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Furumatsu T, Kamatsuki Y, Fujii M, Kodama Y, Okazaki Y, Masuda S, Ozaki T. Medial meniscus extrusion correlates with disease duration of the sudden symptomatic medial meniscus posterior root tear. Orthop Traumatol Surg Res 2017; 103:1179-1182. [PMID: 28951279 DOI: 10.1016/j.otsr.2017.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 05/09/2017] [Revised: 07/11/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Medial meniscus posterior root tear (MMPRT) leads to abnormal biomechanics of the knee by inducing the medial meniscus extrusion (MME). However, a time-dependent increase of the MME is not fully elucidated in patients suffering from the acute MMPRT. The aim of this study was to investigate the relationships among disease duration of the MMPRT and severity of the MME. We hypothesized that MME measurement correlates with disease duration after a sudden onset of the minor traumatic MMPRT during the short-term follow-up period. MATERIALS AND METHODS Forty-six patients who had an accurate episode of the posteromedial painful popping were investigated. All the patients were diagnosed having a symptomatic MMPRT with magnetic resonance imaging (MRI) examinations. Absolute MME was measured using MRI scans within 12 months after painful popping events. A correlation coefficient between duration from injury to MRI examination and absolute MME was evaluated. RESULTS Mean absolute MME was 4.5±1.6mm (range, 1.1-8.8mm) on MRI measurements. A good correlation was observed between MME measurement and duration from injury to MRI examination (R2=0.612). The best-fit equation for predicting each value was: MME=0.014×disease duration+3.288mm. DISCUSSION This study demonstrated that absolute MME increases progressively within the short duration after the onset of symptomatic MMPRT. Our results suggest that preoperative MME assessment may be important in determining disease duration and treatment strategy of the MMPRT. LEVEL OF EVIDENCE Retrospective cohort study level IV.
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Affiliation(s)
- T Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Y Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - M Fujii
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Y Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Y Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - S Masuda
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - T Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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252
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Trisolino G, Favero M, Lazzaro A, Martucci E, Strazzari A, Belluzzi E, Goldring SR, Goldring MB, Punzi L, Grigolo B, Olivotto E. Is arthroscopic videotape a reliable tool for describing early joint tissue pathology of the knee? Knee 2017; 24:1374-1382. [PMID: 28823808 DOI: 10.1016/j.knee.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/27/2017] [Revised: 06/22/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to assess the reliability of the videotape scoring system collected during knee arthroscopy for meniscal tears, and to test the consistency with intra-operative findings. METHODS Fifty-seven patients undergoing arthroscopic treatment of meniscal tears were included in the analysis. The cartilage damage was assessed intra-operatively, at six sites, using the Outerbridge scoring system. The meniscal tears were graded according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification. The presence of synovial inflammation was scored, at four different sites, according to the macro-score method. The total cartilage, meniscal and synovial scores were calculated for each knee by the sum of the maximum grade of the lesions at each anatomic site. In order to assess the reliability of the arthroscopic scoring system, the videotapes recorded during the arthroscopy were reviewed by two independent observers one year after the surgery and compared with the scores completed by the surgeon during the operation. RESULTS The total cartilage score showed substantial inter-rater and intra-rater reliability, and moderate consistency with the intra-operative score provided by the surgeon. The total meniscal score showed substantial inter-rater and intra-rater reliability, and good consistency with the intra-operative findings. The total synovial score showed substantial inter-rater agreement, substantial intra-rater reliability, and moderate consistency with intra-operative findings. CONCLUSIONS The videotape scoring system provided a reliable and reproducible system for recording the intra-operative state of the whole joint pathology in patients undergoing arthroscopic treatment of meniscal tears.
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Affiliation(s)
- Giovanni Trisolino
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy; Pediatric Orthopedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy; Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy.
| | - Antonello Lazzaro
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Ermanno Martucci
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alessandro Strazzari
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Elisa Belluzzi
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | | | | | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Brunella Grigolo
- Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy
| | - Eleonora Olivotto
- Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy
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253
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Waibel FW, Bachmann E, Viehöfer AF, Schürholz K, Snedeker JG, Fucentese SF. Open Meniscus Repair In Full And Partial Horizontal Meniscal Lesions : A Biomechanical Cadaver Study. Acta Orthop Belg 2017; 83:684-689. [PMID: 30423679] [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: 06/09/2023]
Abstract
Horizontal meniscal tears are often treated by partial meniscectomy. Some clinical studies have shown successful repair. The purpose of this study was to show that axial loading causes less horizontal displacement in partial than in total horizontal lesions and that suture of those lesions prevents horizontal displacement. Forty menisci were tested : sutured partial horizontal lesions (ten), sutured total horizontal lesions (ten) and matched unsutured control groups (ten each). Samples were put in a custom made fixation device. 1000 cycles with axial loading, simulating partial weight-bearing of 15kg, were applied. Displacement was measured and construct stiffness was calculated. No suture failure or pullout occurred. Horizontal displacement was insignificantly lower in partial then in full lesions as well as in sutured samples than in the control groups. Horizontal displacement is low in both sutured and unsutured menisci in our test setting. Further studies with higher loads are required.
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254
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Abstract
RATIONALE Bilateral discoid medial menisci is an extremely rare abnormality of the knee joint. The presence of a discoid medial meniscus has been associated with magnetic resonance imaging (MRI) and radiographic changes in the tibial region, such as cupping of the medial tibial plateau and tibial physis collapse. While discoid medial meniscal tears with hypoplasia of the femoral medial condyles have not been previously reported. Herein, we report a case of bilateral discoid medial menisci associated with meniscal tears and femoral bone changes. PATIENT CONCERNS A 28-year-old man presented with left knee pain and restricted range of motion; the right knee was asymptomatic. DIAGNOSES Based on radiographic and MRI findings, he was diagnosed with bilateral discoid medial meniscal tears. INTERVENTIONS Partial meniscectomy and reshaping were performed for the torn discoid medial meniscus of the left knee only. OUTCOMES MRI revealed short, flattened femoral medial condyles in the coronal and sagittal planes, and hypoplasia of the femoral medial condyles in the axial plane; these findings were confirmed arthroscopically in the left knee. The patient had a satisfactory results at the 12-month follow-up. LESSONS This case indicates a potential link between discoid medial menisci and hypoplasia of the femoral medial condyle. We recommend preservation of the discoid medial meniscus in asymptomatic patients, while arthroscopic partial meniscectomy and reshaping is recommended in symptomatic patients.
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Affiliation(s)
- Hong-De Wang
- Department of Orthopedics, Third Hospital of Hebei Medical University
- Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Shi-Jun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University
- Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
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255
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Bassett W, Korsh J, Swan KG. Managing atraumatic meniscal tears in middle-aged patients. J Fam Pract 2017; 66:E1-E6. [PMID: 29099517] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
What role does arthroscopic surgery have in the treatment of patients with atraumatic meniscal tears and osteoarthritis? The authors reviewed the literature to find out.
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Affiliation(s)
- William Bassett
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Jeremy Korsh
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kenneth G Swan
- University Orthopedic Associates, New Brunswick, NJ, USA
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256
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Abram SGF, Middleton R, Beard DJ, Price AJ, Hopewell S. Patient-reported outcome measures for patients with meniscal tears: a systematic review of measurement properties and evaluation with the COSMIN checklist. BMJ Open 2017; 7:e017247. [PMID: 29030413 PMCID: PMC5652504 DOI: 10.1136/bmjopen-2017-017247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Meniscal tears occur frequently in the population and the most common surgical treatment, arthroscopic partial meniscectomy, is performed in approximately two million cases worldwide each year. The purpose of this systematic review is to summarise and critically appraise the evidence for the use of patient-reported outcome measures (PROMs) in patients with meniscal tears. DESIGN A systematic review was undertaken. Data on reported measurement properties were extracted and the quality of the studies appraised according to Consensus-based Standards for the Selection of Health Measurement Instruments. DATA SOURCES A search of MEDLINE, Embase, AMED and PsycINFO, unlimited by language or publication date (last search 20 February 2017). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Development and validation studies reporting the measurement properties of PROMs in patients with meniscal tears were included. RESULTS 11 studies and 10 PROMs were included. The overall quality of studies was poor. For measurement of symptoms and functional status, there is only very limited evidence supporting the selection of either the Lysholm Knee Scale, International Knee Documentation Committee Subjective Knee Form or the Dutch version of the Knee injury and Osteoarthritis Outcome Score. For measuring health-related quality of life, only limited evidence supports the selection of the Western Ontario Meniscal Evaluation Tool (WOMET). Of all the PROMs evaluated, WOMET has the strongest evidence for content validity. CONCLUSION For patients with meniscal tears, there is poor quality and incomplete evidence regarding the validity of the currently available PROMs. Further research is required to ensure these PROMs truly reflect the symptoms, function and quality of life of patients with meniscal tears. PROPERO REGISTRATION NUMBER CRD42017056847.
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Affiliation(s)
- Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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257
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Marchetti DC, Phelps BM, Dahl KD, Slette EL, Mikula JD, Dornan GJ, Bucci G, Turnbull TL, Singleton SB. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears. Arthroscopy 2017; 33:1840-1848. [PMID: 28754246 DOI: 10.1016/j.arthro.2017.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/12/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. METHODS Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. RESULTS No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged from 498 to 561 mm2, 786 to 997 N/mm2, and 1,990 to 2,215 N/mm2, respectively. CONCLUSIONS Contact area, mean contact pressure, and peak contact pressure were not significantly different between the all-inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level. CLINICAL RELEVANCE An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration.
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Affiliation(s)
| | - Brian M Phelps
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Erik L Slette
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jacob D Mikula
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Gabriella Bucci
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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258
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Rathcke MW, Lind M, Boesen MI, Nissen N, Boesen AP, Mygind-Klavsen B, Hölmich P. [Treatment of meniscal pathology]. Ugeskr Laeger 2017; 179:V05170361. [PMID: 28918786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The menisci play a major role in knee function regarding joint movement, stability, load distribution and load transmission. Injuries to the menisci cause pain, and meniscal tears are a common reason for patient referral. In Denmark, partial meniscectomy increased significantly until 2010, and several studies have questioned the long-term effect of meniscectomy as an overall procedure. A Danish national clinical guideline on knee meniscal pathology was published in May 2016, and this article is a short summary of updated knowledge on meniscal pathology and relevant conclusions from the guideline.
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259
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Fredberg U. [Not Available]. Ugeskr Laeger 2017; 179:V69382. [PMID: 28918781] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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260
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Abstract
BACKGROUND Meniscal lesions are among the most important musculoskeletal disorders and are the most common indication for knee joint arthroplasty. However, the structural integrity and function is rarely retained, and a loss of tissue results. Thus, there is a huge demand for meniscal replacement options. CURRENT PROCEDURES Autografts were used in the past but did not fulfill expectations. Meniscus allografts have been developed to be a viable treatment option. However, availability is limited and evidence of a long-term chondroprotective effect scarce. Artificial scaffolds made from either collagen or PCU foam are available, which aid the regeneration of meniscal tissue and are rather intended as a partial replacement with an intact peripheral rim. Those implants thus have a limited spectrum of indication. While they seem to be symptomatically effective, it remains unclear whether they can reduce secondary cartilage damage. Newer developments aim at a permanent replacement of lost meniscal tissue. LIMITATIONS In summary, there is currently no meniscal replacement available for a broad range of indications and with a solid scientific foundation. Prophylactic use should be limited to cases with a high chance of progression to osteoarthritis, like a lateral total meniscectomy. Otherwise meniscal replacement should be considered in younger, symptomatic patients with mild to moderate secondary changes. Potential causes of the initial meniscal injury like instability or deformities should be carefully assessed and addressed. In many cases, osteotomy might be a viable alternative to meniscus replacement.
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Affiliation(s)
- C Stärke
- Orthopädische Universitätsklinik Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - S Kopf
- Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland
| | - R Becker
- Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland
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261
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Thorlund JB. Deconstructing a popular myth: why knee arthroscopy is no better than placebo surgery for degenerative meniscal tears. Br J Sports Med 2017; 51:1630-1631. [PMID: 28615215 DOI: 10.1136/bjsports-2017-097877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 11/04/2022]
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262
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See PLP. Clinics in diagnostic imaging (177). Medical meniscus bucket-handle tear with medial oblique meniscomeniscal ligament. Singapore Med J 2017; 58:241-245. [PMID: 28536729 DOI: 10.11622/smedj.2017038] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 29-year-old man with a previous football injury to his left knee presented with pain of the same knee. The patient twisted it as he was turning a corner quickly while going up the stairs, leading to internal rotation of his femur on his tibia with his knee in flexion. MR imaging revealed a bucket-handle tear of the medial meniscus, as well as a complete tear of the anterior cruciate ligament. However, image interpretation was complicated by the presence of a medial oblique meniscomeniscal ligament, a rare normal variant among intermeniscal ligaments of the knee. All four recognised variants of intermeniscal ligaments are discussed, with emphasis on their prevalence, imaging and anatomical features, and the way in which they may mimic meniscal tears.
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263
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Uquillas C, Arno S, Ramme A, Oh C, Walker P, Meislin R. Contact Analysis of Horizontal Cleavage Tear Treatment. Bull Hosp Jt Dis (2013) 2017; 75:164-172. [PMID: 28902600] [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: 06/07/2023]
Abstract
Horizontal cleavage tears (HCT) commonly occur in the posterior horn of the medial meniscus due to aging and degeneration. The purpose of this study was to investigate the surgical treatment of HCTs and their effect on dynamic tibiofemoral contact mechanics. The tibiofemoral contact mechanics of 10 cadaver knees were investigated using a custom dynamic loading apparatus, pressure sensor, and motion sensing camera. Three loading conditions were analyzed: 500 N compressive load, 500 N compressive load with 100 N posterior shear, and 500 N compressive load with 2.5 Nm of internal torque. Real-time peak contact pressures and contact areas were recorded throughout the full range of motion. After testing the intact meniscal state, a horizontal cleavage tear was created and included 50% of the width of the meniscus. The following procedures were performed, and the loading conditions described above were analyzed: HCT superior flap removal (5 specimens), HCT inferior flap removal (remaining 5 specimens), and both flaps removed (all 10 specimens). Statistical analysis was performed using a mixed linear effects model using the R-statistical package. The mixed linear effects statistical model identified statistically significant differences between independent variables, including the procedure performed, meniscal flap removed, meniscal region, loading condition, and knee flexion angle with respect to contact area and peak contact pressure. Peak contact pressure and contact area were not affected by selective flap removal (superior vs. inferior) or removal of both flaps of the HCT. We recommend that in the treatment of horizontal cleavage tears of the posterior horn of the medial meniscus, the outer 50% of the posterior horn of the medial meniscus should be maintained for load transmission.
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264
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Leopold SS. Editorial: Appropriate Use? Guidelines on Arthroscopic Surgery for Degenerative Meniscus Tears Need Updating. Clin Orthop Relat Res 2017; 475:1283-1286. [PMID: 28251473 PMCID: PMC5384939 DOI: 10.1007/s11999-017-5296-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA.
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265
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Russo A, Capasso R, Varelli C, Laporta A, Carbone M, D'Agosto G, Giovine S, Zappia M, Reginelli A. MR imaging evaluation of the postoperative meniscus. Musculoskelet Surg 2017; 101:37-42. [PMID: 28210945 DOI: 10.1007/s12306-017-0454-3] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 06/06/2023]
Abstract
MR imaging has been widely evaluated in the assessment of patients with recurrent or residual symptoms following meniscal surgery. Importantly, the causes of such symptoms may relate to failure or complication of the surgical procedure, a possible recurrent or residual meniscal tear, or may be related to other causes of joint symptoms, including tears of the contralateral meniscus, or local hyaline cartilage, or marrow abnormalities subjacent to or distant to the meniscal surgical site. The complex diagnostic issues involved in the MR imaging evaluation of the postoperative meniscus were identified in early MR imaging studies. The knowledge of the normal MR imaging appearance of the knee after the more common repair procedures will allow radiologists to recognize complications associated with such procedures. In this article, we discuss the MR imaging evaluation of the knee after meniscal surgery.
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Affiliation(s)
- A Russo
- Department of Radiology, S. G. Moscati Hospital, Via Gramsci, 81031, Aversa, Italy.
| | - R Capasso
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - C Varelli
- Varelli Diagnostic Institute of Naples, Naples, Italy
| | - A Laporta
- Department of Radiology, Solofra Hospital, Avellino, Italy
| | - M Carbone
- Department of Radiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G D'Agosto
- Diagnostic DAM Institute, Nocera Inferiore (Salerno), Italy
| | - S Giovine
- Department of Radiology, S. G. Moscati Hospital, Via Gramsci, 81031, Aversa, Italy
| | - M Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Reginelli
- Department of Internal Clinical and Experimental Medicine and Surgery, Second University of Naples, Caserta, Italy
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266
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Abstract
BACKGROUND Meniscal extrusion is related to degeneration of the native knee joint. However, the clinical effect of the phenomenon after meniscal allograft transplantation (MAT) has not been clearly identified. Purpose/Hypothesis: The purpose of this study was to evaluate the change in meniscal extrusion in both the coronal and sagittal planes after lateral MAT through the midterm follow-up period. We hypothesized that meniscal extrusion does not progress during the midterm follow-up period. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 patients with a mean follow-up of 51.1 ± 7.1 months were included in the study. The patients underwent lateral MAT using the keyhole technique. Postoperative magnetic resonance imaging (MRI) was performed at 6-week, 1-year, and midterm (3- to 5-year) follow-up. In the coronal plane, the absolute value of meniscal subluxation and the relative percentage of extrusion (RPE) were measured. In the sagittal plane, meniscal subluxation was measured as the absolute and relative anterior cartilage meniscal distance (ACMD) and posterior cartilage meniscal distance (PCMD). The joint-space width (JSW) on weightbearing radiographs with 2 different knee positions was measured preoperatively and at 1-year and midterm follow-up. The Lysholm score was assessed at the same time points. RESULTS In the coronal plane, the mean absolute meniscal extrusion at 6-week, 1-year, and final follow-up was 2.90 ± 0.94, 2.85 ± 0.97, and 2.83 ± 0.89 mm, respectively, and the mean RPE was 27.0% ± 9.4%, 27.1% ± 10.1%, and 27.8% ± 9.7%, respectively. There were no statistically significant differences in absolute and relative coronal extrusion among the 3 time periods ( P > .05). The percentage of patients with meniscal extrusion (≥3 mm) was 37.0% at 6-week follow-up and 34.8% at 1-year and final follow-up. In the sagittal plane, the mean absolute ACMD was 2.59 ± 1.75, 2.58 ± 1.85, and 2.37 ± 1.60 mm, respectively, and the mean relative ACMD was 20.7% ± 13.1%, 20.6% ± 13.8%, and 19.0% ± 12.2%, respectively, at the 3 follow-up time points. The mean absolute PCMD was -1.23 ± 3.34, -1.28 ± 3.08, and -1.42 ± 2.77 mm, respectively, and the mean relative PCMD was -10.3% ± 25.9%, -11.0% ± 24.6%, and -12.2% ± 23.2%, respectively, at the same time points. Sagittal extrusion was not significantly different between the time points ( P > .05). The mean JSW at 2 days preoperatively, 1 year postoperatively, and midterm follow-up was 5.40 ± 1.07, 5.44 ± 1.04, and 5.43 ± 0.98 mm, respectively, on anterior-posterior radiographs with full extension, and it was 4.90 ± 0.94, 4.94 ± 0.98, and 4.89 ± 0.96 mm, respectively, on posterior-anterior radiographs with 45° of flexion. The mean JSW values were not significantly different between the 3 different time points ( P > .05). The mean preoperative Lysholm score was 58. 9 ± 8.3; the score increased to 90.4 ± 9.7 at 1 year postoperatively and 90.5 ± 10.1 at final follow-up, which is a significant improvement compared with the preoperative status ( P < .05). There was no statistically significant difference between the scores at the 2 postoperative time points ( P > .05). CONCLUSION This study demonstrated that extrusion of the meniscal allograft did not significantly progress either in the coronal or sagittal plane after lateral MAT during the midterm follow-up period.
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Affiliation(s)
- Nam-Ki Kim
- Department of Orthopedic Surgery, Medi-Yin Hospital, Paju, Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, College of Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jae-Hyan Kim
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
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267
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Randsborg PH, Røtterud JH. [Degenerative meniscal ruptures should not be operated]. Tidsskr Nor Laegeforen 2017; 137:258. [PMID: 28225222 DOI: 10.4045/tidsskr.16.1028] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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269
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Seil R, Karlsson J, Beaufils P, Becker R, Kopf S, Ollivier M, Denti M. The difficult balance between scientific evidence and clinical practice: the 2016 ESSKA meniscus consensus on the surgical management of degenerative meniscus lesions. Knee Surg Sports Traumatol Arthrosc 2017; 25:333-334. [PMID: 28247038 DOI: 10.1007/s00167-017-4458-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 01/17/2023]
Affiliation(s)
- R Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg-Clinique d' Eich, 78, Rue d'Eich, 1460, Luxembourg, Germany.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78, Rue d'Eich, 1460, Luxembourg, Germany.
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Molndal, Sweden
| | - P Beaufils
- Orthopaedics Department, Centre Hospitalier de Versailles, 78150, Le Chesnay, France
| | - R Becker
- Department of Orthopaedics and Traumatology, Hospital Brandenburg, Medical School Theodor, Fontane, Hochstrasse 26, 14770, Havel, Brandenburg, Germany
| | - S Kopf
- Center for Musculosketal Surgery, Charité-University Medicine Berlin, AugustenburgerPlatz, 1, 13353, Berlin, Germany
| | - M Ollivier
- Orthopaedics Department, Centre Hospitalier de Versailles, 78150, Le Chesnay, France
| | - M Denti
- Galeazzi Orthopaedic Institute, Milan, Italy
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270
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Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. PLoS One 2017; 12:e0170710. [PMID: 28125675 PMCID: PMC5268414 DOI: 10.1371/journal.pone.0170710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/09/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We describe a special, interesting phenomenon found in the anterior horn of the lateral meniscus (AHLM): most tear patterns in the AHLM are distinctive, with loose fibers in injured region and circumferential fiber bundles were separated. We name it as macerated tear. The goal of this study was to bring forward a new type of meniscal tear in the AHLM and investigate its clinical value. MATERIALS AND METHODS AHLM tears underwent arthroscopic surgery from January 2012 to December 2014 were included. Data regarding the integrity of AHLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos. RESULTS A total of 60 AHLM tears in 60 patients (mean age 27.1 years) were grouped into horizontal tears (n = 15, 25%), vertical tears (n = 14, 23%), complex tears (n = 6, 10%), and macerated tears (n = 25, 42%). There were 6 patients with AHLM cysts in macerated tear group and one patient in vertical tear group. 60 patients were performed arthroscopic meniscus repairs and were followed-up with averaged 18.7 months. Each group had significant postoperative improvement in Lysholm and IKDC scores (p < 0.05). However, the macerated tear group showed least functional recovery of Lysholm and IKDC scores compared to other groups (p < 0.05). In addition, there were no differences in postoperative range of motion, return to work, or return to sport/other baseline activities between the four groups (p > 0.05). CONCLUSIONS This study demonstrated that the macerated tear is common in the tear pattern of AHLM. However, feasibility of the treatment of this type of meniscal tear, especially the meniscus repairs still requires further study.
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Affiliation(s)
- Jiapeng Zheng
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wenliang Zhai
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Qiang Li
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Qianxin Jia
- Department of Radiology, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Dasheng Lin
- Department of Orthopaedic Surgery, the Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
- Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
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271
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Carreau JH, Sitton SE, Bollier M. Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review. Iowa Orthop J 2017; 37:123-132. [PMID: 28852346 PMCID: PMC5508273] [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: 06/07/2023]
Abstract
Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option.
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Affiliation(s)
- Joseph H. Carreau
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and Clinics
| | - Sean E. Sitton
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and Clinics
| | - Matthew Bollier
- Department of Orthopedics and Rehabilitation University of Iowa Hospitals and Clinics
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Abstract
PURPOSE To study discoid meniscus in children who underwent arthroscopic surgery at our center. SUBJECTS AND METHODS Thirty-four patients (39 knees) younger than 15 years with discoid lateral meniscus (mean age, 12.9 years; 13 males, 21 females) who underwent arthroscopic surgeries since 2007 were studied. The surgical procedure consisted of, in principle, saucerization with additional suture repair in the case of meniscal instability at the peripheral rim of the residual meniscus. The mechanisms of symptom onset, symptoms, complications and postoperative outcome in these cases were examined. In addition, Lysholm scores were obtained before surgery and at the last postoperative follow-up in all patients. RESULTS Symptom onset was associated with sports in 18 knees, fall in 3 knees, and no definitive trigger in the remaining knees. The presenting symptoms were pain in 32 knees, catching in 11 knees, and locking in 6 knees. According to Watanabe classification, 26 knees were complete type and 13 knees were incomplete type. The modes of tear included horizontal tear in 10 knees and longitudinal tear in 10 knees, while no definitive tear was present on the knee joint surface. The surgical procedures included saucerization only in 22 knees, partial meniscectomy in 10 knees, and saucerization with suture repair in 5 knees. The mean Lysholm score was 63.9 before surgery, and improved significantly to 92.3 at the last follow-up. Only two knees developed osteochondritis dissecans after surgery. Two knees required reoperation; one knee underwent subtotal meniscectomy and one knee had partial meniscectomy with suturing. CONCLUSION Although the short-term outcome after saucerization with or without suture repair for discoid meniscus is favorable, degenerative change or change of lower limb alignment may occur in the long term. Further long-term study is required.
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Affiliation(s)
- Tetsuo Hagino
- The Sports Medicine and Knee Center, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan.
| | - Satoshi Ochiai
- The Sports Medicine and Knee Center, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Shinya Senga
- The Sports Medicine and Knee Center, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Takashi Yamashita
- The Sports Medicine and Knee Center, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
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273
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Ridley TJ, McCarthy MA, Bollier MJ, Wolf BR, Amendola A. Age Differences in the Prevalence of Isolated Medial and Lateral Meniscal Tears in Surgically Treated Patients. Iowa Orthop J 2017; 37:91-94. [PMID: 28852341 PMCID: PMC5508267] [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: 06/07/2023]
Abstract
PURPOSE To compare the prevalence of isolated lateral and medial meniscal tears in different aged populations. METHODS A five-year retrospective review for meniscal procedures performed on a total of 782 patients. Each chart was reviewed to document the prevalence of medial or lateral meniscal injuries. Inclusion criteria were patients found to have documented evidence of meniscal tear, either lateral or medial, without any concomitant injuries and/or any other procedures performed. Patients excluded from the study were those with concomitant pathologies, such as chondromalacia, malalignment or ligamentous injuries. Patients were classified by age into three groups: < 20 years, 20-30 years and > 30 years old. RESULTS 68.7% of patients had medial meniscal tears, (average age 37.6 years), 17.1% of these were isolated medial meniscus injuries (average 31.9 years). 31.3% had lateral meniscal injuries (average 27.7 years). Of these, 18.8 % had isolated lateral meniscal injuries (average 22.8 years). All remaining patients had additional diagnoses/procedures. Isolated medial meniscal injuries were more common in older patients as 48 of the 92 isolated medial tears (52.2%) were found in patients > 30 years of age (p <0.001). Isolated lateral meniscal injuries, on the other hand, were more common in younger patients. 29 of the 46 isolated lateral tears (63%) occurred in patients under 20 years (p = 0.002). Only seven (15.2%) isolated lateral tears were shown in patients older than 30 years. CONCLUSION Isolated lateral meniscal tears are more common in patients < 20 years, and decrease with age, while the prevalence of medial meniscal tears increase with age.
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Affiliation(s)
- T J Ridley
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Mark A McCarthy
- Department of Orthopaedic Surgery, Mayo Clinic, Eau Claire, WI
| | - Matthew J Bollier
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
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274
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Látal P, Šimeček K, Kloub M. [Arthroscopic Finding of Knee Joint in Relation to Age and Its Comparison with Pre-Operative Clinical Finding - a Retrospective Study]. Acta Chir Orthop Traumatol Cech 2017; 84:175-181. [PMID: 28809636] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE OF THE STUDY In the retrospective study of two South Bohemian centres we present the comparison of pre-operative anamnestic clinical signs in relation to the arthroscopic intraoperative finding. The obtained data is used also to evaluate the arthroscopic finding in relation to age and sex. MATERIAL AND METHODS The arthroscopic findings of patients who underwent surgery in 2013-2014 period (1.1.2013-31.12.2014) at the Department of Trauma Surgery of České Budějovice Hospital, a.s. and in 2014 (1.1.-31.12.2014) at the Department of Orthopaedics and Traumatology of Písek Hospital, a.s. were evaluated. In total, 1 021 patients underwent surgery, with the mean age of 44 years. The patients were not selected. The group includes all the patients who underwent surgery, including those in whom repeat arthroscopy was performed, in the respective period of time, regardless of the mechanism of difficulties. A preoperative MRI scan was carried out in 470 patients. The referring physician was present during the examination. In all the patients undergoing surgery, the main clinical preoperative sign was examined based on the documentation, namely in the following order - hemarthros, locked knee, hydrops or merely a pain. In the arthroscopic finding, the medial meniscal lesion - anterior and posterior horn, and complete tear was assessed. The same was done for lateral meniscus. In anterior cruciate ligament - ACL - partial or complete tear was assessed. We identified the frequency of findings in relation to age and evaluated the correlations between the clinical signs and the arthroscopic finding. We calculated the sensitivity and specificity of hemarthros as a sign of ACL tear. The analysis was conducted based on the medical history in medical record documentation and the surgical protocol. The cartilage was not assessed. RESULTS Analysis of clinical and anamnestic signs in relation to arthroscopic findings 1. Negative arthroscopic findings (potential cartilage damage with no damage to other soft structures and normal arthroscopic findings) are in 83% accompanied by a mere knee pain. 2. High percentage of isolated locked joint (15%) in negative findings 3. Complete ACL tears are most frequently reported in the under-35 age category - 43% of 191 men who underwent surgery and 33% of 102 women. 4. Isolated injuries to ACL without the meniscus tear are frequent in younger patients - 30% - 40% of the total number of patients with injured ACL. 5. In patients older than 56 years of age the ACL damage is accompanied by concurrent meniscus tear (96% in men, 100% in women). 6. Sensitivity of hemarthros (68%) for complete ACL tear. Specificity of the presence of hemarthros in complete ACL lesions (91%) indicates that there are also complete ACL tears with no hemarthros whatsoever in the medical history. For partial tears the values of sensitivity and specificity are 27% and 67%, respectively. In partial tear, the presence of hemarthros is not a diagnostic lead. 7. In 15% of negative findings a "locked knee" was present. It was not a genuinely locked knee, but rather an antalgic position. Not every locked knee must necessarily mean a meniscus lesion or ACL tear. 8. Isolated meniscus tear is in 75% accompanied only by pain. 9. In our group of patients, isolated osteoarthrosis or malacic cartilage without any damage to ligaments or menisci was rare - only in 22 cases (2% of the entire group). DISCUSSION There are lots of studies which focus on comparing the clinical findings with perioperative pathology of knee joint and the importance of pre-operative clinical examination. Our extensive retrospective study proved that in 56-plus age category virtually each ACL injury is accompanied by a meniscal lesion, which can be explained by a possible ACL damage at a young age and subsequent instability resulting in meniscus tear or frequent presence of degenerative meniscal changes at an older age. A small number of isolated degenerative cartilage damage was established (2%). We fully agree with the authors who prove that the degenerative cartilage changes are ever since the very beginning accompanied by changes of the other soft structure of the knee. We revealed a high percentage of locked knee joint in negative arthroscopic findings. According to the clinical pre-operative examination, the locked knee does not automatically mean the meniscal lesion or ACL tear. In agreement with the others we prove a close association between hemarthros and ACL injury. CONCLUSIONS 1. A clinical examination, a detailed medical history is necessary 2. With hemarthros in medical history, there is a likelihood of complete ACL tear. Conversely, even a seemingly trivial knee sprain without hemarthros or locked knee can mean the ACL tear. 3. Where a mere pain is present, it mostly indicates an isolated meniscal damage or a negative finding. 4. Degenerative cartilage changes are accompanied by degeneration of menisci and ligaments. 5. Our group of patients did not include any case of hemarthros in the medical history with a negative arthroscopic finding. Hemarthros always indicated a more serious damage to knee soft structures. Key words: knee joint injuries, knee arthroscopy, sensitivity, specificity, hemarthros.
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Affiliation(s)
- P Látal
- Oddělení úrazové chirurgie, Nemocnice České Budějovice, a. s
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van de Graaf VA, Scholtes VAB, Wolterbeek N, Noorduyn JCA, Neeter C, van Tulder MW, Saris DBF, de Gast A, Poolman RW. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study): protocol of a randomised controlled trial. BMJ Open 2016; 6:e014381. [PMID: 28003302 PMCID: PMC5223724 DOI: 10.1136/bmjopen-2016-014381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard treatment choice to conservative treatment alone could save over €30 millions of direct medical costs on an annual basis. Economic evaluation studies comparing surgery to conservative treatment are lacking. METHODS AND ANALYSIS A multicentre randomised controlled trial (RCT) with an economic evaluation alongside was performed to assess the (cost)-effectiveness of surgery and conservative treatment for meniscal tears. We will include 402 participants between 45 and 70 years with an MRI-confirmed symptomatic, non-obstructive meniscal tears to prove non-inferiority of conservative treatment. Block randomisation will be web-based. The primary outcome measure is a physical function, measured by the International Knee Documentation Committee 'Subjective Knee Form'. Furthermore, we will perform a cost-effectiveness and cost-utility analysis from societal perspective and a budget impact analysis from a societal, government and insurer perspective. Secondary outcomes include general health, quality of life, activity level, knee pain, physical examination, progression of osteoarthritis and the occurrence of adverse events. ETHICS AND DISSEMINATION This RCT will be performed in accordance with the Declaration of Helsinki and has been approved by the Ethics Committee (number NL44188.100.13). The results of this study will be reported in peer-reviewed journals and at international conferences. We further aim to disseminate our results to guideline committees. TRIAL REGISTRATION NUMBER NCT01850719.
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Affiliation(s)
| | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Julia C A Noorduyn
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | | | - Maurits W van Tulder
- Department of Health Sciences & EMGO+ Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniël B F Saris
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Arthur de Gast
- Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
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276
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Felli L, Garlaschi G, Muda A, Tagliafico A, Formica M, Zanirato A, Alessio-Mazzola M. Comparison of clinical, MRI and arthroscopic assessments of chronic ACL injuries, meniscal tears and cartilage defects. Musculoskelet Surg 2016; 100:231-238. [PMID: 27628912 DOI: 10.1007/s12306-016-0427-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of this study was to compare the accuracy of clinical examination to that of MRI evaluated by two independent radiologists for the diagnosis of meniscal tears and chronic anterior cruciate ligament injuries and to assess the MRI accuracy in the diagnosis of cartilage defects. METHODS Seventy-six consecutive patients with suspected intra-articular knee pathology were prospectively evaluated by objective examination, 1.5 T MRI, re-examined by trained radiologist and arthroscopy. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Agreement analysis with kappa (К) coefficient values was performed for meniscal and ACL tears. RESULTS No differences were found between diagnostic accuracy of clinical examination, the first and second MRI reports in diagnosis of medial meniscus (84 vs 96 vs 97 %) and anterior cruciate ligament injuries (93 vs 78 vs 89 %). For the lateral meniscal tears, the accuracy of the second radiologist was significantly higher than those of the first (96 vs 75 %; p < 0.01) and clinical examination (96 vs 86 %; p = 0.02). High diagnostic values were obtained for the diagnosis of full-thickness chondral defects with sensitivity of 100 %, specificity of 95 % and accuracy of 95 %. CONCLUSION Clinical and MRI evaluations have no differences in the diagnosis of medial meniscus and anterior cruciate ligament injuries. A trained radiologist obtained better sensitivity, specificity and accuracy in the diagnosis of lateral meniscus. 1.5 T MRI does not represent the technique of choice in the evaluation of chondral defect but demonstrated high diagnostic accuracy for detection of full-thickness chondral defects. LEVEL OF EVIDENCE Diagnostic prospective study, Level II.
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Affiliation(s)
- L Felli
- Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - G Garlaschi
- Radiology Unit, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - A Muda
- Radiology Unit, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - A Tagliafico
- Department of Experimental Medicine (DIMES), Institute of Anatomy, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Formica
- Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - A Zanirato
- Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Alessio-Mazzola
- Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Tan Y, Zhou P, Ma C. Analysis of sport-injured pattern of anterior cruciate ligament in the reconstruction period of Chinese college students. J Sports Med Phys Fitness 2016; 56:1346-1351. [PMID: 26333792] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In this study, we aimed to investigate the college students' injury patterns caused by sport activities in anterior cruciate ligament (ACL) reconstruction stage, and to estimate the association between activities at the time of injury and the odds of simplex ACL injuries. METHODS A cohort of 2548 college students with primary ACL reconstruction was recruited from Hebei Province, China. Football, basketball, sprint, table tennis and badminton had been chosen as the most prevalent sports activities causing injuries in colleges. The concurrent injury patterns at the time of ACL reconstruction were simplex ACL, meniscus, cartilage, and multi-ligament injuries. RESULTS Compared with football, college students playing basketball were 4.95 (95% confidence interval [CI], 2.61-8.76) times more likely to have simplex ACL tear, 2.31 (95% CI, 1.73-3.05) times more inclined to have lateral meniscus injury, 2.53 (95% CI, 1.22-3.67) times more likely to have a cartilage injury, and 1.93 (95% CI, 1.22-3.04) times more likely to have a medial meniscus injury. Students playing sprint were 2.04 (95% CI, 1.78-3.38) times more likely to have cartilage injury. CONCLUSIONS Injury patterns are associated with certain sports. Compared with football, basketball has a greater possibility of leading to simplex ACL tear, as well as medial meniscus, lateral meniscus and cartilage injuries. Additionally, injury patterns observed during surgery may reflect the forces applied to the knee by the given sports performed.
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Affiliation(s)
- Yingjie Tan
- College of Physical Education, Langfang Teacher's University, Langfang, China -
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Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T. Pullout repair of a medial meniscus posterior root tear using a FasT-Fix ® all-inside suture technique. Orthop Traumatol Surg Res 2016; 102:951-954. [PMID: 27567426 DOI: 10.1016/j.otsr.2016.06.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 04/06/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
A medial meniscus posterior root tear (MMPRT) may increase the tibiofemoral contact pressure by decreasing the tibiofemoral contact area. Meniscal dysfunction induced by posterior root injury may lead to the development of osteoarthritic knees. Repair of a MMPRT can restore medial meniscus (MM) function and prevent knee osteoarthritis progression. Several surgical procedures have been reported for treating a MMPRT. However, these procedures are associated with several technical difficulties. Here, we describe a technique to stabilize a torn MM posterior root using the FasT-Fix® all-inside meniscal suture device and a new aiming device. The uncut free-end of the FasT-Fix® suture can be used as a thread for transtibial pullout repair. Our procedure might help overcome the technical difficulties in arthroscopic treatment of a MMPRT.
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Affiliation(s)
- Y Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - T Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - M Fujii
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - T Tanaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - S Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - T Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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279
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Simonetta R, Di Vico G, Papalia R, Vasta S, Denaro V. Arthroscopic all-inside treatment of popliteomeniscal fascicles tears: surgical technique and results from the first 6 consecutive patients. J BIOL REG HOMEOS AG 2016; 30:91-97. [PMID: 28002905] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Athletes whose knees are subjected to sudden changes of direction and high jumps such as martial arts athletes, dancers, wrestlers and football players are at higher risk of injuring popliteomeniscal fascicles. Painful squatting and mechanical symptoms such as locking sensation are common. Current available treatments includes open or arthroscopic in repair. Arthroscopic repair with all-inside device can relieve symptoms and restore knee function. Six patients from two surgical centers with isolated popliteomeniscal fascicles tears were treated with arthroscopic all-inside repair. The surgical technique is thoroughly described. All patients showed consistent symptoms and MRI findings, as well as meniscal hypermobility during arthroscopic probing. Moreover, four out of six showed a chondral lesion of the lateral femoral condyle. All of them had their lateral meniscus sutured with one or more sutures. Symptoms were relieved and all but one were able to return to play at the pre-injury level. No postoperative complications were encountered. The diagnosis of the disruption of popliteomeniscal fascicles is challenging and often seen in athletes that play sports which involve repetitive twisting. However, patients complaints are consistent. Arthroscopic repair with an all-inside device showed to be a reliable and easy technique for addressing the condition, although some issues still need to be investigated, such as how much constraint the repair should provide. Arthroscopic all-inside repair of popliteomeniscal tears prove to be safe and effective in the short-term follow-up, allowing for sport activity resumption.
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Affiliation(s)
- R Simonetta
- Istituto Cure Ortopediche Traumatologiche, Messina, Italy
| | - G Di Vico
- Casa di Cura San Michele, Maddaloni (CE), Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - S Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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280
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Bates NA, McPherson AL, Rao MB, Myer GD, Hewett TE. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries. Knee Surg Sports Traumatol Arthrosc 2016; 24:2778-2786. [PMID: 25510363 PMCID: PMC4469632 DOI: 10.1007/s00167-014-3478-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this epidemiologic study was to quantify the incidence, expense, and concomitant injuries for anterior cruciate ligament reconstruction (ACLR) procedures in the USA from 2003 to 2011 that required an inpatient stay. It was hypothesized that the relative reported rates of concomitant knee injuries would be greater with the MCL and menisci compared to all other concomitant knee injuries. METHODS The National Inpatient Sample from 2003 to 2011 was retrospectively sampled using ICD-9-CM codes to identify ACLR patients and to extrapolate national averages. RESULTS Between the years of 2003-2011, an average of 9,037 ± 1,728 inpatient hospitalization included ACLRs, of which 4,252 ± 1,824 were primarily due to the ACLR. Inpatient visits primarily due to ACLR involved an average hospitalization of 1.7 ± 0.2 days and cost $30,118 ± 9,066 per patient. Knee injuries that were commonly reported along with inpatient ACLRs included medial meniscus damage (18.1 %), lateral meniscus damage (16.8 %), collateral ligament repairs (12.3 %), and medial collateral ligament strains (6.9 %). Prevalence of meniscus injuries was consistent across years, but MCL-related injuries increased over time. CONCLUSIONS ACLR-related inpatient hospitalizations account for approximately 7.1 % of the total ACLRs performed annually in the USA. Inpatient ACLR procedures continue to decrease in frequency; however, the mean cost per patient increased. Meniscus and collateral ligament injuries were the most commonly reported concomitant knee injuries. The clinical relevance of this investigation is that it informs, on a large clinical cohort of patients, the current state of incidence and expense for ACLR surgeries in an inpatient setting. LEVEL OF EVIDENCE Prognostic, retrospective study, Level II.
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Affiliation(s)
- Nathaniel A Bates
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA
- Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - April L McPherson
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marepalli B Rao
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Environmental Health-Genomics, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D Myer
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Athletic Training Division, School of Allied Medical Professions, The Ohio State University, Columbus, OH, USA
| | - Timothy E Hewett
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA.
- The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA.
- Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
- Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221, USA.
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281
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Guler O, Isyar M, Karataş D, Ormeci T, Cerci H, Mahirogulları M. Investigating the relationship between internal tibial torsion and medial collateral ligament injury in patients undergoing knee arthroscopy due to tears in the posterior one third of the medial meniscus. Knee 2016; 23:655-8. [PMID: 26751979 DOI: 10.1016/j.knee.2015.09.020] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/07/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the relationship between medial collateral ligament (MCL) injury and degree of internal tibial torsion in patients who had undergone arthroscopic resection due to tears in the posterior one third of the medial meniscus. METHODS Seventy-one patients were allocated into two groups with respect to foot femur angle (FFA) and transmalleolar angle (TMA) (Group 1 31 patients with FFA<8° and Group 2 40 patients with FFA≥8°). The groups were compared in terms of valgus instability, Lysholm score, magnetic resonance view, FFA, and TMA, both before and after the operation. RESULTS Lysholm scores were higher in Group 2 at both postoperative week 1 (p<0.001) and month 1 (p=0.045) relative to Group 1. Preoperative cartilage injury was encountered more frequently in Group 1 (p=0.037) than in Group 2. MCL injury was detected more frequently in Group 1 compared to Group 2 postoperatively at week 1 (p=0.001). CONCLUSION We conclude that FFA and TFA, indicators of internal tibial torsion, may serve as markers for foreseeing clinical improvement and complications following arthroscopic surgery. LEVEL OF EVIDENCE level III retrospective comparative study.
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Affiliation(s)
- Olcay Guler
- Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey.
| | - Mehmet Isyar
- Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey
| | - Dilek Karataş
- Department of Radiology, Nisa Hospital, Istanbul, Turkey
| | - Tugrul Ormeci
- Department of Radiology, Medipol University, Medical Faculty, Istanbul, Turkey
| | - Halis Cerci
- Department of Orthopedics and Traumatology, Nisa Hospital, Istanbul, Turkey
| | - Mahir Mahirogulları
- Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey
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282
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Kreinest M, Reisig G, Ströbel P, Dinter D, Attenberger U, Lipp P, Schwarz M. A Porcine Animal Model for Early Meniscal Degeneration - Analysis of Histology, Gene Expression and Magnetic Resonance Imaging Six Months after Resection of the Anterior Cruciate Ligament. PLoS One 2016; 11:e0159331. [PMID: 27434644 PMCID: PMC4951152 DOI: 10.1371/journal.pone.0159331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 06/30/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/OBJECTIVE The menisci of the mammalian knee joint balance the incongruence between femoral condyle and tibial plateau and thus menisci absorb and distribute high loads. Degeneration processes of the menisci lead to pain syndromes in the knee joint. The origin of such degenerative processes on meniscal tissue is rarely understood and may be described best as an imbalance of anabolic and catabolic metabolism. A standardized animal model of meniscal degeneration is needed for further studies. The aim of the current study was to develop a porcine animal model with early meniscal degeneration. MATERIAL AND METHODS Resection of the anterior cruciate ligament (ACLR) was performed on the left knee joints of eight Göttingen minipigs. A sham operation was carried out on the right knee joint. The grade of degeneration was determined 26 weeks after the operation using histology and magnetic resonance imaging (MRI). Furthermore, the expression of 14 genes which code for extracellular matrix proteins, catabolic matrix metalloproteinases and inflammation mediators were analyzed. RESULTS Degenerative changes were detected by a histological analysis of the medial meniscus after ACLR. These changes were not detected by MRI. In terms of their gene expression profile, these degenerated medial menisci showed a significantly increased expression of COL1A1. CONCLUSION This paper describes a new animal model for early secondary meniscal degeneration in the Göttingen minipig. Histopathological evidence of the degenerative changes could be described. This early degenerative changes could not be seen by NMR imaging.
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Affiliation(s)
- Michael Kreinest
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Molecular Cell Biology, University Medical Centre Homburg, Saarland University, Homburg/Saar, Germany
| | - Gregor Reisig
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Centre Göttingen, Göttingen, Germany
| | - Dietmar Dinter
- Department of Radiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrike Attenberger
- Department of Radiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Lipp
- Department of Molecular Cell Biology, University Medical Centre Homburg, Saarland University, Homburg/Saar, Germany
| | - Markus Schwarz
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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283
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Abstract
Meniscus tears are commonly encountered in the athletic population and can result in significant loss of playing time. Current treatment methods for acute tears consist of meniscectomy and meniscal repair, whereas meniscal allograft transplant is reserved as a salvage procedure for symptomatic meniscectomized patients who desire a more functional knee. This review describes the postoperative rehabilitation protocol for each procedure and evaluates the outcomes in existing literature as it pertains to the athlete.
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Affiliation(s)
- Alaina M Brelin
- Orthopaedic Surgery Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
| | - John-Paul H Rue
- Orthopaedic Surgery Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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284
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Alvarez-Diaz P, Alentorn-Geli E, Llobet F, Granados N, Steinbacher G, Cugat R. Return to play after all-inside meniscal repair in competitive football players: a minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24:1997-2001. [PMID: 25261222 DOI: 10.1007/s00167-014-3285-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Received: 04/06/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the mid-to-long-term return to sports after all-inside meniscal repair in competitive football players. METHODS All football players undergoing all-inside meniscal repair with a minimum Tegner activity score of 9 and minimum follow-up of 5 years were eligible for inclusion. Patients were excluded if: (a) they had ipsilateral or contralateral: meniscectomy, posterior cruciate ligament tear, multi-ligament knee injuries, osteotomies, or meniscal transplant (b) they had meniscal tears in the anterior horn, and (c) they had bucket-handle tears. All patients included were contacted by phone and asked for current sport status or Tegner score. Preoperative Tegner scores were collected from the medical charts. RESULTS All patients (n = 29) were men with a median (range) age of 27 (18-37) years and a follow-up of 6 (5-8) years. All meniscal injuries were complete and longitudinal tears. The median preinjury Tegner activity score was 9 (range 9-10). Two patients required revision arthroscopy (6.7 %) with partial meniscectomy before being able to return to competitive football due to suture failure. Twenty-six patients (89.6 %) returned to the same level of competition after recovering from surgery. At the last follow-up, 13 patients (45 %) were able to continue playing football at any level, and 8 (28 %) of them were able to return to the same pre-injury competitive level. The main reasons for the decreased level of activity (from competitive to recreational) or to give up football were job-related or changes in their personal life situation, but were not related to knee or meniscal disorders. Fourteen patients underwent meniscal repair alone, whereas 15 patients had an associated ACL reconstruction procedure. There were no significant differences in the collected variables between both subgroups. CONCLUSIONS All-inside meniscal repair allows for excellent results with regard to return-to-play rates in competitive football. However, only half of the patients are still playing football in the mid-to-long-term follow-up, although reasons to give up football are not related to knee or meniscal disorders. LEVEL OF EVIDENCE Case series, Level-IV.
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Affiliation(s)
- Pedro Alvarez-Diaz
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Ronda Sant Pere 19-21, 08010, Barcelona, Spain.
- Fundación García-Cugat, Barcelona, Spain.
- Artroscopia gc, S.L., Department of Orthopaedic Surgery, Hospital Quirón, Barcelona, Spain.
- Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Eduard Alentorn-Geli
- Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar, Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Federico Llobet
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
- Departamento de Ortopedia y Traumatología, Hospital Calderón Guardia, Barrio Aranuez, San José, Costa Rica
| | - Nelson Granados
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
| | - Gilbert Steinbacher
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
| | - Ramón Cugat
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
- Fundación García-Cugat, Barcelona, Spain
- Artroscopia gc, S.L., Department of Orthopaedic Surgery, Hospital Quirón, Barcelona, Spain
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285
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Ahn JH, Jeong SH, Kang HW. Risk Factors of False-Negative Magnetic Resonance Imaging Diagnosis for Meniscal Tear Associated With Anterior Cruciate Ligament Tear. Arthroscopy 2016; 32:1147-54. [PMID: 26922836 DOI: 10.1016/j.arthro.2015.11.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 05/19/2015] [Revised: 09/30/2015] [Accepted: 11/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify risk factors that predict false-negative magnetic resonance imaging (MRI) diagnosis for meniscal tear coincident with anterior cruciate ligament injury using multivariate logistic regression. METHODS We reviewed the medical records of consecutive patients who underwent arthroscopic anterior cruciate ligament reconstruction from January 2006 through December 2014. Exclusion criteria were no meniscal tear or incomplete tear less than 10 mm in length, delay to surgery from initial injury more than 1 year, delay to surgery from preoperative MRI more than 4 weeks, revisions, fracture histories, and multiple ligament injuries. According to preoperative MRI diagnosis, the meniscal tears were sorted into true-positive MRI and false-negative MRI groups. Multivariate logistic regression was used to analyze risk factors including age, gender, body mass index, time from injury to MRI, knee instability, concomitant ligament injury, intra-articular effusion, bone contusion, cartilage injury, meniscal tear location, and meniscal tear pattern. RESULTS Enrolled 249 meniscal tears (159 medial and 90 lateral menisci) were sorted into true-positive MRI (n = 136) and false-negative MRI (n = 113) groups. As time from injury to MRI diagnosis increased, the risk of the false-negative MRI diagnosis decreased (adjusted odds ratio [OR], 0.859; 95% confidence interval [CI], 0.802-0.921). Meniscal tear location within the posterior one-third was a significant risk factor compared with tear within the anterior one-third (adjusted OR, 11.823; 95% CI, 2.272-61.519). Peripheral longitudinal tear pattern was also a significant risk factor (adjusted OR, 3.522; 95% CI, 1.256-9.878). CONCLUSIONS Significant risk factors for false-negative MRI included short time from injury to MRI diagnosis, meniscal tear location within the posterior one-third, and peripheral longitudinal tear pattern. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggido, Republic of Korea.
| | - Seung Hyo Jeong
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggido, Republic of Korea
| | - Ho Won Kang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggido, Republic of Korea
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286
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Di Matteo B, Moran CJ, Tarabella V, Viganò A, Tomba P, Marcacci M, Verdonk R. A history of meniscal surgery: from ancient times to the twenty-first century. Knee Surg Sports Traumatol Arthrosc 2016; 24:1510-8. [PMID: 26231150 DOI: 10.1007/s00167-015-3717-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/24/2015] [Accepted: 07/13/2015] [Indexed: 11/27/2022]
Abstract
The science and surgery of the meniscus have evolved significantly over time. Surgeons and scientists always enjoy looking forward to novel therapies. However, as part of the ongoing effort at optimizing interventions and outcomes, it may also be useful to reflect on important milestones from the past. The aim of the present manuscript was to explore the history of meniscal surgery across the ages, from ancient times to the twenty-first century. Herein, some of the investigations of the pioneers in orthopaedics are described, to underline how their work has influenced the management of the injured meniscus in modern times. Level of evidence V.
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MESH Headings
- History, 15th Century
- History, 16th Century
- History, 17th Century
- History, 18th Century
- History, 19th Century
- History, 20th Century
- History, 21st Century
- History, Ancient
- History, Medieval
- Humans
- Menisci, Tibial/surgery
- Orthopedic Procedures/history
- Orthopedic Procedures/methods
- Orthopedics
- Tibial Meniscus Injuries/surgery
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Affiliation(s)
- B Di Matteo
- II Orthopaedic Clinic and Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - C J Moran
- Trinity College and Sports Surgery Clinic, Dublin, Ireland
| | - V Tarabella
- II Orthopaedic Clinic and Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - A Viganò
- Donazione Putti, Biblioteche Scientifiche Istituto Ortopedico Rizzoli, Rizzoli Orthopaedic Institute, Via Pupilli n. 1, 40136, Bologna, Italy
| | - P Tomba
- Donazione Putti, Biblioteche Scientifiche Istituto Ortopedico Rizzoli, Rizzoli Orthopaedic Institute, Via Pupilli n. 1, 40136, Bologna, Italy
| | - M Marcacci
- II Orthopaedic Clinic and Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - R Verdonk
- Orthopaedics and Traumatology, Gent State University, Ghent, Belgium
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287
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Swart NM, van Oudenaarde K, Reijnierse M, Nelissen RGHH, Verhaar JAN, Bierma-Zeinstra SMA, Luijsterburg PAJ. Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis. J Sci Med Sport 2016; 19:990-998. [PMID: 27129638 DOI: 10.1016/j.jsams.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 09/21/2015] [Revised: 03/16/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study evaluated the effectiveness of exercise therapy in patients with meniscal lesions. DESIGN Systematic review and meta-analysis. METHODS Nine databases were searched up to July 2015, including EMBASE and Medline OvidSP. Randomized and controlled clinical trials in adults with traumatic or degenerative meniscal lesions were considered for inclusion. Interventions had to consist of exercise therapy in non-surgical patients or after meniscectomy, and had to be compared with meniscectomy, no exercise therapy, or to a different type of exercise therapy. Primary outcomes were pain and function on short term (≤3 months) and long term (>3 months). Two researchers independently selected the studies, assessed the risk of bias, and extracted data. RESULTS Of the 1415 identified articles 14 articles describing 12 studies were included; all had some concerns about the risk of bias. There was no significant difference between exercise therapy and meniscectomy for pain (MD 0.27 [-4.30,4.83]) and function (SMD -0.32 [-0.68,0.03]). After meniscectomy, there was conflicting evidence for the effectiveness of exercise therapy when compared to no exercise therapy for pain and function. There was no significant difference between various types of exercise therapy for pain (MD 19.30 [-6.60,45.20]) and function (SMD 0.01 [-0.27,0.28]). CONCLUSIONS Exercise therapy and meniscectomy yielded comparable results on pain and function. Exercise therapy compared to no exercise therapy after meniscectomy showed conflicting evidence at short term, but was more effective on function at long term. The preferable type/frequency/intensity of exercise therapy remains unclear. The strength of the evidence was low to very low.
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Affiliation(s)
- N M Swart
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - K van Oudenaarde
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - R G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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288
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Yan F, Xie F, Gong X, Wang F, Yang L. Effect of anterior cruciate ligament rupture on secondary damage to menisci and articular cartilage. Knee 2016; 23:102-5. [PMID: 26298288 DOI: 10.1016/j.knee.2015.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 02/04/2015] [Revised: 06/05/2015] [Accepted: 07/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of anterior cruciate ligament (ACL) rupture on secondary damage to menisci and articular cartilage. METHOD A total of 366 patients with knee ACL rupture were divided into the following six groups based on the time span from the initial injury to ACL reconstruction: (1) <1.5months; (2) between 1.5 and three months; (3) between three and six months; (4) between six and 12months; (5) between 12 and 24months, and (6) >24months. During ACL reconstruction, impairment of meniscal or chondral integrity was systematically documented. RESULTS Of the 366 patients involved in this study, meniscal and chondral damage were found in 223 (60.9%) and 75 (20.5%) patients, respectively. In addition, the incidence of medial meniscal and chondral damage was significantly increased when ACL reconstruction was delayed. The incidence of medial meniscal and chondral damage was found to be 6.1 and 9.9 times higher in patients with a time from initial injury (TFI) of >24months than those with a TFI of <1.5months, respectively. CONCLUSION In this study, correlations between secondary damage to the menisci and/or the articular cartilage and time after initial injury were found in Chinese population. Our data suggested that ACL reconstruction should be performed as early as possible after ACL rupture to avoid secondary meniscal and/or chondral damage. It is recommended that the best time range for ACL reconstruction is between four and six weeks after initial injury.
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Affiliation(s)
- Fei Yan
- Center of Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, Shapingba, People's Republic of China
| | - Feng Xie
- Military Training Medicine Institute in the 150th Hospital of PLA, Luoyang, Henan, People's Republic of China
| | - Xiaoyuan Gong
- Center of Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, Shapingba, People's Republic of China
| | - Fuyou Wang
- Center of Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, Shapingba, People's Republic of China
| | - Liu Yang
- Center of Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, Shapingba, People's Republic of China.
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