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Ciszkiewicz A, Mazurkiewicz Ł, Małachowski J. Assessing the behavior of a hybrid model of the knee with contact surrogate under parameter uncertainties. Comput Methods Biomech Biomed Engin 2024:1-10. [PMID: 38907716 DOI: 10.1080/10255842.2024.2364813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
Modeling the knee is an important factor in increasing the quality of life of both healthy individuals and patients. Nevertheless, the intricate nature of the knee makes this problem complicated. In this study, an extension to an established planar knee joint model with Hertzian contact pairs is proposed with contact mechanics based on polynomial chaos expansion surrogate. Firstly, the finite element (FE) model is made representing a contact pair of sphere-to-plane type with two layers on both bodies, corresponding to the cartilage and the bone. Five variables corresponding to both geometry and material parameters are used to parametrize this model. Then, 128 distinct variants of the FE model are created based on a quasi-Monte Carlo sequence. This dataset is used to train and validate the surrogate. The trained surrogate is proven to have predictive capabilities with an average nRMSE of 0.2% in randomized test/train splits. When included in a model of the knee and tested under parameter uncertainties in Monte Carlo simulations, it results in nRMSE of 58% for angular coordinate compared to the original model with Hertzian pair. This signifies the high influence of contact formulation on the model output and the need for more physically based models in knee contact modeling.
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Affiliation(s)
- Adam Ciszkiewicz
- Faculty of Mechanical Engineering, Cracow University of Technology, Cracow, Poland
| | - Łukasz Mazurkiewicz
- Faculty of Mechanical Engineering, Military University of Technology, Warsaw, Poland
| | - Jerzy Małachowski
- Faculty of Mechanical Engineering, Military University of Technology, Warsaw, Poland
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2
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Enayati M, Liu W, Madry H, Neisiany RE, Cucchiarini M. Functionalized hydrogels as smart gene delivery systems to treat musculoskeletal disorders. Adv Colloid Interface Sci 2024; 331:103232. [PMID: 38889626 DOI: 10.1016/j.cis.2024.103232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Despite critical advances in regenerative medicine, the generation of definitive, reliable treatments for musculoskeletal diseases remains challenging. Gene therapy based on the delivery of therapeutic genetic sequences has strong value to offer effective, durable options to decisively manage such disorders. Furthermore, scaffold-mediated gene therapy provides powerful alternatives to overcome hurdles associated with classical gene therapy, allowing for the spatiotemporal delivery of candidate genes to sites of injury. Among the many scaffolds for musculoskeletal research, hydrogels raised increasing attention in addition to other potent systems (solid, hybrid scaffolds) due to their versatility and competence as drug and cell carriers in tissue engineering and wound dressing. Attractive functionalities of hydrogels for musculoskeletal therapy include their injectability, stimuli-responsiveness, self-healing, and nanocomposition that may further allow to upgrade of them as "intelligently" efficient and mechanically strong platforms, rather than as just inert vehicles. Such functionalized hydrogels may also be tuned to successfully transfer therapeutic genes in a minimally invasive manner in order to protect their cargos and allow for their long-term effects. In light of such features, this review focuses on functionalized hydrogels and demonstrates their competence for the treatment of musculoskeletal disorders using gene therapy procedures, from gene therapy principles to hydrogel functionalization methods and applications of hydrogel-mediated gene therapy for musculoskeletal disorders, while remaining challenges are being discussed in the perspective of translation in patients. STATEMENT OF SIGNIFICANCE: Despite advances in regenerative medicine, the generation of definitive, reliable treatments for musculoskeletal diseases remains challenging. Gene therapy has strong value in offering effective, durable options to decisively manage such disorders. Scaffold-mediated gene therapy provides powerful alternatives to overcome hurdles associated with classical gene therapy. Among many scaffolds for musculoskeletal research, hydrogels raised increasing attention. Functionalities including injectability, stimuli-responsiveness, and self-healing, tune them as "intelligently" efficient and mechanically strong platforms, rather than as just inert vehicles. This review introduces functionalized hydrogels for musculoskeletal disorder treatment using gene therapy procedures, from gene therapy principles to functionalized hydrogels and applications of hydrogel-mediated gene therapy for musculoskeletal disorders, while remaining challenges are discussed from the perspective of translation in patients.
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Affiliation(s)
- Mohammadsaeid Enayati
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Saar, Germany
| | - Wei Liu
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Saar, Germany
| | - Rasoul Esmaeely Neisiany
- Biotechnology Centre, Silesian University of Technology, Krzywoustego 8, 44-100 Gliwice, Poland; Department of Polymer Engineering, Hakim Sabzevari University, Sabzevar 9617976487, Iran
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Saar, Germany.
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Dejea H, Pierantoni M, Orozco GA, B Wrammerfors ET, Gstöhl SJ, Schlepütz CM, Isaksson H. In Situ Loading and Time-Resolved Synchrotron-Based Phase Contrast Tomography for the Mechanical Investigation of Connective Knee Tissues: A Proof-of-Concept Study. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308811. [PMID: 38520713 DOI: 10.1002/advs.202308811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Articular cartilage and meniscus transfer and distribute mechanical loads in the knee joint. Degeneration of these connective tissues occurs during the progression of knee osteoarthritis, which affects their composition, microstructure, and mechanical properties. A deeper understanding of disease progression can be obtained by studying them simultaneously. Time-resolved synchrotron-based X-ray phase-contrast tomography (SR-PhC-µCT) allows to capture the tissue dynamics. This proof-of-concept study presents a rheometer setup for simultaneous in situ unconfined compression and SR-PhC-µCT of connective knee tissues. The microstructural response of bovine cartilage (n = 16) and meniscus (n = 4) samples under axial continuously increased strain, or two steps of 15% strain (stress-relaxation) is studied. The chondrocyte distribution in cartilage and the collagen fiber orientation in the meniscus are assessed. Variations in chondrocyte density reveal an increase in the top 40% of the sample during loading, compared to the lower half. Meniscus collagen fibers reorient perpendicular to the loading direction during compression and partially redisperse during relaxation. Radiation damage, image repeatability, and image quality assessments show little to no effects on the results. In conclusion, this approach is highly promising for future studies of human knee tissues to understand their microstructure, mechanical response, and progression in degenerative diseases.
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Affiliation(s)
- Hector Dejea
- Department of Biomedical Engineering, Lund University, Box 118, Lund, 221 00, Sweden
- MAX IV Laboratory, Lund University, Lund, 224 84, Sweden
| | - Maria Pierantoni
- Department of Biomedical Engineering, Lund University, Box 118, Lund, 221 00, Sweden
| | - Gustavo A Orozco
- Department of Biomedical Engineering, Lund University, Box 118, Lund, 221 00, Sweden
| | | | - Stefan J Gstöhl
- Swiss Light Source, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | | | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, Lund, 221 00, Sweden
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Zhang Q, Yang X, Wang K, Xu Z, Liu W. A High-Density Hydrogen Bond Locking Strategy for Constructing Anisotropic High-Strength Hydrogel-Based Meniscus Substitute. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2310035. [PMID: 38509852 PMCID: PMC11165514 DOI: 10.1002/advs.202310035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Mimicking anisotropic features is crucial for developing artificial load-bearing soft tissues such as menisci). Here, a high-density hydrogen bond locking (HDHBL) strategy, involving preloading a poly(N-acryloylsemicarbazide) (PNASC) hydrogel with an aqueous solution containing a hydrogen bond breaking agent, followed by water exchange, to fabricate anisotropic high-strength hydrogels are proposed. During this process, multiple high-density hydrogen bonds of the PNASC network are re-established, firmly freezing oriented molecular chains, and creating a network with an anisotropic microstructure. The resulting anisotropic hydrogels exhibit superior mechanical properties: tensile strength over 9 MPa, Young's modulus exceeding 120 MPa along the orientation direction, and fatigue thresholds exceeding 1900 J m-2. These properties meet the mechanical demands for load-bearing tissue substitutes compared to other reported anti-fatigue hydrogels. This strategy enables the construction of an anisotropic meniscal scaffold composed of circumferentially oriented microfibers by preloading a digital light processing-3D printed PNASC hydrogel-based wedge-shaped construct with a resilient poly(N-acryloyl glycinamide) hydrogel. The 12-week implantation of a meniscus scaffold in rabbit knee joints after meniscectomy demonstrates a chondroprotective effect on the femoral condyle and tibial plateau, substantially ameliorating the progression of osteoarthritis. The HDHBL strategy enables the fabrication of various anisotropic polymer hydrogels, broadening their scope of application.
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Affiliation(s)
- Qian Zhang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Xuxuan Yang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Kuan Wang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Ziyang Xu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
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Wong PC, Chen KH, Wang WR, Chen CY, Wang YT, Lee YB, Wu JL. Injectable ChitHCl-DDA tissue adhesive with high adhesive strength and biocompatibility for torn meniscus repair and regeneration. Int J Biol Macromol 2024; 270:132409. [PMID: 38768918 DOI: 10.1016/j.ijbiomac.2024.132409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
Suture pull-through is a clinical problem in meniscus repair surgery due to the sharp leading edge of sutures. Several tissue adhesives have been developed as an alternative to traditional suturing; however, there is still no suitable tissue adhesive specific for meniscus repair treatment due to unsatisfactory biosafety, biodegradable, sterilizable, and tissue-bonding characteristics. In this study, we used a tissue adhesive composed of chitosan hydrochloride reacted with oxidative periodate-oxidized dextran (ChitHCl-DDA) combined with a chitosan-based hydrogel and oxidative dextran to attach to the meniscus. We conducted viscoelastic tests, viscosity tests, lap shear stress tests, Fourier transform infrared (FTIR) spectroscopy, swelling ratio tests, and degradation behavior tests to characterize these materials. An MTT assay, alcian blue staining, migration assay, cell behavior observations, and protein expression tests were used to understand cell viability and responses. Moreover, ex vivo and in vivo tests were used to analyze tissue regeneration and biocompatibility of the ChitHCl-DDA tissue adhesive. Our results revealed that the ChitHCl-DDA tissue adhesive provided excellent tissue adhesive strength, cell viability, and cell responses. This tissue adhesive has great potential for torn meniscus tissue repair and regeneration.
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Affiliation(s)
- Pei-Chun Wong
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Hao Chen
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Ru Wang
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Ying Chen
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yu-Tzu Wang
- Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan
| | - Yu-Bin Lee
- Department of Advanced Toxicology Research, Korea Institute of Toxicology, Daejeon 34114, Republic of Korea
| | - Jia-Lin Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Orthopedics Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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6
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Oyama S, Kanamoto T, Ebina K, Etani Y, Hirao M, Goshima A, Otani S, Hikida M, Yamakawa S, Ito S, Okada S, Nakata K. Cyclic compressive loading induces a mature meniscal cell phenotype in mesenchymal stem cells with an atelocollagen-based scaffold. Front Bioeng Biotechnol 2024; 12:1394093. [PMID: 38832131 PMCID: PMC11145507 DOI: 10.3389/fbioe.2024.1394093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction: Biomechanical stimulation is reportedly pivotal in meniscal regeneration, although its effect on mesenchymal stem cell (MSC) meniscal differentiation remains elusive. In this study, we investigated how cyclic compressive loading (CCL) could impact MSCs using three-dimensional cultures in atelocollagen-based meniscal substitute (ACMS). Methods: We extracted MSCs from the meniscus, synovium, and articular cartilage, cultured them in three-dimensional cultures, and exposed them to CCL for 7 days. We then compared the transcriptomes of MSCs treated with and without CCL. Results: Our RNA-seq analysis revealed that CCL induced significant transcriptome changes, significantly affecting chondrocyte-related genes, including SOX9, TGFB1, and PRG4 upregulation. CCL induced transcriptional differentiation of meniscus progenitors toward mature meniscal cells. Conclusion: This study unveils the potential of mechanical stress in promoting MSC meniscal differentiation within ACMS. Our investigations provide new insights for mechanisms underlying meniscal regeneration with ACMS.
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Affiliation(s)
- Shohei Oyama
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Takashi Kanamoto
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Etani
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Shunya Otani
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Minami Hikida
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shohei Ito
- Taisho Pharmaceutical Co., Ltd., Saitama, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Nakata
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
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van Minnen BS, van Tienen TG. The Current State of Meniscus Replacements. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09902-1. [PMID: 38744802 DOI: 10.1007/s12178-024-09902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW The field of meniscus replacement is changing continuously, with new devices emerging and others disappearing from the market. With the current tendency to preserve the knee joint, meniscus implants may become more relevant than ever. The purpose of this review is to provide an overview of the current state of partial and total meniscus replacements that have been developed beyond the academic phase. The available clinical and pre-clinical data is evaluated, and omissions are identified. RECENT FINDINGS Recent systematic reviews have shown a lack of homogenous clinical data on the CMI and Actifit meniscal scaffolds, especially regarding long-term performance without concomitant surgical interventions. Clinical studies on the medial total meniscus prostheses NUsurface and Artimis are ongoing, with the NUsurface being several years ahead. New techniques for meniscus replacement are rapidly developing, including the Artimis lateral meniscus prosthesis and the MeniscoFix 3D-printed scaffold. All evaluated clinical studies point towards improved clinical outcomes after implantation of partial and total meniscus replacements. Long-term data on survival and performance is of low quality for CMI and Actifit and is unavailable yet for NUsurface and Artimis. It is of major importance that future research focuses on optimizing fixation methods and identifying the optimal treatment strategy for each patient group. New techniques for total and partial replacement of the medial and lateral meniscus will be followed with interest.
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Affiliation(s)
- B S van Minnen
- Orthopaedic Research Lab, Radboud University Medical Centre, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- ATRO Medical BV, Liessentstraat 9A, 5405 AH, Uden, The Netherlands.
| | - T G van Tienen
- Orthopaedic Research Lab, Radboud University Medical Centre, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- ATRO Medical BV, Liessentstraat 9A, 5405 AH, Uden, The Netherlands
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Liu N, Jiang J, Liu T, Chen H, Jiang N. Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue-Hard Tissue Insertions: A Comparative Review. ACS Biomater Sci Eng 2024; 10:2659-2679. [PMID: 38697939 DOI: 10.1021/acsbiomaterials.3c01796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Connective tissue attaches to bone across an insertion with spatial gradients in components, microstructure, and biomechanics. Due to regional stress concentrations between two mechanically dissimilar materials, the insertion is vulnerable to mechanical damage during joint movements and difficult to repair completely, which remains a significant clinical challenge. Despite interface stress concentrations, the native insertion physiologically functions as the effective load-transfer device between soft tissue and bone. This review summarizes tendon, ligament, and meniscus insertions cross-sectionally, which is novel in this field. Herein, the similarities and differences between the three kinds of insertions in terms of components, microstructure, and biomechanics are compared in great detail. This review begins with describing the basic components existing in the four zones (original soft tissue, uncalcified fibrocartilage, calcified fibrocartilage, and bone) of each kind of insertion, respectively. It then discusses the microstructure constructed from collagen, glycosaminoglycans (GAGs), minerals and others, which provides key support for the biomechanical properties and affects its physiological functions. Finally, the review continues by describing variations in mechanical properties at the millimeter, micrometer, and nanometer scale, which minimize stress concentrations and control stretch at the insertion. In summary, investigating the contrasts between the three has enlightening significance for future directions of repair strategies of insertion diseases and for bioinspired approaches to effective soft-hard interfaces and other tough and robust materials in medicine and engineering.
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Affiliation(s)
- Nian Liu
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610207, China
| | - Jialing Jiang
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610207, China
| | - Tiancheng Liu
- West China Hospital, Sichuan University, Chengdu, Sichuan 610207, China
| | - Haozhe Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases, & National Clinical Research Center for Oral Disease, & West China Hospital of Stomatology and the Research Center for Nano Biomaterials, Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610041, China
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Wu L, Ying M, Ye Y, Wang D, Chen C, Liu C. Correlation of meniscus tear type with synovial inflammation and the therapeutic potential of docosapentaenoic acid. BMC Musculoskelet Disord 2024; 25:375. [PMID: 38734632 PMCID: PMC11088038 DOI: 10.1186/s12891-024-07491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Synovitis, characterized by inflammation of the synovial membrane, is commonly induced by meniscus tears. However, significant differences in inflammatory responses and the key inflammatory mediators of synovium induced by different types of meniscal tears remain unclear. METHODS Magnetic resonance imaging (MRI) was employed to identify the type of meniscus tear, and the quantification of synovial inflammation was assessed through H&E staining assay. Transcription and expression levels of IL-1β and IL-6 were evaluated using bioinformatics, ELISA, RT-qPCR, and IHC of CD68 staining assays. The therapeutic potential of Docosapentaenoic Acid (DPA) was determined through network pharmacology, ELISA, and RT-qPCR assays. The safety of DPA was assessed using colony formation and EdU staining assays. RESULTS The results indicate that both IL-1β and IL-6 play pivotal roles in synovitis pathogenesis, with distinct expression levels across various subtypes. Among tested meniscus tears, oblique tear and bucket handle tear induced the most severe inflammation, followed by radial tear and longitudinal tear, while horizontal tear resulted in the least inflammation. Furthermore, in synovial inflammation induced by specific meniscus tears, the anterior medial tissues exhibited significantly higher local inflammation than the anterior lateral and suprapatellar regions, highlighting the clinical relevance and practical guidance of anterior medial tissues' inflammatory levels. Additionally, we identified the essential omega-3 fatty acid DPA as a potential therapeutic agent for synovitis, demonstrating efficacy in blocking the transcription and expression of IL-1β and IL-6 with minimal side effects. CONCLUSION These findings provide valuable insights into the nuanced nature of synovial inflammation induced by various meniscal tear classifications and contribute to the development of new adjunctive therapeutic agents in the management of synovitis.
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Affiliation(s)
- Lichuang Wu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325000, China
| | - Ming Ying
- School of Pharmaceutical Sciences, Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325035, China
| | - Yiheng Ye
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325000, China
| | - Dongdong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325000, China
| | - Chengwei Chen
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325000, China
| | - Cailong Liu
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, 1210 University Town, Wenzhou, Zhejiang, 325000, China.
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Ahmed MM, Zaino M, Moustafa M, Alajam RA, Alameer AH, Morsy WE, Fayed EM, Malik S, Amin WM. Kinesio Taping Increases Peak Torque of Quadriceps Muscle After Arthroscopic Meniscectomy, Double-Blinded RCT. Int J Gen Med 2024; 17:1897-1908. [PMID: 38736667 PMCID: PMC11086643 DOI: 10.2147/ijgm.s463753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study was conducted to release the debate and examine the short-term impact of KT on the quadriceps muscle following arthroscopic surgery for partial meniscectomy. Patients and Methods As part of a double-blind, randomized controlled trial, 40 people who had an arthroscopic partial meniscectomy (APM) were randomly put into two groups, A and B. Group A received Kinesio tape (KT) for the superficial heads of the quadriceps muscle, while group B received placebo KTk. After 10 minutes of KT application, the peak torque of both groups was measured using a Biodex isokinetic dynamometer. Results Peak torque showed a significant increase in group A in comparison with group B during angular velocity 60◦/Sec. (F (1, 130) = 58.9, p <0.001, ƞ2 =0.31) and during angular velocity 180◦/Sec. (F (1, 38) = 25.0, p <0.001, ƞ2 =0.40). Conclusion After APM, individuals experienced an immediate and significant improvement in the quadriceps' peak torque following KT application to the Rectus femoris, Vastus medialis, and Vastus lateralis muscles from origin to insertion.
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Affiliation(s)
- Mohamed M Ahmed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohammad Zaino
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mahmoud Moustafa
- Diagnostic Radiography Technology Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ramzi Abdu Alajam
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdulaziz H Alameer
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Walaa E Morsy
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Esraa Mohammed Fayed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Shazia Malik
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Wafaa Mahmoud Amin
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Basic Science for Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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11
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Luo A, Gou S, Tong N, Liu B, Jiao L, Xu H, Wang Y, Ding T. Visual interpretable MRI fine grading of meniscus injury for intelligent assisted diagnosis and treatment. NPJ Digit Med 2024; 7:97. [PMID: 38622284 PMCID: PMC11018801 DOI: 10.1038/s41746-024-01082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
Meniscal injury represents a common type of knee injury, accounting for over 50% of all knee injuries. The clinical diagnosis and treatment of meniscal injury heavily rely on magnetic resonance imaging (MRI). However, accurately diagnosing the meniscus from a comprehensive knee MRI is challenging due to its limited and weak signal, significantly impeding the precise grading of meniscal injuries. In this study, a visual interpretable fine grading (VIFG) diagnosis model has been developed to facilitate intelligent and quantified grading of meniscal injuries. Leveraging a multilevel transfer learning framework, it extracts comprehensive features and incorporates an attributional attention module to precisely locate the injured positions. Moreover, the attention-enhancing feedback module effectively concentrates on and distinguishes regions with similar grades of injury. The proposed method underwent validation on FastMRI_Knee and Xijing_Knee dataset, achieving mean grading accuracies of 0.8631 and 0.8502, surpassing the state-of-the-art grading methods notably in error-prone Grade 1 and Grade 2 cases. Additionally, the visually interpretable heatmaps generated by VIFG provide accurate depictions of actual or potential meniscus injury areas beyond human visual capability. Building upon this, a novel fine grading criterion was introduced for subtypes of meniscal injury, further classifying Grade 2 into 2a, 2b, and 2c, aligning with the anatomical knowledge of meniscal blood supply. It can provide enhanced injury-specific details, facilitating the development of more precise surgical strategies. The efficacy of this subtype classification was evidenced in 20 arthroscopic cases, underscoring the potential enhancement brought by intelligent-assisted diagnosis and treatment for meniscal injuries.
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Affiliation(s)
- Anlin Luo
- Key Laboratory of Intelligent Perception an Image Understanding of Ministry of Education, School of Artificial Intelligence, Xidian University, 710071, Xi'an, China
| | - Shuiping Gou
- Key Laboratory of Intelligent Perception an Image Understanding of Ministry of Education, School of Artificial Intelligence, Xidian University, 710071, Xi'an, China.
- AI-based Big Medical lmaging Data Frontier Research Center, Academy of Advanced Interdisciplinary Research, Xidian University, 710071, Xi'an, Shaanxi, China.
| | - Nuo Tong
- AI-based Big Medical lmaging Data Frontier Research Center, Academy of Advanced Interdisciplinary Research, Xidian University, 710071, Xi'an, Shaanxi, China
| | - Bo Liu
- Key Laboratory of Intelligent Perception an Image Understanding of Ministry of Education, School of Artificial Intelligence, Xidian University, 710071, Xi'an, China
| | - Licheng Jiao
- Key Laboratory of Intelligent Perception an Image Understanding of Ministry of Education, School of Artificial Intelligence, Xidian University, 710071, Xi'an, China
| | - Hu Xu
- Xijing Orthopaedics Hospital, The Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Yingchun Wang
- Xijing Orthopaedics Hospital, The Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Tan Ding
- Xijing Orthopaedics Hospital, The Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.
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12
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González-Duque MI, Flórez AM, Torres MA, Fontanilla MR. Composite Zonal Scaffolds of Collagen I/II for Meniscus Regeneration. ACS Biomater Sci Eng 2024; 10:2426-2441. [PMID: 38549452 DOI: 10.1021/acsbiomaterials.3c01737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The meniscus is divided into three zones according to its vascularity: an external vascularized red-red zone mainly comprising collagen I, a red-white interphase zone mainly comprising collagens I and II, and an internal white-white zone rich in collagen II. Known scaffolds used to treat meniscal injuries do not reflect the chemical composition of the vascular areas of the meniscus. Therefore, in this study, four composite zonal scaffolds (named A, B, C, and D) were developed and characterized; the developed scaffolds exhibited the main chemical components of the external (collagen I), interphase (collagens I/II), and internal (collagen II) zones of the meniscus. Noncomposite scaffolds were also produced (named E), which had the same shape as the composite scaffolds but were entirely made of collagen I. The composite zonal scaffolds were prepared using different concentrations of collagen I and the same concentration of collagen II and were either cross-linked with genipin or not cross-linked. Porous, biodegradable, and hydrophilic scaffolds with an expected chemical composition were obtained. Their pore size was smaller than the size reported for the meniscus substitutes; however, all scaffolds allowed the adhesion and proliferation of human adipose-derived stem cells (hADSCs) and were not cytotoxic. Data from enzymatic degradation and hADSC proliferation assays were considered for choosing the cross-linked composite scaffolds along with the collagen I scaffold and to test if composite zonal scaffolds seeded with hADSC and cultured with differentiation medium produced fibrocartilage-like tissue different from that formed in noncomposite scaffolds. After 21 days of culture, hADSCs seeded on composite scaffolds afforded an extracellular matrix with aggrecan, whereas hADSCs seeded on noncomposite collagen I scaffolds formed a matrix-like fibrocartilage without aggrecan.
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Affiliation(s)
- Martha Isabel González-Duque
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - Adriana Matilde Flórez
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - María Alejandra Torres
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
| | - Marta Raquel Fontanilla
- Tissue Engineering Group, Departmento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia, Av. Carrera 30 # 45-10, Bogotá 111321, D.C., Colombia
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Sabouri P, Hashemi A. Effect of loading direction and anatomical location on the ultimate tensile stress, fracture toughness, and failure patterns of knee meniscus. Knee 2024; 48:120-127. [PMID: 38579436 DOI: 10.1016/j.knee.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/05/2024] [Accepted: 03/18/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Rupture of the knee menisci is a common injury that can have implications for other conditions, such as osteoarthritis. The fracture toughness of soft tissue (Jc) is a mechanical property that characterizes its resistance to tear extension. To date, Jc of the meniscus has not been quantified. METHODS Cyclic tensile tests were conducted on meniscus samples to determine Jc and explore its characteristics. Initially, the study investigated the impact of an initial notch on the ultimate tensile stress. This allowed for an understanding of how the presence of a notch affects its structural integrity. Subsequently, Jc was measured in both the radial and circumferential directions to assess its loading direction dependency. Furthermore, the study assessed the effect of anatomical location by comparing samples collected from the femoral and tibial layers. RESULTS Defect tolerance of the meniscus is influenced by the loading direction. In the circumferential direction, the presence of an initial notch did not affect the ultimate stress, and no crack expansion was observed. In radial samples with a notch length of 40% or more of the total width, crack propagation occurred, leading to a decrease in the ultimate stress (p< 0.01). Additionally, Jc was found to be higher in the femoral layer compared to the tibial layer (p= 0.017). CONCLUSION The study also examined the failure patterns of the meniscus to enhance our understanding of its pathology. These insights contribute to a better comprehension of meniscus injuries and can aid in the development of more effective treatment strategies.
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Affiliation(s)
- Pouya Sabouri
- Biomechanical Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran 15875-4413, Iran
| | - Ata Hashemi
- Biomechanical Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran 15875-4413, Iran.
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14
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Gupta S, Dwivedi A, Chavan SK, Gupta P. Lateral Meniscus Zip Lesion of Knee: Classification and Repair Methods. Arthrosc Tech 2024; 13:102911. [PMID: 38690337 PMCID: PMC11056721 DOI: 10.1016/j.eats.2024.102911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament. Such lateral meniscus posterior horn lesions have been termed zip lesions. The lateral meniscus posterior horn is the major restraint for the pivot shift maneuver. Considering the morphology of condyles, lateral meniscus preservation and repair of unstable meniscocapsular posterior tear are needed to prevent future osteoarthritis. In this Technical Note, we aim to classify zip lesions of the posterior horn of the lateral meniscus. Zip lesions are located posteriorly and often are missed on magnetic resonance imaging and routine diagnostic arthroscopy. We recommend looking from the anteromedial portal and exploring the posterolateral compartment to identify hidden zip lesions, equivalent to medial-sided ramp lesions. We describe various all-inside techniques to repair these inaccessible tears.
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Wagner KR, Kaiser JT, Quigley RA, Hevesi M, Damodar D, Meeker ZD, Cotter EJ, Yanke AB, Cole BJ. Revision and Conversion to Arthroplasty Are Low Among Adolescents Undergoing Meniscal Allograft Transplantation Using the Bridge-In-Slot Technique at Midterm Follow-Up. Arthroscopy 2024; 40:1186-1194.e1. [PMID: 37597703 DOI: 10.1016/j.arthro.2023.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To report midterm outcomes after primary medial and lateral meniscal allograft transplantation (MAT) with fresh-frozen allografts implanted with the bridge-in-slot technique in the adolescent patient population. METHODS Adolescent patients less than 18 years old at the time of primary MAT from 1999 to 2016 were retrospectively identified. International Knee Documentation Committee (IKDC) subjective form, Lysholm, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales scores were collected before surgery and at 1-year, 2-year, and a minimum 5-year follow-up. Thresholds for achieving clinically significant outcomes were calculated, and the proportion of patients achieving minimal clinically important difference (MCID), patient-acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) was determined. Meniscus reoperation (partial, subtotal, or total meniscectomy, repair, or failure) and failure (revision MAT or conversion to arthroplasty) rates were determined. RESULTS Forty-four (female n = 33; male n = 11) of 62 identified patients met inclusion criteria and were followed for a mean of 9.5 ± 3.8 years (range, 5.0-17.7). Lateral MAT was performed in most patients (n = 35/44 [80%]). Isolated MAT was performed in 27 (61%) patients. Common concomitant procedures included osteochondral allograft transplantation (32%), autologous chondrocyte implantation (18%), and anterior cruciate ligament reconstruction (14%). MCID, PASS, and SCB were achieved by patients at a minimum 5-year follow-up for IKDC (62%; 76%; 31%), Lysholm (62%; 79%; 23%), and KOOS questionnaires (Pain [65%; 81%; 41%], Symptoms [58%; 81%; 47%], Activities of Daily Living [53%; 77%; 35%], Sport [86%; 75%; 50%], and Quality of Life [59%; 81%; 59%]), respectively. Fourteen patients (32%) underwent reoperation at an average of 5.0 ± 4.3 years (range, 0.8-14.0) after MAT. Three (7%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range, 2.8-4.9) after transplantation. No patients underwent arthroplasty. Overall survival free from failure at 1, 2, 5, and 10 years was 100%, 100%, 93%, and 93%, respectively. At the time of final follow-up, 80% of patients reported satisfaction with their current physical status. CONCLUSIONS Primary MAT in adolescent patients resulted in significant and durable functional improvements at mid- to long-term follow-up. At an average of 9.5 years after surgery, meniscal reoperation rate was 32% whereas graft survival free of revision MAT was 93%. Adolescents undergoing MAT demonstrated similar functional outcomes and graft survivability when compared to available adult MAT literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan A Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Eric J Cotter
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
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16
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Nishizawa K, Harato K, Kobayashi S, Niki Y, Nagura T. Alteration of knee joint moment after anterior cruciate ligament reconstruction conditions in subjects with and without meniscal pathology. Knee 2024; 48:8-13. [PMID: 38471193 DOI: 10.1016/j.knee.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The effects of anterior cruciate ligament (ACL) reconstruction on postoperative gait biomechanics remain controversial, and the influence of meniscus pathology on pre- and post-ACL reconstruction biomechanical changes has not yet been studied. Here, we aimed to clarify the difference in knee joint moment between pre- and post-ACL reconstruction conditions in subjects with and without meniscal pathology. METHODS Twenty-four subjects with unilateral ACL reconstruction injuries participated in this study. A total of 13 of the subjects had concomitant meniscus injuries. Gait analysis was performed preoperatively and at 11 months postoperatively. Three-dimensional knee joint angles and moments were calculated based on motion-capture data. The total joint moment and contribution of individual moments during the stance phase were assessed. For statistical analysis, we compared pre- and postoperative alterations, and differences were assessed in subjects with and without meniscal pathology. RESULTS Tibial rotation excursion was lower in subjects with meniscal pathology than in those with intact menisci postoperatively. An significant increase in the contribution of the knee flexion moment and a significant decrease in the contribution of the knee adduction moment postoperatively were observed in subjects with intact menisci. CONCLUSIONS Patients with ACL injury showed different postoperative alterations in joint moments depending on the concomitant meniscal injury.
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Affiliation(s)
- Kohei Nishizawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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17
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Huang M, Shao H, Zhang S, Gao H, Feng S, Sun L, Yu C, Du X, Chen J, Li Y. Single-Dose Radial Extracorporeal Shock Wave Therapy Modulates Inflammation During Meniscal Tear Healing in the Avascular Zone. Am J Sports Med 2024; 52:710-720. [PMID: 38353544 DOI: 10.1177/03635465231221725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) promotes tissue healing by modulating inflammation, which has implications for meniscal tear healing in the avascular zone. PURPOSE To evaluate the effects of a single dose of radial ESWT on the healing process and inflammation of the meniscus and knee joints after meniscal tears in the avascular zone. STUDY DESIGN Controlled laboratory study. METHODS Avascular tears were induced in the medial meniscus (MM) of 72 Sprague-Dawley rats. One week postoperatively, the rats received a single session of radial ESWT with a Power+ handpiece (ESWT group; n = 36) or with a fake handpiece (sham-ESWT group; n = 36). The rats were then euthanized at 2, 4, or 8 weeks postoperatively. The MMs were harvested for analysis of healing (hematoxylin-eosin, safranin O-Fast Green, and collagen type 2 staining) and inflammation (interleukin [IL]-1β and IL-6 staining). Lateral menisci and synovia were obtained to evaluate knee joint inflammation (enzyme-linked immunosorbent assay of IL-1β and IL-6). Cartilage degeneration was assessed in the femurs and tibial plateaus using safranin O-Fast Green staining. RESULTS The ESWT group showed significantly better meniscal healing scores than the sham-ESWT group at 4 (P = .0066) and 8 (P = .0050) weeks postoperatively. The IL-1β level was significantly higher in the sham-ESWT group than in the ESWT group at 2 (MM: P = .0009; knee joint: P = .0160) and 8 (MM: P = .0399; knee joint: P = .0001) weeks. The IL-6 level was significantly lower in the sham-ESWT group than in the ESWT group at 2 (knee joint: P = .0184) and 4 (knee joint: P = .0247) weeks but higher at 8 weeks (MM: P = .0169; knee joint: P = .0038). The sham group had significantly higher osteoarthritis scores than the ESWT group at 4 (tibial plateau: P = .0157) and 8 (femur: P = .0048; tibial plateau: P = .0359) weeks. CONCLUSION A single dose of radial ESWT promoted meniscal tear healing in the avascular zone, modulated inflammatory factors in the menisci and knee joints in rats, and alleviated cartilage degeneration. CLINICAL RELEVANCE Radial ESWT can be considered a potential option for improving meniscal tear healing in the avascular zone because of its ability to modulate inflammation.
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Affiliation(s)
- Mingru Huang
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Shao
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shurong Zhang
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Gao
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Sijia Feng
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Sun
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengxuan Yu
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiner Du
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunxia Li
- Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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18
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Starbuck C, Walters V, Herrington L, Barkatali B, Jones R. Knee Offloading by Patients During Walking and Running After Meniscectomy. Orthop J Sports Med 2024; 12:23259671231214766. [PMID: 38524891 PMCID: PMC10958822 DOI: 10.1177/23259671231214766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 03/26/2024] Open
Abstract
Background Changes in knee loading have been reported after meniscectomy. Knee loading has previously been assessed during jogging and treadmill running rather than overground running, which could give altered results. Purpose/Hypothesis The purpose of this study was to evaluate knee function during overground running and walking after meniscectomy. It was hypothesized that the affected limb would demonstrate higher external knee adduction moment, lower knee flexion moment (KFM), and lower knee rotation moment (KRM) compared with the contralateral limb and with healthy individuals. Study Design Controlled laboratory study. Methods Kinematic and kinetic data were collected during running and walking in individuals after a meniscectomy and healthy individuals. Total knee joint moments (TKJM) were calculated from the sagittal, frontal, and transverse knee moments. Isometric quadriceps strength, perceived knee function, and kinesiophobia were also assessed. A mixed linear model compared differences between the affected leg, the contralateral leg, and the healthy leg. Results Data were collected on 20 healthy individuals and 30 individuals after a meniscectomy (mean ± SD, 5.7 ± 2.9 months postsurgery), with 12, 16, and 2 individuals who had medial, lateral, and both medial and lateral meniscectomy, respectively. The affected limb demonstrated lower TKJM (P < .001), KFM (P = .004), and KRM (P < .001) during late stance of walking compared with the healthy group. Lower TKJM and KFM were observed during running in the affected limb compared with the contralateral limb and healthy group. No significant differences were observed between contralateral and healthy limbs except for KRM during late stance of walking. Lower quadriceps strength was observed in the affected (P < .001) and contralateral limbs (P = .001) compared with the healthy group. Individuals after a meniscectomy also reported greater kinesiophobia (P = .006) and lower perceived knee function (31.1%; P < .001) compared with the healthy group. Conclusion After meniscectomy, individuals who sustained a traumatic meniscal injury showed lower TKJM in the affected limb compared with the contralateral limb and healthy individuals. This decrease in TKJM can be attributed to altered knee-loading strategies in the sagittal and transverse planes. Clinical Relevance Improving movement strategies, quadriceps strength, and kinesiophobia through rehabilitation approaches will allow individuals to load their knee appropriately when returning to sport. Registration NCT03379415 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Chelsea Starbuck
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Vanessa Walters
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Lee Herrington
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
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19
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Lee DR, Lu Y, Reinholz AK, Till SE, Lamba A, Saris DBF, Camp CL, Krych AJ. Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00152-X. [PMID: 38401664 DOI: 10.1016/j.arthro.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature. METHODS A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means. RESULTS The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from -2.4 to -0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and -0.9 to -0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from -0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias. CONCLUSIONS The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Dustin R Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Anna K Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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20
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Fotaki A, Triantafyllou A, Koulouvaris P, Skouras AZ, Stasinopoulos D, Gkrilias P, Kyriakidou M, Stasi S, Antonakis-Karamintzas D, Tsolakis C, Savvidou O, Papagiannis G. Excessive Knee Internal Rotation during Grand Plié in Classical Ballet Female Dancers. Sports (Basel) 2024; 12:54. [PMID: 38393275 PMCID: PMC10893237 DOI: 10.3390/sports12020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Classical ballet dancers are exposed daily to physically demanding movements. Among these, the Grand Plié stands out for its biomechanical complexity, particularly the stress applied to the knee joint. This study investigates the knee kinematics of healthy professional classical ballet dancers performing the Grand Plié. Twenty dancers were evaluated with a motion analysis system using a marker-based protocol. Before measurements, the self-reported Global Knee Functional Assessment Scale was delivered for the knees' functional ability, and the passive range of knee motion was also assessed. The average score on the Global Knee Functional Assessment Scale was 94.65 ± 5.92. During a complete circle of the Grand Plié movement, executed from the upright position, the average maximum internal rotation of the knee joint was 30.28° ± 6.16°, with a simultaneous knee flexion of 134.98° ± 4.62°. This internal rotation observed during knee flexion exceeds the typical range of motion for the joint, suggesting a potential risk for knee injuries, such as meniscal tears. The findings provide an opportunity for future kinematic analysis research, focusing on the movement of the Grand Plié and other common ballet maneuvers. These data have the potential to yield valuable information about the knee kinematics concerning meniscus damage.
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Affiliation(s)
- Aspasia Fotaki
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (P.G.); (M.K.)
| | - Panagiotis Koulouvaris
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
| | - Apostolos Z. Skouras
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
| | - Dimitrios Stasinopoulos
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Science, University of West Attica, 12243 Egaleo, Greece; (D.S.); (S.S.)
| | - Panagiotis Gkrilias
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (P.G.); (M.K.)
| | - Maria Kyriakidou
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (P.G.); (M.K.)
| | - Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Science, University of West Attica, 12243 Egaleo, Greece; (D.S.); (S.S.)
| | - Dimitrios Antonakis-Karamintzas
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
| | - Charilaos Tsolakis
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
- Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Olga Savvidou
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
| | - Georgios Papagiannis
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (P.K.); (A.Z.S.); (D.A.-K.); (C.T.); (O.S.); (G.P.)
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (P.G.); (M.K.)
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21
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Maimaitimin M, Yang F, Huang H, Ao Y, Wang J. Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model. Clin Orthop Relat Res 2024; 482:386-398. [PMID: 37732715 PMCID: PMC10776144 DOI: 10.1097/corr.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND No single graft type has been shown to have a benefit in acetabular labral reconstruction. The native labrum and lateral meniscus share many similarities, suggesting that the meniscus may be a promising source of graft material in labral reconstruction. QUESTIONS/PURPOSES Using a pig model, we sought to evaluate the healing process of fresh-frozen meniscus allograft for acetabular reconstruction by assessing (1) MRI and macroscopic observations of the meniscus allograft; (2) histologic appearance and immunohistologic evaluation of the meniscus allograft, native meniscus, and labrum; (3) microscopic assessment of the native labrum and meniscus via scanning electron microscopy; and (4) biomechanical assessment of tensile properties. METHODS Twelve skeletally mature male miniature Bama pigs (24 hips) were randomly divided into two groups: labral defect group (control) and lateral meniscus allograft group. The selection of Bama pig specimens was based on the similarity of their acetabular labrum to that of the human acetabular labrum, characterized by the presence of fibrocartilage-like tissue lacking blood vessels. The pigs underwent bilateral hip surgery. Briefly, a 1.5-cm-long section was resected in the anterior dorsal labrum, which was left untreated or reconstructed using an allogeneic lateral meniscus. The pigs were euthanized at 12 and 24 weeks postoperatively, and then evaluated by macroscopic observations and MRI measurement to assess the extent of coverage of the labral defect. We also performed a histologic analysis and immunohistologic evaluation to assess the composition and structure of meniscus allograft, native labrum, and meniscus, as well as scanning electron microscopy assessment of the microstructure of the native labrum and meniscus and biomechanical assessment of tensile properties. RESULTS Imaging measurement and macroscopic observations revealed that the resected area of the labrum was fully filled in the lateral meniscus allograft group, whereas in the control group, the labral defect remained at 24 weeks. The macroscopic scores of the meniscus allograft group (8.2 ± 0.8) were higher than those of the control groups (4.8 ± 1.0) (mean difference 3.3 [95% CI 1.6 to 5.0]; p < 0.001). Moreover, in the meniscus allograft group, histologic assessment identified fibrocartilage-like cell cluster formation at the interface between the graft and acetabulum; cells and fibers arranged perpendicularly to the acetabulum and tideline structure that were similar to those of native labrum could be observed at 24 weeks. Immunohistochemical results showed that the average optical density value of Type II collagen at the graft-acetabulum interface was increased in the meniscus allograft group at 24 weeks compared with at 12 weeks (0.259 ± 0.031 versus 0.228 ± 0.023, mean difference 0.032 [95% CI 0.003 to 0.061]; p = 0.013). Furthermore, the tensile modulus of the lateral meniscus allograft was near that of the native labrum at 24 weeks (54.7 ± 9.9 MPa versus 63.2 ± 11.3 MPa, mean difference -8.4 MPa [95% CI -38.3 to 21.4]; p = 0.212). CONCLUSION In a pig model, lateral meniscus allografts fully filled labral defects in labral reconstruction. Regeneration of a fibrocartilage transition zone at the graft-acetabulum interface was observed at 24 weeks. CLINICAL RELEVANCE The use of an autograft meniscus for labral reconstruction may be a viable option when labral tears are deemed irreparable. Before its clinical implementation, it is imperative to conduct a comparative study involving tendon grafts, which are extensively used in current clinical practice.
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Affiliation(s)
- Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, PR China
- Beijing Key Laboratory of Sports Injuries, Beijing, PR China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, PR China
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22
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Schwer J, Ignatius A, Seitz AM. The biomechanical properties of human menisci: A systematic review. Acta Biomater 2024; 175:1-26. [PMID: 38092252 DOI: 10.1016/j.actbio.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
Biomechanical characterization of meniscal tissue ex vivo remains a critical need, particularly for the development of suitable meniscus replacements or therapeutic strategies that target the native mechanical properties of the meniscus. To date, a huge variety of test configurations and protocols have been reported, making it extremely difficult to compare the respective outcome parameters, thereby leading to misinterpretation. Therefore, the purpose of this systematic review was to identify test-specific parameters that contribute to uncertainties in the determination of mechanical properties of the human meniscus and its attachments, which derived from common quasi-static and dynamic tests in tension, compression, and shear. Strong evidence was found that the determined biomechanical properties vary significantly depending on the specific test parameters, as indicated by up to tenfold differences in both tensile and compressive properties. Test mode (stress relaxation, creep, cyclic) and configuration (unconfined, confined, in-situ), specimen shape and dimensions, preconditioning regimes, loading rates, post-processing of experimental data, and specimen age and degeneration were identified as the most critical parameters influencing the outcome measures. In conclusion, this work highlights an unmet need for standardization and reporting guidelines to facilitate comparability and may prove beneficial for evaluating the mechanical properties of novel meniscus constructs. STATEMENT OF SIGNIFICANCE: The biomechanical properties of the human meniscus have been studied extensively over the past decades. However, it remains unclear to what extent both test protocol and specimen-related differences are responsible for the enormous variability in material properties. Therefore, this systematic review analyzes the biomechanical properties of the human meniscus in the context of the underlying testing protocol. The most sensitive parameters affecting the determination of mechanical properties were identified and critically discussed. Currently, it is of utmost importance for scientists evaluating potential meniscal scaffolds and biomaterials to have a control group rather than a direct comparison to the literature. Standardization of both test procedures and reporting requirements is needed to improve and accelerate the development of meniscal replacement constructs.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany.
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23
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Kelly SR, Daniel AV, Smith PA. Open Medial Meniscotibial Ligament Repair With Concomitant Open Superficial Medial Collateral Ligament Repair With Internal Brace Augmentation. Arthrosc Tech 2024; 13:102837. [PMID: 38312884 PMCID: PMC10838063 DOI: 10.1016/j.eats.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024] Open
Abstract
The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Historically, nonsurgical management for these injuries has been favored for a majority of grade I-III sprains, particularly femoral-based. However, when coupled with other injuries such as meniscotibial ligament tears or distal Stener type avulsion tears, early surgical management for these cases is recommended. This will allow for stabilization and protection of the meniscus in addition to preventing residual valgus laxity, especially related to more severe Stener-like avulsions of the superficial MCL that can be seen with meniscotibial ligament tears. Utilizing an open approach, meniscotibial repair with suture anchors with internal brace augmentation for the MCL repair can provide a strong final construct, and a safe and fast recovery.
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Affiliation(s)
- Shayne R Kelly
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri, U.S.A
| | - Adam V Daniel
- Columbia Orthopedic Group, Columbia, Missouri, U.S.A
| | - Patrick A Smith
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri, U.S.A
- Columbia Orthopedic Group, Columbia, Missouri, U.S.A
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24
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Cowie RM, Macri-Pellizzeri L, McLaren J, Sanderson WJ, Felfel RM, Scotchford CA, Scammell BE, Grant DM, Sottile V, Jennings LM. Functional performance of a bi-layered chitosan-nano-hydroxyapatite osteochondral scaffold: a pre-clinical in vitro tribological study. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230431. [PMID: 38204795 PMCID: PMC10776221 DOI: 10.1098/rsos.230431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
Osteochondral grafts are used for repair of focal osteochondral lesions. Autologous grafts are the gold standard treatment; however, limited graft availability and donor site morbidity restrict use. Therefore, there is a clinical need for different graft sources/materials which replicate natural cartilage function. Chitosan has been proposed for this application. The aim of this study was to assess the biomechanics and biotribology of a bioresorbable chitosan/chitosan-nano-hydroxyapatite osteochondral construct (OCC), implanted in an in vitro porcine knee experimental simulation model. The OCC implanted in different surgical positions (flush, proud and inverted) was compared to predicate grafts in current clinical use and a positive control consisting of a stainless steel graft implanted proud of the cartilage surface. After 3 h (10 800 cycles) wear simulation under a walking gait, subsidence occurred in all OCC samples irrespective of surgical positioning, but with no apparent loss of material and low meniscus wear. Half the predicate grafts exhibited delamination and scratching of the cartilage surfaces. No graft subsidence occurred in the positive controls but wear and deformation of the meniscus were apparent. Implanting a new chitosan-based OCC either optimally (flush), inverted or proud of the cartilage surface resulted in minimal wear, damage and deformation of the meniscus.
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Affiliation(s)
- Raelene M. Cowie
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Laura Macri-Pellizzeri
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane McLaren
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Reda M. Felfel
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
- Department of Mechanical and Aerospace Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK
- Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Colin A. Scotchford
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Brigitte E. Scammell
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | - David M. Grant
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Virginie Sottile
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Louise M. Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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25
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Ronca A, D'Amora U, Capuana E, Zihlmann C, Stiefel N, Pattappa G, Schewior R, Docheva D, Angele P, Ambrosio L. Development of a highly concentrated collagen ink for the creation of a 3D printed meniscus. Heliyon 2023; 9:e23107. [PMID: 38144315 PMCID: PMC10746456 DOI: 10.1016/j.heliyon.2023.e23107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
The most prevalent extracellular matrix (ECM) protein in the meniscus is collagen, which controls cell activity and aids in preserving the biological and structural integrity of the ECM. To create stable and high-precision 3D printed collagen scaffolds, ink formulations must possess good printability and cytocompatibility. This study aims to overlap the limitation in the 3D printing of pure collagen, and to develop a highly concentrated collagen ink for meniscus fabrication. The extrusion test revealed that 12.5 % collagen ink had the best combination of high collagen concentration and printability. The ink was specifically designed to have load-bearing capacity upon printing and characterized with respect to rheological and extrusion properties. Following printing of structures with different infill, a series of post-processing steps, including salt stabilization, pH shifting, washing, freeze-drying, crosslinking and sterilization were performed, and optimised to maintain the stability of the engineered construct. Mechanical testing highlighted a storage modulus of 70 kPa for the lower porous structure while swelling properties showed swelling ratio between 9 and 11 after 15 min of soaking. Moreover, human avascular and vascular meniscus cells cultured on the scaffolds deposited a meniscus-like matrix containing collagen I, II and glycosaminoglycans after 28 days of culture. Finally, as proof-of-concept, human size 3D printed meniscus scaffold were created.
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Affiliation(s)
- Alfredo Ronca
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Ugo D'Amora
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Elisa Capuana
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - Carla Zihlmann
- Geistlich Pharma AG (Geistlich), Bahnhofstrasse 40, CH-6110 Wolhusen, Switzerland
| | - Niklaus Stiefel
- Geistlich Pharma AG (Geistlich), Bahnhofstrasse 40, CH-6110 Wolhusen, Switzerland
| | - Girish Pattappa
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Ruth Schewior
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wurzburg, Germany
| | - Peter Angele
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
- Sporthopaedicum Regensburg, Hildegard von Bingen Strasse 1, 93053 Regensburg, Germany
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
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26
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Kim S, Glaviano NR, Park J. Exercise-induced fatigue affects knee proprioceptive acuity and quadriceps neuromuscular function more in patients with ACL reconstruction or meniscus surgery than in healthy individuals. Knee Surg Sports Traumatol Arthrosc 2023; 31:5428-5437. [PMID: 37787863 DOI: 10.1007/s00167-023-07596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To observe how knee proprioceptive acuity and quadriceps neuromuscular function change during and after repeated isokinetic knee-extension exercise in patients with anterior cruciate ligament reconstruction (ACLR) or meniscus surgery. METHODS Patients with ACLR or meniscus surgery and matched controls (n = 19 in each group) performed knee-flexion replication at 15° and 75°, and quadriceps peak torque (PT), central activation ratio (CAR) and rate of torque development (RTD) at baseline and immediately after every five sets of isokinetic knee-extension exercise (times 1-5). RESULTS Compared to the baseline, the ACLR and control groups displayed errors in knee-flexion replication at 75° only at time 5 (115.9-155.6%; p ≤ 0.04, d ≥ 0.97), whereas the meniscus surgery group exhibited errors at all time points (142.5-265.6%; p ≤ 0.0003, d ≥ 1.4). Significant percentage reductions in quadriceps CAR were observed between times 4 and 5 in the ACLR group (-5.8%; p = 0.0002, d = 0.96), but not in the meniscus surgery (-1.4%; n.s.) and control (0.1%; n.s.) groups. Significant percentage reductions in quadriceps RTD were observed between times 4 and 5 in the ACLR (-24.2%; p = 0.007, d = 0.99) and meniscus surgery (-23.0%; p = 0.01, d = 0.85) groups, but not in the control group (-0.2%; n.s.). CONCLUSION Patients with ACLR or meniscus surgery displayed a greater loss in knee proprioceptive acuity and quadriceps neuromuscular function during and after exercise than healthy individuals. Evidence-based interventions to enhance exercise-induced fatigue resistance should be implemented following ACLR or meniscus surgery, aiming to prevent proprioceptive and neuromuscular changes within the knee joint and quadriceps. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea.
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27
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Amiri F, Bologna E, Nuzzo G, Moroni L, Zingales M. Fractional-order poromechanics for a fully saturated biological tissue: Biomechanics of meniscus. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3732. [PMID: 37203427 DOI: 10.1002/cnm.3732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
Biomechanics of biological fibrous tissues as the meniscus are strongly influenced by past histories of strains involving the so-called material hereditariness. In this paper, a three-axial model of linear hereditariness that makes use of fractional-order calculus is used to describe the constitutive behavior of the tissue. Fluid flow across meniscus' pores is modeled in this paper with Darcy relation yielding a novel model of fractional-order poromechanics, describing the evolution of the diffusion phenomenon in the meniscus. A numerical application involving an 1D confined compression test is reported to show the effect of the material hereditariness on the pressure drop evolution.
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Affiliation(s)
- Fabiana Amiri
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Emanuela Bologna
- Department of Engineering, University of Palermo, Palermo, Italy
- Bio/NanoMechanics for Medical Sciences Laboratory (BNM 2-Lab), Advanced Technology Network (ATeN)-Center, CHAB Pole, Palermo, Italy
| | - Gianmarco Nuzzo
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Lorenzo Moroni
- Complex Tissue Regeneration Department, MERLN Institute for Technology-inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Massimiliano Zingales
- Department of Engineering, University of Palermo, Palermo, Italy
- Bio/NanoMechanics for Medical Sciences Laboratory (BNM 2-Lab), Advanced Technology Network (ATeN)-Center, CHAB Pole, Palermo, Italy
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28
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Liu H, Gong H, Chen P, Zhang L, Cen H, Fan Y. Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint. Med Biol Eng Comput 2023; 61:3087-3101. [PMID: 37624535 DOI: 10.1007/s11517-023-02906-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.
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Affiliation(s)
- Haibo Liu
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China.
| | - Peng Chen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Le Zhang
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Haipeng Cen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
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29
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Yang J, Wang H, Zhou Y, Duan L, Schneider KH, Zheng Z, Han F, Wang X, Li G. Silk Fibroin/Wool Keratin Composite Scaffold with Hierarchical Fibrous and Porous Structure. Macromol Biosci 2023; 23:e2300105. [PMID: 37247409 DOI: 10.1002/mabi.202300105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Indexed: 05/31/2023]
Abstract
The present study describes a silk microfiber reinforced meniscus scaffold (SMRMS) with hierarchical fibrous and porous structure made from silk fibroin (SF) and wool keratin (WK) using electrospinning and freeze-drying technology. This study focuses on the morphology, secondary structure, mechanical properties, and water absorption properties of the scaffold. The cytotoxicity and biocompatibility of SMRMS are assessed in vivo and in vitro. The scaffold shows hierarchical fibrous and porous structure, hierarchical pore size distribution (ranges from 50 to 650 µm), robust mechanical properties (compression strength can reach at 2.8 MPa), and stable biodegradability. A positive growth condition revealed by in vitro cytotoxicity testing indicates that the scaffold is not hazardous to cells. In vivo assessments of biocompatibility reveal that only a mild inflammatory reaction is present in implanted rat tissue. Meniscal scaffold made of SF/WK composite shows a potential application prospect in the meniscal repair engineering field with its development.
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Affiliation(s)
- Jie Yang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huan Wang
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Yuhang Zhou
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Lirong Duan
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Karl H Schneider
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, Waehringer Gurtel 18-20, Vienna, 1090, Austria
| | - Zhaozhu Zheng
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Fengxuan Han
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Suzhou Medical College, Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaoqin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Gang Li
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, Jiangsu, 215123, China
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Zhen T, Fang J, Hu D, Ruan M, Wang L, Fan S, Shen Q. Risk stratification by nomogram of deep learning radiomics based on multiparametric magnetic resonance imaging in knee meniscus injury. INTERNATIONAL ORTHOPAEDICS 2023; 47:2497-2505. [PMID: 37386277 DOI: 10.1007/s00264-023-05875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To construct and validate a nomogram model that integrated deep learning radiomic features based on multiparametric MRI and clinical features for risk stratification of meniscus injury. METHODS A total of 167 knee MR images were collected from two institutions. All patients were classified into two groups based on the MR diagnostic criteria proposed by Stoller et al. The automatic meniscus segmentation model was constructed through V-net. LASSO regression was performed to extract the optimal features correlated to risk stratification. A nomogram model was constructed by combining the Radscore and clinical features. The performance of the models was evaluated by ROC analysis and calibration curve. Subsequently, the model was simulated by junior doctors in order to test its practical application effect. RESULTS The Dice similarity coefficients of automatic meniscus segmentation models were all over 0.8. Eight optimal features, identified by LASSO regression, were employed to calculate the Radscore. The combined model showed a better performance in both the training cohort (AUC = 0.90, 95%CI: 0.84-0.95) and the validation cohort (AUC = 0.84, 95%CI: 0.72-0.93). The calibration curve indicated a better accuracy of the combined model than either the Radscore or clinical model alone. The simulation results showed that the diagnostic accuracy of junior doctors increased from 74.9 to 86.2% after using the model. CONCLUSION Deep learning V-net demonstrated great performance in automatic meniscus segmentation of the knee joint. It was reliable for stratifying the risk of meniscus injury of the knee by nomogram which integrated the Radscores and clinical features.
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Affiliation(s)
- Tao Zhen
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China
| | - Jing Fang
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310006, China
| | - Dacheng Hu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China
| | - Mei Ruan
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China
| | - Luoyu Wang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China
| | - Sandra Fan
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China
| | - Qijun Shen
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Zhejiang, 310006, Hangzhou, China.
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Yang L, Chiu CH, Hsu KY, Chuang CA, Chen ACY, Chan YS, Yang CP. Using Single Peroneal Longus Tendon Graft for Segmental Meniscus Transplantation and Revision Anterior Cruciate Ligament Combined Anterolateral Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1497. [PMID: 37629787 PMCID: PMC10456414 DOI: 10.3390/medicina59081497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency.
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Affiliation(s)
- Ling Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Keelung 204, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
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Bottomley J, Al-Dadah O. Arthroscopic Meniscectomy vs Meniscal Repair: Comparison of Clinical Outcomes. Cureus 2023; 15:e44122. [PMID: 37750149 PMCID: PMC10518210 DOI: 10.7759/cureus.44122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Background Meniscal tears are the most common injury of the knee. Surgical treatment has fallen into contention recently and includes arthroscopic meniscectomy and meniscal repair. The primary aim of this study was to quantitatively evaluate patients with isolated meniscal tears and compare their outcomes with patients who have undergone arthroscopic meniscus surgery. The secondary aim of this study was to compare the clinical outcomes of patients who have undergone arthroscopic meniscectomy with patients who have undergone arthroscopic meniscal repair. Methods This comparative clinical study screened 334 patients to identify subjects who underwent arthroscopic knee surgery for isolated meniscal tears and compare them to patients with symptomatic isolated meniscal tears awaiting surgery using validated patient-reported outcome measures. These included the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Form, Lysholm score, Tegner score, EuroQol-5 Dimension, and the 12-Item Short Form Health Survey. Results A total of 117 patients (Meniscal Tear group (n=36), Meniscectomy group (n=64), and Meniscal Repair group (n=17)) were included in the final data analysis. Both the Meniscectomy group and the Meniscal Repair group (mean 55-month follow-up) showed significantly better clinical outcomes than patients in the Meniscal Tear group (p<0.05). Overall, the Meniscal Repair group demonstrated superior clinical outcomes when compared to the Meniscectomy group (p<0.05). Conclusion Arthroscopic knee surgery showed significant clinical benefit at medium-term follow-up in treating patients with isolated meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy.
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Affiliation(s)
- James Bottomley
- Trauma and Orthopedic Surgery, South Tyneside District Hospital, South Shields, GBR
| | - Oday Al-Dadah
- Orthopedics, Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, GBR
- Trauma and Orthopedic Surgery, South Tyneside District Hospital, South Shields, GBR
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Weaver AP, Walaszek MC, Roman DP, Harkey MS, Kuenze C. The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:2357-2365. [PMID: 37272684 PMCID: PMC10865339 DOI: 10.1177/03635465231177626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. HYPOTHESIS Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. RESULTS An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type (P = .61) or meniscal procedure at the time of ACLR (P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type (P = .38) or meniscal procedure at the time of ACLR (P = .40). CONCLUSION Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.
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Affiliation(s)
- Adam P. Weaver
- Address correspondence to Adam P. Weaver, PT, DPT, Sports Physical Therapy, Connecticut Children’s, 399 Farmington Ave, Farmington, CT 06032, USA () (Twitter: @adampweaver)
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Rajani AM, Shah UA, Mittal A, Gupta S, Garg R, Rajani AA, Punamiya M, Singhal R. AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair. Malays Orthop J 2023; 17:13-20. [PMID: 37583526 PMCID: PMC10425007 DOI: 10.5704/moj.2307.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 08/17/2023] Open
Abstract
Introduction The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray's test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.
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Affiliation(s)
- A M Rajani
- Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India
| | - U A Shah
- Department of Orthopaedics, Surgikids Hospital, Ahmedabad, India
| | - Ars Mittal
- Department of Orthopaedics, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - S Gupta
- Department of Orthopaedics, Galaxy Hospital, Bhopal, India
| | - R Garg
- Department of Orthopaedics, Canadian Specialist Hospital, Dubai, United Arab Emirates
| | - A A Rajani
- Department of Radiology, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - M Punamiya
- Department of Physiotherapy, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
| | - R Singhal
- Department of Biostatistics, Orthopaedic Arthroscopy Knee and Shoulder Clinic, Mumbai, India
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Massey PA, Sampognaro G, Starnes E, Lowery MT, Duncan M, Sherman WF, Zhang AS. Improved Outcomes After Reinforced Radial Meniscus Repair Augmented With Bone Marrow Aspirate Concentrate. Arthrosc Sports Med Rehabil 2023; 5:e843-e851. [PMID: 37388894 PMCID: PMC10300602 DOI: 10.1016/j.asmr.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/21/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To assess clinical outcomes of patients who have undergone surgical repair of radial meniscal tears with reinforced suture bar (rebar) technique augmented with bone marrow aspirate concentrate. Methods This is a retrospective study of a single fellowship-trained sports medicine surgeon's experience on all patients who underwent a reinforced repair (rebar) of a radial meniscus tear from November 2016 to 2018, with a minimum of 12-month follow-up. Lysholm scores, IKDC (International Knee Documentation Committee) Subjective Knee Form scores, and Tegner scale were collected postoperatively at periods for at least 1 year and retrospectively studied. Results Patients were followed for an average of 36.3 ± 25.0 months [range: 12.0-69.0 months]. Pain scores improved from 6.1 ± 2.1 to 0.4 ± 1.4 at 1 year (P < .001). IKDC Subjective Knee Form scores improved from 63 ± 26 to 90 ± 13 (P = .021). Lysholm scores improved from 64 ± 28 to 94 ± 9 (P = .025). Based on a calculated minimal clinical important difference (MCID) of 1.5, 100% of patients had improvement above the MCID. In addition, 88% of patients had a 1-year IKDC Subjective Knee Form score above the patient acceptable symptomatic state. Preoperative Tegner activity scale improved from 3 ± 1.5 to 8 ± 2.6 (P = .007). Patients returned to their preinjury activity with little difference in the Tegner activity scale when we compared preinjury and 1-year postoperative (8.1 ± 1.3 vs 8.0 ± 2.6 respectively, P = .317). Conclusions The rebar repair technique for radial meniscus tears, with bone marrow aspirate concentrate augmentation, showed improved outcomes in both pain and function at minimum follow-up of 12 months. Patients were able to return to a high preinjury activity level by 1 year, and 100% of patients had improvement above the MCID and 88% met patient acceptable symptomatic state. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Patrick A. Massey
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Gabriel Sampognaro
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Ellie Starnes
- Louisiana State University School of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Michael Todd Lowery
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | | | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Andrew S. Zhang
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Berlinberg EJ, Song M, Sivasundaram L, Patel HH, Mascarenhas R, Forsythe B. Total Knee Arthroplasty After Meniscectomy Is More Likely in Patients With Bicompartmental or Complex Tears. Arthrosc Sports Med Rehabil 2023; 5:e577-e587. [PMID: 37388875 PMCID: PMC10300543 DOI: 10.1016/j.asmr.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/16/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine the relationship between meniscus tear morphologies, stratified by location and pattern, and knee arthroplasty rates in a commercial insurance population. Methods The PearlDiver database was queried for patients ≥35 years old with a meniscus tear of specified laterality and ≥2 years follow-up between 2015 and 2018. Two analyses were conducted with cohorts matched on age, sex, Charlson Comorbidity Index, obesity, osteoarthritis (OA), and treatment (meniscectomy vs conservative): one with equal-sized subgroups by tear location (medial only, lateral only, or both medial and lateral) and another by tear pattern (bucket-handle, complex, or peripheral). The rate of subsequent total knee arthroplasty (TKA) was compared between matched groups. Results In total, 129,987 patients (mean age: 57.8 ± 10.5 years) were matched by tear location; 1,734 patients with medial-only tears (4.0%), 1,786 with lateral-only tears (4.1%), and 2,611 with medial plus lateral tears (6.0%) underwent a TKA within 5 years (P < .001). Patients with both medial and lateral tears were 1.55-fold more likely to undergo TKA. In total, 24,213 patients (mean age: 56.0 ± 10.5 years) were matched by tear pattern; 296 patients with bucket-handle tears (3.7%), 373 with complex tears (4.6%), and 336 with peripheral tears (4.2%) underwent TKA (P = .01). Patients with complex tears were 1.29-fold more likely to undergo TKA than patients with bucket-handle tears (P = .002). Conclusions In matched cohorts of patients with degenerative meniscus tears, having both medial plus lateral tears conferred a 1.5-fold risk of TKA, whereas complex tears conferred a 1.3-fold risk within 5 years. Specific meniscal tear patterns and locations harbor varying risk in progressing to end-stage knee OA, and these data may help counsel patients about their likelihood of progressing to end-stage OA warranting an arthroplasty procedure. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Elyse J. Berlinberg
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
- NYU Grossman School of Medicine, New York, New York, U.S.A
| | - Melissa Song
- NYU Grossman School of Medicine, New York, New York, U.S.A
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Barceló X, Garcia O, Kelly DJ. Chondroitinase ABC Treatment Improves the Organization and Mechanics of 3D Bioprinted Meniscal Tissue. ACS Biomater Sci Eng 2023. [PMID: 37192278 DOI: 10.1021/acsbiomaterials.3c00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The meniscus is a fibrocartilage tissue that is integral to the correct functioning of the knee joint. The tissue possesses a unique collagen fiber architecture that is integral to its biomechanical functionality. In particular, a network of circumferentially aligned collagen fibers function to bear the high tensile forces generated in the tissue during normal daily activities. The limited regenerative capacity of the meniscus has motivated increased interest in meniscus tissue engineering; however, the in vitro generation of structurally organized meniscal grafts with a collagen architecture mimetic of the native meniscus remains a significant challenge. Here we used melt electrowriting (MEW) to produce scaffolds with defined pore architectures to impose physical boundaries upon cell growth and extracellular matrix production. This enabled the bioprinting of anisotropic tissues with collagen fibers preferentially oriented parallel to the long axis of the scaffold pores. Furthermore, temporally removing glycosaminoglycans (sGAGs) during the early stages of in vitro tissue development using chondroitinase ABC (cABC) was found to positively impact collagen network maturation. Specially we found that temporal depletion of sGAGs is associated with an increase in collagen fiber diameter without any detrimental effect on the development of a meniscal tissue phenotype or subsequent extracellular matrix production. Moreover, temporal cABC treatment supported the development of engineered tissues with superior tensile mechanical properties compared to empty MEW scaffolds. These findings demonstrate the benefit of temporal enzymatic treatments when engineering structurally anisotropic tissues using emerging biofabrication technologies such as MEW and inkjet bioprinting.
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Affiliation(s)
- Xavier Barceló
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
| | - Orquidea Garcia
- Johnson & Johnson 3D Printing Innovation & Customer Solutions, Johnson & Johnson Services, Inc., Dublin D02 R590, Ireland
| | - Daniel J Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin D02 R590, Ireland
- Department of Mechanical, Manufacturing, & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin D02 R590, Ireland
- Advanced Materials & Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland & Trinity College Dublin, Dublin D02 F6N2, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland
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Langhans MT, Lamba A, Saris DBF, Smith P, Krych AJ. Meniscal Extrusion: Diagnosis, Etiology, and Treatment Options. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09840-4. [PMID: 37191818 DOI: 10.1007/s12178-023-09840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. RECENT FINDINGS Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration. Meniscus extrusion has been associated with degenerative joint disease, posterior root and radial meniscal tears, and acute trauma. Meniscus centralization and meniscotibial ligament repair have been proposed as techniques to address meniscal extrusion with promising biomechanical, animal model, and early clinical reports. Further studies on the epidemiology of meniscus extrusion and associated long-term nonoperative outcomes will help to elucidate its role in meniscus dysfunction and resultant arthritic development. Understanding and appreciation for the anatomic attachments of the meniscus will help to inform future repair techniques. Long-term reporting on the clinical outcomes of meniscus centralization techniques will yield insights into the clinical significance of meniscus extrusion correction.
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Affiliation(s)
- Mark T Langhans
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Starbuck C, Walters V, Herrington L, Barkatali B, Jones R. No differences in knee joint loading between individuals who had a medial or lateral meniscectomy: An ancillary study. Knee 2023; 42:304-311. [PMID: 37141797 DOI: 10.1016/j.knee.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy is a frequently undertaken procedure for traumatic meniscal injuries. The location of knee joint degeneration and long-term prognosis differs between knees who have had a medial or lateral meniscectomy. However, there is no evidence comparing knee loading following a medial or lateral meniscectomy during sporting tasks. This study compared knee loading during walking and running between individuals who either had a medial or lateral meniscectomy. METHODS Knee kinematic and kinetic data were collected during walking and running in individuals three to twelve months post-surgery. Participants were grouped according to the location of surgery (medial, n = 12, and lateral, n = 16). An independent t-test compared knee biomechanics between the groups and Hedge's g effects sizes were also conducted. RESULTS External knee adduction and knee flexion moments were similar between groups for walking and running with negligible to small effect sizes (effect size, 0.08-0.30). Kinematic (effect size, 0.03-0.22) and spatiotemporal (effect size, 0.02-0.59) outcomes were also similar between the groups. CONCLUSIONS The lack of differences in surrogate knee loading variables between medial and lateral meniscectomy groups was unexpected. These findings suggest that combining groups in the short-term period following surgery is applicable. However, the data presented in this study cannot explain the differences in long-term prognosis between medial and lateral meniscectomies.
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Affiliation(s)
- Chelsea Starbuck
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, UK; Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK.
| | - Vanessa Walters
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK
| | - Lee Herrington
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK
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Zhang Z, Zhang W, Zhang Y. The "Hand as Foot" teaching method in meniscal injury. Asian J Surg 2023:S1015-9584(23)00406-2. [PMID: 37137778 DOI: 10.1016/j.asjsur.2023.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
| | - Wenli Zhang
- Shandong Province Jining Health School, China
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41
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Prendergast ME, Heo SJ, Mauck RL, Burdick JA. Suspension bath bioprinting and maturation of anisotropic meniscal constructs. Biofabrication 2023; 15:10.1088/1758-5090/acc3c3. [PMID: 36913724 PMCID: PMC10156462 DOI: 10.1088/1758-5090/acc3c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/13/2023] [Indexed: 03/14/2023]
Abstract
Due to limited intrinsic healing capacity of the meniscus, meniscal injuries pose a significant clinical challenge. The most common method for treatment of damaged meniscal tissues, meniscectomy, leads to improper loading within the knee joint, which can increase the risk of osteoarthritis. Thus, there is a clinical need for the development of constructs for meniscal repair that better replicate meniscal tissue organization to improve load distributions and function over time. Advanced three-dimensional bioprinting technologies such as suspension bath bioprinting provide some key advantages, such as the ability to support the fabrication of complex structures using non-viscous bioinks. In this work, the suspension bath printing process is utilized to print anisotropic constructs with a unique bioink that contains embedded hydrogel fibers that align via shear stresses during printing. Constructs with and without fibers are printed and then cultured for up to 56 din vitroin a custom clamping system. Printed constructs with fibers demonstrate increased cell and collagen alignment, as well as enhanced tensile moduli when compared to constructs printed without fibers. This work advances the use of biofabrication to develop anisotropic constructs that can be utilized for the repair of meniscal tissue.
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Affiliation(s)
| | - Su-Jin Heo
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104 USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Robert L. Mauck
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104 USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Jason A. Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104 USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO 80303, USA
- Department of Chemical and Biological Engineering, College of Engineering and Applied Science, University of Colorado Boulder, Boulder, CO 80303, USA
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Lee HY, Bin SI, Kim JM, Lee BS, Kim SM, Lee SJ. Lateral Meniscal Allograft Transplantation Provides a Chondroprotective Effect on Articular Cartilage: Quantitative 3-T Magnetic Resonance Imaging T2 Mapping. Arthroscopy 2023; 39:1000-1007. [PMID: 36332852 DOI: 10.1016/j.arthro.2022.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to assess the cartilage status in patients who underwent isolated lateral meniscus allograft transplantation (MAT) using preoperative and postoperative quantitative 3-T magnetic resonance imaging T2 mapping at midterm follow-up period. METHODS Patients who underwent lateral MAT without cartilage treatment procedures between 2010 and 2019 were assessed by quantitative magnetic resonance imaging preoperatively and postoperatively. On the sagittal section image following the center of the lateral femoral condyle, the weight-bearing area of the articular cartilage was divided into 6 segments based on the meniscal coverage area from anterior to posterior direction. The mean T2 values of each of the 6 segments were measured for 3 regions of interest: overall, deep, and superficial layers. The change in T2 values was statistically analyzed by paired t-tests. The Lysholm score was used to evaluate clinical function. RESULTS A total of 105 patients were included in the study. The mean follow-up period was 3.2 years (range 2.0-5.4 years). Among the 6 segments, the mean T2 value showed significant improvement in the overall layer of F2 (the middle weight-bearing area of femoral condyle) and TP3 (the posterior weight-bearing area of tibia condyle) segments (P = .013 and .021, respectively) and the superficial layer of the F3 (the posterior weight-bearing area of femoral condyle) segments (P = .028). The mean T2 value of all the other segments did not show a statistically significant change. The mean Lysholm score significantly improved from 66.5 ± 15.8 to 89.3 ± 10.0 (P < .001). Overall, 73.3% and 96.2% of the patients met the minimal clinically important difference and patient acceptable symptomatic state, respectively. CONCLUSIONS The mean T2 value of the articular cartilage of the weight-bearing area was either maintained or showed statistically significant improvement depending on the location following isolated lateral MAT. Thus, the transplanted meniscus seems to have a chondroprotective effect on the weight-bearing cartilage. LEVEL OF EVIDENCE Level IV, retrospective therapeutic case series.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji Medical Center Daejeon Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea; Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, College of Medicine, Wonkwang University, Gunpo, Republic of Korea
| | - Seon-Jong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lopez SG, Kim J, Estroff LA, Bonassar LJ. Removal of GAGs Regulates Mechanical Properties, Collagen Fiber Formation, and Alignment in Tissue Engineered Meniscus. ACS Biomater Sci Eng 2023; 9:1608-1619. [PMID: 36802372 DOI: 10.1021/acsbiomaterials.3c00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The complex fibrillar architecture of native meniscus is essential for proper function and difficult to recapitulate in vitro. In the native meniscus, proteoglycan content is low during the development of collagen fibers and progressively increases with aging. In vitro, fibrochondrocytes produce glycosaminoglycans (GAGs) early in culture, in contrast to native tissue, where they are deposited after collagen fibers have formed. This difference in the timing of GAG production hinders the formation of a mature fiber network in such in vitro models. In this study, we removed GAGs from collagen gel-based tissue engineered constructs using chondroitinase ABC (cABC) and evaluated the effect on the formation and alignment of collagen fibers and the subsequent effect on tensile and compressive mechanical properties. Removal of GAGs during maturation of in vitro constructs improved collagen fiber alignment in tissue engineered meniscus constructs. Additionally, removal of GAGs during maturation improved fiber alignment without compromising compressive strength, and this removal improved not only fiber alignment and formation but also tensile properties. The increased fiber organization in cABC-treated groups also appeared to influence the size, shape, and location of defects in these constructs, suggesting that treatment may prevent the propagation of large defects under loading. This data gives another method of modulating the ECM for improved collagen fiber formation and mechanical properties in tissue engineered constructs.
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Affiliation(s)
- Serafina G Lopez
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Jongkil Kim
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, New York 14853, United States
- Kavli Institute for Nanoscale Science at Cornell, Cornell University, Ithaca, New York 14853, United States
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
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Ozeki N, Mizuno M, Yanada S, Okada T, Kubota R, Kushida Y, Furuoka H, Endo K, Katano H, Nakamura K, Ohya S, Koga H, Sekiya I. Autologous Synovial Mesenchymal Stem Cell Transplantation Suppresses Inflammation Caused by Synovial Harvesting and Promotes Healing in a Micro Minipig Repaired Meniscus Model. Transplant Proc 2023; 55:470-480. [PMID: 36906438 DOI: 10.1016/j.transproceed.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/05/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Allogeneic synovial mesenchymal stem cells (MSCs) effectively promote meniscus healing in micro minipigs. We investigated the effect of autologous synovial MSC transplantation on meniscus healing in a micro minipig model of meniscus repair showing synovitis after synovial harvesting. MATERIALS AND METHODS Synovium was harvested from the left knee of the micro minipigs after arthrotomy and used to prepare synovial MSCs. The left medial meniscus in the avascular region was injured, repaired, and transplanted with synovial MSCs. First, synovitis was compared after 6 weeks in knees with and without synovial harvesting. Second, the repaired meniscus was compared for the autologous MSC group and the control group (in which synovium was harvested but MSCs were not transplanted) 4 weeks after transplantation. RESULTS Synovitis was more severe in knees subjected to synovium harvesting than in knees not subjected to harvesting. Menisci treated with autologous MSCs showed no red granulation at the tear of the meniscus, but menisci not treated with MSCS showed red granulation. Macroscopic scores, inflammatory cell infiltration scores, and matrix scores assessed by toluidine blue staining were all significantly better in the autologous MSC group than in the control group without MSCs (n = 6). CONCLUSION Autologous synovial MSC transplantation suppressed the inflammation caused by synovial harvesting in micro minipigs and promoted healing of the repaired meniscus.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takuya Okada
- Japan Tissue Engineering Co., Ltd., Aichi, Japan
| | - Rei Kubota
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kushida
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideto Furuoka
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Endo
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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Heiss R, Laredo JD, Wirth W, Jansen MP, Marijnissen ACA, Lafeber F, Lalande A, Weinans HH, Blanco FJ, Berenbaum F, Kloppenburg M, Haugen IK, Engelke K, Roemer FW. Quantitative CT of the knee in the IMI-APPROACH osteoarthritis cohort: Association of bone mineral density with radiographic disease severity, meniscal coverage and meniscal extrusion. Bone 2023; 168:116673. [PMID: 36623756 DOI: 10.1016/j.bone.2023.116673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a highly prevalent chronic condition. The subchondral bone plays an important role in onset and progression of OA making it a potential treatment target for disease-modifying therapeutic approaches. However, little is known about changes of periarticular bone mineral density (BMD) in OA and its relation to meniscal coverage and meniscal extrusion at the knee. Thus, the aim of this study was to describe periarticular BMD in the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort at the knee and to analyze the association with structural disease severity, meniscal coverage and meniscal extrusion. DESIGN Quantitative CT (QCT), MRI and radiographic examinations were acquired in 275 patients with knee osteoarthritis (OA). QCT was used to assess BMD at the femur and tibia, at the cortical bone plate (Cort) and at the epiphysis at three locations: subchondral (Sub), mid-epiphysis (Mid) and adjacent to the physis (Juxta). BMD was evaluated for the medial and lateral compartment separately and for subregions covered and not covered by the meniscus. Radiographs were used to determine the femorotibial angle and were evaluated according to the Kellgren and Lawrence (KL) system. Meniscal extrusion was assessed from 0 to 3. RESULTS Mean BMD differed significantly between each anatomic location at both the femur and tibia (p < 0.001) in patients with KL0. Tibial regions assumed to be covered with meniscus in patients with KL0 showed lower BMD at Sub (p < 0.001), equivalent BMD at Mid (p = 0.07) and higher BMD at Juxta (p < 0.001) subregions compared to regions not covered with meniscus. Knees with KL2-4 showed lower Sub (p = 0.03), Mid (p = 0.01) and Juxta (p < 0.05) BMD at the medial femur compared to KL0/1. Meniscal extrusion grade 2 and 3 was associated with greater BMD at the tibial Cort (p < 0.001, p = 0.007). Varus malalignment is associated with significant greater BMD at the medial femur and at the medial tibia at all anatomic locations. CONCLUSION BMD within the epiphyses of the tibia and femur decreases with increasing distance from the articular surface. Knees with structural OA (KL2-4) exhibit greater cortical BMD values at the tibia and lower BMD at the femur at the subchondral level and levels beneath compared to KL0/1. BMD at the tibial cortical bone plate is greater in patients with meniscal extrusion grade 2/3.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Jean-Denis Laredo
- Service de Radiologie, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France; Bioimagerie Ostéo-articulaires (B3OA), UMR, CNRS, 7052 INSERM U1271,10 Avenue de Verdun, 75010 Paris, France
| | - Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria; Chondrometrics GmbH, Ludwig-Zeller-Straße 12, 83395 Freilassing, Germany
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Anne C A Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Floris Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Agnes Lalande
- Servier, 50 rue Carnot, 92284 Suresnes cedex, France
| | - Harrie H Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Francisco J Blanco
- Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS, Centro de Investigación CICA, Departamento de Fisioterapia y Medicina, Universidad de A Coruña, A Coruña, Spain; Servicio de Reumatologia, INIBIC- Universidade de A Coruña, As Xubias 84, 15006 A Coruña, Spain
| | - Francis Berenbaum
- Sorbonne University, Inserm, APHP Hôpital Saint-Antoine, 75571 Paris cedex 12, France
| | - Margreet Kloppenburg
- Departments of Rheumatology, Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands
| | - Ida K Haugen
- Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Klaus Engelke
- Department of Immunology and Rheumatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany; Institute of Medical Physics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Henkestr. 91, 91052 Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, MA, USA
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Does Accelerated Rehabilitation Provide Better Outcomes Than Restricted Rehabilitation in Postarthroscopic Repair of Meniscal Injury? J Sport Rehabil 2023; 32:335-345. [PMID: 36476967 DOI: 10.1123/jsr.2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. OBJECTIVE To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). EVIDENCE ACQUISITION Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. EVIDENCE SYNTHESIS Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = -4.66; 95% confidence interval, -8.6 to -0.73; P = .02; I2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior-posterior view (mean difference = -7.08; 95% confidence interval, -10.92 to -3.24; P = .0003; I2 = 0%) and lateral view (mean difference = -10.33; 95% confidence interval, -16.9 to -3.75; P = .002; I2 = 17%). CONCLUSION This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.
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Wang Y, Chen J, Li D, Yang R, Xiang X. Single Needle All-Inside Technique for Lateral Meniscus Repair at Popliteal Hiatus Area: Safe, Effective, and Time-Saving. Arthrosc Tech 2023; 12:e371-e375. [PMID: 37013010 PMCID: PMC10066337 DOI: 10.1016/j.eats.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/06/2022] [Indexed: 04/05/2023] Open
Abstract
The lateral meniscus tear at the popliteal hiatus area is a tricky problem in clinical treatment due to the difficulty of preoperative diagnosis, narrow space for operation, lack of capsular attachments, and risk of vascular injuries. This article introduces an arthroscopic single-needle, all-inside technique suitable for repairing longitudinal and horizontal lateral meniscus tears at the popliteus tendon hiatus area. We believe this technique is safe, effective, economical and reproducible.
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Affiliation(s)
- Yuanyuan Wang
- The Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jianfa Chen
- The Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ding Li
- The Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaobing Xiang
- The Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
- Address correspondence to Xiaobing Xiang, M.D., The Fourth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No.16 Airport Road, Guangzhou 510000, China.
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She Y, Tang S, Zhu Z, Sun Y, Deng W, Wang S, Jiang N. Comparison of temporomandibular joint disc, meniscus, and intervertebral disc in fundamental characteristics and tissue engineering. J Biomed Mater Res B Appl Biomater 2023; 111:717-729. [PMID: 36221912 DOI: 10.1002/jbm.b.35178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 01/21/2023]
Abstract
The temporomandibular joint (TMJ) disc, meniscus and intervertebral disc (IVD) are three fibrocartilage discs, which play critical roles in our daily life. Their degeneration contributes to diseases such as TMJ disorders, osteoarthritis and degenerative disc disease, affecting patients' quality of life and causing substantial morbidity and mortality. Interestingly, similar in some aspects of fundamental characteristics, they exhibit differences in other aspects such as biomechanical properties. Highlighting these similarities and differences can not only benefit a comprehensive understanding of them and their pathology but also assist in future research of tissue engineering. Likewise, comparing their tissue engineering in cell sources, scaffold and stimuli can guide imitation and improvement of their engineered discs. However, the anatomical structure, function, and biomechanical characteristics of the IVD, TMJ, and Meniscus have not been compared in any meaningful depth needed to advance current tissue engineering research on these joints, resulting in incomplete understanding of them and their pathology and ultimately limiting future research of tissue engineering. This review, for the first time, comprehensively compares three fibrocartilage discs in those aspects to cast light on their similarities and differences.
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Affiliation(s)
- Yilin She
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Disease and West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shiyi Tang
- West China Medical School, Sichuan University, Chengdu, China
| | - Zilin Zhu
- College of Life Sciences, Sichuan University, Chengdu, China
| | - Yixin Sun
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Disease and West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wanyu Deng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Disease and West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sicheng Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Disease and West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Disease and West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Histological Findings and T2 Relaxation Time in Canine Menisci of Elderly Dogs—An Ex Vivo Study in Stifle Joints. Vet Sci 2023; 10:vetsci10030182. [PMID: 36977221 PMCID: PMC10053884 DOI: 10.3390/vetsci10030182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Osteoarthritis is a chronic disease that often affects the canine stifle joint. Due to their biomechanical function, the menisci in the canine stifle play an important role in osteoarthritis. They compensate for the incongruence in the joint and distribute and minimize compressive loads, protecting the hyaline articular cartilage from damage. Meniscal degeneration favors the development and progression of stifle joint osteoarthritis. Qualitative magnetic resonance imaging (MRI) is the current golden standard for detecting meniscal changes, but it has limitations in detecting early signs of meniscal degeneration. A quantitative MRI offers new options for detecting early structural changes. T2 mapping can especially visualize structural changes such as altered collagen structures and water content, as well as deviations in proteoglycan content. This study evaluated T2 mapping and performed a histological scoring of menisci in elderly dogs that had no or only low radiographic osteoarthritis grades. A total of 16 stifles from 8 older dogs of different sex and breed underwent ex vivo magnet resonance imaging, including a T2 mapping pulse sequence with multiple echoes. A histological analysis of corresponding menisci was performed using a modified scoring system. The mean T2 relaxation time was 18.2 ms and the mean histological score was 4.25. Descriptive statistics did not reveal a correlation between T2 relaxation time and histological score. Ex vivo T2 mapping of canine menisci did not demonstrate histological changes, suggesting that early meniscal degeneration can be present in the absence of radiological signs of osteoarthritis, including no significant changes in T2 relaxation time.
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Lazarte MDLÁ, Manzano A, Sanchez RS, Abdala V. Ontogeny of the meniscus in the anuran Xenopus laevis. Anat Rec (Hoboken) 2023; 306:457-469. [PMID: 36089759 DOI: 10.1002/ar.25076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
The anuran knee joint is subjected to the jump, one of the tetrapods' most demanding mechanical stresses. Consistent with this continuous effort, the knee of the anurans has a complex structure comparable to that of an amniote. Here, we describe the ontogeny of the Xenopus knee tissues and study the morphogenesis of the knee joint shape by performing a geometric morphometric analysis of specially selected anatomical structures: the menisci and the long bone epiphyses. A meniscus is a crescent-shaped fibrocartilaginous structure, with a triangular cross-section inserted between joints surfaces. A meniscus transmits load across the tibiofemoral joint by increasing congruity of the long bone epiphysis and decreasing the resulting stress exerted on the articular cartilage. We ask two questions: (1) what is the tissue composition along the ontogeny of the menisci of a swimming frog? (2) How do the menisci acquire the shape that will allow their adjustment? We studied the structures and tissue ontogeny of the knee of several specimens of Xenopus laevis and evaluated the congruity of the knee structures across the species ontogeny. Histological sections showed that the cavitation process responsible for separating the menisci and the epiphyses seems to be pivotal in shaping the conformity of these structures and the long bone epiphyses of the hindlimbs. The geometric morphometric analysis allowed us to interpret three phases of differentiation associated with limb functionality. The characteristic shape of the meniscus appears early in the ontogeny of the knee, simultaneously with the epiphysis contours.
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Affiliation(s)
| | - Adriana Manzano
- Centro de Investigación Científica y Transferencia Tecnológica a la Producción (CICYTTP) CONICET, Diamante, Entre Ríos, Argentina
- Cátedra de Embriología y Anatomía Animal, Facultad de Ciencias y Tecnología (FCyT-UADER), Oro Verde, Entre Ríos, Argentina
| | - Romel S Sanchez
- Cátedra de Biología General, Facultad de Cs. Naturales e IML, UNT, Tucumán, Argentina
- Instituto Superior de Investigaciones Biológicas (INSIBIO) CONICET-UNT, and Instituto de Biología "Dr. Francisco D. Barbieri", Facultad de Bioquímica, Química y Farmacia, UNT, Tucumán, Argentina
- Cátedra de Fisiología, Departamento Biomédico-Fisiología, Facultad de Medicina, UNT, Tucumán, Argentina
| | - Virginia Abdala
- Instituto de Biodiversidad Neotropical (IBN), UNT-CONICET, Tucumán, Argentina
- Cátedra de Biología General, Facultad de Cs. Naturales e IML, UNT, Tucumán, Argentina
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