Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping

Extracorporeal shockwave therapy for degenerative meniscal tears results in a decreased T2 relaxation time and pain relief: An exploratory randomized clinical trial

PURPOSE

The optimal management of degenerative meniscal tears remains controversial. Extracorporeal shockwave therapy (ESWT) has been shown to promote tissue repair in both preclinical and clinical studies; however, its effect on degenerative meniscal tears remains unknown. This study aimed to examine whether ESWT improves meniscal degeneration.

METHODS

This randomized trial was conducted between 2020 and 2022 and involved patients with degenerative medial meniscal tears. Patients were allocated to receive either focused ESWT (0.25 mJ/mm2, 2000 impulses, 3 sessions with a 1-week interval) or sham treatment. Patients were evaluated using magnetic resonance imaging (MRI) before treatment and at 12 months after treatment. The primary endpoint was improvement in meniscal degeneration, as assessed by the change in T2 relaxation time from baseline on MRI T2 mapping. Knee pain and clinical outcomes were also examined at the same time.

RESULTS

Of 29 randomized patients, 27 patients (mean age 63.9 ± 8.7 years; females 37%; ESWT group 14 patients; control group 13 patients) were included in the final analysis. At 12 months postintervention, patients in the ESWT group showed a greater decrease in the T2 relaxation time (ESWT group -2.9 ± 1.7 ms vs. control group 1.0 ± 1.9 ms; p < 0.001) and had less knee pain (p = 0.04). The clinical outcomes at 12 months post-treatment were not statistically significant. No adverse events were reported.

CONCLUSION

ESWT decreased the T2 relaxation time in the meniscus at 12 months post-treatment. ESWT also provided pain relief, but no differences were observed in clinical outcomes.

LEVEL OF EVIDENCE

Level II.

Effect of inside-out meniscal repair on meniscal dimension in meniscal tear patients

Background

It remains controversial whether meniscal repair causes meniscal extrusion. This study aimed to investigate the effect of inside-out meniscal repair on meniscal dimensions in patients with meniscal tear of the mid-body-posterior horn.

Methods

This retrospective study included 75 patients who underwent meniscal repair followed by MRI within 2 weeks after surgery between 2020 and 2022. Patients with a discoid lateral meniscus, pull-out repair, concomitant osteotomy, all-inside repair only, and revision surgery were excluded. Thirty-three meniscal tear treated using an inside-out arthroscopic repair technique were included in the lateral meniscus (LM, n = 19) and medial meniscus (MM, n = 14) tear groups. Thirty-six participants with intact meniscus were included as controls. Meniscal extrusion and posterior shift were measured on coronal and sagittal MRI pre-operatively and within 2 weeks postoperatively.

Results

Preoperative coronal extrusion was significantly greater in the LM tear group than in the control group (P = 0.001). Coronal extrusion and posterior shift were significantly smaller postoperatively than preoperatively in the LM tear group (P < 0.001 and, P = 0.008, respectively). Pre- and postoperative coronal extrusion in the MM tear group were not significantly different (P = 0.291). Postoperative coronal extrusion in both LM and MM tear groups were not significantly correlated with the number of sutures required for repair (LM: P = 0.765, R = -0.076, MM: P = 0.1, R = 0.497).

Conclusions

The torn meniscus of the mid-body - posterior horn before surgery was extruded and shifted posteriorly in both LM and MM tears, and repair using an inside-out arthroscopic technique was effective in reducing meniscal extrusion and posteriors shift in the LM tear immediately after surgery.

Wrisberg variant of the lateral discoid meniscus in children: review of the literature and presentation of case series

INTRODUCTION

The Wrisberg variant of the discoid lateral meniscus is a very rare disorder and is characterized by the hypermobility and instability of the meniscus caused by the absence of its posterior tibial attachment, with only its meniscofemoral junction (Wrisberg's ligament) maintained, and inserted in the posterior horn of the meniscus. As a result, the posterior horn of the lateral meniscus is mobile; often subluxing into the joint.

MATERIALS AND METHODS

A total of eight skeletally immature patients with symptomatic Wrisberg variant of the discoid lateral meniscus were included in this study. Each knee was evaluated with MRI and arthroscopy. We graded unstable discoid menisci according to their discoid morphology (complete vs. incomplete), meniscal intra-substance degeneration, and the presence or absence of meniscal tears. All eight menisci were evaluated as degenerated with no meniscal tears. Five of them were evaluated as complete. Due to the severely degenerated meniscus, we considered it unnecessary to repair the detached posterior tibial ligament, so we performed a reshaping of the discoid meniscus, restoring a C-shape, excising the hypertrophied central part of the meniscus, and creating a posterior horn with a remaining rim of 6-8 mm. For evaluation of the knee function preoperatively and postoperatively we used the online International Knee Documentation Committee (IKDC) system. The purpose of this study is to emphasize the importance of MRI in identifying and revealing the unstable (Wrisberg variant) type of discoid meniscus in children.

RESULTS

The mean patient age at the time of surgery was 8.25 ± 2.91 years (range 5-13 years). The average follow-up was 3.75 ± 0.46 years (range 3-4) years. The mean preoperative IKDC score was 22.37 ± 1.50 (range 21-25) points. The mean postoperative IKDC score was 80.50 ± 1.77 (range 79-84) points.

CONCLUSIONS

MRI is a valuable tool in the evaluation of the shape, stability, and consistency of symptomatic discoid menisci. It is helpful for the detection of the unstable Wrisberg variant.

Lateral meniscus autograft transplantation using hamstring tendon with a sandwiched bone marrow - derived fibrin clot: A case report

INTRODUCTION AND IMPORTANCE

Tendon autograft is a durable solution for the sub/total meniscus; however it is still considered a temporary solution.

CASE PRESENTATION

We report the case of a 17-year-old woman with history of subtotal lateral meniscectomy performed 6 years ago. We treated her with lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched bone marrow aspirate (BMA)-derived fibrin clot. T2 relaxation times of the anterior and posterior horns of both menisci and of the cartilage were assessed.

CLINICAL DISCUSSION

Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot improved clinical and radiographic outcomes at the 24-month follow-up. These findings suggest that the lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot transformed into a meniscus-like tissue and resulted in preservation of the articular cartilage.

CONCLUSION

Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot can function as a meniscal transplant after total or subtotal meniscectomy in young patients.