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Qi B, Wang Z, Cao Y, Zhao H. Study on the treatment of osteoarthritis by acupuncture combined with traditional Chinese medicine based on pathophysiological mechanism: A review. Medicine (Baltimore) 2024; 103:e37483. [PMID: 38579081 PMCID: PMC10994424 DOI: 10.1097/md.0000000000037483] [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: 01/01/2024] [Accepted: 02/13/2024] [Indexed: 04/07/2024] Open
Abstract
Osteoarthritis (OA) is a major contributor to disability and social costs in the elderly. As the population ages and becomes increasingly obese, the incidence of the disease is higher than in previous decades. In recent years, important progress has been made in the causes and pathogenesis of OA pain. Modern medical treatment modalities mainly include the specific situation of the patient and focus on the core treatment, including self-management and education, exercise, and related weight loss. As an important part of complementary and alternative medicine, TCM has remarkable curative effect, clinical safety, and diversity of treatment methods in the treatment of OA. Traditional Chinese Medicine treatment of OA has attracted worldwide attention. Therefore, this article will study the pathophysiological mechanism of OA based on modern medicine, and explore the treatment of OA by acupuncture combined with Chinese Medicine.
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Affiliation(s)
- Biao Qi
- Shenzhen Baoan District Shiyan People’s Hospital, Shenzhen, China
| | - Zeyu Wang
- Shenzhen Pingshan District Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Ying Cao
- Shenzhen Pingshan District Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Haishen Zhao
- Community Health Service Center of Nanhui New Town, Shanghai, China
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Birmingham TB, Primeau CA, Shariff SZ, Reid JNS, Marsh JD, Lam M, Dixon SN, Giffin JR, Willits KR, Litchfield RB, Feagan BG, Fowler PJ. Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e246578. [PMID: 38635272 DOI: 10.1001/jamanetworkopen.2024.6578] [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] [Indexed: 04/19/2024] Open
Abstract
Importance It is unclear whether arthroscopic resection of degenerative knee tissues among patients with osteoarthritis (OA) of the knee delays or hastens total knee arthroplasty (TKA); opposite findings have been reported. Objective To compare the long-term incidence of TKA in patients with OA of the knee after nonoperative management with or without additional arthroscopic surgery. Design, Setting, and Participants In this ad hoc secondary analysis of a single-center, assessor-blinded randomized clinical trial performed from January 1, 1999, to August 31, 2007, 178 patients were followed up through March 31, 2019. Participants included adults diagnosed with OA of the knee referred for potential arthroscopic surgery in a tertiary care center specializing in orthopedics in London, Ontario, Canada. All participants from the original randomized clinical trial were included. Data were analyzed from June 1, 2021, to October 20, 2022. Exposures Arthroscopic surgery (resection or debridement of degenerative tears of the menisci, fragments of articular cartilage, or chondral flaps and osteophytes that prevented full extension) plus nonoperative management (physical therapy plus medications as required) compared with nonoperative management only (control). Main Outcomes and Measures Total knee arthroplasty was identified by linking the randomized trial data with prospectively collected Canadian health administrative datasets where participants were followed up for a maximum of 20 years. Multivariable Cox proportional hazards regression models were used to compare the incidence of TKA between intervention groups. Results A total of 178 of 277 eligible patients (64.3%; 112 [62.9%] female; mean [SD] age, 59.0 [10.0] years) were included. The mean (SD) body mass index was 31.0 (6.5). With a median follow-up of 13.8 (IQR, 8.4-16.8) years, 31 of 92 patients (33.7%) in the arthroscopic surgery group vs 36 of 86 (41.9%) in the control group underwent TKA (adjusted hazard ratio [HR], 0.85 [95% CI, 0.52-1.40]). Results were similar when accounting for crossovers to arthroscopic surgery (13 of 86 [15.1%]) during follow-up (HR, 0.88 [95% CI, 0.53-1.44]). Within 5 years, the cumulative incidence was 10.2% vs 9.3% in the arthroscopic surgery group and control group, respectively (time-stratified HR for 0-5 years, 1.06 [95% CI, 0.41-2.75]); within 10 years, the cumulative incidence was 23.3% vs 21.4%, respectively (time-stratified HR for 5-10 years, 1.06 [95% CI, 0.45-2.51]). Sensitivity analyses yielded consistent results. Conclusions and Relevance In this secondary analysis of a randomized clinical trial of arthroscopic surgery for patients with OA of the knee, a statistically significant association with delaying or hastening TKA was not identified. Approximately 80% of patients did not undergo TKA within 10 years of nonoperative management with or without additional knee arthroscopic surgery. Trial Registration ClinicalTrials.gov Identifier: NCT00158431.
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Affiliation(s)
- Trevor B Birmingham
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Codie A Primeau
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Salimah Z Shariff
- Bone and Joint Institute, University of Western Ontario, London, Canada
- ICES Western, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Jennifer N S Reid
- ICES Western, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Jacquelyn D Marsh
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Melody Lam
- ICES Western, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie N Dixon
- ICES Western, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - J Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Kevin R Willits
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Robert B Litchfield
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Brian G Feagan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Peter J Fowler
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Tsourmas NF, Bernacki EJ, Hunt DL, Kalia N, Lavin RA, Yuspeh L, Leung N, Green-McKenzie J, Tao XG. Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier. J Occup Environ Med 2024; 66:280-285. [PMID: 38234200 DOI: 10.1097/jom.0000000000003044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. OBJECTIVE To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). METHOD A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. RESULTS The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. CONCLUSIONS Undergoing an AM is associated with an increased risk of TKA in WC claimants.
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Affiliation(s)
- Nicholas F Tsourmas
- From the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (N.F.T., E.J.B., R.A.L., N.K., L.Y., N.L., X.T.); AF Group, Lansing, MI (D.L.H.); General Electric, Norwalk, Connecticut (N.K.); Corporate Administration Office, Strategy, Enterprise Risk, and Research, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana (L.Y.); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (N.F.T., N.L.). University of Pennsylvania, Philadelphia, Pennsylvania (J.G.-M.)
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Hernigou J, Lechien D, Kyriakidis T, Valcarenghi J, Muregancuro A, Hupez A, Callewier A. Arthroscopy with partial meniscectomy for degenerative tear does not increase the risk of total knee arthroplasty at five year follow up; however, this population undergoes total knee arthroplasty with a lower threshold of osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2024; 48:737-743. [PMID: 37919557 DOI: 10.1007/s00264-023-06024-0] [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: 08/01/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Degenerative meniscus tears can cause discomfort in some patients, and when medical treatments fail to provide relief, arthroscopy may be considered before resorting to knee prosthesis. However, the benefits of arthroscopy over nonsurgical treatments in patients over 60 years old are limited, and the evidence regarding its overall efficiency and drawbacks remains scarce. Furthermore, there has been no investigation into whether those patients treated with partial meniscectomy, undergo the knee operation at an earlier stage of osteoarthritis. METHODS This study focused on data from a single Belgian hospital, involving patients over 60 years old with internal meniscal tears. The participants were categorized into two groups based on the treatment they received: arthroscopic partial meniscectomy (APM) or conservative management. The primary outcome assessed was the occurrence of knee arthroplasty within a five year period. Secondary outcomes included evaluating the ICRS cartilage grade and the time taken until total knee arthroplasty (TKA). RESULTS A total of 194 patients with internal meniscal tears were included in the study. At the 5-year mark, the overall rate of knee arthroplasty was found to be 16.5%, with 11.9% of cases occurring within two years. After the 5-year follow-up, it was observed that 19.2% (24 patients) of the APM group and 11.6% (8 patients) of the conservative management group underwent knee arthroplasty. Notably, patients over 70 years old who underwent APM had a higher risk of eventually requiring TKA compared to those who received conservative management. Additionally, patients who underwent meniscectomy and later underwent TKA showed less wear in the internal compartment of the knee compared to patients in the conservative treatment group who underwent TKA. CONCLUSION The study suggests that patients who underwent arthroscopy faced a similar risk of knee arthroplasty compared to those who underwent conservative management, excepted for patients over 70 years old. Despite this similar risk of arthroplasty for the whole population, they exhibited lower osteoarthritis severity when compared to the conservative group.
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Affiliation(s)
- Jacques Hernigou
- Department of Orthopaedic Surgery and Traumatology, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium.
- Université libre de Bruxelles, Bruxelles, Belgium.
| | | | - Theofylaktos Kyriakidis
- 2nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Hellas, Greece
| | - Jérôme Valcarenghi
- Department of Orthopaedic Surgery and Traumatology, A. Paré Hospital, Hainaut, Belgium
| | - Aimée Muregancuro
- Department of Anesthesia, EpiCURA Baudour Hornu Hospital, Hainaut, Belgium
| | - Alexandre Hupez
- Department of Orthopaedic Surgery and Traumatology, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
| | - Antoine Callewier
- Department of Orthopaedic Surgery and Traumatology, EpiCURA Baudour Hornu Ath Hospital, Hainaut, Belgium
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Kon E, Anzillotti G, Di Matteo B, Hernigou P. Mission (im)possible: meniscal preservation and cartilage regeneration. INTERNATIONAL ORTHOPAEDICS 2023; 47:2371-2374. [PMID: 37702841 DOI: 10.1007/s00264-023-05969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Affiliation(s)
- Elizaveta Kon
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Milan, Pieve Emanuele, Italy
| | - Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Milan, Pieve Emanuele, Italy
| | - Berardo Di Matteo
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Milan, Rozzano, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Milan, Pieve Emanuele, Italy.
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Voinier D, Neogi T, Arbeeva L, Voinier S, Master H, Thoma LM, Brunette M, Jakiela JT, White DK. Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2023; 31:1091-1100. [PMID: 36822497 PMCID: PMC10523474 DOI: 10.1016/j.joca.2022.12.012] [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: 07/01/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. METHODS We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2 years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2 years, adjusting for potential confounders. RESULTS We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8 kg/m2). Mean PA composition was: MVPA 9.1 min/day, LPA 278 min/day, SED 690 min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β = -0.0005, P = 0.97), nor was LPA (β = 0.06, P = 0.27) or SED (β = -0.06, P = 0.21). CONCLUSION Using CoDA, PA composition was not associated with medial JSW loss over 2 years.
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Affiliation(s)
- D Voinier
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Arbeeva
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - S Voinier
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - H Master
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA.
| | - L M Thoma
- University of North Carolina at Chapel Hill, Division of Physical Therapy, Chapel Hill, NC, USA.
| | - M Brunette
- Evidation Health Inc, San Mateo, CA, USA.
| | - J T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - D K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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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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The value of reducing arthroscopic partial meniscectomy in the treatment of degenerative meniscus tears: a budget impact analysis. Int J Technol Assess Health Care 2023; 39:e7. [PMID: 36650723 DOI: 10.1017/s0266462322003361] [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: 01/19/2023]
Abstract
AIMS Numerous studies have shown that arthroscopic partial meniscectomy (APM) is not (cost-) effective in patients with symptoms attributed to a degenerative meniscus tear. We aimed to assess the budget impact of reducing APM in routine clinical practice in this population. MATERIALS AND METHODS A patient-level state transition model was developed to simulate patients recently diagnosed with a degenerative meniscus tear. Three strategies were compared: "current guideline" (i.e., postpone surgery to at least 3 months after diagnosis), "APM at any time" (i.e., APM available directly after diagnosis), and "nonsurgical" (i.e., APM no longer performed). Total societal costs over 5 years were calculated to determine the budget impact. Probabilistic and deterministic sensitivity analyses were conducted to address uncertainty. RESULTS The average cost per patient over 5 years were EUR 5,077, EUR 4,577, and EUR 4,218, for the "APM at any time," "current guideline," and "nonsurgical" strategy, respectively. Removing APM from the treatment mix (i.e., 30,000 patients per year) in the Netherlands, resulted in a reduction in health care expenditures of EUR 54 million (95 percent confidence interval [CI] EUR 38 million-EUR 70 million) compared to the "current guideline strategy" and EUR 129 million (95 percent CI EUR 102 million-EUR 156 million) compared to the "APM at any time" strategy. Sensitivity analyses showed that uncertainty did not alter our conclusions. CONCLUSIONS Substantial costs can be saved when APM is no longer performed to treat symptoms attributed to degenerative meniscus tears in the Netherlands. It is therefore recommended to further reduce the use of APM to treat degenerative meniscus tears.
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Deng T, Li X, Guo Z, Guo S, Zhou Y, Zhang W, Zhang Y. Management Strategies and Imaging Observation of Early and Delayed Intelligent Treatment of Meniscus Sports Injury under Knee Osteoarthroscopy. SCANNING 2022; 2022:8716823. [PMID: 36111266 PMCID: PMC9448593 DOI: 10.1155/2022/8716823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Objective To investigate the meniscus characteristics of knee osteoarthritis and its guiding significance for minimally invasive surgery. Methods A total of 100 patients with knee meniscus sports injuries who were treated in our hospital from January 2019 to January 2022 were selected as the research subjects and were grouped according to the interval between injury and surgery, with an interval of 2 months: the early group (53 cases) within 2 months and the delayed group (47 cases) with an interval of more than 2 months. The distribution of intraoperative complications in the two groups was observed and recorded, and the changes in pain degree, joint range of motion, knee joint function, and quality of life scores before and after operation were compared between the two groups. Results The postoperative VAS score, range of motion, Lysholm score, IKDC knee subjective function score, and quality of life score were significantly improved in both groups (P < 0.05). The incidence of intra-articular cartilage injury in the delayed group was significantly higher than that in the early group (P < 0.05). The patellofemoral cartilage injury was the main part of intra-articular cartilage injury in the two groups, and the incidence of patellofemoral cartilage injury in the delayed group was significantly higher than that in the early group (P < 0.05). The cartilage damage was mainly cartilage damage, and the grades I-II and III-IV cartilage damages were significantly increased in the extension group. Conclusion Meniscal injury in knee osteoarthritis has certain microscopic characteristics. In this paper, the microscopic classification of meniscus injury in knee osteoarthritis is helpful to guide microscopic surgery and improve the minimally invasive knee osteoarthritis effect of surgical treatment.
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Affiliation(s)
- Tong Deng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xu Li
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhe Guo
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Shuang Guo
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yan Zhou
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Zhang
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ying Zhang
- Beijing Jishuitan Hospital, Beijing 100035, China
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Fernández-Matías R, García-Pérez F, Gavín-González C, Martínez-Martín J, Valencia-García H, Flórez-García MT. Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 143:2609-2620. [PMID: 35996030 DOI: 10.1007/s00402-022-04579-y] [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: 06/03/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are no meta-analytical data in the long term for comparing surgery and exercise for meniscal tear. The aim of this study is to compare the effectiveness of exercise versus arthroscopic partial meniscectomy (APM) plus exercise for degenerative meniscal tears (DMT) in knee function at 5-year follow-up. MATERIALS AND METHODS A systematic search of Medline, EMBASE, Web of Science, SciELO, SPORTDiscus, Scopus, and Cochrane Library was performed. The studies were included if they were randomized controlled trials performed in patients aged ≥ 18 years with DMT, that compared physical therapy to APM at 5-year follow-up, and reported at least one outcome measure of knee function/disability. Risk of bias was analyzed with the Cochrane RoB-2 tool and certainty of evidence with GRADE recommendations. A random effects model meta-analysis was performed. RESULTS 3743 articles were identified and 4 met the criteria. Three had low risk of bias and one had some concerns. There were no significant between-group differences, in within-group changes from baseline to 5-year, on the Knee Injury and Osteoarthritis Outcome Score pain (- 2.28; 95% CI - 5.41 to 0.84), symptoms (- 0.24; 95% CI - 4.13 to 3.64), activities of daily living (- 2.16; 95% CI - 6.16 to 1.83) and quality of life (- 3.98; 95% CI - 9.05 to 1.10). There was a significant difference in support of APM plus exercise for sport/recreation (- 9.28; 95% CI - 18.28 to - 0.29). Leave-one-out sensitivity analysis revealed a non-significant difference in sport/recreation (- 5.05; 95% CI - 12.04 to 1.94). There were no differences in other patient-reported outcome measures. CONCLUSION Moderate certainty of evidence suggests that the addition of APM to an exercise program adds no benefits in knee function at 5-year follow-up.
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Affiliation(s)
- Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain.
- Physiotherapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain.
| | - Fernando García-Pérez
- Physiotherapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain
| | - Carlos Gavín-González
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain
| | - Javier Martínez-Martín
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain
| | - Homero Valencia-García
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, 28922, Madrid, Spain
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Kitahashi T, Kogawa R, Nakamura K, Sekiya I. Integrin β1, PDGFRβ, and type II collagen are essential for meniscus regeneration by synovial mesenchymal stem cells in rats. Sci Rep 2022; 12:14148. [PMID: 35986079 PMCID: PMC9391488 DOI: 10.1038/s41598-022-18476-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractSynovial mesenchymal stem cells (MSCs) injected into the knee promote meniscus regeneration in several animal models; however, the mode of action is unknown. Our purpose was to identify the molecules responsible for this meniscus regeneration. Rat synovial MSCs were treated with neutralizing antibodies for integrin β1, PDGFRβ, or CD44 or with the CRISPR/Cas9 system to delete Vcam1, Tnfr1, or Col2a1 genes. After partial meniscectomy, rat knees were injected with MSCs, and the regenerated meniscus area was quantified three weeks later. The in vivo and in vitro functions were compared between the treated and control MSCs. Anti-integrin β1 neutralizing antibody inhibited in vitro MSC adhesion to collagen-coated chambers, anti-PDGFRβ neutralizing antibody inhibited proliferation in culture dishes, and Col2a1 deletion inhibited in vitro chondrogenesis. In vivo, the regenerated meniscus area was significantly smaller after injection of MSCs treated with integrin β1 and PDGFRβ neutralizing antibodies or lacking type II collagen gene than after control MSC injection. By contrast, the regenerated areas were similar after injection of control, CD44-, Vcam1-, or Tnfr1 treated MSCs (n = 12–16) MSCs. Synovial MSCs injected into the knee joint promoted meniscus regeneration by adhesion to integrin β1 in the meniscectomized region, proliferation by PDGFRβ, and cartilage matrix production from type II collagen.
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Santana DC, Oak SR, Jin Y, Rothy A, Lee LL, Katz JN, Winalski CS, Duryea J, Jones MH. Increased Joint Space Narrowing After Arthroscopic Partial Meniscectomy: Data From the Osteoarthritis Initiative. Am J Sports Med 2022; 50:2075-2082. [PMID: 35604336 DOI: 10.1177/03635465221096790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy (APM) is widely performed and remains an important therapeutic option for patients with a meniscal tear. However, it is debated whether or not APM accelerates the progression of osteoarthritis (OA) in the long term. PURPOSE/HYPOTHESIS The purpose was to compare the progression of OA measured by the change in tibiofemoral joint space width (JSW)-a quantitative measure of OA radiographic severity-across 3 groups with a midterm follow-up: (1) patients undergoing APM; (2) those with a meniscal tear treated nonoperatively; and (3) those without a tear. We hypothesized that the reduction in JSW would be greatest in patients undergoing APM and least in those patients without a tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Using the Osteoarthritis Initiative cohort, a total of 144 patients were identified that underwent APM with at least 12 months of follow up and without previous knee surgery. Those with a meniscal tear who did not have APM (n = 144) and those without a tear (n = 144) were matched to patients who had APM by sex, age, Kellgren-Lawrence (KL) grade, and follow up time. Participants underwent magnetic resonance imaging at baseline. Knee radiographs to assess JSW were collected annually or biannually. The change in minimum medial compartment JSW was calculated using a validated automated method. A piecewise linear mixed effects model was constructed to examine the relationship between JSW decline over time and treatment group-adjusting for age, body mass index, smoking status, KL grade, and baseline JSW. RESULTS All groups had comparable baseline JSW-ranging from 4.33 mm to 4.38 mm. The APM group had a rate of JSW decline of -0.083 mm/mo in the first 12 months and -0.014 mm/mo between 12 and 72 months. The rate of JSW decline in the APM group was approximately 27 times greater in the first 12 months than that in the nonsurgical group (-0.003 mm/mo) and 5 times greater than that in the no tear group (-0.015 mm/mo); however, there was no significant difference between groups for 12 to 72 months (nonsurgical group: -0.009 mm/mo; no tear group: -0.010 mm/mo). The adjusted JSW in the APM group was 4.38 mm at baseline and decreased to 2.57 mm at 72 months; the JSW in the nonsurgical group declined from 4.31 mm to 3.73 mm, and in the no tear group it declined from 4.33 mm to 3.54 mm. There was a statistically significant difference in JSW change between baseline and 72 months for the APM group compared with the other groups (P < .001), but not between the nonsurgical and no tear groups (P = .12). CONCLUSION In the first postoperative year, APM results in a faster rate of joint space narrowing compared with knees undergoing nonsurgical management of meniscal tears. Thereafter, there are comparable rates of OA progression regardless of the chosen management. APM results in a persistent decrease in JSW over at least 72 months. An untreated meniscal tear does not contribute to radiographic progression-assessed by JSW-as compared with an intact meniscus.
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Affiliation(s)
- Daniel C Santana
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sameer R Oak
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Ling-Ling Lee
- Cleveland Clinic Family Medicine Residency, Lakewood, Ohio, USA
| | - Jeffrey N Katz
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl S Winalski
- Department of Radiology and Biomedical Engineering, Program of Advanced Musculoskeletal Imaging, Lerner Research Institute, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeff Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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McHugh C, Opare-Addo M, Collins J, Jones M, Selzer F, Losina E, Katz J. Treatment of the syndrome of knee pain and meniscal tear in middle-aged and older persons: A narrative review. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4. [PMID: 35991623 PMCID: PMC9384701 DOI: 10.1016/j.ocarto.2022.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: Design: Results: Conclusion:
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Di Matteo B, Anzillotti G, Kon E. Navigating around the Current Options to Preserve and Regenerate Meniscus: A Long Journey Still to Be Pursued. Int J Mol Sci 2022; 23:ijms23116057. [PMID: 35682735 PMCID: PMC9181105 DOI: 10.3390/ijms23116057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Berardo Di Matteo
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Correspondence:
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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Gadelkarim M, elmegeed AA, Hafez A, Awad AK, Shehata MA, AbouEl-Enein A, Alsadek ME, Deeb MA, Afifi AM. Safety and Efficacy of Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Joint Bone Spine 2022; 89:105404. [DOI: 10.1016/j.jbspin.2022.105404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
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Rampersaud YR, Canizares M, Zywiel MG, Leroux T, Gandhi R, Veillette C, Marshall W, Ogilvie-Harris D, Cram P, Coyte P, Mohamed N. Evaluation of Trends in Knee Arthroscopy from 2004 to 2019 in Ontario, Canada. NEJM EVIDENCE 2022; 1:EVIDoa2100036. [PMID: 38319226 DOI: 10.1056/evidoa2100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND: How changes in recommendations for the use of knee arthroscopy have influenced real-world practice remains unclear. We assessed temporal trends in knee arthroscopy volume, costs, and rates of progression to knee arthroplasty following arthroscopy in Ontario, Canada. METHODS: We used diagnostic codes from population-based administrative databases from Ontario, Canada, to identify patients who underwent knee arthroscopy from April 1, 2004 to March 31, 2019. We calculated arthroscopy volume, costs, and rates of progression to knee arthroplasty within 1, 2, and 5 years following arthroscopy. RESULTS: A total of 408,040 arthroscopy procedures were included. The number of procedures declined 8.9% from 24,070 in 2004/2005 to 21,930 in 2018/2019. The volume of arthroscopy for osteoarthritis declined by 77.9% between 2007/2008 and 2018/2019. For degenerative meniscus disorders, the volume increased by 57.6% between 2004/2005 and 2013/2014, and then declined by 34.6% between 2013/2014 and 2018/2019. Among patients with osteoarthritis, rates of progression to knee arthroplasty were 3.8%, 9.6%, and 16.0%, at 1, 2, and 5 years, respectively, compared with rates among patients with degenerative meniscal disorders, which were 1.6%, 4.1%, and 7.3% at 1, 2, and 5 years, respectively. Over this period, progression to knee arthroplasty rates declined across diagnosis groups. These trends remained after adjusting for patient, surgeon, and hospital characteristics. CONCLUSIONS: In Ontario, Canada, utilization of knee arthroscopy declined between 2004/2005 and 2018/2019, with a concomitant decline in the rates of progression to knee arthroplasty within 1 to 5 years. Among the possible interpretations, our data are consistent with the hypothesis that clinical practice evolved as evidence-based recommendations against the use of knee arthroscopy for degenerative diagnoses were promulgated. (Funded by the Toronto General and Western Hospital Foundation through the University Health Network–Schroeder Arthritis Institute.)
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Affiliation(s)
- Y Raja Rampersaud
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | | | - Michael G Zywiel
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Timothy Leroux
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Christian Veillette
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Wayne Marshall
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Darrel Ogilvie-Harris
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
| | - Peter Cram
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Peter Coyte
- Institute of Health Policy, Management and Evaluation, School of Public Health, University of Toronto, Toronto
| | - Nizar Mohamed
- Schroeder Arthritis Institute, University Health Network, Toronto
- Division of Orthopaedic Surgery, University Health Network, Toronto
- Department of Surgery, University of Toronto, Toronto
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Sebastianelli WJ, Hanna T, Smith NP. Treatment, Return to Play, and Performance Following Meniscus Surgery. Curr Rev Musculoskelet Med 2022; 15:157-169. [PMID: 35467166 DOI: 10.1007/s12178-022-09754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The standard of care in meniscal tear management is constantly evolving, especially for athletes and high-demand patients. Meniscus repairs, meniscus transplants, and partial meniscectomies are commonly performed, and rehabilitation methods following these operations are becoming more sophisticated. The ultimate goal of these procedures is returning patients to full activity with minimal risks. Return to play should be systematic, pathology dependent, and individualized to an athlete's needs, expectations, and level of play. This article provides a review of the current treatment modalities of meniscus tears, the rehabilitation protocols following each modality, and the return to play criteria that must be met before releasing the player to competition. In addition, it overviews articles that describe performance outcomes of patients that have undergone meniscus surgery. RECENT FINDINGS Current research shows high return to play rates for athletes that undergo meniscus surgery and describes effective rehabilitation protocols to facilitate recovery. There is an increased emphasis on meniscus preservation in recent literature. In addition, meniscus allograft transplantation has demonstrated its efficacy as a salvage procedure and has become a stronger consideration in the athlete with meniscus pathology. No standardized return to play protocol can be applied uniformly to all kinds of meniscal surgeries, and two athletes with the same pathology cannot be expected to follow identical paths towards full recovery. A multidisciplinary approach to care should be provided to the patients, and in the case of patients with high levels of athleticism, the road to recovery starts even before the injury itself.
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Affiliation(s)
- Wayne J Sebastianelli
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA.
| | - Tammam Hanna
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA
| | - Nathan P Smith
- Penn State College of Medicine, Department of Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
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Sports Participation and Performance 5 Years After Arthroscopic Partial Meniscectomy: A Retrospective Cohort Study of 288 Patients. J Orthop Sports Phys Ther 2022; 52:224-232. [PMID: 35442751 DOI: 10.2519/jospt.2022.10785] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate return to sport (RTS) approximately 5 years after arthroscopic partial meniscectomy (APM). DESIGN Retrospective cohort study. METHODS Knee Arthroscopy Cohort Southern Denmark patients were asked about RTS and reasons for non-RTS approximately 5 years (range, 4-6 years) after APM using online questionnaires. Patients engaged in their sport at the pre-injury level at follow-up were classified as "RTS" (or "returned to sport") and as being engaged in their sport with (1) full participation and performance, (2) reduced performance, or (3) both reduced participation and performance. Self-reported knee function was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS We included 288 patients (mean ± SD age, 49 ± 12 years; 44% women). Of these, 172 patients (60%; 95% confidence interval, 54%-65%) were classified as returned to sport, but only 42% (72/172) reported full participation and performance. Persistent problems with the operated knee were reported by 60% of the patients as the main reason for reduced participation or performance and by 70% of the patients as the main reason for not returning to pre-injury levels of their sport. Patients who had returned to sport, on average, improved by 10.1 points (95% confidence interval, 5.7-14.4) more in KOOS4 scores from baseline to 5 years than non-RTS patients. CONCLUSION At approximately 5 years after APM, 6 in every 10 patients had returned to their sport at pre-injury levels, but only 1 in every 4 returned with full participation and performance, mainly due to persistent knee problems. Greater improvements in KOOS scores were observed in patients who were classified as returned to sport. J Orthop Sports Phys Ther 2022;52(4):224-232. doi:10.2519/jospt.2022.10785.
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Wijn SRW, Rovers MM, Hannink G. Confounding adjustment methods in longitudinal observational data with a time-varying treatment: a mapping review. BMJ Open 2022; 12:e058977. [PMID: 35304403 PMCID: PMC8935170 DOI: 10.1136/bmjopen-2021-058977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To adjust for confounding in observational data, researchers use propensity score matching (PSM), but more advanced methods might be required when dealing with longitudinal data and time-varying treatments as PSM might not include possible changes that occurred over time. This study aims to explore which confounding adjustment methods have been used in longitudinal observational data to estimate a treatment effect and identify potential inappropriate use of PSM. DESIGN Mapping review. DATA SOURCES We searched PubMed, from inception up to January 2021, for studies in which a treatment was evaluated using longitudinal observational data. ELIGIBILITY CRITERIA Methodological, non-medical and cost-effectiveness papers were excluded, as were non-English studies and studies that did not study a treatment effect. DATA EXTRACTION AND SYNTHESIS Studies were categorised based on time of treatment: at baseline (interventions performed at start of follow-up) or time-varying (interventions received asynchronously during follow-up) and sorted based on publication year, time of treatment and confounding adjustment method. Cumulative time series plots were used to investigate the use of different methods over time. No risk-of-bias assessment was performed as it was not applicable. RESULTS In total, 764 studies were included that met the eligibility criteria. PSM (165/201, 82%) and inverse probability weighting (IPW; 154/502, 31%) were most common for studies with a treatment at baseline (n=201) and time-varying treatment (n=502), respectively. Of the 502 studies with a time-varying treatment, 123 (25%) used PSM with baseline covariates, which might be inappropriate. In the past 5 years, the proportion of studies with a time-varying treatment that used PSM over IPW increased. CONCLUSIONS PSM is the most frequently used method to correct for confounding in longitudinal observational data. In studies with a time-varying treatment, PSM was potentially inappropriately used in 25% of studies. Confounding adjustment methods designed to deal with a time-varying treatment and time-varying confounding are available, but were only used in 45% of the studies with a time-varying treatment.
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Affiliation(s)
- Stan R W Wijn
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms and Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
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Collins JE, Shrestha S, Losina E, Marx RG, Guermazi A, Jarraya M, Jones MH, Levy BA, Mandl LA, Williams EE, Wright RW, Spindler KP, Katz JN. Five-Year Structural Changes in Patients with Meniscal Tear and Osteoarthritis: Data from an RCT of Arthroscopic Partial Meniscectomy vs. Physical Therapy. Arthritis Rheumatol 2022; 74:1333-1342. [PMID: 35245416 PMCID: PMC9339455 DOI: 10.1002/art.42105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/12/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Data from long-term follow-up of several randomized controlled trials (RCTs) of arthroscopic partial meniscectomy (APM) vs. non-operative therapy or sham have suggested that APM may be associated with increased risk of worsening in radiographic features of osteoarthritis (OA). Our objective was to estimate the risk of MRI-based OA structural changes using baseline, 18-month, and 60-month MRI data from an RCT of APM vs. physical therapy in participants with meniscal tear and OA. METHODS We used data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical change in joint structure. Analyses assessed change from baseline to 18 months and 18-to-60 months. We performed both intention-to-treat and as-treated analyses. RESULTS The analytic sample included 302 participants. For both treatment groups, more change was seen over the earlier (baseline - 18 months) interval than the later interval. APM was associated with increased risk of any worsening in cartilage surface area damage score (relative risk 1.35, 95% CI 1.14-1.61), osteophytes, and effusion-synovitis over the earlier time period. Only change in osteophytes was significantly different between treatment groups in the later time period. CONCLUSION These findings suggest the association between APM and MRI-based changes is most apparent in the 18 months after surgery. The reason for the attenuation of this association over longer follow-up merits further investigation.
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Affiliation(s)
- Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Swastina Shrestha
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Boston University School of Public Health, Boston, MA
| | - Robert G Marx
- Department of Orthopaedic Surgery, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA
| | - Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine Boston, MA.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Morgan H Jones
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Lisa A Mandl
- Department of Medicine, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY
| | - Emma E Williams
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Better Outcomes but No Difference in Joint Space Narrowing at Five Years Among Patients Without Unstable Chondral Lesions Versus Those With Unstable Chondral Lesions (Left In Situ) at the Time of Arthroscopic Partial Meniscectomy. Arthroscopy 2022; 38:936-944. [PMID: 34265389 DOI: 10.1016/j.arthro.2021.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare 5-year outcomes among patients with and without unstable chondral lesions undergoing arthroscopic partial meniscectomy (APM). METHODS Using data from the Chondral Lesions And Meniscal Procedures (ChAMP) Trial, we compared outcomes for patients with unstable chondral lesions found at the time of APM and left in situ (CL-noDeb, N = 71) versus patients without unstable chondral lesions (NoCL, N = 47) at 5 years after APM. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog pain scale, Short-form Health Survey (SF-36), physical knee measurements, progressive joint space narrowing on radiographs, and the rate of additional knee surgery. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% confidence intervals (CIs) adjusted for age, body mass index, and preoperative score (for postoperative scores). RESULTS Compared with CL-noDeb, NoCL subjects had significantly greater improvement at 5 years in the KOOS score for function in sport and recreation (MD = 9.9 [95% CI, 0.7-19.1]), SF-36 pain (MD = 13.9 [95% CI, 5.5-22.3]), knee extension (MD = 0.8 [95% CI, 0.1-1.5]), and decreased quadriceps circumference at the mid-portion of the patella (MD = -1.5 [95% CI, -2.7 to -0.3). A greater proportion of patients in the NoCL group achieved the MCID for all outcome scores except for the WOMAC pain score (89% CL-NoDeb vs 87% NoCL) and SF-36 general (29% CL-NoDeb vs 23% NoCL). There were no significant group differences in measures of progressive radiographic joint space narrowing in any compartments of the operative knee and no significant difference in the rate of additional knee surgery within 5 years of the initial APM. CONCLUSIONS Patients undergoing APM without unstable chondral lesions had statistically significantly better outcomes than patients with unstable chondral lesions at 5 years after surgery; however, there were no group differences in progressive radiographic joint space narrowing. LEVEL OF EVIDENCE Level II, prospective comparative study.
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22
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Liu Q, Chu H, LaValley MP, Hunter DJ, Zhang H, Tao L, Zhan S, Lin J, Zhang Y. Prediction models for the risk of total knee replacement: development and validation using data from multicentre cohort studies. THE LANCET RHEUMATOLOGY 2022; 4:e125-e134. [PMID: 36177295 PMCID: PMC9517949 DOI: 10.1016/s2665-9913(21)00324-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Few prognostic prediction models for total knee replacement are available, and the role of radiographic findings in predicting its use remains unclear. We aimed to develop and validate predictive models for total knee replacement and to assess whether adding radiographic findings improves predictive performance. Methods We identified participants with recent knee pain (in the past 3 months) in the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI). The baseline visits of MOST were initiated in 2003 and of OAI were initiated in 2004. We developed two predictive models for the risk of total knee replacement within 60 months of follow-up by fitting Cox proportional hazard models among participants in MOST. The first model included sociodemographic and anthropometric factors, medical history, and clinical measures (referred to as the clinical model). The second model added radiographic findings into the predictive model (the radiographic model). We evaluated each model's discrimination and calibration performance and assessed the incremental value of radiographic findings using both category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI). We tuned the models and externally validated them among participants in OAI. Findings We included 2658 participants from MOST (mean age 62·4 years [SD 8·1], 1646 [61·9%] women) in the training dataset and 4060 participants from OAI (mean age 60·9 years [9·1], 2379 [58·6%] women) in the validation dataset. 290 (10·9%) participants in the training dataset and 174 (4·3%) in the validation dataset had total knee replacement. The retained predictive variables included in the clinical model were age, sex, race, history of knee arthroscopy, frequent knee pain, current use of analgesics, current use of glucosamine, body-mass index, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, and the most predictive factors were age, race, and WOMAC pain score. The retained predictive variables in the radiographic model were age, sex, race, frequent knee pain, current use of analgesics, WOMAC pain score, and Kellgren-Lawrence grade, and the most predictive factors were Kellgren-Lawrence grade, race, and age. The C-statistic was 0·79 (95% CI 0·76-0·81) for the clinical model and 0·87 (0·85-0·99) for the radiographic model in the training dataset. The calibration slope was 0·95 (95% CI 0·86-1·05) and 0·96 (0·87-1·04), respectively. Adding radiograph findings significantly improved predictive performance with an NRI of 0·43 (95% CI 0·38-0·50) and IDI of 0·14 (95% CI: 0·10-0·18). Both models, with tuned coefficients, showed a good predictive performance among participants in the validation dataset. Interpretation The risk of total knee replacement can be predicted based on common risk factors with good discrimination and calibration. Additionally, adding radiographic findings of knee osteoarthritis into the model substantially improves its predictive performance. Funding National Natural Science Foundation of China, National Key Research and Development Program, and Beijing Municipal Science & Technology Commission.
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Strength of interference screw fixation of meniscus prosthesis matches native meniscus attachments. Knee Surg Sports Traumatol Arthrosc 2022; 30:2259-2266. [PMID: 34665300 PMCID: PMC9206603 DOI: 10.1007/s00167-021-06772-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/07/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Meniscal surgery is one of the most common orthopaedic surgical interventions. Total meniscus replacements have been proposed as a solution for patients with irreparable meniscal injuries. Reliable fixation is crucial for the success and functionality of such implants. The aim of this study was to characterise an interference screw fixation system developed for a novel fibre-matrix-reinforced synthetic total meniscus replacement in an ovine cadaveric model. METHODS Textile straps were tested in tension to failure (n = 15) and in cyclic tension (70-220 N) for 1000 cycles (n = 5). The textile strap-interference screw fixation system was tested in 4.5 mm-diameter single anterior and double posterior tunnels in North of England Mule ovine tibias aged > 2 years using titanium alloy (Ti6Al4Va) and polyether-ether-ketone (PEEK) screws (n ≥ 5). Straps were preconditioned, dynamically loaded for 1000 cycles in tension (70-220 N), the fixation slippage under cyclic loading was measured, and then pulled to failure. RESULTS Strap stiffness was at least 12 times that recorded for human meniscal roots. Strap creep strain at the maximum load (220 N) was 0.005 following 1000 cycles. For all tunnels, pull-out failure resulted from textile strap slippage or bone fracture rather than strap rupture, which demonstrated that the textile strap was comparatively stronger than the interference screw fixation system. Pull-out load (anterior 544 ± 119 N; posterior 889 ± 157 N) was comparable to human meniscal root strength. Fixation slippage was within the acceptable range for anterior cruciate ligament graft reconstruction (anterior 1.9 ± 0.7 mm; posterior 1.9 ± 0.5 mm). CONCLUSION These findings show that the textile attachment-interference screw fixation system provides reliable fixation for a novel ovine meniscus implant, supporting progression to in vivo testing. This research provides a baseline for future development of novel human meniscus replacements, in relation to attachment design and fixation methods. The data suggest that surgical techniques familiar from ligament reconstruction may be used for the fixation of clinical meniscal prostheses.
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Reito A, Harris IA, Karjalainen T. Arthroscopic partial meniscectomy: did it ever work? Acta Orthop 2021; 93:1-10. [PMID: 34605736 PMCID: PMC8815409 DOI: 10.1080/17453674.2021.1979793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.
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Affiliation(s)
- Aleksi Reito
- Department of Orthopaedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia
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Pihl K, Englund M, Christensen R, Lohmander LS, Jørgensen U, Viberg B, Fristed JV, Thorlund JB. Less improvement following meniscal repair compared with arthroscopic partial meniscectomy: a prospective cohort study of patient-reported outcomes in 150 young adults at 1- and 5-years' follow-up. Acta Orthop 2021; 92:589-596. [PMID: 33929284 PMCID: PMC8519526 DOI: 10.1080/17453674.2021.1917826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery.Patients and methods - We included 150 patients aged 18-40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life-KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4-6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint.Results - 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference -12, [95% CI -19 to -4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar.Interpretation - Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.
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Affiliation(s)
- Kenneth Pihl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden;
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; ,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark;
| | - L Stefan Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
| | - Uffe Jørgensen
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark;
| | - Bjarke Viberg
- Department of Orthopedics, Lillebaelt Hospital, Kolding, Denmark;
| | | | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; ,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Correspondence:
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Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Scrivens B, Connaughton A, Zhou Z, Zhao J. Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: Analysis of Patient Outcomes and Degenerative Joint Disease at 5 Years in the Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:1569-1577. [PMID: 34133394 DOI: 10.2106/jbjs.20.01582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the effect of debridement (CL-Deb) versus observation (CL-noDeb) of unstable chondral lesions on knee pain 5 years after arthroscopic partial meniscectomy (APM) in patients enrolled in the Chondral Lesions And Meniscus Procedures (ChAMP) Trial. Secondarily, other knee symptoms, function, general health, and the rate of additional surgery on the affected knee were examined. METHODS Patients aged ≥30 years who had an unstable Outerbridge grade-II, III, or IV chondral lesion when undergoing APM were randomly allocated to the CL-Deb (n = 98) or CL-noDeb (n = 92) group; ∼80% in each group completed a 5-year follow-up. Outcomes were measured preoperatively and at 5 years postoperatively, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Short Form-36 (SF-36), physical knee measurements, knee radiographs, and rate of additional knee surgery at 5 years. The primary outcome was the 5-year WOMAC pain score. Group comparisons were made using the t test for continuous outcomes and the Fisher exact test for categorical outcomes. RESULTS There were no significant differences between the groups with respect to the primary outcome, the WOMAC pain score (CL-Deb: 86.0 [95% confidence interval (CI): 82.9 to 89.1]) versus CL-noDeb: 88.3 [95% CI: 85.5 to 91.1]; p = 0.27), or secondary outcomes at 5 years. There were also no differences in radiographic measurements of joint-space narrowing in any compartment (medial or lateral tibiofemoral or medial, central, or lateral patellofemoral) as well as no difference in the rate of additional knee surgery within 5 years after APM between the CL-Deb and CL-noDeb groups. CONCLUSIONS Outcomes for the CL-Deb and CL-noDeb groups did not differ at 5 years postoperatively, suggesting that there is no long-term benefit of arthroscopic debridement of chondral lesions encountered during APM. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Leslie J Bisson
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Melissa A Kluczynski
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - William M Wind
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Marc S Fineberg
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Geoffery A Bernas
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Michael A Rauh
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - John M Marzo
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Brian Scrivens
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Alexander Connaughton
- Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Zehua Zhou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Jiwei Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison, Wisconsin
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Mason D, Englund M, Watt FE. Prevention of posttraumatic osteoarthritis at the time of injury: Where are we now, and where are we going? J Orthop Res 2021; 39:1152-1163. [PMID: 33458863 DOI: 10.1002/jor.24982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
This overview of progress made in preventing post-traumatic osteoarthritis (PTOA) was delivered in a workshop at the Orthopaedics Research Society Annual Conference in 2019. As joint trauma is a major risk factor for OA, defining the molecular changes within the joint at the time of injury may enable the targeting of biological processes to prevent later disease. Animal models have been used to test therapeutic targets to prevent PTOA. A review of drug treatments for PTOA in rodents and rabbits between 2016 and 2018 revealed 11 systemic interventions, 5 repeated intra-articular or topical interventions, and 5 short-term intra-articular interventions, which reduced total Osteoarthritis Research Society International scores by 30%-50%, 20%-70%, and 0%-40%, respectively. Standardized study design, reporting of effect size, and quality metrics, alongside a "whole joint" approach to assessing efficacy, would improve the translation of promising new drugs. A roadblock to translating preclinical discoveries has been the lack of guidelines on the design and conduct of human trials to prevent PTOA. An international workshop addressing this in 2016 considered inclusion criteria and study design, and advocated the use of experimental medicine studies to triage candidate treatments and the development of early biological and imaging biomarkers. Human trials for the prevention of PTOA have tested anakinra after anterior cruciate ligament rupture and dexamethasone after radiocarpal injury. PTOA offers a unique opportunity for defining early mechanisms of OA to target therapeutically. Progress in trial design and high-quality preclinical research, and allegiance with patients, regulatory bodies, and the pharmaceutical industry, will advance this field.
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Affiliation(s)
- Deborah Mason
- Biomechanics and Bioengineeering Centre Versus Arthritis, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund Unversity, Lund, Sweden
| | - Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
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Influence of peracetic acid-ethanol sterilisation on the biomechanical properties of human meniscus transplants. J Exp Orthop 2021; 8:18. [PMID: 33674898 PMCID: PMC7936009 DOI: 10.1186/s40634-021-00336-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Meniscus allograft transplantation (MAT) is a possible treatment for patients suffering with pain after meniscectomy. Here, peracetic acid (PAA) sterilised meniscus transplants were investigated on whether they would provide an adequate alternative to fresh-frozen transplants in their viscoelastic and mechanical properties. Methods In this analysis, 31 menisci donors (26 male and 5 female) were included. The average donor age was 49.87 years, ranging from 32 to 65 years. Menisci of matched pairs of knees underwent chemical sterilisation while counterparts were left fresh-frozen. Stiffness and load to failure were determined via suture retention. Further menisci were analysed while attached to the tibial bone block using a novel test device to mimic physiological load distribution. Meniscus relaxation, stiffness and failure loads were determined. Histology and biphasic properties of the menisci were examined and results were analysed using paired t-tests. Results A novel custom built test device allowed the application of physiological loads for suture retention testing and revealed no significant differences between PAA sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) regarding stiffness and failure load, respectively. Furthermore, initial 200 N loading showed significantly higher strain in sterilised menisci (18.87 ± 1.56) compared to fresh frozen (13.81 ± 1.04). Load relaxation experiments demonstrated significantly lower relaxation for sterilised menisci (77.71 ± 1.62) compared to fresh-frozen (89.11 ± 1.00, p-value < 0.0001). Conclusion Peracetic acid sterilised human menisci performed equally to fresh-frozen counterparts in a suture retention test and in physiological failure testing providing an adequate alternative. However, meniscus relaxation, biphasic properties and strain were shown to be significantly different between the groups. A common problem of MAT is graft extrusion or shrinkage, therefore the parameters measured here should be considered and may influence meniscus extrusion after transplantation. Level of evidence n/a (experimental study)
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Dantas LO, Salvini TDF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther 2021; 25:135-146. [PMID: 33262080 PMCID: PMC7990728 DOI: 10.1016/j.bjpt.2020.08.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation. OBJECTIVE To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA. CONCLUSION There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | | | - Timothy E McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA.
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O'Leary H, Ryan LG, Robinson K, Conroy EJ, McCreesh K. "You'd be better off to do the keyhole and make a good job of it" a qualitative study of the beliefs and treatment expectations of patients attending secondary care with degenerative meniscal tears. Musculoskelet Sci Pract 2021; 51:102281. [PMID: 33161307 DOI: 10.1016/j.msksp.2020.102281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current clinical practice guidelines for degenerative meniscal tears recommend conservative management yet patients are frequently referred to the consultant orthopaedic surgeon despite a lack of evidence for the use of arthroscopy. OBJECTIVES To explore the beliefs about their condition and treatment expectations of patients referred to a secondary care orthopaedic clinic with a degenerative meniscal tear. DESIGN AND METHODS Design and MethodsThis qualitative study involved ten patients who participated in semi-structured telephone interviews. Data were subjected to thematic analysis and findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. RESULTS Analysis identified five themes. Participants described beliefs, strongly influenced by magnetic resonance imaging (MRI) results, that damaged structures were causing their knee problems ("The meniscus is busted"), and expected their knee problems to inevitably worsen over time ("It's only going to get worse"). Participants were hopeful the orthopaedic consultation would clarify their problem and lead to a subsequent definitive intervention ("Hopefully they will give me answers"). Most participants viewed surgery as "the quick and straightforward solution" necessary to repair faulty cartilage. Exercise was not seen as compatible with the recovery process by most ("Would I make it worse?"). CONCLUSIONS How participants understand their knee problem contributes to surgical expectations and perceptions that it is not amenable to conservative management. Findings suggest a need to educate both patients and primary care clinicians about the safety and efficacy of exercise as first-line therapy for degenerative meniscal tears. The negative role of MRI in promoting surgical expectations needs further consideration.
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Affiliation(s)
- Helen O'Leary
- Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland.
| | - Liam G Ryan
- Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland
| | - Katie Robinson
- School of Allied Health, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Eimear J Conroy
- Orthopaedic Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
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McKeon BP, Zaslav KR, Alfred RH, Alley RM, Edelson RH, Gersoff WK, Greenleaf JE, Kaeding CC. Preliminary Results From a US Clinical Trial of a Novel Synthetic Polymer Meniscal Implant. Orthop J Sports Med 2020; 8:2325967120952414. [PMID: 33062765 PMCID: PMC7536377 DOI: 10.1177/2325967120952414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/09/2020] [Indexed: 01/03/2023] Open
Abstract
Background: At least 760,000 outpatient meniscectomies are performed in the United States
each year, making this the most common musculoskeletal procedure. However,
meniscal resection can alter the joint biomechanics and overload the
articular cartilage, which may contribute to degenerative changes and the
need for knee replacement. Avoiding or delaying knee replacement is
particularly important in younger or more active patients. Synthetic
meniscal implants have been developed in an attempt to restore the natural
joint biomechanics, alleviate pain and disability, and potentially minimize
degenerative changes in patients who require meniscectomy. Purpose To evaluate the preliminary results from 2 ongoing trials that are evaluating
the safety and effectiveness of a synthetic polymer meniscal implant
(NUsurface; Active Implants, LLC). Study Design: Cohort study; Level of evidence, 2. Methods: This was a preliminary analysis of the first 100 patients enrolled across 2
studies for 12 months: a single-arm, intervention-only study and a
randomized controlled trial comparing the investigational meniscal implant
with nonsurgical therapy. There were 65 patients in the implant group (30
randomized) and 35 in the control group. Outcomes included Knee injury and
Osteoarthritis Outcome Score (KOOS) and adverse events (AEs) collected at
baseline and follow-up visits of 6 weeks, 6 months, and 12 months. Results: No statistically significant differences were found in baseline
characteristics between the implant and control groups. At 12 months,
follow-up KOOS data were available for 87% of the 100 included patients.
Significantly greater improvements from baseline were observed in the
implant group compared with controls in all KOOS subcomponents, except for
symptoms (119%-177% greater improvement at 12 months). AEs were reported at
similar rates between the 2 groups, with 12 AEs among 11 patients in the
implant group (16.9%) versus 5 AEs among 5 patients (14.3%) in the control
group (P = .99). Conclusion: These preliminary results suggest significant improvements in pain and
function scores with the implant over nonsurgical therapy and a similar
adverse event rate.
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Affiliation(s)
- Brian P McKeon
- Boston Sports & Shoulder Center, Waltham, Massachusetts, USA
| | - Kenneth R Zaslav
- Ortho Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Richard H Alfred
- The Bone & Joint Center and Albany Medical College, Albany, New York, USA
| | - R Maxwell Alley
- The Bone & Joint Center and Albany Medical College, Albany, New York, USA
| | | | - Wayne K Gersoff
- Advanced Orthopedic and Sports Medicine Specialists, Denver, Colorado, USA
| | | | - Christopher C Kaeding
- Sports Medicine Institute and Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Patients with lateral compartment knee osteoarthritis during arthroscopy are at highest risk of subsequent knee arthroplasty. Knee 2020; 27:1476-1483. [PMID: 33010764 DOI: 10.1016/j.knee.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/30/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic treatment of knee osteoarthritis has declined, in part due to concerns with conversion to arthroplasty. Some studies have investigated the demographic predictors for conversion to arthroplasty, few have assessed the risk factors within the knee itself. Our aim was to analyse the demographics and anatomical wear features of a large cohort of patients undergoing knee arthroscopy. METHODS A retrospective analysis of 1760 cases spanning over 17 years undergoing knee arthroscopy was performed. Patients were 36 years or older at time of the index arthroscopy. Each patient received the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of all regions as well an estimate of the remaining meniscal percentage. Demographic factors as well as intraoperatively collected data were analysed as predictive variables for subsequent conversion to arthroplasty using a multi-step Cox regression analysis. RESULTS A total of 102 patients (6.2%) were converted to arthroplasty. Age at arthroscopy (hazard ratio (HR) 1.073; 95% confidence interval (CI) 1.058-1.088) and ICRS grade of the lateral tibial plateau (HR 1.166; 95% CI 1.066-1.276) were statistically significant predicting variables for conversion to arthroplasty. CONCLUSIONS The results of this study indicate that higher ICRS grade of the lateral tibial plateau at arthroscopy is the most significant predictor for conversion to knee arthroplasty, with a hazard equal to an increase in age. The absence of these factors does not justify arthroscopic treatment of patients with knee osteoarthritis. LEVEL OF EVIDENCE III.
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Sochacki KR, Varshneya K, Calcei JG, Safran MR, Abrams GD, Donahue J, Sherman SL. Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database. Am J Sports Med 2020; 48:2353-2359. [PMID: 32667826 DOI: 10.1177/0363546520935453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series. PURPOSE To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05. RESULTS A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery (P < .001), meniscal transplantation (P = .005), or total knee arthroplasty (P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001). CONCLUSION Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.
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Affiliation(s)
- Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Kunal Varshneya
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph Donahue
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
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Berg B, Roos EM, Englund M, Kise NJ, Tiulpin A, Saarakkala S, Engebretsen L, Eftang CN, Holm I, Risberg MA. Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthritis Cartilage 2020; 28:897-906. [PMID: 32184135 DOI: 10.1016/j.joca.2020.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. DESIGN Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. RESULTS The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. CONCLUSION The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01002794).
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Affiliation(s)
- B Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - M Englund
- Faculty of Medicine, Department of Clinical Sciences, Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
| | - N J Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
| | - A Tiulpin
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - L Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.
| | - C N Eftang
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
| | - I Holm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - M A Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Han X, Yang B, Zou F, Sun J. Clinical therapeutic efficacy of mesenchymal stem cells derived from adipose or bone marrow for knee osteoarthritis: a meta-analysis of randomized controlled trials. J Comp Eff Res 2020; 9:361-374. [PMID: 32141308 DOI: 10.2217/cer-2019-0187] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: This meta-analysis, only including randomized controlled trials (RCTs), was conducted to assess separately and compare the therapeutic efficacy of adipose-derived mesenchymal stem cells (ADMSCs) and bone marrow-derived mesenchymal stem cells (BMSCs) for knee osteoarthritis (OA) at the same follow-up time. Methods: Potential relevant researches were identified from PubMed, Web of Science, Embase, Cochrane Library and clinicaltrials.gov. The data, from clinical trials concentrating on knee OA treated with ADMSCs or BMSCs, were extracted and pooled for meta-analysis to compare the clinical outcomes of patients with knee OA in visual analog scale (VAS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Lysholm knee scale (Lysholm) and Tegner activity scale (Tegner). Results: Nine randomized controlled trials including a total of 377 patients met the inclusion criteria. This meta-analysis obtained the following results. First, the improvement of VAS scores was statistically significant after BMSCs treatment at 6-, 12- and 24-month follow-up compared with control groups (p < 0.01). In contrast, the improvement of WOMAC scores was of no statistical significance, but showed a positive trend with the prolongation of the follow-up time (6 months: mean difference [MD] = 6.51; 95% CI: -2.38 to 15.40; p = 0.15; 12 months: MD = -6.81; 95% CI: -13.94 to 0.33; p = 0.06). Lysholm scores presented a similar pattern (12 months: MD = 1.93; 95% CI: -11.52 to 15.38; p = 0.78; 24 months: MD = 8.94; 95% CI: 1.45 to 16.43; p = 0.02). Second, VAS and WOMAC scores of patients after ADMSCs treatment were significantly improved at any follow-up time (p ≤ 0.05). The improvement of Lysholm scores was of no statistical significance compared with control groups, although treatment outcome at 12-month follow-up was better than that at 24-month follow-up, which was debatable because only data of one clinical trial were pooled in the analysis (12 months: MD = 7.50; 95% CI: -1.94 to 16.94; p = 0.12; 24 months: MD = 5.10; 95% CI: -3.02 to 13.22; p = 0.22). Finally, by comparing the statistical results of VAS and WOMAC scores, it could be concluded that the therapeutic effect of ADMSCs on knee OA was more effective than that of BMSCs. Conclusion: This meta-analysis showed that regeneration with BMSCs or ADMSCs had a great application potential in the treatment of patients with knee OA, and ADMSCs tended to be superior to BMSCs according to the limited clinical evidences available.
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Affiliation(s)
- Xinxin Han
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Bo Yang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Fagui Zou
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jianbo Sun
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
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Wijn SRW, Rovers MM, Rongen JJ, Østerås H, Risberg MA, Roos EM, Hare KB, van de Graaf VA, Poolman RW, Englund M, Hannink G. Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis. BMJ Open 2020; 10:e031864. [PMID: 32152157 PMCID: PMC7064080 DOI: 10.1136/bmjopen-2019-031864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients that do need APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment. METHODS AND ANALYSIS An existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs' characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health. ETHICS AND DISSEMINATION All trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017067240.
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Affiliation(s)
- Stan R W Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan J Rongen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - May A Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
- Division of Orthopedic Surgery, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
| | - Ewa M Roos
- Department of Sports and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Kristoffer B Hare
- Department of Orthopedics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Medium-Term Results of Arthroscopic Partial Meniscectomy from a Single High-Volume Center. Indian J Orthop 2020; 54:358-365. [PMID: 32399157 PMCID: PMC7205941 DOI: 10.1007/s43465-019-00018-0] [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: 02/17/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Abstract
AIM Clinical practice is moving away from treating meniscal tears in patients with osteoarthritis unless there are mechanical symptoms. This study assessed the risk of needing further surgery for osteoarthritis in the 5 years following partial meniscectomy in different age groups and different grades of knee osteoarthritis. METHODS All partial meniscectomies were performed by the senior author during a 31-month period. Data were collected and analyzed retrospectively using electronic patients' records and imaging database. Patients who had previous arthroscopy, anterior cruciate ligament pathology, discoid meniscus or were less than 34 years old were excluded from the study. Range of follow-up was 3 to 5 years. Osteoarthritis was classified intra-operatively using the Outerbridge classification. Knees that needed further surgical treatment in the form of joint replacement or osteotomy were considered as failures. The population was split into three groups according to their age (35-54, 55-64 and 65+). Survival analysis was calculated using the life table method. RESULTS 207 knees were included. In the 35-54 age group, patients with no/mild OA had a survival rate of 97.59% and the severe OA group had a survival rate of 73.5%. In the 55-64 age group, these figures were 100% and 73.6%, respectively. In the >65 age group, the survival rates were 100% and 65%, respectively. CONCLUSION Our study shows that patients with no/mild OA should be considered for APM. Patient's with meniscal tears and severe OA should be counseled on the outcomes and risks of further surgery after an APM.
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Smith L, Barratt A, Buchbinder R, Harris IA, Doust J, Bell K. Trends in knee magnetic resonance imaging, arthroscopies and joint replacements in older Australians: still too much low‐value care? ANZ J Surg 2020; 90:833-839. [DOI: 10.1111/ans.15712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Leon Smith
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
| | - Alexandra Barratt
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical EpidemiologyCabrini Institute Melbourne Victoria Australia
- Department of Epidemiology and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Ian A. Harris
- South Western Clinical School, The University of New South WalesLiverpool Hospital Sydney New South Wales Australia
- Orthopaedics DepartmentLiverpool Hospital Sydney New South Wales Australia
| | - Jenny Doust
- Institute for Evidence‐Based HealthcareBond University Gold Coast Queensland Australia
| | - Katy Bell
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
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Neumann J, Kern K, Sun D, Foreman SC, Joseph GB, Gersing AS, Nevitt MC, McCulloch CE, Quitzke A, Link TM. Cartilage degeneration post-meniscectomy performed for degenerative disease versus trauma: data from the Osteoarthritis Initiative. Skeletal Radiol 2020; 49:231-240. [PMID: 31289901 PMCID: PMC8172084 DOI: 10.1007/s00256-019-03267-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/10/2019] [Accepted: 06/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the extent of cartilage deterioration in knees with prior meniscal resection related to trauma versus knees with resection related to degenerative disease, and to compare cartilage deterioration in knees with meniscal surgery to knees without meniscal surgery, controlling for prior knee trauma. MATERIALS AND METHODS In this cross-sectional study, we assessed cartilage deterioration in right knees of Osteoarthritis Initiative participants: (i) with meniscal surgery due to injury (n = 79); (ii) matched control knees with a prior injury but without meniscal surgery (n = 79); (iii) with meniscal surgery but without preceding injury (n = 36); and (iv) matched control knees without meniscal surgery or prior knee injury (n = 36). Cartilage composition was measured using T2 measurements derived using semi-automatic cartilage segmentation of the right. Linear regression analysis was used to compare compartmental values of T2 between groups. RESULTS Comparing the mean T2 values in surgical cases with and without injury our results did not show significant differences (group i vs. iii, p > 0.05). However, knees with previous meniscal surgery showed significantly (p < 0.001) higher mean T2 values across all compartments (i.e., global T2) when compared to those without meniscal surgery for both knees with a history of trauma (group i vs. ii) and knees without prior trauma (group iii vs. iv). Similar results were obtained when analyzing the compartments separately. CONCLUSIONS Cartilage deterioration, assessed by T2, is similar in knees undergoing meniscal surgery after trauma and for degenerative conditions. Both groups demonstrated greater cartilage deterioration than nonsurgical knees, controlling for prior knee injury.
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Affiliation(s)
- Jan Neumann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany.
| | - Kai Kern
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Dong Sun
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Sarah C Foreman
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Gabby B Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Alexandra S Gersing
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Azien Quitzke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
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Sonesson S, Kvist J, Yakob J, Hedevik H, Gauffin H. Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study. Orthop J Sports Med 2020; 8:2325967119893920. [PMID: 32047825 PMCID: PMC6985975 DOI: 10.1177/2325967119893920] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, –6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group (P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Jafar Yakob
- Division of Radiological Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Division of Surgery, Orthopedics and Oncology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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On Patient Safety: Orthopaedic Surgeons Must Stop Performing Arthroscopic Partial Meniscectomy on Patients with Arthritic Knees. Clin Orthop Relat Res 2020; 478:28-30. [PMID: 31809288 PMCID: PMC7000064 DOI: 10.1097/corr.0000000000001072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Huan X, Jinhe Y, Rongzong Z. Identification of Pivotal Genes and Pathways in Osteoarthritic Degenerative Meniscal Lesions via Bioinformatics Analysis of the GSE52042 Dataset. Med Sci Monit 2019; 25:8891-8904. [PMID: 31758856 PMCID: PMC6884941 DOI: 10.12659/msm.920636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To better understand the process of osteoarthritic degenerative meniscal lesions (DMLs) formation, this study analyzed the dataset GSE52042 using bioinformatics methods to identify the pivotal genes and pathways related to osteoarthritic DMLs. Material/Methods The GSE52042 dataset, comprising diseased meniscus samples and healthier meniscus samples, was downloaded and the differentially-expressed genes (DEGs) were extracted. The reactome pathways assessment and functional analysis were performed using the “ClusterProfiler” package and “ReactomePA” package of Bioconductor. The protein–protein interaction network was constructed, followed by the extraction of hub genes and modules. Results A set of 154 common DEGs, including 64 upregulated DEGs and 90 downregulated DEGs, were obtained. GO analysis suggested that the DEGs primarily participated in positive regulation of the mitotic cell cycle and extracellular matrix organization. Reactome pathway analysis showed that the DEGs were predominantly enriched in TP53, which regulates transcription of genes involved in G2 cell cycle arrest and extracellular matrix organization. The top 10 hub genes were TYMS, AURKA, CENPN, NUSAP1, CENPM, TPX2, CDK1, UBE2C, BIRC5, and CCNB1. The genes in the 2 modules were primarily associated with M Phase and keratan sulfate degradation. Conclusions A series of pivotal genes and reactome pathways were identified elucidate the molecular mechanisms involved in the formation of osteoarthritic DMLs and to discover potential therapeutic targets.
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Affiliation(s)
- Xu Huan
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
| | - Ying Jinhe
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
| | - Zheng Rongzong
- Department of Joint Surgery, Lishui Municipal Central Hospital, Lishui, Zhejiang, China (mainland)
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Abram SGF, Judge A, Beard DJ, Price AJ. Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates. Osteoarthritis Cartilage 2019; 27:1420-1429. [PMID: 31034923 DOI: 10.1016/j.joca.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the proportion of patients undergoing arthroscopic partial meniscectomy (APM) then subsequently receiving a knee arthroplasty within one or two years, with focus on patients over the age of 60 years and regional variation. METHODS Patients undergoing APM in England over 20-years (01-April-1997 to 31-March 2017) were identified in the national Hospital Episode Statistics (HES). The proportion of patients undergoing arthroplasty in the same knee within one or two years of APM was determined and trends were analysed over time nationally and by NHS Clinical Commissioning Group (CCG) region. RESULTS 806,195 APM patients were eligible for analysis with at least one-year of follow up and 746,630 with two-years. The odds of arthroplasty conversion within one year increased over the study period (odds ratio [OR] 3.10 within 1-year in 2014 vs 2000; 95% confidence interval [CI] 2.75-3.50). For patients undergoing APM aged 60 years or older in 2015-16, 9.9% (1689/17,043; 95% CI 9.5-10.4) underwent arthroplasty within 1-year and, in 2014-15, 16.6% (3100/18,734; 95% CI 16.0-17.1) underwent arthroplasty within 2-years. There was greater than 10-fold variation by CCG. CONCLUSIONS Over the study period, the proportion of patients undergoing arthroplasty within one-year of APM increased. In 2015-16, of patients aged 60 years or older who underwent APM, 10% subsequently underwent knee arthroplasty within one year (17% within two years in 2014-15) and there was a high level of regional variation in this outcome. The development and adoption of national treatment guidance is recommended to improve and standardise treatment selection.
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Affiliation(s)
- S G F Abram
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - A Judge
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; NIHR Biomedical Research Centre, Bristol & Musculoskeletal Research Unit, University of Bristol, UK
| | - D J Beard
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - A J Price
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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Abram SGF, Judge A, Beard DJ, Carr AJ, Price AJ. Long-term rates of knee arthroplasty in a cohort of 834 393 patients with a history of arthroscopic partial meniscectomy. Bone Joint J 2019; 101-B:1071-1080. [DOI: 10.1302/0301-620x.101b9.bjj-2019-0335.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aims The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone arthroscopic partial meniscectomy (APM). Patients and Methods A retrospective national cohort of patients with a history of isolated APM was identified over a 20-year period. Patients with prior surgery to the same knee were excluded. The primary outcome was knee arthroplasty. Hazard ratios (HRs) were adjusted by patient age, sex, year of APM, Charlson comorbidity index, regional deprivation, rurality, and ethnicity. Risk of arthroplasty in the index knee was compared with the patient’s contralateral knee (with vs without a history of APM). A total of 834 393 patients were included (mean age 50 years; 37% female). Results Of those with at least 15 years of follow-up, 13.49% (16 256/120 493; 95% confidence interval (CI) 13.30 to 13.69) underwent subsequent arthroplasty within this time. In women, 22.07% (95% CI 21.64 to 22.51) underwent arthroplasty within 15 years compared with 9.91% of men (95% CI 9.71 to 10.12), corresponding to a risk ratio (RR) of 2.23 (95% CI 2.16 to 2.29). Relative to the general population, patients with a history of APM were over ten times more likely (RR 10.27; 95% CI 10.07 to 10.47) to undergo arthroplasty rising to almost 40 times more likely (RR 39.62; 95% CI 27.68 to 56.70) at a younger age (30 to 39 years). In patients with a history of APM in only one knee, the risk of arthroplasty in that knee was greatly elevated in comparison with the contralateral knee (no APM; HR 2.99; 95% CI 2.95 to 3.02). Conclusion Patients developing a meniscal tear undergoing APM are at greater risk of knee arthroplasty than the general population. This risk is three-times greater in the patient’s affected knee than in the contralateral knee. Women in the cohort were at double the risk of progressing to knee arthroplasty compared with men. These important new reference data will inform shared decision making and enhance approaches to treatment, prevention, and clinical surveillance. Cite this article: Bone Joint J 2019;101-B:1071–1080.
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Affiliation(s)
- Simon G. F. Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, Bristol, UK
| | - David J. Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - Andrew J. Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
| | - Andrew J. Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford, UK
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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Early Surgery or Physical Therapy for Nonobstructive Meniscal Tears. Am J Phys Med Rehabil 2019; 99:e50-e52. [PMID: 31335346 DOI: 10.1097/phm.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barnds B, Morris B, Mullen S, Schroeppel JP, Tarakemeh A, Vopat BG. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc 2019; 27:2316-2321. [PMID: 30941471 DOI: 10.1007/s00167-019-05481-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/06/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to determine the cost of arthroscopic partial meniscectomy (APM), one of the most common surgeries performed by orthopaedic surgeons, and the associated rate of progression to knee arthroplasty (KA) compared to patients treated non-operatively after diagnosis of meniscal tear. METHODS Utilizing data mining software (PearlDiver, Colorado Springs, CO), a national insurance database of approximately 23.5 million orthopaedic patients was queried for patients diagnosed with a meniscal tear. Patients were classified by treatment: non-operative and arthroscopic partial meniscectomy and were followed after initial diagnosis for cost and progression to knee arthroplasty. RESULTS There were 176,407 subjects in the non-op group and 114,194 subjects in the arthroscopic partial meniscectomy group. Arthroscopic partial meniscectomy generated more cost than non-operative ($3842.57 versus $411.05, P < 0.001). Arthroscopic partial meniscectomy demonstrated greater propensity to need future knee arthroplasty (11.4% at 676 days) than those treated non-operatively (9.5% at 402 days) (P < 0.001). Female patients demonstrated a higher rate of progression to knee arthroplasty in the arthroscopic partial meniscectomy and non-operative groups (P < 0.001). CONCLUSION Compared to non-operative treatment for meniscal tears, arthroscopic partial meniscectomy is more expensive and does not appear to decrease the rate of progression to knee arthroplasty. Patients undergoing arthroscopic partial meniscectomy yielded on average a delay of only 9 months (274 days) before undergoing knee arthroplasty. Female patients experienced a significantly higher rate of progression to knee arthroplasty. The authors recognize the limitations of this type of study including its retrospective nature, reliance upon accurate coding and billing information, and the inability to determine whether symptoms including mechanical locking played a role in the decision to perform an APM. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brandon Barnds
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Brandon Morris
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Scott Mullen
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - John Paul Schroeppel
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Armin Tarakemeh
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Bryan G Vopat
- Department of Orthopaedics, The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
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van de Graaf VA, van Dongen JM, Willigenburg NW, Noorduyn JCA, Butter IK, de Gast A, Saris DBF, van Tulder MW, Poolman RW. How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study. Br J Sports Med 2019; 54:538-545. [PMID: 31227493 PMCID: PMC7212930 DOI: 10.1136/bjsports-2018-100065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Abstract
Objectives To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis—this paper—we examined whether PT is non-inferior to APM. Methods We recruited patients aged 45–70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively. Results We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (−€1803; 95% CI −€3008 to −€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs. Conclusions The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears. Trial registration numbers NCT01850719 and NTR3908.
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Affiliation(s)
- Victor A van de Graaf
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands .,Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Julia C A Noorduyn
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Ise K Butter
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Arthur de Gast
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Centre - mN, Diakonessenhuis, Utrecht, The Netherlands
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
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Pihl K, Ensor J, Peat G, Englund M, Lohmander S, Jørgensen U, Nissen N, Fristed JV, Thorlund JB. Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery. Br J Sports Med 2019; 54:13-22. [PMID: 31186258 DOI: 10.1136/bjsports-2018-100321] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS4) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS4 change score constitutes improvement. Prognostic performance was assessed using R2 statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS4. The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R2=0.162, optimism adjusted R2=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). CONCLUSION Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery. TRIAL REGISTRATION NUMBER NCT01871272.
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Affiliation(s)
- Kenneth Pihl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Joie Ensor
- Centre for Prognosis Research, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - George Peat
- Centre for Prognosis Research, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Uffe Jørgensen
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Nis Nissen
- Department of Orthopedics, Lillebaelt Hospital, Kolding, Denmark
| | | | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Murphy CA, Garg AK, Silva-Correia J, Reis RL, Oliveira JM, Collins MN. The Meniscus in Normal and Osteoarthritic Tissues: Facing the Structure Property Challenges and Current Treatment Trends. Annu Rev Biomed Eng 2019; 21:495-521. [DOI: 10.1146/annurev-bioeng-060418-052547] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The treatment of meniscus injuries has recently been facing a paradigm shift toward the field of tissue engineering, with the aim of regenerating damaged and diseased menisci as opposed to current treatment techniques. This review focuses on the structure and mechanics associated with the meniscus. The meniscus is defined in terms of its biological structure and composition. Biomechanics of the meniscus are discussed in detail, as an understanding of the mechanics is fundamental for the development of new meniscal treatment strategies. Key meniscal characteristics such as biological function, damage (tears), and disease are critically analyzed. The latest technologies behind meniscal repair and regeneration are assessed.
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Affiliation(s)
- Caroline A. Murphy
- Stokes Laboratories, Bernal Institute, School of Engineering, University of Limerick, Limerick V94 PC82, Ireland
| | - Atul K. Garg
- Manufacturing Technology and Innovation Global Supply Chain, Johnson & Johnson, Bridgewater, New Jersey 08807, USA
| | - Joana Silva-Correia
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
| | - Rui L. Reis
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, University of Minho, 4805-017 Barco, Guimarães, Portugal
| | - Joaquim M. Oliveira
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, University of Minho, 4805-017 Barco, Guimarães, Portugal
| | - Maurice N. Collins
- Stokes Laboratories, Bernal Institute, School of Engineering, University of Limerick, Limerick V94 PC82, Ireland
- Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Drobnič M, Ercin E, Gamelas J, Papacostas ET, Slynarski K, Zdanowicz U, Spalding T, Verdonk P. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc 2019; 27:1817-1824. [PMID: 30859265 DOI: 10.1007/s00167-019-05424-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/15/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To provide a current review on the evidence for management of the symptomatic meniscus-deficient knee. METHODS A literature review was performed detailing the natural history and origin of symptoms in a meniscus-deficient knee, in addition to strategies for non-surgical management, meniscus scaffolds, meniscus allograft transplantation (MAT), isolated cartilage repair, unloading osteotomies, meniscus prosthesis, and joint replacements which were revealed as treatment possibilities. RESULTS Meniscus deficiency was recognized to lead to an early onset knee osteoarthritis (OA). A subset of patients develop post-meniscectomy syndrome: dull and nagging pain after a short pain-free interval subsequently to meniscectomy, which can be accompanied by transient effusions. Evidence for non-surgical management of post-meniscectomy knee pain is lacking. Two available meniscus scaffolds, indicated for symptomatic segmental meniscus deficiency, show pain relief at mid-term follow-up, and effect on joint preservation is unclear. MAT represents a durable solution for sub/total meniscus deficiency (80% survival at 10 years), but it is still considered a temporary solution for post-meniscectomy pain. MAT may also reduce the progression of OA. Isolated cartilage repair without a meniscus reconstruction is commonly performed, but better results were reported with preserved or reconstructed menisci. Osteotomies are used in the combination of misaligned knee and meniscus reconstruction or as pain solution for irreversible unilateral knee structural changes following a meniscectomy. Polycarbonate-urethane medial meniscus prosthesis is currently undergoing clinical trial. Joint replacements should be limited to later stages of post-meniscectomy OA. CONCLUSIONS Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000, Ljubljana, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Ersin Ercin
- Department of Orthopaedics and Traumatology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Joao Gamelas
- Department of Orthopaedics and Traumatology, Lusíadas Hospital, NOVA Medical School, Lisbon, Portugal
| | | | | | - Urszula Zdanowicz
- Carolina Medical Center, Warsaw, Poland.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Tim Spalding
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium
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