The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis

A systematic review and meta-analysis examining alterations in medial meniscus extrusion and clinical outcomes following high tibial osteotomy

Background

Medial meniscal extrusion (MME) is both a contributor to and a consequence of medial knee osteoarthritis (OA), with each condition exacerbating the other.High tibial osteotomy (HTO) realigns varus to valgus to alleviate medial compartment stress.This study conducted a systematic review and meta-analysis to evaluate alterations in medial meniscus extrusion values and clinical outcomes following high tibial osteotomy (HTO).

Methods

Eligible studies were identified through a comprehensive search of databases including PubMed, Scopus, Web of Science, Ovid, Embase, Cochrane Library, and CNKI up to May 13, 2024.The primary goal was to assess the values of medial meniscus extrusion before and after HTO surgery.Secondary objectives were other clinical outcomes such as imaging assessments and clinical functional assessments in medial knee OA patients.All meta-analyses used random effects models, assessing between-study heterogeneity in effect sizes with the I2 statistic and P values.A P value under 0.05 was considered statistically significant.

Results

Eight observational studies were included, involving 316 affected knees from 311 patients.The mean difference(MD) in the change in MME values was 2.78 (95% CI, 2.65 to 2.92; P < 0.0001).The other imaging assessments, HKA angle (MD, 8.82; 95% CI, 8.57 to 9.07; P < 0.0001), WBL ratio (MD, -34.98; 95% CI, -36.03 to -33.93; P < 0.0001), medial proximal tibial angle (MD, -8.61; 95% CI, -9.17 to -8.04; P < 0.0001) and posterior tibial slope angle (MD, -1.19; 95% CI, -2.10 to -0.27; P = 0.011), changed obviously in postoperative period.Post-surgery improvements were noted in clinical assessments, including KOOS (MD, -38.41; 95% CI, -39.28 to -37.55; P < 0.0001), Tegner activity scale (MD, -2.55; 95% CI, -2.74 to -2.37; P < 0.0001), Pain VAS (MD, 5.73; 95% CI, 5.44 to 6.02; P < 0.0001), and WOMAC scores (MD, 36.52; 95% CI, 34.46 to 38.59; P < 0.0001) compared to preoperative values.

Conclusions

This systematic review and meta-analysis demonstrated that HTO effectively reduced MME values in patients with medial knee OA and concurrent MME.Simultaneously, HTO corrected lower limb force lines, significantly enhancing imaging and clinical functional assessments in patients.

The use of lateral wedge insoles delays osteoarthritis progression and improves clinical outcomes in medial meniscus posterior root repair

Purpose

The purpose of this retrospective study was to evaluate the efficacy of using a lateral wedge insole (LWI) during the first 3 months after medial meniscus posterior root (MMPR) repair.

Methods

Overall, 179 patients were categorized into LWI use (LWI group, 90 patients) and nonuse (control group, 89 patients) groups. Patients in the LWI group were instructed to wear an LWI from the initiation of load bearing up to 3 months postoperatively. Medial meniscus extrusion (MME) was evaluated preoperatively and 1 year postoperatively, Kellgren-Lawrence (KL) grade and clinical scores were evaluated preoperatively and 2 years postoperatively, and second-look arthroscopic meniscal healing scores were evaluated at 1 year postoperatively.

Results

The proportion of patients with KL grade progression at 2 years postoperatively was significantly lower in the LWI group than in the control group (23.3% vs. 39.3%; p = 0.024). Change in the MME at 1 year postoperatively was significantly smaller in the LWI group than in the control group (1.1 ± 1.2 vs. 1.6 ± 1.4 mm; p = 0.042). The Lysholm score (p = 0.003) and Knee Injury and Osteoarthritis Outcome Scores-sport and recreation function (p = 0.027) at 2 years postoperatively were significantly superior in the LWI group than in the control group. The arthroscopic meniscal healing score after 1 year was not significantly different between the LWI and control groups (total score, 7.6 ± 1.1 vs. 7.4 ± 1.3 points; p = 0.732). The anteroposterior width of the repaired posterior root at 1 year second-look evaluation was significantly broader in the LWI group than in the control group (7.7 ± 1.6 vs. 6.9 ± 1.6 mm; p = 0.001).

Conclusions

The use of LWI is an effective way to delay postoperative osteoarthritis progression and improve clinical outcomes after MMPR repair.

Level of Evidence

Level III.

Osteoarthritis year in review 2024: Biomechanics

OBJECTIVE

We aimed to systematically review and summarize the literature of the past year on osteoarthritis (OA) and biomechanics, to highlight gaps and challenges, and to present some promising approaches and developments.

METHODS

A systematic literature search was conducted using Pubmed and the Web of Science Core Collection. We included original articles and systematic reviews on OA and biomechanics in human subjects published between April 2023 and April 2024.

RESULTS

Of the 155 studies that met the inclusion criteria, 9 were systematic reviews and 146 were original (mostly cross-sectional) studies that included a total of 6488 patients and 1921 controls with a mean age of 57.5 and 44.7 years, respectively. Promising advances have been made in medical imaging of affected soft tissue structures, the relationship between soft tissue properties and biomechanical changes in OA, new technologies to facilitate easier assessment of ambulatory biomechanics, and personalized physics-based models that also include complex chemical and mechanobiological mechanisms, all of which are relevant to gaining mechanistic insights into the pathophysiology of OA.

CONCLUSIONS

There is still an unmet need for larger longitudinal data sets that combine clinical, radiological, and biomechanical outcomes to characterize the biomechanical fingerprint that underlies the trajectory of functional decline and biomechanical phenotypes of OA. In addition, criteria and guidelines for control groups, as well as methods and standards for model verification allowing for comparisons between studies are needed.

Medial meniscus extrusion during gait is associated with decrease in knee rotation in early-stage knee osteoarthritis

BACKGROUND

In patients with medial knee osteoarthritis (OA), medial meniscus extrusion during gait is aggravated by mechanical stress, such as knee adduction moment (KAM). Conversely, the decrease in the range of knee rotation during stance phase is also one of the important issues in early knee OA, whereas the correlation between medial meniscus extrusion and knee rotation during gait are unclear.

RESEARCH QUESTION

To investigate the correlation between increase in medial meniscus extrusion and range of knee rotation during gait in patients with early- and late-stage of knee OA.

METHODS

Forty patients with medial knee OA were enrolled and divided into early- and late-OA group by Kellgren-Lawrence grading scale. During gait tasks, the extent of medial meniscus extrusion was measured using ultrasonography and kinetic/kinematic data were measured using three-dimensional motion analysis system. The correlation between medial meniscus extrusion and the range of knee rotation or KAM were evaluated in the overall, early-, and late- OA groups.

RESULTS

A significant negative correlation was observed between an increase in medial meniscus extrusion and range of knee rotation angle in early-OA group only. However, an increase in medial meniscus extrusion significantly correlated with the second KAM peak in the overall and early-OA groups.

SIGNIFICANCE

The decrease in range of knee rotation during stance phase may be associated with the increase in medial meniscus extrusion during gait in patients with early knee OA.