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Abstract
PURPOSE We report our experience with the effect of location and configuration of meniscal tears on clinical outcomes. METHODS A retrospective review of patients who underwent partial meniscectomy or meniscal repair between 2008 and 2016 was conducted. One hundred fourteen knees in 106 patients were included, comprising 43 partial meniscectomies and 71 meniscal repairs. Patients were graded pre- and postoperatively with the International Knee Documentation Committee (IKDC) score and Tegner Activity Level Scale. Meniscal tears were classified according to location (anterior horn, body, posterior horn, and others) and type (radial, horizontal, longitudinal, and complex) and subgroups were analyzed for their effect on outcomes. RESULTS All tears, whether treated with partial meniscectomy or repair, showed significant improvement in postoperative scores (p < 0.05); 39.47% of tears involved the posterior horn alone, 10.53% involved the body alone, 3.51% involved the anterior horn alone, and 46.49% were complex tears that spanned more than one area. Complex tears treated with repair had significantly better scores (IKDC, p = 0.002; Tegner, p = 0.008) than complex tears treated with meniscectomy. Longitudinal tears showed results suggesting better short-term outcomes with meniscectomy than with repair (IKDC, p = 0.036; Tegner p = 0.018), a potential statistical anomaly. Horizontal and radial tears showed no significant difference in outcomes, regardless of treatment. Tears in different locations (anterior horn, body, posterior horn, and others) showed no significant difference in outcomes, regardless of treatment. CONCLUSION Meniscal surgery yields significant improvement in postoperative scores. Complex tears showed significantly better postoperative scores when treated with repair.
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Barber FA, Howard MS, Ashraf W, Spenciner DB. The Biomechanical Performance of the Latest All-Inside Meniscal Repair Devices. Arthroscopy 2020; 36:3001-3007. [PMID: 32315765 DOI: 10.1016/j.arthro.2020.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical characteristics of recently introduced meniscal repair devices with a hand-tied, inside-out meniscal suture in a human meniscus model. METHODS In detached adult human menisci, vertical longitudinal cuts were created 3 mm from the synovial-meniscal junction, simulating a bucket-handle meniscal tear. Each cut was repaired using a single device. Group 1 received a vertical mattress suture of No. 2-0 OrthoCord; group 2, TrueSpan device with PEEK (polyether ether ketone) anchors containing No. 2-0 OrthoCord suture; group 3, TrueSpan device with biodegradable poly-lactide-co-glycolide (PLGA) anchors containing No. 2-0 OrthoCord suture; group 4, Meniscal Cinch II device; group 5, AIR meniscal repair device; and group 6, FasT-Fix 360 device. All samples were preloaded at 5 N and cycled 200 times between 5 and 20 N. The specimens that survived cyclic loading were destructively tested at 12.5 mm/s. Endpoints included maximum load, displacement, stiffness, and failure mode. RESULTS The mean failure loads were as follows: 95.8 N for OrthoCord suture, 87.1 N for TrueSpan with PEEK, 84.6 N for TrueSpan with PLGA, 48.6 N for Meniscal Cinch II, 72.3 N for AIR, and 68.1 N for FasT-Fix 360. Repairs performed with OrthoCord suture (P = .002) and both TrueSpan devices (P < .03) but not the FasT-Fix 360 device or AIR device were statistically significantly stronger than Meniscal Cinch II repairs. Mean cyclic displacement measured 1.1 mm for OrthoCord, 1.5 mm for TrueSpan with PEEK, 1.5 mm for TrueSpan with PLGA, 2.1 mm for Meniscal Cinch II, 1.1 mm for AIR, and 1.4 mm for FasT-Fix 360. The Meniscal Cinch II device showed more displacement than all other devices (P < .05). The FasT-Fix 360, AIR, and Meniscal Cinch II devices failed by anchor pullout from the peripheral meniscus. OrthoCord and both TrueSpan devices failed by suture pulling through the bucket-handle tissue. CONCLUSIONS OrthoCord suture is stronger than the AIR, FasT-Fix 360, and Meniscal Cinch II devices. The TrueSpan device with PEEK and TrueSpan device with PLGA are stronger than the Meniscal Cinch II device. The Meniscal Cinch II device failed during cyclic loading with greater cyclic displacement than the AIR device, FasT-Fix 360 device, OrthoCord, and TrueSpan device with PEEK. The Meniscal Cinch II, AIR, and FasT-Fix 360 devices failed by anchor pullout, whereas OrthoCord and both TrueSpan devices failed by suture pull-through. CLINICAL RELEVANCE Some newly introduced all-inside meniscal repair devices show inferior failure strength compared with earlier versions that might adversely impact clinical outcomes.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine Center, Plano, Texas, U.S.A
| | | | - Wasik Ashraf
- Crystal Run Healthcare, New Windsor, New York, U.S.A
| | - David B Spenciner
- DePuy Synthes Mitek Sports Medicine, Raynham, Massachusetts, U.S.A.; Rensselaer Polytechnic Institute, Troy, New York, U.S.A
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153
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Wang X, Jing L, Wang X, Li Z, Li Z, Zhang Z, Yang J. Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study. Medicine (Baltimore) 2020; 99:e23351. [PMID: 33217878 PMCID: PMC7676584 DOI: 10.1097/md.0000000000023351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to analyze the relationship between medial posterior tibial slope (MPTS) and medial meniscus slope (MMS) with the location of meniscal lesions. We hypothesize that meniscuses with greater MPTS and MMS are more likely to have lesions in posterior horn.A total of 292 patients underwent arthroscopic surgery between January 2014 to September 2019 due to knee osteoarthritis (OA) and meniscal lesions were reviewed. Based upon the location of meniscal tears, patients were categorized as group B (tears in posterior horn) and group A (other sites). MPTS and MMS were measured from magnetic resonance imaging (MRI) slices. Osteoarthritis grade was evaluated in anteroposterior radiographs by the criteria defined by Kellgeren and Lawrence. Demographic data, OA grade, MPTS, and MMS for the 2 groups were compared and analyzed.The group A had 29 (39%) male and 45 (61%) female subjects with a mean age of 57.07 ± 6.79 years. Group B consists of 74 (34%) male and 144 (66%) female subjects with a mean age of 58.90 ± 7.594 years. (P = .067 and P = .458 for age and sex, respectively). In group A, 31 knees (42%) were determined to be Kellgren-Lawrence grade one, 32 knees (43%) grade two, and 11 knees (15%) grade three. In group B, 86 knees (39%) were categorized in grade one, 85 knees (39%) in grade two, and 47 knees (26%) in grade three (P = .085). The mean MPTS was 5.06 ± 2.11 degree for group A and 6.15 ± 2.37 degree for group B (P = .001). The mean MMS for group A was lower than group B (1.38 ± 2.12 degree vs 3.14 ± 2.92 degree; P < .000)This study demonstrated that increased MPTS and MMS may be considered as the risk factors for medial meniscal posterior horn tears.
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Affiliation(s)
- Xiaotan Wang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine
| | - Lizhong Jing
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
| | - Xiaole Wang
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
| | - Zhen Li
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou
| | - Zhuang Li
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Zhiwei Zhang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine
| | - Jiushan Yang
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
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154
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Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Akiyama H. Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing. Knee Surg Sports Traumatol Arthrosc 2020; 28:3474-3480. [PMID: 31748918 DOI: 10.1007/s00167-019-05782-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and meniscus healing after arthroscopic repair of horizontal-cleavage meniscus tears, compared with vertical-longitudinal meniscus tears. METHODS This was a retrospective review of a consecutive series of 52 meniscal repairs for horizontal-cleavage tears (n = 27) or vertical-longitudinal tears (n = 25); the groups were compared with respect to clinical symptoms and meniscal healing. Arthroscopic meniscal repair was performed using the inside-out technique with a marrow-stimulating technique. Clinical symptoms were evaluated using the Lysholm score and Knee injury and osteoarthritis outcome score (KOOS). Meniscus healing was evaluated by MRI. RESULTS The mean follow-up periods were 35.4 ± 8.9 months in the horizontal-cleavage tear group and 39.8 ± 8.3 months in the vertical-longitudinal tear group. There were no significant differences in Lysholm score and KOOS, including each subscale, between the horizontal-cleavage tear- and vertical-longitudinal tear-groups at the final follow-up. At the final follow-up, MRI meniscus grades 0 and 1 were significantly more frequent in the vertical-longitudinal tear-group than in the horizontal-cleavage tear-group, while grade 3 was significantly more frequent in the horizontal-cleavage tear group than in the vertical-longitudinal tear group (p < 0.0001). CONCLUSIONS Although meniscus healing of horizontal-cleavage tears may be poor, arthroscopic repair should be considered for horizontal-cleavage tears because it does provide good clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan
- Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan.
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Japan
| | - Hiroki Yoshioka
- Department of Orthopaedic Surgery, Yamauchi Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan
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155
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Balazs GC, Greditzer HG, Wang D, Marom N, Potter HG, Rodeo SA, Marx RG, Williams RJ. Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3576-3586. [PMID: 32358631 DOI: 10.1007/s00167-020-06017-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of various methods of treatment of stable and unstable ramp lesions compared to patients with no meniscal pathology at the time of primary ACL reconstruction. METHODS All patients with a preoperative MRI performed at our facility who were enrolled in an institutional ACL registry and 1-year clinical follow-up were identified. A musculoskeletal radiologist reviewed preoperative MRI scans for evidence of a ramp lesion. Ramp lesions were classified as stable if a peripheral tear of the posterior horn of the medial meniscus was identified by MRI, but did not displace into the medial compartment with anteriorly directed probing at the time of surgery. Ramp lesions were classified as unstable if a tear was identified by preoperative MRI at the meniscocapsular junction and the meniscus was displaceable into the medial compartment with probing. Reoperation rates for ACL graft failure or recurrent medial meniscus pathology were collected. Patient-reported outcome scores (IKDC, SF12 PCS, SF12 MCS, and Marx Activity scale) were recorded at baseline and final follow-up. RESULTS A total of 162 patients were included in the analysis with median 2-year (range 1-5 years) clinical follow-up. Patients with a repaired unstable ramp lesion had a significantly higher likelihood of reoperation for recurrent medial meniscus pathology than patients without meniscal pathology at the time of index surgery. Patients with an untreated stable ramp lesion had a similar rate of reoperation when compared to patients without meniscal pathology. At final follow-up, there was no difference between groups in IKDC score, SF12 PCS/MCS, or Marx activity score or change in any score. CONCLUSIONS Patients with untreated stable ramp lesions have similar clinical outcomes at median 2-year (range 1-5 years) follow-up when compared to patients without a ramp lesion. Treatment of stable ramp lesions at the time of ACL reconstruction does not have clinical benefit. LEVEL OF EVIDENCE III.
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Affiliation(s)
- George C Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
| | - Harry G Greditzer
- Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, USA
| | - Niv Marom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Robert G Marx
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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156
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Okazaki Y, Furumatsu T, Okamoto S, Hiranaka T, Kintaka K, Miyazawa S, Ozaki T. Diagnostic performance of open MRI in the flexed knee position for the detection of medial meniscus ramp lesions. Skeletal Radiol 2020; 49:1781-1788. [PMID: 32488335 DOI: 10.1007/s00256-020-03480-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify the diagnostic performance of magnetic resonance imaging (MRI) in the knee-flexed position for the detection of meniscal ramp lesions in patients with anterior cruciate ligament tears. MATERIALS AND METHODS Forty-three patients (mean age 24.5 ± 9.5 years; 21 males, 22 females) with an arthroscopically proven anterior cruciate ligament tear were included in this retrospective study. The presence of the following two important features on MRI was recorded: irregularity of the medial meniscus at the posterior margin, and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin. Findings obtained in arthroscopy served as the reference standard. The diagnostic sensitivity, specificity, and inter-observer agreement were calculated. RESULTS Sixteen ramp lesions were noted on arthroscopy (37.2%). With an irregularity of the medial meniscus at the posterior margin on MRI, the sensitivity and specificity were 87.5 and 59.3% at 10° knee flexion and 93.8 and 85.2% at 90° flexion, respectively. The complete fluid filling sign on MRI showed sensitivity and specificity of 31.3 and 100% at 10° knee flexion and 87.5 and 100% at 90° flexion, respectively. The concordance between the two observers for the two MRI features was very good (k = 0.70-0.88). CONCLUSION MRI with the knee in the flexed position improves the diagnostic performance of the detection of meniscal ramp lesions compared with MRI with the knee in the extended position.
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Affiliation(s)
- Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Soichiro Okamoto
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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157
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Tashiro Y, Mori T, Kawano T, Oniduka T, Arner JW, Fu FH, Iwamoto Y. Meniscal ramp lesions should be considered in anterior cruciate ligament-injured knees, especially with larger instability or longer delay before surgery. Knee Surg Sports Traumatol Arthrosc 2020; 28:3569-3575. [PMID: 32767080 DOI: 10.1007/s00167-020-06161-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/14/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the incidence of meniscal ramp lesions in an anterior cruciate ligament (ACL) injured knees and to clarify whether ramp lesions are related to chronic ACL deficiency and increased knee instability. METHODS Consecutive ACL injured patients were evaluated arthroscopically for a ramp lesion via a trans-notch view and evidence of menisco-capsular injury was recorded. Other concomitant injuries to the knee were also noted. Incidence of meniscal ramp lesions, delay before surgery, and anterior-posterior stability was analyzed. All patients underwent bilateral KT-2000 evaluation. RESULTS One hundred and three consecutive ACL injured patients with a mean age of 24 years were included in this study. In total, a ramp lesion was found in 10 knees (9.7%) via a trans-notch view. None of these lesions could be identified by the standard view from the anterolateral portal. Other medial meniscal lesions were found in 26 knees (25.2%) by standard arthroscopic viewing. The ramp lesion group had significantly longer delay before surgery with a median of 191 days (p < 0.01) as well as a larger side-to-side difference of KT-2000 measurement (7.3 ± 1.8 mm; p < 0.01), compared with the intact medial meniscus group (53 days and 5.5 ± 1.5 mm, respectively). CONCLUSION Ramp lesions that were identified using a trans-notch view were not visualized with standard arthroscopic views. Increased anterior tibial translation and longer delay before surgery were seen in knees with ramp lesions. Careful inspection of the posteromedial menisco-capsular region is required as hidden menisco-capsular lesions may occur which may result in residual knee instability. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Yasutaka Tashiro
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan
| | - Tatsuya Mori
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan
| | - Tsutomu Kawano
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan
| | - Toshihiro Oniduka
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan
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158
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Okazaki Y, Furumatsu T, Yamauchi T, Okazaki Y, Kamatsuki Y, Hiranaka T, Kajiki Y, Zhang X, Ozaki T. Medial meniscus posterior root repair restores the intra-articular volume of the medial meniscus by decreasing posteromedial extrusion at knee flexion. Knee Surg Sports Traumatol Arthrosc 2020; 28:3435-3442. [PMID: 32253480 DOI: 10.1007/s00167-020-05953-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/23/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Transtibial repair of a medial meniscus posterior root tear (MMPRT) can improve clinical outcomes, although meniscal extrusion remains. However, few studies have investigated the volume of meniscal extrusion. This study aimed to evaluate the effect of transtibial repair in reducing the volume using three-dimensional (3D) magnetic resonance imaging, at 10° and 90° knee flexion. METHODS Twenty patients with MMPRTs and 16 volunteers with normal knees participated. The 3D models of meniscus were constructed using SYNAPSE VINCENT®. The meniscal extrusion and its volume were measured at 10° and 90° knee flexion. Differences between the pre- and postoperative examinations were assessed using the Wilcoxon signed-rank test. The postoperative parameters were compared to those in patients with normal knees. RESULTS There were no significant pre- and postoperative differences in any parameter at 10° knee flexion. At 90° knee flexion, the posterior extrusion and its meniscal volume were decreased significantly after transtibial repair (p < 0.05), even though these parameters were larger than in the normal knees. On the other hand, intra-articular meniscal volume calculated by the extrusion volume was increased to the level of the normal knee. CONCLUSIONS This study demonstrated that transtibial repairs improved the intra-articular/intra-tibial surface volume of the medial meniscus by reducing the posteromedial extrusion during knee flexion. This 3D analysis is clinically relevant in evaluating that, while transtibial root repair has a limited ability to reduce meniscal extrusion, it can restore the functional volume of the medial meniscus which contributes to the shock absorber postoperatively. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Takatsugu Yamauchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Kochi Health Science Center, 2125-1 Ike, Kochi, Kochi, 781-8555, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kajiki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Ximing Zhang
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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159
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Abstract
If our consciousness is not prepared, it is difficult to identify a ramp lesion on preoperative magnetic resonance imaging due to its low sensitivity. In clinical practice, the prevalence of ramp lesion in the anterior cruciate ligament (ACL)-injured knee can be up to 30%, with an increased frequency in chronic ACL injuries and in revision ACL. To identify the ramp lesion, routine arthroscopic exploration of the posteromedial portion of knee using a trans-notch view during ACL reconstruction therefore seems essential. A decrease in reoperation rate for secondary meniscectomy from 25% to 7% since 2013 was published by our department, after the adoption of a systematic repair through a posteromedial portal with a suture hook device for ramp lesions identified at the time of ACL reconstruction.
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160
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Tang X, Marshall B, Wang JH, Zhu J, Li J, Linde MA, Smolinski P, Fu FH. Partial meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3481-3487. [PMID: 32889558 DOI: 10.1007/s00167-020-06209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of a lateral meniscus posterior root tear, partial meniscectomy, and total meniscectomy on knee biomechanics in the setting of anterior cruciate ligament (ACL) reconstruction. METHODS Thirteen fresh-frozen cadaver knees were tested with a robotic testing system under an 89.0-N anterior tibial load at full extension (FE), 15°, 30°, 60° and 90° of knee flexion and a simulated pivot-shift loading (7.0 Nm valgus and 5.0 Nm internal tibial rotation) at FE, 15° and 30° of knee flexion. Anterior tibial translation (ATT) and the in-situ force of ACL graft under the different loadings were measured in four knee states: (1) ACL reconstruction with intact lateral meniscus (Intact meniscus), (2) ACL reconstruction with lateral meniscal posterior root tear (Root tear), (3) ACL reconstruction with lateral posterior partial meniscectomy (Partial meniscectomy) and (4) ACL reconstruction with total lateral meniscectomy (Total meniscectomy). RESULTS Under anterior tibial loading, compared with an intact meniscus, root tear significantly increased ATT at 15° and 30° of knee flexion (p < 0.05) and partial meniscectomy had almost same increased ATT as with root tear at any knee flexion between FE and 90°. Under simulated pivot-shift loading, total meniscectomy increased ATT compared with intact meniscus, root tear, partial meniscectomy at FE (p < 0.05). CONCLUSION Under anterior tibial and simulated pivot-shift loading, partial meniscectomy has no significant effect on the stability of ACL-reconstructed knee with lateral meniscal posterior root tear, while total meniscectomy increased laxity at less than 30° of knee flexion. Clinically, in cases of irreparable meniscal root tears or persistent pain a partial meniscectomy can be considered in the setting of ACL reconstruction.
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Affiliation(s)
- Xin Tang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jian Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Nakagawa S, Arai Y, Inoue H, Fujii Y, Kaihara K, Mikami Y. Relationship of alignment in the lower extremity with early degeneration of articular cartilage after resection of the medial meniscus: Quantitative analysis using T2 mapping. Medicine (Baltimore) 2020; 99:e22984. [PMID: 33126373 PMCID: PMC7598867 DOI: 10.1097/md.0000000000022984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to examine the relationship between cartilage degeneration early after partial medial meniscectomy and abnormal alignment in the lower extremity.The subjects were 34 patients (37 knees) with medial meniscal tear who underwent arthroscopic partial meniscectomy. MRI was performed before and 6 months after surgery. T2 mapping images in sagittal sections of medial femoral condyle were produced and 10 regions of interest were set at intervals of 10° in the articular cartilage in the femur. Subjects with an increase in T2 of ≥6% at a flexion angle of 30° were assigned to the degeneration group. Patient background, hip-knee-ankle (HKA) angle, and total resection of meniscal segments were compared between this group and the other patients to identify factors involved in degeneration of articular cartilage.T2 values 6 months after surgery in 3 ROIs at flexion angles of 30° to 50° were significantly longer than those before surgery. The preoperative HKA angle was significantly higher in the degeneration group. T2 values in articular cartilage of the femoral condyle increased earlier after meniscectomy with abnormal alignment in the lower extremity.Meniscectomy in cases with abnormal alignment may have a risk of early onset of osteoarthritis.Level of evidence: Level IV.
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Affiliation(s)
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | | | | | | | - Yasuo Mikami
- Department of Rehabilitation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,
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买买提克里木· 吐, 贾 勇, 许 刚, 何 春, 张 飞, 刘 剑, 王 鹏, 吾木尔 别. [Clinical observation of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:1238-1242. [PMID: 33063486 PMCID: PMC8171879 DOI: 10.7507/1002-1892.202003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear (BHT). METHODS Between August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in "suture loop". There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score. RESULTS All the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation ( t=31.060, P=0.000). CONCLUSION Arthroscopic all-inside combined with outside-in "suture loop" repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.
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Affiliation(s)
- 吐松江 买买提克里木·
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 勇 贾
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 刚 许
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 春青 何
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 飞 张
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 剑 刘
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 鹏波 王
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
| | - 别克 吾木尔
- 中国人民解放军新疆军区总医院骨科(乌鲁木齐 830000)Department of Orthopaedics, Urumqi General Hospital of Military, Urumqi Xinjiang, 830000, P.R.China
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163
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Atsumi S, Hara K, Arai Y, Kamitani A, Nakagawa S, Inoue H, Kubo T. Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports. Medicine (Baltimore) 2020; 99:e22609. [PMID: 33031317 PMCID: PMC7544389 DOI: 10.1097/md.0000000000022609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture arthroscopic technique for sports-related horizontal meniscal tears.The inter-leaf vertical suture procedure was performed to repair sports-related horizontal tears in the middle and posterior segments of the medial (11 cases) and lateral (2 cases) menisci in 13 patients (mean age: 30 ± 14 years). Pre- and post-operative Barrett criteria, Lysholm scores, and patient ability to resume sports were assessed. Magnetic resonance imaging (MRI) grades and signal intensity changes near the joint capsule were evaluated in the 9 cases among which pre- and post-operative MRI images were available.All Barrett criteria items were negative following surgery; Lysholm scores increased from 70.2 ± 13.1 before surgery to 98.9 ± 2.64 after surgery (P < .01). All patients were able to resume their sport. Preoperative MRI grade of tears was 3 for all patients; postoperative MRI grades were 1 in 3 cases, 2 in 4 cases, and 3 in 2 cases (P < .05). Importantly, MRI signal intensity at the repaired menisci near the joint capsule was reduced in 8 of these 9 cases postoperatively.The inter-leaf vertical suture procedure is associated with good outcomes for horizontal tears in the middle and posterior segments of the medial and lateral menisci. The procedure is useful and convenient.
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Affiliation(s)
- Satoru Atsumi
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Kunio Hara
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | - Aguri Kamitani
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | | | - Hiroaki Inoue
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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164
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Akkaya M, Gursoy S, Ozberk N, Simsek ME, Korkusuz F, Bozkurt M. Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application. Musculoskelet Surg 2020; 106:145-153. [PMID: 32960435 DOI: 10.1007/s12306-020-00681-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the impact of biodegradable polyurethane meniscus scaffold implantation (BPMSI) on muscle strength and balance in comparison with the healthy contralateral knee in patients with irreparable medial meniscus defect. METHODS This observational and prospective case-cohort study was conducted with patients who had irreparable meniscal defects and underwent arthroscopic meniscus scaffold implantation. Surgeries were carried out on the medial meniscus of 16 right and 4 left knees. Visual analog scale (VAS) was used to assess the degree of pain relief. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm (LYS) score were used to evaluate the functional improvement at weeks 12, 24 and 36. Concentric and eccentric quadriceps and hamstring peak torque (PT) as well as the peak torque-to-body weight (PTB) ratio, anterior-posterior, mediolateral and overall stability indexes were assessed at the same time points. RESULTS Twenty male patients with a mean age and body mass index of 32.2 ± 8.8 years and 26.2 ± 4.2 kg/m2, respectively, were included in the study. The amount of pain decreased from 7.6 ± 1.5% to 2.9 ± 1.5% at postoperative week 36. Range of motion, Lysholm score and KOOS increased from 87.0ο ± 9.5ο to 115.0ο ± 15.1ο, 30.8 ± 4.3 to 81.5 ± 5.3 and 37.4 ± 5.3 to 74.1 ± 7.2, respectively. Concentric quadriceps and hamstring peak torque values and peak torque/body weight ratios were improved in the knees that received a meniscus scaffold implant. Anterior/posterior, medial/lateral, and overall stability indexes with or without biofeedback exhibited a slight improvement, which was not statistically significant. CONCLUSION BPMSI led to decreased pain and improved function at postoperative week 36. Although muscle strength almost returned to normal, balance parameters did not recover within 36 weeks after the procedure.
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Affiliation(s)
- M Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey.
| | - S Gursoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
| | - N Ozberk
- Department of Physical Treatment and Rehabilitation, Middle East Technical University Medical Center, 06100, Ankara, Turkey
| | - M E Simsek
- Department of Orthopedics and Traumatology, Lokman Hekim University, 06100, Ankara, Turkey
| | - F Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06800, Ankara, Turkey
| | - M Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
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165
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Butt U, Vuletić F, Stenhouse G, Hudetz D, Bradbury N. Meniscal scaffold for the treatment of partial meniscal defect-clinical and radiological outcomes in a two-year follow-up. Int Orthop 2020; 45:977-983. [PMID: 32949258 DOI: 10.1007/s00264-020-04811-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of meniscal scaffolds is to fill the defect, allow regeneration of meniscal-like tissues, and to prevent long-term risk of cartilage wear and tear. The aim of this study was to evaluate clinical results after two years and magnetic resonance imaging (MRI) results a year after implantation of a meniscal scaffold. METHODS Fifteen patients were recruited into a prospective, single-arm, single-center study, and treated with meniscal scaffolds as a result of segmental meniscal defect due to previous partial meniscectomy. Patients were evaluated using functional knee scores used pre-operatively and 6, 12, and 24 months postoperatively. The radiological outcome was assessed using MRI at 12 months by evaluating scaffold size, morphology, and intensity according to the Genovese grading system. Cartilage assessment was completed according to The International Cartilage Repair Society (ICRS) score. RESULTS All patients completed a follow-up of 24 months. A statistically significant increase in mean levels of all functional scores was present in all patients. On the MRI, all but one of the patients presented an incorporated meniscal implant. In most of the patients (73%), the meniscal implant was a Genovese type III. Type II and III signal intensities were present in all scaffolds when compared with the residual meniscal tissue. A stable cartilage (ICRS) status was observed in 80% of the patients compared with the pre-operative cartilage scores. CONCLUSION In our case series of patients treated with the meniscal scaffold implant, we observed good clinical results at a two year follow-up. Furthermore, MRI findings suggest that meniscal scaffolds might have a beneficial effect on articular cartilage.
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Affiliation(s)
- Umer Butt
- AO Clinic (Institute of Trauma, Orthopaedics and Sports Injury), Nazimabad No.4, Karachi, Pakistan
- Circle Bath Hospital, Bath, UK
| | - Filip Vuletić
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia.
| | | | - Damir Hudetz
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia
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166
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Faucett SC, Krych AJ, Chahla J, Maestu R, LaPrade RF. Outcomes of Arthroscopic All-Inside Repair vs Observation in Older Patients With Meniscus Root Tears: Letter to the Editor. Am J Sports Med 2020; 48:NP49-NP50. [PMID: 32870045 DOI: 10.1177/0363546520947032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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167
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Dragoo JL. Outcomes of Arthroscopic All-Inside Repair vs Observation in Older Patients With Meniscus Root Tears: Response. Am J Sports Med 2020; 48:NP50-NP51. [PMID: 32870044 DOI: 10.1177/0363546520947039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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168
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Ahmed I, Khatri C, Parsons N, Hutchinson CE, Staniszewska S, Price AJ, Metcalfe A. Meniscal Tear Outcome (METRO) review: a protocol for a systematic review summarising the clinical course and patient experiences of meniscal tears in the current literature. BMJ Open 2020; 10:e036247. [PMID: 32753448 PMCID: PMC7406020 DOI: 10.1136/bmjopen-2019-036247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Meniscal tears are a common knee injury with an incidence of 60 per 100 000. Management of meniscal tears can include either non-operative measures or operative procedures such as arthroscopic partial meniscectomy (APM). Despite substantial research evaluating the effectiveness of APM in the recent past, little is known about the clinical course or the experiences of patients with a meniscal tear. AIM To summarise the short to long-term patterns of variability in outcome in patients with a meniscal tear.To summarise the evidence on patient experiences of meniscal tears. In particular, we will focus on patient experiences of treatment options, treatment pathways and their views of the outcomes used in meniscal tear research. METHODS AND ANALYSIS Two search strategies will be developed to identify citations from EMBASE, MEDLINE, AMED, CENTRAL, Web of Science and Sociofile. The date of our planned search is 14 August 2020. For the quantitative review we will identify studies reporting patient-reported outcome measures in patients after a meniscal tear. The standardised mean change will be used to assess the variation in size of response and summarise the overall response to each treatment option. All studies will undergo quality assessment using either the Cochrane risk of bias or the Newcastle-Ottawa tool.A qualitative systematic review will be used to identify studies reporting views and experiences of patients with a meniscal tear. All studies will be assessed using the Critical Appraisal Skills Programme tool and if sufficient data are present a meta-synthesis will be performed to identify first, second and third-order constructs. ETHICS AND DISSEMINATION Given the nature of this study, no formal ethical approval will be sought. Results from the review will be disseminated at national conferences and will be submitted to a peer-reviewed journal for publication. Lay summaries will be freely available via the study Twitter page. PROSPERO REGISTRATION NUMBER CRD42019122179.
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Affiliation(s)
- Imran Ahmed
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Chetan Khatri
- Trauma and Orthopaedics, --University Hospital Coventry and Warwickshire, Coventry, West Midlands, UK
| | | | | | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ahmed I, Bowes M, Hutchinson CE, Parsons N, Staniszewska S, Price AJ, Metcalfe A. Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear. BMJ Open 2020; 10:e038681. [PMID: 32660954 PMCID: PMC7359070 DOI: 10.1136/bmjopen-2020-038681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This study is designed to explore the baseline characteristics of patients under 55 years of age with a meniscal tear, and to describe the relationship between the baseline characteristics and patient-reported outcome measures (PROMs) over 12 months. Research has highlighted the need for a trial to investigate the effectiveness of arthroscopic meniscectomy in younger patients. Before this trial, we need to understand the patient population in greater detail. METHODS AND ANALYSIS This is a multicentre prospective cohort study. Participants aged between 18 and 55 years with an MRI confirmed meniscal tear are eligible for inclusion. Baseline characteristics including age, body mass index, gender, PROMs duration of symptoms and MRI will be collected. The primary outcome measure is the Western Ontario Meniscal Evaluation Tool at 12 months. Secondary outcome measures will include PROMs such as EQ5D, Knee Injury and Osteoarthritis Outcome Score and patient global impression of change score at 3, 6 and 12 months. ETHICS AND DISSEMINATION The study obtained approval from the National Research Ethics Committee West Midlands-Black Country research ethics committee (19/WM/0079) on 12 April 2019. The study is sponsored by the University of Warwick. The results will be disseminated via peer-reviewed publication. TRIAL REGISTRATION NUMBER UHCW R&D Reference: IA428119. University of Warwick Sponsor ID: SC.08/18-19.
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Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | | | | | - Nicholas Parsons
- Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | | | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Lin Y, Zhao J, Qiu H, Huang Y. All-inside versus inside-out suture techniques in arthroscopic meniscus repair: A prospective randomized study protocol. Medicine (Baltimore) 2020; 99:e20688. [PMID: 32629640 PMCID: PMC7337569 DOI: 10.1097/md.0000000000020688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND With advancements in our understanding of meniscal function, treatment options for meniscal injuries have evolved considerably over the past few decades. The aim of the current study was to compare the all-inside and inside-out techniques with regard to retear rate, functional outcomes, and perioperative complications in patients who had undergone arthroscopic meniscus repair. We hypothesized that there was no significant difference between the 2 groups in terms of postoperative outcomes after arthroscopic meniscus repair. METHODS This study was a prospective randomized blinded study, with a parallel design and an allocation ratio of 1:1 for the treatment groups. This study was approved by the Institutional Review Board in our hospital and written informed consent was obtained from all subjects participating in the trial. It was carried out in accordance with the principles of the Helsinki Declaration. A total of 70 patients who meet inclusion criteria are randomized to either all-inside or inside-out group. The primary outcome measure was retear rate. Retear was determined by repeat arthroscopic evaluation of patients with follow-up for symptoms of persistent or new pain, catching, or locking that was possibly related to the meniscal repair. Secondary outcomes included disease-specific quality of life measurement with the Western Ontario Meniscal Evaluation Tool, range of motion, operative time, and adverse events at surgery or throughout the follow-up period. RESULTS This study has limited inclusion and exclusion criteria and a well-controlled intervention. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5589).
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171
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Bisping L, Lenz R, Lutter C, Schenck RC, Tischer T. Hyperflexion Knee Injury with Anterior Cruciate Ligament Rupture and Avulsion Fractures of Both Posterior Meniscal Attachments: A Case Report. JBJS Case Connect 2020; 10:e1900541. [PMID: 32910586 DOI: 10.2106/jbjs.cc.19.00541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 54-year-old patient presented with low-velocity hyperflexion knee trauma while falling at a ski lift with anterior cruciate ligament (ACL) rupture and avulsion fractures of both posterior meniscal attachments. Meniscal avulsions were treated arthroscopically using transtibial sutures; a partial medial collateral ligament tear was treated conservatively. Six weeks later, reconstruction of the ACL was performed, and both meniscal attachments were stable. CONCLUSION Hyperflexion of the knee puts direct shear and compressive force on the posterior tibia. This can result in ligament injuries combined with avulsion fractures of both posterior meniscal attachments. Arthroscopic treatment is a practicable technique for this type of injury.
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Affiliation(s)
- Lucas Bisping
- 1Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany 2Department of Orthopaedic Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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172
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Goes RA, Cavalcanti AS, Siqueira Campos AL, de Farias Cardoso R, Coelho ON, McCormack RG, Barretto JM, Mangiavini L, Luceri F. Prediction of reparability of meniscal tears in athletes using magnetic resonance. J BIOL REG HOMEOS AG 2020; 34:153-162. Congress of the Italian Orthopaedic Research Society. [PMID: 33261272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Meniscal tears account for approximately 15% of all knee injuries and almost 25% of them require surgical procedures. Magnetic Resonance Imaging (MRI) is widely used for noninvasive assessment of the knee joint and is considered reliable and a powerful tool for the detection of soft tissue injuries of the knee. The aim of the study was to evaluate the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) to predict the meniscal tears repair in sports practitioners. 104 incoming consecutive patients who underwent knee joint ligament reconstruction and/or arthroscopy for the treatment of meniscal injury at knee joint were imaged using a 1.5-T MRI scanner prior to arthroscopy. MRI images were evaluated for anterior cruciate ligament (ACL), articular cartilage, and meniscal injury. Images were correlated with arthroscopic findings, used as the gold standard. The sensitivity, specificity, and accuracy of MRI in predicting meniscal repair were 61.1%, 65.94%, and 64.58%, respectively. The agreement between MRI and arthroscopy yielded a kappa index of 0.236, indicating fair agreement. When the menisci were evaluated separately, 65.85% sensitivity, 45.45% specificity, and 54.16% accuracy were found for the medial meniscus, while 46.15%, 79.51%, and 75.0% for the lateral meniscus, respectively. The accuracy was 62.09% in whose patients that arthroscopy was performed up to 3 months after MRI and 67.18% in those that this time frame was more than 3 months before surgery. The 54 meniscal injuries occurred more frequently in the posterior horn; most injuries had a longitudinal pattern and were located in the red-red (vascular) zone. We suggest that magnetic resonance imaging is only moderately accurate for the prediction of meniscus reparability.
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Affiliation(s)
- R A Goes
- Knee & Sports Injuries Centre, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, RJ, Brazil
| | - A S Cavalcanti
- Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, RJ, Brazil
| | - A L Siqueira Campos
- Knee Centre, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - R de Farias Cardoso
- Orthopaedic Oncologic Centre, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, RJ, Brazil
| | - O N Coelho
- Research Physical Education Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - R G McCormack
- Sports injuries Department, University of British Columbia, Vancouver, BC, Canada
| | - J M Barretto
- Knee Centre, D'Or Institute and Private Clinic, Rio de Janeiro, RJ, Brazil
| | - L Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - F Luceri
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Nobile F, Condello V, Madonna V, Screpis DU, Di Donato SL, Kon E, Marcacci M, Di Matteo B, Zorzi C. All-inside repair of meniscal bucket handle tears: a retrospective study at mean 4-years follow-up evaluation. J BIOL REG HOMEOS AG 2020; 34:183-190. Congress of the Italian Orthopaedic Research Society. [PMID: 33261275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bucket-handle tears represent approximately 10% of all meniscal tears. Despite the common treatment is subtotal meniscectomy, repair is technically feasible although complex, and represents a key strategy to avoid severe meniscal tissue loss that could accelerate joint degeneration over time. The aim of this retrospective study was to determine the outcomes of arthroscopically-assisted bucket-handle tear repair, and to identify factors correlating with clinical results. Fifty-four patients affected by meniscal bucket handle tear were included in the present retrospective analysis and evaluated up to mean 4-years follow-up. All patients were treated by arthroscopic-assisted all-inside repair. The primary outcome was considered the need for a re-operation due to failure of meniscal repair. Patients were also evaluated by the following items: KOOS, Lysholm, Tegner, IKDC-subjective and Quadruple-VAS score. Subgroup analysis was performed to identify whether concurrent ACL reconstruction, side of the lesion, age at surgery and time from injury to repair could influence clinical outcome. Ten out 54 patients (18.5%) were considered failed and needed reoperation, mainly within one year from surgery. Overall, there was a significant increase in all clinical scores considered and patients were able to get back to previous sport activity level. Patients with concurrent ACL reconstruction presented a lower risk of failure (p=0.025). Patients with lateral meniscus repair showed better clinical outcome compared to medial meniscus. Timing from injury and age at surgery did not correlated with clinical outcome. Our series showed fair results in bucket handle repair up to middle term evaluation. Concomitant ACL reconstruction was associated with lower failure rate whereas lateral meniscus involvement was associated with higher functional scores at final follow-up evaluation.
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Affiliation(s)
- F Nobile
- Orthopaedic Surgeon, Department of Orthopedics and Traumatology, Montevarchi, Arezzo, Italy
| | - V Condello
- Orthopaedic Surgeon, Orthopedic Department, Clinica Humanitas Castelli, Bergamo, Italy
| | - V Madonna
- Orthopaedic Surgeon, Orthopedic Department, Clinica Humanitas Castelli, Bergamo, Italy
| | - D U Screpis
- Orthopaedic Surgeon, Orthopaedic Department, Sacro Cuore - Don Calabria Hospital, Negrar, Verona, Italy
| | - S L Di Donato
- Orthopaedic Surgeon, Department of Orthopaedics, University of Naples Federico II, Naples, Italy
| | - E Kon
- Associate Professor, Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy & Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano (MI) & First Moscow State Medical University, Sechenov University, Moscow, Russia, Italy
| | - M Marcacci
- Full Professor, Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy & Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - B Di Matteo
- Adjunct Professor, Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy & Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - C Zorzi
- Head of Department, Orthopaedic Department, Sacro Cuore, Don Calabria Hospital, Negrar, Verona, Italy
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174
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Song JH, Bin SI, Kim JM, Lee BS, Son DW. Does Age Itself Have an Adverse Effect on Survivorship of Meniscal Allograft Transplantation? A Cartilage Status and Time From Previous Meniscectomy-Matched Cohort Study. Am J Sports Med 2020; 48:1696-1701. [PMID: 32396461 DOI: 10.1177/0363546520916727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aging process is accompanied by several conditions that could affect the outcome of meniscal allograft transplantation (MAT). These conditions have made it difficult for clinicians to determine the effect of chronologic age on survivorship after MAT. HYPOTHESIS Advanced age does not have an adverse effect on survivorship of MAT when controlling for age-related factors, such as cartilage status and time from previous meniscectomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The records of 264 consecutive patients who underwent primary medial or lateral MAT were reviewed. To check whether there was a difference in MAT survivorship according to age, a cutoff value was calculated from a time-dependent receiver operating characteristic curve. Survival rates, as well as clinical improvement as determined using the Lysholm score, were compared between groups divided by the cutoff value. Patients were matched for cartilage status and elapsed time from previous meniscectomy. Differences in survivorship and clinical outcomes were assessed between the matched groups. RESULTS A time-dependent receiver operating characteristic curve showed that the difference in MAT survivorship was maximized with a cutoff age of 43 years. Kaplan-Meier analysis showed a significant difference in MAT survivorship between the older and younger groups (log-rank test, P = .01). However, after matching for cartilage status and time from previous meniscectomy, which left 56 patients per group, there was no significant difference in MAT survivorship (log-rank test, P = .10) between the groups. Regarding clinical outcomes, the mean Lysholm scores were not significantly different between the older and younger groups (P = .19, before matching; P = .39, after matching). CONCLUSION MAT survivorship was more affected by age-related prognostic factors, such as cartilage status and time from previous meniscectomy, than age itself. Clinical outcomes did not show differences according to age, either.
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Affiliation(s)
- Ju-Ho Song
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Dong-Wook Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
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175
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Hiranaka T, Furumatsu T, Miyazawa S, Okazaki Y, Okazaki Y, Takihira S, Kodama Y, Kamatsuki Y, Masuda S, Saito T, Ozaki T. Comparison of the clinical outcomes of transtibial pull-out repair for medial meniscus posterior root tear: Two simple stitches versus modified Mason-Allen suture. Knee 2020; 27:701-708. [PMID: 32563426 DOI: 10.1016/j.knee.2020.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/27/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Shota Takihira
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atagomachi, Iwakuni, Yamaguchi 740-8510, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Kochi Health Science Center, 2125-1 Ike, Kochi 781-8555, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Chikamori Hospital, 1-1-16 Ookawasuji, Kochi 780-8522, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Hiranaka T, Furumatsu T, Kamatsuki Y, Miyazawa S, Okazaki Y, Masuda S, Okazaki Y, Kodama Y, Ozaki T. The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear. Knee 2020; 27:899-905. [PMID: 32249020 DOI: 10.1016/j.knee.2020.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing. METHODS We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC-TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0-10). The association between AC-TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC-TC distance cut-off for improved MM healing score (≥7) was determined using receiver operating characteristic analysis. RESULTS The AC-TC distance and meniscal healing score were significantly associated (y = -0.42x + 9.48, R2 = 0.342; P = 0.002), with the optimum AC-TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%. CONCLUSIONS This study demonstrates that AC-TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing.
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Affiliation(s)
- Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan.
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Kochi Health Science Center, Kochi, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
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Orsini NG, Favreau H, Eichler D, Ollivier M, Bonnomet F, Ehlinger M. Meniscus sutures by arthrotomy for a non-transfixing horizontal lesion associated with a cyst. Int Orthop 2020; 44:1071-1076. [PMID: 31993712 DOI: 10.1007/s00264-020-04491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Meniscal cysts are rare in Stoller grade II horizontal lesions. Several techniques are described in the literature for their management, without any real gold standard. The objective of this work was to report a series of meniscal sutures associated with cyst resection by arthrotomy. The hypothesis was that the results were satisfactory and comparable with the data in the literature regardless of the technique reported without morbidity added by arthrotomy. MATERIALS AND METHODS This was a monocentric retrospective study on 13 patients, aged 33 on average with a grade II meniscus lesion associated with a cyst (9 lateral and 4 medial menisci). Pre-operative data available was the VAS (5.7/10) and the Lysholm score (61/100). Primary endpoints were as follows: pain (visual analogue scale), global satisfaction, Lysholm functional score, and return to sports and professional activities at a minimum of two years. Secondary endpoints were complications, possible recurrence, and/or surgical revision. Recurrences, complications, and surgical recovery were gathered. RESULTS Patients were evaluated with an average follow-up of 32 months. All patients were satisfied or very satisfied. The VAS significantly improved (0.2/10, p < 0.05) as well as the Lysholm score (97/100, p < 0.05). All patients returned to their professional activity: 11 within two months, one within six weeks, and one in the first post-operative week (this patient being a student). Only one patient did not resume pre-operative sport level due to a femoropatellar syndrome, not linked to the meniscal surgery performed. However, only 11 patients resumed their previous sport level (84.6%). No recurrence or surgical revision occurred. DISCUSSION The results are good and similar to the literature, confirming the working hypothesis. These results are equivalent to partial meniscectomies and arthroscopic sutures associated with a procedure on the cyst by arthroscopy or arthrotomy. The literature is in favour of a procedure on the cyst. CONCLUSION The results confirm the effectiveness of a direct approach suture of non-transfixing meniscal lesions associated with a cyst resection with a good functional recovery, without additional morbidity. The hypothesis was confirmed.
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Affiliation(s)
- Nicolas Girodano Orsini
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ollivier
- Département de Chirurgie Orthopédique, Hôpital Sainte-Marguerite, Hôpital Universitaire de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France.
- Laboratoire ICube, équipe MMB, CNRS, Illkirch, France.
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Toanen C, Dhollander A, Bulgheroni P, Filardo G, Zaffagnini S, Spalding T, Monllau JC, Gelber P, Verdonk R, Beaufils P, Pujol N, Bulgheroni E, Asplin L, Verdonk P. Polyurethane Meniscal Scaffold for the Treatment of Partial Meniscal Deficiency: 5-Year Follow-up Outcomes: A European Multicentric Study. Am J Sports Med 2020; 48:1347-1355. [PMID: 32267737 DOI: 10.1177/0363546520913528] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A biodegradable polyurethane scaffold was developed to treat patients with the challenging clinical condition of painful partial meniscal defects. HYPOTHESIS The use of an acellular polyurethane scaffold in patients with symptomatic partial meniscal defects would result in both midterm pain relief and improved function. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 155 patients with symptomatic partial meniscal defects (101 medial and 54 lateral) were implanted with a polyurethane scaffold in a prospective, single-arm, multicentric study with a minimum 5-year follow-up. Clinical outcomes were measured with the visual analog scale for pain, International Knee Documentation Committee subjective knee evaluation form, Lysholm knee scale, and Knee injury and Osteoarthritis Outcome Score at baseline and at 2- and 5-year follow-ups. Magnetic resonance imaging (MRI) was used to evaluate the knee joint, meniscal implant, and meniscal extrusion. Kaplan-Meier survival analysis was also performed. Removal of the scaffold, conversion to a meniscal transplant, and unicompartmental/total knee arthroplasty were used as endpoints. RESULTS Eighteen patients were lost to follow-up (11.6%). The patients who were included in this study showed significant clinical improvement after surgery as indicated by the different outcome measures (P = .01). However, the clinical improvement tended to stabilize between 2 and 5 years of follow-up. MRI scans of the scaffolds in 56 patients showed a smaller-sized implant in the majority of the cases when compared with the native meniscus with an irregular surface at the 5-year follow-up. During the follow-up period, 87.6% of the implants survived in this study. At 5 years of follow-up, 87.9% of the medial scaffolds were still functioning versus 86.9% of the lateral scaffolds. In total, 23 treatments had failed: 10 removed scaffolds because of breakage, 7 conversions to meniscal allograft transplantation, 4 conversions to unicompartmental knee arthroplasty, and 2 conversions to total knee arthroplasty. CONCLUSION The polyurethane meniscal implant was able to improve knee joint function and reduce pain in patients with segmental meniscal deficiency over 5 years after implantation. The MRI appearance of this scaffold was different from the original meniscal tissue at the midterm follow-up. The treatment survival rates of 87.9% of the medial scaffolds and 86.9% of the lateral scaffolds in the present study compared favorably with those published concerning meniscal allograft transplantation after total meniscectomy.
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Affiliation(s)
- Cecile Toanen
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Aad Dhollander
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Paolo Bulgheroni
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Giuseppe Filardo
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Stefano Zaffagnini
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Tim Spalding
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Joan Carles Monllau
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Pablo Gelber
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Rene Verdonk
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Philippe Beaufils
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Erica Bulgheroni
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Laura Asplin
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Peter Verdonk
- Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
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Shu HT, Day J, Bodendorfer BM, Argintar EH. Anterior Cruciate Ligament Retensioning-A Novel Revision Procedure Using Suture Augmentation: A Case Report With A 3-Year Follow-up. JBJS Case Connect 2020; 10:e0092. [PMID: 32649083 DOI: 10.2106/jbjs.cc.19.00092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE We report the case of a 44-year-old woman with previous anterior cruciate ligament (ACL) reconstruction 25 years ago in the right knee, who sustained a bucket-handle medial meniscus tear after pain and instability while pivoting during tennis. Magnetic resonance imaging demonstrated an intact but vertical and anterior ACL graft. A novel ACL retensioning procedure with suture augmentation (SA) was performed as the revision procedure. Excellent clinical outcomes and knee stability were obtained at both 17 and 36 months postoperatively. CONCLUSIONS In certain cases, ACL retensioning with SA may be performed as the revision procedure for unsuccessful primary ACL reconstruction.
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Affiliation(s)
- Henry T Shu
- 1Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC 2School of Medicine, Georgetown University, Washington, DC 3Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC
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Kirk Melton JT. Editorial Commentary: Meniscal Cartilage Suture in the Anterior Cruciate Ligament Reconstructed Knee; To Absorb or Not to Absorb: That Is the Question. Arthroscopy 2020; 36:1083-1085. [PMID: 32247405 DOI: 10.1016/j.arthro.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
When considering repair of the meniscal cartilages of the knee, the indications for repair must be carefully considered. The morphology of the tear, the zone of injury, and likely vascularity have an impact on patient selection. Patient factors, chronicity of tear, medial or lateral tear, and tear complexity all have a bearing on whether to repair or resect and how best to achieve stable repair. The consequences of meniscectomy are well established, and meniscal tissue resection comes at a cost. The success rates of meniscal cartilage repair are greater when performed in conjunction with anterior cruciate ligament reconstruction. Patient outcomes are better for anterior cruciate ligament reconstruction when performed with meniscal repair than when partial meniscectomy is performed. The optimal configuration of sutures, the suture material used, and the type of suture technique are all important considerations. The focus of this commentary is on the use of absorbable versus nonabsorbable suture material.
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181
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Ricci V, Özçakar L, Galletti L, Domenico C, Galletti S. Ultrasound-Guided Treatment of Extrusive Medial Meniscopathy: A 3-Step Protocol. J Ultrasound Med 2020; 39:805-810. [PMID: 31617613 DOI: 10.1002/jum.15142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/30/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
Medial knee pain is commonplace in clinical practice and can be related to several pathologic conditions: ie, medial plica syndrome, saphenous nerve entrapment, pes anserine syndrome, medial collateral ligament injury, and medial meniscus disorders. Ultrasound (US) imaging represents a valuable first-line diagnostic approach to adequately visualize the superficial structures in the medial compartment of the knee to easily plan for prompt treatment. Currently, the management of chronic degenerative diseases involving the menisci, and causing their extrusion, consists of surgery (arthroscopic partial meniscectomy). This procedure often allows only a partial resolution of pain and functional impairment. In the pertinent literature, US-guided interventions for the medial meniscus are proposed, mainly to decrease pain and inflammation or to induce regeneration. Likewise, this Technical Innovation describes in detail the US findings of medial extrusive meniscopathy and also illustrates a novel US-guided technique to treat the bursa of the medial collateral ligament, the extruded fragment of the medial meniscus, and the synovial parameniscal recesses simultaneously.
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Affiliation(s)
- Vincenzo Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Lisa Galletti
- Physical Medicine and Rehabilitation Unit, San Giovanni in Persiceto, Bologna, Italy
| | - Creta Domenico
- Physical Medicine and Rehabilitation Service, Madre Fortunata Toniolo Private Hospital, Bologna, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
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Abstract
Whether to repair or resect meniscal tears remains a matter of controversy. In theory, partial meniscectomy increases contact pressure, which may result in progressive and early cartilage degeneration and early osteoarthritis. Meniscal preservation is the preferred treatment option, but only a small percentage of meniscal tears are suitable for repair. Two recent registry studies challenge this approach and suggest that partial meniscectomy has similar clinical outcomes in the short term. Whether these findings can be maintained in the long term remains to be seen.
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Antosh IJ, Cameron KL, Marsh NA, Posner MA, DeBerardino TM, Svoboda SJ, Owens BD. Likelihood of Return to Duty Is Low After Meniscal Allograft Transplantation in an Active-duty Military Population. Clin Orthop Relat Res 2020; 478:722-730. [PMID: 32229741 PMCID: PMC7282605 DOI: 10.1097/corr.0000000000000915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is considered a viable surgical treatment option in the symptomatic, postmeniscectomy knee and as a concomitant procedure with ACL revision and articular cartilage repair. Although promising outcomes have recently been reported in active and athletic populations, MAT has not been well-studied in the high-demand military population. QUESTIONS/PURPOSES (1) What proportion of active-duty military patients who underwent MAT returned to full, unrestricted duty? (2) What demographic and surgical variables, if any, correlated with return to full, unrestricted duty? METHODS Between 2005 and 2015, three fellowship-trained sports surgeons (TMD, SJS, BDO) performed 110 MAT procedures in active-duty military patients, of which 95% (104 patients) were available for follow-up at a minimum 2 years (mean 2.8 ± SD 1.1 year). During the study period, indications for MAT generally included unicompartmental pain and swelling in a postmeniscectomized knee and as a concomitant procedure when a meniscal-deficient compartment was associated with either an ACL revision reconstruction or cartilage repair. Demographic and surgical variables were collected and analyzed. The primary endpoints were the decision for permanent profile activity restrictions and military duty termination by a medical board. The term "medical board" implies termination of military service because of medical reasons. We elected to set statistical significance at p < 0.001 to reduce the potential for spurious statistical findings in the setting of a relatively small sample size. RESULTS Forty-six percent (48 of 104) of eligible patients had permanent profile activity restrictions and 50% (52 of 104) eventually had their military duty terminated by a military board. Only 20% (21 of 104) had neither permanent profile activity restrictions nor medical-board termination and were subsequently able to return to full duty, and only 13% (13 of 104) continued unrestricted military service beyond 2 years after surgery. Age, gender, tobacco use, and BMI did not correlate with return to full duty. Combat arms soldiers were less likely to have permanent profile activity restrictions (odds ratio 4.76 [95% confidence interval 1.93 to 11.8]; p = 0.001) and were more likely to return to full duty than soldiers in support roles (OR 0.24 [95% CI 0.09 to 0.65]; p = 0.005), although these findings did not reach statistical significance. Officers were more likely to return to full duty than enlisted soldiers at more than 2 years after surgery (OR 17.44 [95% CI 4.56 to 66.65]; p < 0.001). No surgical variables correlated with return-to-duty endpoints. CONCLUSIONS Surgeons should be aware of the low likelihood of return to military duty at more than 2 years after MAT and counsel patients accordingly. Based on this study, MAT does not appear to be compatible with continued unrestricted military duty for most patients. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Ivan J Antosh
- I. J. Antosh, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905 USA
| | - Kenneth L Cameron
- K. L. Cameron, M. A. Posner, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Nathan A Marsh
- N. Marsh, Department of Orthopaedic Surgery, Womack Army Medical Center, Ft. Bragg, NC, USA
| | - Matthew A Posner
- K. L. Cameron, M. A. Posner, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Thomas M DeBerardino
- T. M. DeBerardino, Combined Baylor School of Medicine & San Antonio, Texas Sports Medicine Fellowship, Burkhart Research Institute of Orthopaedics, The San Antonio Orthopaedic Group, San Antonio, TX, USA
| | - Steven J Svoboda
- S. J. Svoboda, MedStar Orthopaedic Institute, Georgetown University Hospital, Washington, DC, USA
| | - Brett D Owens
- B. D. Owens, Department of Orthopaedic Surgery, Brown Alpert Medical School, Providence, RI, USA
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Wijn SRW, Rovers MM, Rongen JJ, Østerås H, Risberg MA, Roos EM, Hare KB, van de Graaf VA, Poolman RW, Englund M, Hannink G. Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis. BMJ Open 2020; 10:e031864. [PMID: 32152157 PMCID: PMC7064080 DOI: 10.1136/bmjopen-2019-031864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients that do need APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment. METHODS AND ANALYSIS An existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs' characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health. ETHICS AND DISSEMINATION All trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017067240.
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Affiliation(s)
- Stan R W Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan J Rongen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - May A Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
- Division of Orthopedic Surgery, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
| | - Ewa M Roos
- Department of Sports and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Kristoffer B Hare
- Department of Orthopedics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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185
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Hershman EB, Jarvis JL, Mick T, Dushaj K, Elsner JJ. Direct treatment cost outcomes among patients with medial meniscus deficiency: results from a 24-month surveillance study. Curr Med Res Opin 2020; 36:427-437. [PMID: 31914326 DOI: 10.1080/03007995.2020.1713073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Meniscus deficiency is highly prevalent in the United States and represents a substantial societal cost burden. The objective of this case series was to evaluate and compare direct costs associated with treatment for acute or degenerative medial meniscus deficiency.Methods: Case series patients (n = 50) received either non-surgical therapy or an operative partial meniscectomy based on clinical assessment by the principal study investigator which included physical examination and MRI. Cumulative 24-month direct treatment costs were compared between non-surgical and operative cohorts. Direct treatment costs were calculated using billing record reimbursements for all medical services administered by the treating institution, and imputed for medical services prescribed by the treating physician but provided external to the treating institution.Results: At study initiation, 33 patients (67%) were treated with non-surgical care, and 17 patients (33%) received a partial medial meniscectomy. By 24 months, average direct treatment costs were highest for patients who received a partial medial meniscectomy at study initiation ($4488 ± $1265) compared to patients who received non-surgical care at study initiation ($4092 ± $7466), although differences in average direct treatment costs were not statistically significant across treatment cohorts (p = .830). Average direct treatment costs were highest for the subgroup of patients who initiated non-surgical therapy but received a subsequent total knee arthroplasty during the study period (n = 2; $32,197 ± $169).Conclusion: Findings from this case series suggests that patients with acute or degenerative meniscus deficiency incur substantial direct treatment costs related to their knee pathology, particularly for patients receiving total knee arthroplasty.
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Affiliation(s)
- Elliott B Hershman
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | | | - Travis Mick
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Kristina Dushaj
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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186
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Van Elst C, Caekebeke P, Vandenneucker H, Bellemans J, Scheys L. Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms? Acta Orthop Belg 2020; 86:77-81. [PMID: 32490777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Partial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume. In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume. The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm3. This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis.
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187
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Abstract
The menisci play a vital role in knee joint stability, load distribution, and lubrication, protecting the joint surfaces from degenerative change. Meniscal repair protects the joint from increased loading and when successful reduces progression of osteoarthritis. Successful repair involves accurate surgical techniques, guarded postoperative rehabilitation, and potential use of additional biologics to promote healing. An integrated approach to meniscal surgery is required as part of an overall strategy to preserve and restore knee function, preserving meniscal tissue whenever possible. This article reviews the repair techniques: procedures, indications, and rehabilitation for meniscal repair.
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Affiliation(s)
- Tim Spalding
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Iswadi Damasena
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Robert Lawton
- Department of Trauma and Orthopaedic Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, CV2 2DX, UK
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188
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Gilat R, Agar G, Shohat N, Dahan M, Beer Y, Lindner D. Avoiding Injury to the Popliteal Neurovascular Bundle in All-Inside Suturing of the Posterior Horn of the Lateral Meniscus: A Magnetic Resonance Imaging Assessment of Portal Selection and Safety. Arthroscopy 2020; 36:492-498. [PMID: 31901385 DOI: 10.1016/j.arthro.2019.08.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We assessed the risk of injury to the popliteal neurovascular bundle (PNVB) while suturing the posterior horn of the lateral meniscus (PHLM). METHODS We simulated all-inside suturing of the PHLM using magnetic resonance imaging of 60 knees. Lines were drawn from the medial and the lateral edges of the patellar tendon to the PHLM at increasing distances from the posterior cruciate ligament (PCL) to simulate suturing device trajectory. Distance from each line to the PNVB was measured (d). A similar analysis was performed using lines drawn from 1 cm medial and 1 cm lateral to the patellar tendon. We compared the average "d" at increasing distances from the PCL, between the different simulated portal entry points. We have also analyzed the association between different demographic characteristics and the shortest distance from the PVNB to the PHLM. RESULTS Of 1200 measurements performed, the simulated suturing trajectory transected the PNVB 343 times (28.6%). At 0 mm from the PCL, the safest portal was the 1-cm lateral portal (P < .001), with an average "d" of 2.7 mm. At 3 mm, 6 mm, 9 mm, and 12 mm from the PCL, the safest portal was the 1-cm medial portal (P < .001), with average "d" of 3.8 mm, 6.9 mm, 10.1 mm, and 13.5 mm, respectively. Average distance between the PHLM and the PNVB was 7.8 mm. Shorter distance between the PHLM and the PNVB was associated with younger age and female sex (P = .014 and .001, respectively). CONCLUSIONS All-inside suturing of the PHLM at 0 mm from the PCL is safer with a more lateral portal. Beyond 3 mm from the PCL, a more medial portal carries a lower risk to the PNVB. Young and female patients have a shorter distance between the PHLM and the PNVB, suggesting a greater risk for injury to the PNVB. Careful preoperative magnetic resonance imaging assessment may assist in safer portal selection when planning repair of the PHLM. CLINICAL RELEVANCE This study describes a magnetic resonance imaging-based risk assessment for injury of the PVNB while suturing the PHLM. It allows the orthopaedic surgeon a better understanding of the anatomic relationship between the popliteal neurovascular bundle and the lateral meniscus and can assist in portal selection and safety.
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Affiliation(s)
- Ron Gilat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Gabriel Agar
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Moshe Dahan
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
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189
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Featherall J, Oak SR, Strnad GJ, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Spindler KP. Smartphone Data Capture Efficiently Augments Dictation for Knee Arthroscopic Surgery. J Am Acad Orthop Surg 2020; 28:e115-e124. [PMID: 31977610 PMCID: PMC6964865 DOI: 10.5435/jaaos-d-19-00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objectives of this study are (1) to develop a provider-friendly, evidence-based data capture system for lower-limb orthopaedic surgeries and (2) to assess the performance of the data capture system on the dimensions of agreement with operative note and implant log, consistency of data, and speed of provider input. METHODS A multidisciplinary team developed a database and user interfaces for Android and iOS operating systems. Branching logic and discrete fields were created to streamline provider data input. One hundred patients were randomly selected from the first four months of data collection (February to June 2015). Patients were limited to those undergoing anterior cruciate ligament reconstruction, meniscal repair, partial meniscectomy, or a combination of these procedures. Duplicate data on these 100 patients were collected through chart review. These two data sets were compared. Cohen's kappa statistic was used to assess agreement. RESULTS The database and smartphone data capture tool show almost perfect agreement (kappa > 0.81) for all data tested. In addition, data are more comprehensive with near-perfect provider completion (100% for all data tested). Furthermore, provider data entry is extremely efficient (median 151-second completion time). CONCLUSION A well-designed database and user-friendly interface have greater potential for research utility, clinical efficiency, and, thus, cost-effectiveness when compared with standard voice-dictated operative notes. Widespread utilization of such tools can accelerate the pace and improve the quality of orthopaedic clinical research. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joseph Featherall
- From the Cleveland Clinic Lerner College of Medicine (Mr. Featherall), the Department of Orthopaedic Surgery, Cleveland Clinic (Dr. Oak, Mr. Strnad, Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), and the Cleveland Clinic Sports Health Center, Cleveland Clinic (Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), Cleveland, OH
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190
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Abstract
BACKGROUND Although there are several causes of unplanned return to the operating room (RTOR) following pediatric anterior cruciate ligament (ACL) reconstruction (ACLR), prior outcomes studies focus primarily on the risk of graft failure. We sought to comprehensively describe indications for RTOR in pediatric primary ACLR patients, estimate associated rates of RTOR, and assess the impact of concomitant meniscal procedures on these rates. METHODS This retrospective cohort study considered patients who underwent primary ACLR at an urban, pediatric tertiary care hospital between 2013 and 2015. Cohorts were defined based on the presence or absence of a concomitant surgical meniscal procedure with the index ACLR. The primary outcome was RTOR for an indication pertaining to ACLR or a potential predilection for knee injury. Cases of RTOR were cataloged and classified according to indication. Survival analyses were performed using the Kaplan-Meier estimation and competing-risks regression. Comparisons of any-cause RTOR rates were done using log-rank tests. RESULTS After exclusion criteria were applied, 419 subjects were analyzed. RTOR indications were organized into 5 categories. The overall rate for any RTOR by 3 years after surgery was 16.5%. Graft failure and contralateral ACL tear were the most common indications for RTOR, with predicted rates of 10.3% and 7.1%, respectively. ACL graft failure accounted for less than half of RTOR cases cataloged. Patients who had a concomitant meniscus procedure had lower rates of RTOR. CONCLUSIONS Approximately 1 in 6 pediatric ACLR patients underwent ≥1 repeat surgery within 3 postoperative years for indications ranging from wound breakdown to contralateral ACL rupture. While previous studies revealed high rates of complication after pediatric ACLR due primarily to graft failure, we found that re-tear is responsible for less than half of the 3-year RTOR risk. As almost half of re-tears in our sample occurred before clearance to return to full activities, we suspect that the high rate of complication is largely attributable to pediatric patients' high activity levels and difficulties adhering to postoperative restrictions. Early treatment of meniscus pathology may reduce rates of RTOR. LEVEL OF EVIDENCE Level III-therapeutic.
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Affiliation(s)
- Christopher J DeFrancesco
- Division of Orthopaedics, The Children's Hospital of Philadelphia
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eileen P Storey
- Division of Orthopaedics, The Children's Hospital of Philadelphia
| | - John M Flynn
- Division of Orthopaedics, The Children's Hospital of Philadelphia
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191
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Eliasberg CD, Lin KM, Bauer TW, Rodeo SA. Development of a Meniscal Ossicle After a Meniscal Root Repair Augmented with Bone Marrow Aspirate Concentrate: A Case Report. JBJS Case Connect 2020; 10:e0419. [PMID: 32224660 DOI: 10.2106/jbjs.cc.19.00419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 17-year-old boy had persistent knee pain 1 year after medial meniscal root repair augmented with bone marrow aspirate concentrate injection. Radiographs and magnetic resonance imaging (MRI) demonstrated an intrameniscal ossicle which was not present on MRI performed before 6 months. He underwent arthroscopic excision of the meniscal ossicle. At the 7-month follow-up, he had complete relief of his pain. CONCLUSIONS It is possible that the meniscal ossicle developed because of osteoinductive cells and cytokines from the injected bone marrow or the drill hole for root repair and should be considered as a possible complication of this procedure.
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Affiliation(s)
- Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kenneth M Lin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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192
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Baron JE, Shamrock AG, Volkmar AJ, Westermann RW. Haemophilus Parainfluenzae Septic Arthritis Following Primary All-Inside Meniscus Repair: A Case Report and Review of the Literature. Iowa Orthop J 2020; 40:111-114. [PMID: 32742217 PMCID: PMC7368514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Haemophilus parainfluenzae (H. parainfluenzae) is a gram-negative rod that inhabits the oral cavity. It is a common cause of respiratory tract infections and rarely is responsible for musculoskeletal infections in immunocompetent hosts. We present a case of a 17-year-old male whose postoperative course following arthroscopic all-inside meniscus repair was complicated with H. parainfluenzae septic arthritis. The infection was successfully cleared with two arthroscopic irrigation and debridements and antibiotic therapy. The patient successfully returned to full-contact high school football at five months postoperatively. To our knowledge, this represents the first reported case of H. parainfluenzae infection following an orthopaedic procedure in an adolescent. Level of Evidence: IV.
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Affiliation(s)
- Jacqueline E Baron
- Rugers Robert Wood Johnson Medical School, New Brunswick, NJ
- University of Iowa Hospitals and Clinics, Iowa City, IA
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193
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Campbell AL, Strauss E, Gonzalez-Lomas G, Alaia M. Expanding Indications for Meniscal Repair. Bull Hosp Jt Dis (2013) 2020; 78:74-80. [PMID: 32144966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Meniscus surgery has dramatically changed over the last 20 years. This article reviews the advances and current evidence in meniscus repair.
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194
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Mao DW, Upadhyay U, Thalanki S, Lee DYH. All-Inside Lateral Meniscal Repair via Anterolateral Portal Increases Risk of Vascular Injury: A Cadaveric Study. Arthroscopy 2020; 36:225-232. [PMID: 31787348 DOI: 10.1016/j.arthro.2019.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the distance from the device tip to the neurovascular structures during an all-inside medial and lateral meniscal repair using anteromedial and anterolateral portals in a fresh-frozen cadaveric study. METHODS Ten fresh-frozen cadaveric knees were studied. The popliteal artery, popliteal vein, and tibial nerve were identified after dissection via a posterior approach. An all-inside meniscal repair device was set to a 20-mm depth limit and inserted into a fixed point in the posterior horn at the meniscocapsular junction. This was performed for medial and lateral menisci via anteromedial and anterolateral arthroscopic portals. The distances between the device tip and the neurovascular structures were measured. We performed t tests to determine statistical significance. RESULTS The distance between the device and popliteal artery was significantly closer when aimed at the posterior horn of the lateral meniscus via the anterolateral portal (4.7 ± 2.3 mm) versus the anteromedial portal (13.0 ± 8.0 mm, P = .010). The distance to the popliteal vein was closer via the anterolateral portal (6.7 ± 2.9 mm) versus the anteromedial portal (13.9 ± 5.8 mm, P = .004). For medial meniscal repair, the distance to the popliteal artery was significantly closer via the anteromedial portal (12.8 ± 11.3 mm) versus the anterolateral portal (23.8 ± 7.7 mm, P = .022). The distance to the popliteal vein was closer via the anteromedial portal (16.5 ± 11.3 mm) versus the anterolateral portal (28.3 ± 8.2 mm, P = .017). No significant difference was found in the distance to the tibial nerve when aimed at either meniscus via either portal. CONCLUSION For all-inside meniscal repair, the popliteal vein is at risk and the popliteal artery is at high risk of injury when the posterior horn of the lateral meniscus is repaired via an anterolateral working portal. CLINICAL RELEVANCE The popliteal artery and vein are at risk of injury when the posterior horn of the lateral meniscus undergoes all-inside repair via the anterolateral portal. Surgeons need to be aware of the risks when performing this repair.
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Affiliation(s)
- David Weijia Mao
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore.
| | - Upasana Upadhyay
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Srikiran Thalanki
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Dave Yee Han Lee
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
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195
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Baron JE, Day MA, DeMik DE, Westermann RW, Wolf BR. Return to Collegiate Athletics After Distal Femoral Osteotomy: A Report of Three Cases and Review of the Literature. Iowa Orthop J 2020; 40:143-146. [PMID: 32742222 PMCID: PMC7368529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The authors present three cases of high-level athletes with successful return to competitive collegiate athletics following distal femoral osteotomy for knee lateral compartment overload. CONCLUSION Distal femoral varus osteotomy (DFO) is used to treat valgus knee malalignment and to offload the lateral knee compartment in the setting of symptomatic cartilage or meniscus pathology. DFO can be considered a viable treatment for collegiate athletes, with satisfactory outcomes and ability to return to sport participation at pre-injury functional levels.Level of Evidence: IV.
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Molly A Day
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - David E DeMik
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Robert W Westermann
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
| | - Brian R Wolf
- University of Iowa, Department of Orthopedics and Reabilitation, Iowa City, IA
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196
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Abstract
BACKGROUND The meniscus plays a vital role in the normal biomechanics of the knee. However, it is not well studied at the molecular level. The purpose of this study was to determine whether molecular and pathological changes in the meniscal tissue vary depending on the presence or absence of meniscal and/or anterior cruciate ligament tear (ACL). METHODS Six normal menisci (group A), seven simple torn menisci (group B) and seven torn menisci with concomitant anterior cruciate ligament tears (group C) were collected. We observed the pathological changes in the menisci and used real-time polymerase chain reaction along with immunohistochemistry and in situ hybridisation to examine the levels of ACAN, ADAMTS5, COL10A1, CEBPβ, MMP13 and miR-381-3p, miR-455-3p, miR-193b-3p, miR-92a-3p, respectively. Patients were scored preoperatively and postoperatively using the Lysholm Knee Scoring Scale and International Knee Documentation Committee Subjective Knee Evaluation Form. RESULTS Compared with group A, the expression levels of ADAMTS5, COL10A1, CEBPβ, and MMP13 and all the miRNAs were increased while ACAN was down-regulated in groups B and C. Additionally, the gene expression and miRNA levels were higher in group C than that in group B, except for ACAN, which was lower. Several fibrochondrocytes strongly expressed ADAMTS5, CEBPβ, and MMP13 in groups B and C and had high levels of miR-381-3p and miR-455-3p than that in group A. Postoperative Lysholm and IKDC scores were higher in group B than in group C. CONCLUSIONS Our findings suggest that the meniscus tended to degenerate after it was injured, especially when combined with a torn ACL. The miRNAs investigated in this study might also contribute to meniscus degeneration. Patients with a combined injury patterns might have relatively worse joint function.
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Affiliation(s)
- Yi Long
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
- Department of Orthopedics, The Central Hospital of Shao Yang, Shaoyang, 422000, Hunan, China
| | - Jingping Xie
- Department of Orthopedics, The Central Hospital of Shao Yang, Shaoyang, 422000, Hunan, China
| | - Zhi-Qi Zhang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Ziji Zhang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Fangang Meng
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
| | - Aishan He
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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197
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Mok YR, Krishna L. Reply to the letter to the editor: Comment on "Anterior cruciate ligament reconstruction performed within 12 months of the index injury is associated with a lower rate of medial meniscus tears". Knee Surg Sports Traumatol Arthrosc 2019; 27:4064-4065. [PMID: 31087120 DOI: 10.1007/s00167-019-05518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ying Ren Mok
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119288, Singapore.
| | - Lingaraj Krishna
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119288, Singapore
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198
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Kim CW, Lee CR, Gwak HC, Kim JH, Park DH, Kwon YU, Jung SH. Clinical and Radiologic Outcomes of Patients With Lax Healing After Medial Meniscal Root Repair: Comparison With Subtotal Meniscectomy. Arthroscopy 2019; 35:3079-3086. [PMID: 31629584 DOI: 10.1016/j.arthro.2019.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiologic and clinical outcomes between patients who underwent medial meniscus posterior root tear (MMPRT) repair and were subsequently classified as having lax healing based on second-look arthroscopy and patients who underwent subtotal meniscectomy for an MMPRT. METHODS The patients who received pullout repair or subtotal meniscectomy due to MMPRT between January 2011 and December 2014 were retrospectively reviewed. Among the patients who underwent MMPRT repair, those whose lax healing of the repair site was confirmed by second-look arthroscopy (repair/lax healing group) and among the patients who received subtotal meniscectomy, those who have varus deformity of <5° and a Kellgren-Lawrence grade of ≤2 (meniscectomy group) were included in the study population. Medial joint space width, Kellgren-Lawrence grade, International Knee Documentation Committee Subjective Knee Evaluation Form score, and Lysholm Knee score were used for radiologic and clinical assessment. RESULTS The meniscectomy group included 24 patients (average follow-up, 37.2 months), and the repair/lax healing group included 21 patients (average follow-up, 39.2 months). The 2 groups showed improved patient-reported outcomes postoperatively (P < .001). However, medial joint space width (P < .001) became narrow and Kellgren-Lawrence grade (P = .002 and P = .005, respectively) worsened. Comparison of the radiologic outcomes between the 2 groups revealed that the repair/lax healing group had less Kellgren-Lawrence grade progression than the meniscectomy group (P = .014). The grade progressed by ≥2 grades in 4 patients (16.7%) and 0 patients in the meniscectomy and repair/lax healing groups, respectively (P < .001). CONCLUSIONS Although the repair/lax healing group showed improved functional outcomes on short-term follow-up, arthritic change progressed radiologically. Nevertheless, the repair/lax healing group showed better radiologic outcomes than the meniscectomy group, despite lax healing of the repair site. However, because of the small number of cases in this study, the results of this study could be associated with potential for type II or β errors. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Yong-Uk Kwon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Soo-Hwan Jung
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
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199
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Alessio-Mazzola M, Lovisolo S, Capello AG, Zanirato A, Chiarlone F, Formica M, Felli L. Management of ramp lesions of the knee: a systematic review of the literature. Musculoskelet Surg 2019; 104:125-133. [PMID: 31595426 DOI: 10.1007/s12306-019-00624-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature and to assess the clinical outcomes following meniscal ramp lesion treatment and anterior cruciate ligament (ACL) reconstruction. A consensus of the treatment of this pattern of tears is still lacking. METHODS A systematic review of the literature was performed with a comprehensive search on Medline through PubMed, CINAHL, Cochrane, Embase and Google Scholar databases. The PRISMA 2009 flowchart and checklist were considered to edit the review. The included studies were evaluated based on indications, management, surgical technique and clinical results. RESULTS Seven studies (two level II and five level IV evidence) were identified that met inclusion criteria, including a total of 509 patients. The overall main follow-up was 23.6 months. Treatment failure occurred in 8.3% of patients receiving ACL repair and ramp lesion treatment. The repair of ramp lesion is the most used approach in the literature. CONCLUSION There is a lack of literature focused on the management of ramp lesion and ACL injuries. The repair resulted in the most used approach with good clinical results and low failure rate. However, further high-quality studies evaluating the long-term outcomes of different surgical strategies are needed.
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Affiliation(s)
- M Alessio-Mazzola
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - S Lovisolo
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - A G Capello
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - A Zanirato
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - F Chiarlone
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Formica
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - L Felli
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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200
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Duan G, Niu Y, Niu J, Wang F, Li Y, Cao P. Anterior-medial collateral ligament portal : easy access to the torn posteromedial horn of the medial meniscus. Acta Orthop Belg 2019; 85:360-363. [PMID: 31677633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The posteromedial horn of the medial meniscus is prone to injury, and repair of a tear in this portion of the medial meniscus is especially challenging for the arthroscopist. We present a novel technique that allows good management of the posterior horn of the medial meniscus, even in patients with tight medial compartments. This technique uses two standard portals (the anterolateral portal and the anteromedial portal) to conduct arthroscopic examination, and uses a third portal as the workhorse portal to manage the posterior region so that the posterior horn tear can be easily removed. This new third portal is named the anterior-medial collateral ligament portal, and is positioned anterior to the anterior rim of the medial collateral ligament. This three-portal technique decreases the difficulty associated with management of the posteromedial region in knees with tight medial compartments.
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