than in adults, lesions need screening for in apparently normal menisci. This particularly concerns ramp lesions of the medial meniscus. It is important also to be aware of false signs, and notably linear hypersignal of vascular origin in the posterior segment of the medial meniscus. MRI is essential in determining type of tear and guiding surgery in discoid meniscal pathology. Indications for meniscal repair in children are maximal, even in lesions extending into the white zone, and the risk of failure needs to be assumed. All meniscal suture techniques - all-inside, in-out and out-in - need to be acquired. Meniscectomy, even partial, should be exceptional. Treatment of symptomatic discoid meniscus usually involves minimal central meniscoplasty and suture of the discovered lesion. Results of meniscal repair in children are generally very satisfactory, whatever the type or site of lesion. Vertical suture is to be preferred; suture failure is often only partial. In all, optimal treatment of meniscal pathology in children and adolescents requires perfect knowledge of pediatric specificities and above all mastery of repair techniques to restore meniscal tissue as fully as possible so as to conserve future knee function.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Arthroscopy; Cartilage Diseases; Child; Humans; Meniscectomy; Menisci, Tibial
PubMed: 33321242
DOI: 10.1016/j.otsr.2020.102775 -
Journal of ISAKOS : Joint Disorders &... Jun 2023Meniscus tears are prevalent in isolation and in combination with anterior cruciate ligament (ACL) injury. Meniscus lesions can be difficult to access and often display...
Meniscus tears are prevalent in isolation and in combination with anterior cruciate ligament (ACL) injury. Meniscus lesions can be difficult to access and often display complex tear patterns, which result in technical challenges for the operating surgeon during surgical treatment. The aim of this video article is to demonstrate technical tips and tricks for performing all-inside repair of challenging meniscus tears. The presented techniques are indicated in young, physically active patients with symptomatic tears of the lateral and medial menisci, with or without concomitant ACL injury. The procedure is performed using standard anterolateral and anteromedial arthroscopic portals for direct visualization of complex meniscus tear patterns and all-inside instrument access. A suture passing device is used for the placement of suture loops for meniscus root repair. All-inside repair devices are used to repair the radial meniscal tears along the native circumferential fibers using a horizontal mattress suture configuration, with curved devices to achieve optimal access to challenging tears affecting the anterior and posterior aspects at the mid-body of the meniscus. Repair of radial tears at the avascular zone of the meniscus may be augmented with an autologous fibrin clot delivered using an arthroscopic cannula.
Topics: Humans; Arthroscopy; Tibial Meniscus Injuries; Anterior Cruciate Ligament Injuries; Knee Injuries; Menisci, Tibial
PubMed: 36924826
DOI: 10.1016/j.jisako.2023.02.007 -
BMJ Case Reports Oct 2017We present a case of a 19-year-old woman with a forced hyperextension trauma of the knee causing a posteromedial fracture, a medial meniscus root tear and rupture of the...
We present a case of a 19-year-old woman with a forced hyperextension trauma of the knee causing a posteromedial fracture, a medial meniscus root tear and rupture of the posterior cruciate ligament. The posteromedial fracture of the tibial plateau was treated operatively with open reduction and internal fixation. Anatomical reconstruction was achieved. Postoperative treatment included unlimited flexion and minimal weight bearing. After 3 months, the patient had minimal pain after weight bearing and returned to preoperative range of motion.
Topics: Female; Fracture Fixation, Internal; Humans; Knee Joint; Menisci, Tibial; Open Fracture Reduction; Posterior Cruciate Ligament; Range of Motion, Articular; Recovery of Function; Rupture; Tibia; Tibial Fractures; Tibial Meniscus Injuries; Treatment Outcome; Young Adult
PubMed: 29018143
DOI: 10.1136/bcr-2016-217714