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Scientific Reports Oct 2022Meniscus horizontal tears are usually degenerative. It could be asymptomatic and unrelated to knee symptoms. Therefore, there are controversies regarding treatment...
Meniscus horizontal tears are usually degenerative. It could be asymptomatic and unrelated to knee symptoms. Therefore, there are controversies regarding treatment choices. The aim of this study was to evaluate factors that affect the results of non-surgical and surgical treatments for meniscus horizontal tears. We retrospectively studied 159 patients with meniscus horizontal tears with a minimum 2-year follow-up period. Patients were treated non-surgically or arthroscopically. The treatment results were dichotomized into success and failure. The factors considered were age, sex, joint line tenderness, mechanical symptoms, widest tear gap width on sagittal MRI, cartilage lesion grade, discoid meniscus, tear site, and joint alignment. Joint alignment and cartilage lesion grade were the factors that significantly influenced non-surgical treatment results. The widest tear gap width and cartilage lesion grade significantly affected arthroscopic surgery results. The mechanical symptoms did not show any significant relationship with either treatment result. In treating patients with meniscus horizontal tears, patients with varus alignment and advanced cartilage lesions should be informed of possible poor outcomes with non-surgical treatment. If the patient has a wide tear gap or minimal cartilage lesion, arthroscopic surgery would be a good treatment choice. The mechanical symptom was not an adequate factor for arthroscopic surgery.
Topics: Arthroscopy; Humans; Magnetic Resonance Imaging; Menisci, Tibial; Meniscus; Prognosis; Retrospective Studies; Rupture; Tibial Meniscus Injuries
PubMed: 36241683
DOI: 10.1038/s41598-022-21599-1 -
Cells Apr 2019The aim of this study was to review aspects of the pathobiology of the meniscus in health and disease and show how degeneration of the meniscus can contribute to... (Review)
Review
The aim of this study was to review aspects of the pathobiology of the meniscus in health and disease and show how degeneration of the meniscus can contribute to deleterious changes in other knee joint components. The menisci, distinctive semilunar weight bearing fibrocartilages, provide knee joint stability, co-ordinating functional contributions from articular cartilage, ligaments/tendons, synovium, subchondral bone and infra-patellar fat pad during knee joint articulation. The meniscus contains metabolically active cell populations responsive to growth factors, chemokines and inflammatory cytokines such as interleukin-1 and tumour necrosis factor-alpha, resulting in the synthesis of matrix metalloproteases and A Disintegrin and Metalloprotease with ThromboSpondin type 1 repeats (ADAMTS)-4 and 5 which can degrade structural glycoproteins and proteoglycans leading to function-limiting changes in meniscal and other knee joint tissues. Such degradative changes are hall-marks of osteoarthritis (OA). No drugs are currently approved that change the natural course of OA and translate to long-term, clinically relevant benefits. For any pharmaceutical therapeutic intervention in OA to be effective, disease modifying drugs will have to be developed which actively modulate the many different cell types present in the knee to provide a global therapeutic. Many individual and combinatorial approaches are being developed to treat or replace degenerate menisci using 3D printing, bioscaffolds and hydrogel delivery systems for therapeutic drugs, growth factors and replacement progenitor cell populations recognising the central role the menisci play in knee joint health.
Topics: Fibrocartilage; Humans; Knee Joint; Meniscus; Transcriptome; Weight-Bearing; Wound Healing
PubMed: 30959928
DOI: 10.3390/cells8040324 -
Journal of Healthcare Engineering 2021Knee meniscus injuries are more likely to occur in young adults in clinical practice, and their lower age of onset and greater impact on joint function after injury also...
Knee meniscus injuries are more likely to occur in young adults in clinical practice, and their lower age of onset and greater impact on joint function after injury also put forward higher requirements for the treatment and rehabilitation of meniscus injuries. With the rapid development of artificial intelligence technology and arthroscopic minimally invasive technology, arthroscopic meniscus plasty and perovskite nanobiomaterial repair have gradually replaced the previous open meniscus surgery of the knee joint and has become the main method of meniscus injury treatment, and the perovskite nanobiomaterial repair technique that incorporates artificial intelligence technology is also gradually being applied. Therefore, this article studies the role of perovskite nanobiomaterials in the repair of meniscus injuries in football sports and analyzes the biological characteristics of the inner and outer meniscus to provide help to improve the healing rate of meniscus injuries. The study selected six male meniscus-injured patients (meniscus injuries caused by football sports) and obtained six injured menisci. The same cross section of the same part of the meniscus was analyzed inside and outside the meniscus. At the same time, a meniscal injury step was performed on the patient. The biological characteristics of perovskite nano-biomaterials in the repair of meniscus injuries in football sports were compared and analyzed, and the patient's gait before and after surgery was also compared. Experiments have shown that the percentage of the postoperative support phase of the affected limb is significantly higher than that before surgery ( < 0.05), the percentage of the postoperative support phase and flatfoot phase decreased compared with that before surgery, and the gait cycle parameters of both lower extremities improved after surgery, obviously ( < 0.05). It explains that the arthroscopic repair of perovskite nanobiomaterials combined with the artificial intelligence technology to repair the meniscus anterior angle injury is simple and does not require special equipment, has fewer complications, is safe and reliable, and has a high clinical healing rate and a high patient satisfaction rate after surgery. The curative effect is significant; artificial intelligence technology and the application of perovskite nanobiomaterials provide more possibilities for meniscus repair.
Topics: Arthroscopy; Artificial Intelligence; Calcium Compounds; Football; Humans; Male; Meniscus; Oxides; Tibial Meniscus Injuries; Titanium; Young Adult
PubMed: 34367536
DOI: 10.1155/2021/4324138 -
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 -
Theranostics 2021Disruption of anisotropic phenotypes of the meniscus would contribute to OA progression. Exploring phenotype changes of the anisotropic meniscus in joint degeneration...
Disruption of anisotropic phenotypes of the meniscus would contribute to OA progression. Exploring phenotype changes of the anisotropic meniscus in joint degeneration would help understand the biologic interaction between the meniscus and OA, and further facilitate the therapeutic strategies of meniscus injury-related joint degeneration. Meanwhile, engineering biomimetic meniscal tissue mimicking the anisotropy of the healthy meniscus remains a challenge. Meniscal disruption of phenotype anisotropy (PBV growth, cellular phenotype and ECM depositions) was confirmed in OA patient samples. To recapitulate healthy meniscus phenotypes, 3D-bioprinted anisotropic TCM meniscus constructs with PBV growth and regional differential cell and ECM depositions were generated. Transplanted 3D-bioprinted meniscus into rabbit knees recapitulated phenotypes of native healthy meniscus and conferred long-term protection against secondary joint degeneration. 3D-bioprinted TCM meniscus not only restored the anisotropy of native healthy meniscus with PBV infiltration and better shape retention, but better maintained joint function and prevented secondary joint degeneration, which provided a new strategy for the clinical treatment of meniscus injury-related joint degenerative diseases.
Topics: Animals; Anisotropy; Bioprinting; Knee Joint; Meniscus; Phenotype; Rabbits; Tissue Engineering
PubMed: 33859740
DOI: 10.7150/thno.54864 -
Theranostics 2020Meniscus deficiency, the most common and refractory disease in human knee joints, often progresses to osteoarthritis (OA) due to abnormal biomechanical distribution and...
Meniscus deficiency, the most common and refractory disease in human knee joints, often progresses to osteoarthritis (OA) due to abnormal biomechanical distribution and articular cartilage abrasion. However, due to its anisotropic spatial architecture, complex biomechanical microenvironment, and limited vascularity, meniscus repair remains a challenge for clinicians and researchers worldwide. In this study, we developed a 3D printing-based biomimetic and composite tissue-engineered meniscus scaffold consisting of polycaprolactone (PCL)/silk fibroin (SF) with extraordinary biomechanical properties and biocompatibility. We hypothesized that the meticulously tailored composite scaffold could enhance meniscus regeneration and cartilage protection. : The physical property of the scaffold was characterized by scanning electron microscopy (SEM) observation, degradation test, frictional force of interface assessment, biomechanical testing, and fourier transform infrared (FTIR) spectroscopy analysis. To verify the biocompatibility of the scaffold, the viability, morphology, proliferation, differentiation, and extracellular matrix (ECM) production of synovium-derived mesenchymal stem cell (SMSC) on the scaffolds were assessed by LIVE/DEAD staining, alamarBlue assay, ELISA analysis, and qRT-PCR. The recruitment ability of SMSC was tested by dual labeling with CD29 and CD90 by confocal microscope at 1 week after implantation. The functionalized hybrid scaffold was then implanted into the meniscus defects on rabbit knee joint for meniscus regeneration, comparing with the Blank group (no scaffold) and PS group. The regenerated meniscus tissue was evaluated by histological and immunohistochemistry staining, and biomechanical test. Macroscopic and histological scoring was performed to assess the outcome of meniscus regeneration and cartilage protection . : The combination of SF and PCL could greatly balance the biomechanical properties and degradation rate to match the native meniscus. SF sponge, characterized by fine elasticity and low interfacial shear force, enhanced energy absorption capacity of the meniscus and improved chondroprotection. The SMSC-specific affinity peptide (LTHPRWP; L7) was conjugated to the scaffold to further increase the recruitment and retention of endogenous SMSCs. This meticulously tailored scaffold displayed superior biomechanics, structure, and function, creating a favorable microenvironment for SMSC proliferation, differentiation, and extracellular matrix (ECM) production. After 24 weeks of implantation, the histological assessment, biochemical contents, and biomechanical properties demonstrated that the polycaprolactone/silk fibroin-L7 (PS-L7) group was close to the native meniscus group, showing significantly better cartilage protection than the PS group. : This tissue engineering scaffold could greatly strengthen meniscus regeneration and chondroprotection. Compared with traditional cell-based therapies, the meniscus tissue engineering approach with advantages of one-step operation and reduced cost has a promising potential for future clinical and translational studies.
Topics: Animals; Biomechanical Phenomena; Cartilage, Articular; Cell Differentiation; Cells, Cultured; Fibroins; Meniscus; Mesenchymal Stem Cells; Polyesters; Porosity; Printing, Three-Dimensional; Rabbits; Tissue Engineering; Tissue Scaffolds
PubMed: 32308770
DOI: 10.7150/thno.44270 -
Acta Biomaterialia Feb 2024Biomechanical characterization of meniscal tissue ex vivo remains a critical need, particularly for the development of suitable meniscus replacements or therapeutic... (Review)
Review
Biomechanical characterization of meniscal tissue ex vivo remains a critical need, particularly for the development of suitable meniscus replacements or therapeutic strategies that target the native mechanical properties of the meniscus. To date, a huge variety of test configurations and protocols have been reported, making it extremely difficult to compare the respective outcome parameters, thereby leading to misinterpretation. Therefore, the purpose of this systematic review was to identify test-specific parameters that contribute to uncertainties in the determination of mechanical properties of the human meniscus and its attachments, which derived from common quasi-static and dynamic tests in tension, compression, and shear. Strong evidence was found that the determined biomechanical properties vary significantly depending on the specific test parameters, as indicated by up to tenfold differences in both tensile and compressive properties. Test mode (stress relaxation, creep, cyclic) and configuration (unconfined, confined, in-situ), specimen shape and dimensions, preconditioning regimes, loading rates, post-processing of experimental data, and specimen age and degeneration were identified as the most critical parameters influencing the outcome measures. In conclusion, this work highlights an unmet need for standardization and reporting guidelines to facilitate comparability and may prove beneficial for evaluating the mechanical properties of novel meniscus constructs. STATEMENT OF SIGNIFICANCE: The biomechanical properties of the human meniscus have been studied extensively over the past decades. However, it remains unclear to what extent both test protocol and specimen-related differences are responsible for the enormous variability in material properties. Therefore, this systematic review analyzes the biomechanical properties of the human meniscus in the context of the underlying testing protocol. The most sensitive parameters affecting the determination of mechanical properties were identified and critically discussed. Currently, it is of utmost importance for scientists evaluating potential meniscal scaffolds and biomaterials to have a control group rather than a direct comparison to the literature. Standardization of both test procedures and reporting requirements is needed to improve and accelerate the development of meniscal replacement constructs.
Topics: Humans; Biocompatible Materials; Biomechanical Phenomena; Compressive Strength; Meniscus
PubMed: 38092252
DOI: 10.1016/j.actbio.2023.12.010 -
Artificial Intelligence in Medicine May 2020Magnetic resonance imaging (MRI) has proved to be an invaluable component of pathogenesis research in osteoarthritis. Nevertheless, the detection of a meniscal lesion... (Review)
Review
Magnetic resonance imaging (MRI) has proved to be an invaluable component of pathogenesis research in osteoarthritis. Nevertheless, the detection of a meniscal lesion from magnetic resonance (MR) images is always challenging for both clinicians and researchers, because the surrounding tissues lead to similar signals within MR measurements, thus being difficult to discriminate. Moreover, the size and shape of osteoarthritic and non-osteoarthritic menisci vary to a large extent between individuals of same features, e.g. height, weight, age, etc. An effective way to visualize the entire volume of knee menisci is to segment the menisci voxels from the MR images, which is also useful to evaluate particular properties quantitatively. However, segmentation is a tedious and time-consuming task, and requires adequate training for being done properly. With the advancement of both MRI technology and computer methods, researchers have developed several algorithms to automate the task of meniscus segmentation of the individual knee during the last two decades. The objective of this systematic review was to present available fully automatic and semi-automatic segmentation methods of the knee meniscus published in different scientific articles according to the PRISMA statement. This review should provide a vivid description of the scientific advancements to clinicians and researchers in this field to help developing novel automated methods for clinical applications.
Topics: Algorithms; Humans; Knee Joint; Magnetic Resonance Imaging; Meniscus; Osteoarthritis
PubMed: 32505421
DOI: 10.1016/j.artmed.2020.101849 -
Journal of Orthopaedic Surgery and... Mar 2022The indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this...
BACKGROUND
The indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this study was to identify predictors of unfavorable clinical and radiologic outcomes after APM for DMMLs and to choose appropriate indications and improve treatment efficacy.
METHODS
A total of 86 patients with DMMLs undergoing APM were retrospectively reviewed. The mean follow-up time was 32.1 months. Clinical outcomes (including Lysholm score) and radiographic results (including Kellgren-Lawrence grade (K-L grade: 0/1/2/3/4) were evaluated at preoperative and final follow-up. Preoperative prognostic factors, including gender, age, Body Mass Index (BMI), Hip-Knee-Ankle (HKA), Medial Posterior Tibial Slope (MPTS), Medial Meniscus Extrusion (MME), K-L grade, occupational kneeling, and cartilaginous condition (Outerbridge grade ≤ 2, VS ≥ 3), for relatively unfavorable (fair or poor grade) Lysholm and progression of K-L grade, were investigated by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify a cutoff point for the extent of medial meniscal extrusion that was associated with the final Lysholm score.
RESULTS
A significantly improved postoperative Lysholm score (84.5 ± 9.7) compared with the preoperative score (63.8 ± 9.3) (P < 0.001), but a progression of K-L grade (20/36/30/0/0-15/27/25/19/0) (P < 0.001). The adverse prognostic factor of Lysholm score was the advancing age (OR 1.109, P = 0.05) and HKA (OR 0.255, P < 0.001). The adverse prognostic factor of K-L grade progression was MME (OR 10.327, P < 0.001). The cutoff point for the relative value of preoperative medial meniscal extrusion associated with relatively unfavorable Lysholm scores was 2.05 mm (Area = 0.8668, P value < 0.0001, Sensitivity = 62.16%, Specificity = 93.88%).
CONCLUSIONS
Clinically, varus alignment, large MME, and older age were found to predict a poor prognosis after APM for DMMLs. The preoperative extent of MME can be used as a predictive factor for osteoarthritis in APM. Patients with varus and MME should avoid APM. High tibial osteotomy may be an effective treatment strategy.
Topics: Aged; Arthroscopes; Female; Humans; Male; Meniscectomy; Menisci, Tibial; Middle Aged; Prognosis; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35303914
DOI: 10.1186/s13018-022-03045-0 -
Cartilage 2022To perform conventional, morphological, and T2 mapping compositional MRI imaging to assess the cartilage degeneration and osteoarthritic progression in patients with...
Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression.
OBJECTIVE
To perform conventional, morphological, and T2 mapping compositional MRI imaging to assess the cartilage degeneration and osteoarthritic progression in patients with medial meniscus posterior root tears (MMPRTs) who underwent trans-posterior cruciate ligament (PCL) all-inside repair or partial meniscectomy.
DESIGN
Patients with MMPRTs after trans-PCL all-inside repair (group AR) or partial meniscectomy (group PM) between 2015 and 2018 were retrospectively identified. Preoperative and postoperative conventional MRI were collected to assess medial meniscus extrusion (MME) and the whole-organ magnetic resonance imaging score (WORMS). Postoperative morphological MRI and T2 mapping compositional MRI were collected to evaluate the quantitative cartilage thickness/volume and cartilage composition.
RESULTS
The final cohort consisted of 21 patients in group AR and 22 patients in group PM, with no differences in demographic data and baseline patient characteristics between the 2 groups. Group AR demonstrated less progression of articular cartilage wear ( 0.05) and decreased meniscal extrusion ( = 0.008) than group PM at the final follow-up. In addition, group AR demonstrated less extracellular matrix degeneration in the cartilage subregion of the medial compartment ( 0.05) than group PM with lower T2 relaxation times in the superficial layer of the articular cartilage.
CONCLUSION
Trans-PCL all-inside repair of MMPRTs could delay the initial cartilage deterioration and morphological cartilage degeneration compared with partial meniscectomy. However, the amount of residual meniscal extrusion is clinically important, and an improved root repair fixation method should be investigated.
Topics: Cartilage Diseases; Humans; Magnetic Resonance Imaging; Meniscectomy; Menisci, Tibial; Posterior Cruciate Ligament; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 35932104
DOI: 10.1177/19476035221114242