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Kinoshita T, Hashimoto Y, Nishino K, Iida K, Nakamura H. Effect of inside-out meniscal repair on meniscal dimension in meniscal tear patients. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:50-57. [PMID: 38618526 PMCID: PMC11010801 DOI: 10.1016/j.asmart.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/17/2024] [Accepted: 03/17/2024] [Indexed: 04/16/2024] Open
Abstract
Background It remains controversial whether meniscal repair causes meniscal extrusion. This study aimed to investigate the effect of inside-out meniscal repair on meniscal dimensions in patients with meniscal tear of the mid-body-posterior horn. Methods This retrospective study included 75 patients who underwent meniscal repair followed by MRI within 2 weeks after surgery between 2020 and 2022. Patients with a discoid lateral meniscus, pull-out repair, concomitant osteotomy, all-inside repair only, and revision surgery were excluded. Thirty-three meniscal tear treated using an inside-out arthroscopic repair technique were included in the lateral meniscus (LM, n = 19) and medial meniscus (MM, n = 14) tear groups. Thirty-six participants with intact meniscus were included as controls. Meniscal extrusion and posterior shift were measured on coronal and sagittal MRI pre-operatively and within 2 weeks postoperatively. Results Preoperative coronal extrusion was significantly greater in the LM tear group than in the control group (P = 0.001). Coronal extrusion and posterior shift were significantly smaller postoperatively than preoperatively in the LM tear group (P < 0.001 and, P = 0.008, respectively). Pre- and postoperative coronal extrusion in the MM tear group were not significantly different (P = 0.291). Postoperative coronal extrusion in both LM and MM tear groups were not significantly correlated with the number of sutures required for repair (LM: P = 0.765, R = -0.076, MM: P = 0.1, R = 0.497). Conclusions The torn meniscus of the mid-body - posterior horn before surgery was extruded and shifted posteriorly in both LM and MM tears, and repair using an inside-out arthroscopic technique was effective in reducing meniscal extrusion and posteriors shift in the LM tear immediately after surgery.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Health and Sport Management, Osaka University of Health and Sports Science, Graduate School of Sport and Exercise Science, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Ichiba A, Ito E, Kino K. Extrusion of the anterior segment of the medial meniscus extrusion initiates knee osteoarthritis: evaluation using magnetic resonance imaging. J Exp Orthop 2023; 10:135. [PMID: 38091190 PMCID: PMC10719179 DOI: 10.1186/s40634-023-00693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Meniscus extrusion contributes to the progression of knee osteoarthritis (OA). It is not clear which site of the medial meniscus (MM) extrusion (MME) is greatest. Moreover, the relationship between sites of MME and progression of OA has not yet been elucidated. The purpose of this study was to determine which sites of MME that showed the greatest extrusion and to investigate the relationship between the presence of MM tears and MME, the relationship between the progression of OA and MME. METHODS A cohort of 111 patients were studied retrospectively. The OA grade was classified using the Kellgren-Lawrence (K-L) grade. MME was measured at 13 positions from the anterior to the posterior segment using magnetic resonance imaging (MRI) with slices perpendicular to the MM (radial MRI). The relationship between the K-L grade and the site of the MME was investigated. The patients were grouped as follows: The patients over 40-years-old were grouped as follows: patients with the K-L grade ≤1 and without a MM tear (Group En (early, no meniscus tear)); patients with the K-L grade ≤1 with a MM tear (Group Ep (early, positive meniscus tear)); patients with the K-L grade ≥2 and without a MM tear (Group An (advanced, no meniscal tear)); patients over-40 years-old with the K-L grade ≥2 and with a MM tear (Group Ap (advanced, positive meniscus tear)). And patients between 15 and 39-years-old with no abnormal findings on MRI were defined as control group (Group C). RESULTS In the Groups En and Ep, MME was greatest in the anterior segment, and was greater in Group Ep than in Group En. In Groups Ap and Group C, extrusion was greatest in the middle segment. CONCLUSION The results suggest that MME predominantly occurred in the anterior segment with increasing age, after that, MM extruded at the middle segment with progression of OA and MM tear. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Atsushi Ichiba
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan.
| | - Eichi Ito
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan
| | - Keiichiro Kino
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan
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Fukui D, Nishiyama D, Yamanaka M, Tamai H, Nishio N, Kawakami M, Yamada H. Development of a Novel Rat Knee Osteoarthritis Model Induced by Medial Meniscus Extrusion. Cartilage 2023:19476035231205680. [PMID: 37837194 DOI: 10.1177/19476035231205680] [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: 10/15/2023] Open
Abstract
OBJECTIVE The medial meniscus extrusion (MME) is associated with increased stress on the knee joint, which leads to cartilage degeneration. To evaluate the etiology of knee osteoarthritis, it is extremely important to create animal models of the disease that more closely resemble actual clinical conditions in terms of symptomatology, molecular biology, and histology. This study aimed to create a clinically relevant model of MME in rats. DESIGN Behavioral, molecular biological, and histological changes in the newly developed rat MME model were compared with those in sham and medial meniscus transection and medial collateral ligament transection (MMT) models to examine the characteristics of this model. RESULTS In the MME rat model, behavioral evaluation shows abnormalities in gait compared with the other 2 groups, and molecular biological evaluation of the infrapatellar synovia of rats shows that gene expression of inflammatory cytokines, matrix-degrading enzymes, and pain-related nerve growth factor was increased compared with the sham group. Furthermore, histological evaluation reveals that cartilage degeneration was the most severe in the MME group. CONCLUSIONS The newly developed MME model reproduced the characteristic pathology of MME in clinical practice, such as severe pain, inflammation, and rapid progression of osteoarthritis. The MME model, which might more closely mimic human knee osteoarthritis (OA), could be a useful model for elucidating the pathophysiology and considering therapeutic management for knee OA.
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Affiliation(s)
- Daisuke Fukui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Yamanaka
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hidenobu Tamai
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoko Nishio
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mamoru Kawakami
- Department of Orthopedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Adili A, Kaneko H, Aoki T, Liu L, Negishi Y, Tomura J, Wakana S, Momoeda M, Arita H, Hada S, Shiozawa J, Kubota M, Someya Y, Tamura Y, Aoki S, Watada H, Kawamori R, Negishi-Koga T, Okada Y, Ishijima M. Anterior meniscus extrusion is associated with anterior tibial osteophyte width in knee osteoarthritis - The Bunkyo Health Study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100364. [PMID: 37207278 PMCID: PMC10189494 DOI: 10.1016/j.ocarto.2023.100364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background In knee osteoarthritis (OA), medial meniscus extrudes both medially and anteriorly. We reported that full-length width of medial tibial osteophyte, which comprises cartilage and bone parts, is directly associated with medial meniscus extrusion in early-stage knee OA and hypothesized that anterior tibial osteophyte (ATO) is also associated with anterior meniscus extrusion (AME). Thus, we aimed to examine their prevalence and relationship. Methods Elderly subjects (638 females and 507 males; average 72.9 years old) in the Bunkyo Health Study cohort were enrolled. MRI-detected OA changes were evaluated according to the Whole Organ Magnetic Resonance Imaging Score. ATO was evaluated using the method which can assess both cartilage and bone parts of osteophyte by pseudo-coloring images of proton density-weighted fat-suppressed MRI. Results Most subjects showed the Kellgren-Lawrence grade 1/2 of the medial knee OA (88.1%), AME (94.3%, 3.7 ± 2.2 mm), and ATO (99.6%, 4.2 ± 1.5 mm). Among the OA changes, AME was most closely associated with full-length width of ATO (multivariable β = 0.877, p < 0.001). The area under the receiver operating characteristic curve for determining the presence of AME as evaluated by ATO width was 0.75 (95% confidence interval 0.60-0.84, p < 0.001). The odds ratio for the presence of AME as evaluated by ATO width at 2.9 mm was 7.16 (4.23-12.15, p < 0.001, age, gender, BMI, and K-L adjusted). Conclusions AME and ATO were inevitably observed in the elderly subjects and AME was closely associated with full-length width of ATO. Our study provides the first evidence on the close relationship between AME and ATO in knee OA.
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Affiliation(s)
- Arepati Adili
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruka Kaneko
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Corresponding author. Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. Fax: +81 3 3813 3428.
| | - Takako Aoki
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Lizu Liu
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Negishi
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Tomura
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Suguru Wakana
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Momoeda
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hitoshi Arita
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shinnosuke Hada
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Shiozawa
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuaki Kubota
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Someya
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Tamura
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takako Negishi-Koga
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasunori Okada
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Corresponding author. Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. Fax: +81 3 3813 3428.
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Liu B, Xu HY, Zhang R, Han L, Li Y, Sun XF. An Update on Clinical Utility of Musculoskeletal Ultrasonography in Knee Osteoarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1413-1422. [PMID: 36715025 DOI: 10.1002/jum.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In knee osteoarthritis (KOA), timely and accurate assessment of the severity is essential to help orthopedic surgeons determine the most appropriate therapeutic strategies and evaluate disease outcomes and responses for corresponding treatments. In KOA, musculoskeletal ultrasonography (MSUS) could effectively help detect various abnormalities, including synovitis, osteophytes, and cartilage damage. Further, MSUS could be used to monitor the response to different therapies in KOA, to guide local diagnostic and therapeutic procedures. In the future, applications based on continuously evolving US tools could enhance the clinical utility of MSUS in KOA.
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Affiliation(s)
- Bo Liu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui-Ying Xu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Rui Zhang
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Han
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Li
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Feng Sun
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Langhans MT, Lamba A, Saris DBF, Smith P, Krych AJ. Meniscal Extrusion: Diagnosis, Etiology, and Treatment Options. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09840-4. [PMID: 37191818 DOI: 10.1007/s12178-023-09840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. RECENT FINDINGS Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration. Meniscus extrusion has been associated with degenerative joint disease, posterior root and radial meniscal tears, and acute trauma. Meniscus centralization and meniscotibial ligament repair have been proposed as techniques to address meniscal extrusion with promising biomechanical, animal model, and early clinical reports. Further studies on the epidemiology of meniscus extrusion and associated long-term nonoperative outcomes will help to elucidate its role in meniscus dysfunction and resultant arthritic development. Understanding and appreciation for the anatomic attachments of the meniscus will help to inform future repair techniques. Long-term reporting on the clinical outcomes of meniscus centralization techniques will yield insights into the clinical significance of meniscus extrusion correction.
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Affiliation(s)
- Mark T Langhans
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Papalia GF, Za P, Saccone L, Franceschetti E, Zampogna B, Vasta S, Papalia R. Meniscal extrusion: risk factors and diagnostic tools to predict early osteoarthritis. Orthop Rev (Pavia) 2023; 15:74881. [PMID: 37197670 PMCID: PMC10184885 DOI: 10.52965/001c.74881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Meniscal extrusion (ME) is strongly correlated with cartilage wear and osteoarthritis (OA), be-cause of the altered kinematic and the decreased contact area between the tibia and femur. The aim of this narrative review is to analyze the process of ME, focusing on the possible causes, and to evaluate the correlation between ME and knee OA, in order to provide early diagnosis and treatments. Studies written in English that analyzed the causes of ME, provided indications re-garding diagnosis and treatment, and evaluated the relation between ME and early OA were in-cluded. Injuries, degeneration of the meniscal substance and meniscus root tears are associated with significantly increased ME. An extruded meniscus could be a manifestation of other pa-thologies such as disruption of coronary ligaments, cartilage loss, knee malalignment, ligament injuries, or OA. ME is strongly associated with osteoarthritis features, particularly with bone marrow lesion and cartilage damage. Magnetic resonance imaging represents the gold standard for the detection of ME. The severity of the medial meniscus extrusion may also affect healing af-ter repair, and meniscus extrusion is not completely reduced by meniscus posterior root tear re-pair. In this study, we proved that ME represents an important risk factor for early knee OA. We provided alternative theories of ME, such as meniscal fibers injury first and "dynamic extrusion of the menisci". The phenomenon of aging has been described as a new concept in the etiology of ME. Finally, we stated all the main techniques and characteristics of the diagnostic process, as well as the current knowledge in the therapeutic field.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierangelo Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Saccone
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Khoo JR, Yau WP. Repair of meniscus root tear - Is there a difference between medial meniscus root repair and lateral meniscus root repair? A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231175233. [PMID: 37173149 DOI: 10.1177/10225536231175233] [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: 05/15/2023] Open
Abstract
PURPOSE Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature. METHODS Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest. RESULTS Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7 mm, which was significantly larger than the 0.9 ± 1.2 mm observed after LMPRT repair (p < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair (p < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair (p < 0.001). CONCLUSIONS LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.
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Affiliation(s)
- Jun Ren Khoo
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - W P Yau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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Fong FJY, Ong BWL, Lee YHD. Medial Meniscal Extrusion in Patients With Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231151698. [PMID: 36909671 PMCID: PMC9996740 DOI: 10.1177/23259671231151698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 03/14/2023] Open
Abstract
Background Medial meniscal extrusion (MME) has received significant interest because of its correlation with medial meniscus root tears (MMRTs), its potential as a diagnostic tool, and its significance in the progression of knee osteoarthritis (OA). Purpose To (1) evaluate if MMRTs significantly increase MME compared with nonroot tears (NRTs) and no tears and (2) determine the clinical outcomes of increased MME. Study Design Systematic review; Level of evidence, 4. Methods Electronic database searches of PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were conducted on June 6, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist criteria. The searches were conducted using the keywords "meniscus tear" and "extrusion." No restrictions were placed on the date of publication. Quality and sensitivity assessments were conducted on included studies. Major MME was defined as an extrusion ≥3 mm. Results Twenty-two studies involving 7882 knees were included. Compared with patients with NRTs, those with MMRTs had a 1.12-mm greater mean absolute meniscal extrusion (AME) and were 3.45 times more likely to have major MME (P < .001 for both). Compared with patients with no tears, those with MMRTs had a 2.13-mm greater AME (P < .001). Within patients with MMRT, those with widely displaced MMRT had a 1.01-mm greater AME compared with nondisplaced MMRT (P < .001). Patients with OA had a 0.73-mm greater AME and were 3.86 times more likely to have major MME compared with patients without OA (P < .001 for both). Within patients who were not stratified according to MMRT, NRT, or no tears, those who eventually developed OA had a 0.79-mm greater AME than those who did not have OA (P = .02). Conclusion Patients with MMRTs had higher MME values compared with those with other types of meniscal tears and those without any meniscal tears. Patients with knee OA were more likely to have higher MME compared with those without OA.
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Affiliation(s)
- Francis Jia Yi Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Wei Loong Ong
- Department of Orthopaedic Surgery, National University of Singapore, Singapore
| | - Yee Han Dave Lee
- Department of Orthopaedic Surgery, National University of Singapore, Singapore
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Farivar D, Knapik DM, Vadhera AS, Condron NB, Hevesi M, Shewman EF, Ralls M, White GM, Chahla J. Quantifying Meniscal Extrusion Using Ultrasound in the Setting of Concomitant Cadaveric Knee Lesions: Part I: The Medial Meniscotibial Ligament and Posterior Medial Meniscal Root. Arthroscopy 2023:S0749-8063(23)00169-X. [PMID: 36813009 DOI: 10.1016/j.arthro.2023.01.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE 1. Evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) +/- concomitant posterior medial meniscal root (PMMR) tears. 2. Describe how ME varied along length of meniscus. METHODS ME was measured using ultrasonography in 10 human cadaveric knees in conditions: (1) control, either (2a) isolated MTL sectioning, or (2b) isolated PMMR tear, (3) combined PMMR + MTL sectioning, and (4) PMMR repair. Measurements were obtained 1 cm anterior to the MCL (anterior), over the MCL (middle), and 1 cm posterior to the MCL (posterior) +/- 1000N axial loads in 0° and 30° flexion. RESULTS At 0°, MTL sectioning demonstrated greater middle than anterior (P<0.001) and posterior (P<0.001) ME, while PMMR (P=0.0042) and PMMR+MTL (P<0.001) sectioning demonstrated greater posterior than anterior ME. At 30°, PMMR (P<0.001) and PMMR+MTL (P<0.001) sectioning demonstrated greater posterior than anterior ME, and PMMR (P=0.0012) and PMMR+MTL (P=0.0058) sectioning demonstrated greater posterior than anterior ME. PMMR+MTL sectioning demonstrated greater posterior ME at 30° compared to 0° (P=0.0320). MTL sectioning always resulted in greater middle ME (P<0.001), in contrast with no middle ME changes following PMMR sectioning. At 0°, PMMR sectioning resulted in greater posterior ME (P<0.001), but at 30°, both PMMR and MTL sectioning resulted in greater posterior ME (P<0.001). Total ME surpassed 3 mm only when both the MTL and PMMR were sectioned. CONCLUSION The MTL and PMMR contribute most to ME when measured posterior to the MCL at 30° of flexion. ME greater than 3 mm is suggestive of combined PMMR + MTL lesions. CLINICAL RELEVANCE Overlooked MTL pathology may contribute to persistent ME following PMMR repair. We found isolated MTL tears able to cause 2-2.99 mm of ME, but the clinical significance of these magnitudes of extrusion is unclear. The use of ME measurement guidelines with ultrasound may allow for practical MTL and PMMR pathology screening and pre-operative planning.
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Affiliation(s)
- Daniel Farivar
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Nolan B Condron
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Elizabeth F Shewman
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA
| | - Michael Ralls
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory M White
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL USA.
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11
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Vadhera AS, Lee JS, Singh H, Gursoy S, Kunze KN, Verma NN, Chahla J. Injury to the Posterior Horn of the Lateral Meniscus from a Misplaced Tibial Tunnel for Anterior Cruciate Ligament Reconstruction: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e937581. [PMID: 36327165 PMCID: PMC9641552 DOI: 10.12659/ajcr.937581] [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: 01/24/2023]
Abstract
BACKGROUND Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. CASE REPORT A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle reconstruction was performed at that time. Three months after surgery, a medial partial meniscectomy was performed after a medial meniscal tear and failure to reduce initial symptoms during the index procedure. Advanced imaging at our institution 6 months later demonstrated an iatrogenic lateral posterior meniscal root avulsions after malpositioning of the transtibial tunnels. Given the ACL graft integrity upon arthroscopic evaluation, the root tear was repaired using a 2-tunnel transtibial pull-out technique. Advanced imaging 1 year after surgery showed a well-maintained meniscal repair with no extrusion. CONCLUSIONS Accurate transtibial tunnel placement during ACL reconstructive surgery is vital to avoid meniscal root detachment and the associated complications resulting in poor patient outcomes from this iatrogenic injury. Clinicians treating patients with a history of cruciate ligament reconstruction presenting with postoperative pain and instability should consider this pathology in their differential diagnosis.
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Affiliation(s)
- Amar S. Vadhera
- Department of Orthopaedic Surgery, Division of Sports Medicine, MidwestOrthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA,Sidney Kimmel Medical College, Philadelphia, PA, USA,Corresponding Author: Amar S. Vadhera, e-mail:
| | - Jonathan S. Lee
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harsh Singh
- Department of Orthopaedic Surgery, Division of Sports Medicine, MidwestOrthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Kyle N. Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Division of Sports Medicine, MidwestOrthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, MidwestOrthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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12
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Ghouri A, Muzumdar S, Barr AJ, Robinson E, Murdoch C, Kingsbury SR, Conaghan PG. The relationship between meniscal pathologies, cartilage loss, joint replacement and pain in knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2022; 30:1287-1327. [PMID: 35963512 DOI: 10.1016/j.joca.2022.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We conducted a systematic review in order to understand the relationship between imaging-visualised meniscus pathologies, hyaline cartilage, joint replacement and pain in knee osteoarthritis (OA). DESIGN A search of the Medline, Excerpta Medica database (EMBASE) and Cochrane library databases was performed for original publications reporting association between imaging-detected meniscal pathology (extrusion or tear/damage) and longitudinal and cross-sectional assessments of hyaline articular cartilage loss [assessed on magnetic resonance imaging (MRI)], incident joint replacement and pain (longitudinal and cross-sectional) in knee OA. Each association was qualitatively characterised by a synthesis of data from each analysis, based upon study design and quality scoring (including risk of bias assessment and adequacy of covariate adjustment using Cochrane recommended methodology). RESULTS In total 4,878 abstracts were screened and 82 publications were included (comprising 72 longitudinal analyses and 49 cross-sectional). Using high quality, well-adjusted data, meniscal extrusion and meniscal tear/damage were associated with longitudinal progression of cartilage loss, cross-sectional cartilage loss severity and joint replacement, independently of age, sex and body mass index (BMI). Medial and lateral meniscal tears were associated with cartilage loss when they occurred in the body and posterior horns, but not the anterior horns. There was a lack of high quality, well-adjusted meniscal pathology and pain publications and no clear independent association between meniscal extrusion or tear/damage with pain severity, progression in pain or incident frequent knee symptoms. CONCLUSION Meniscal features have strong associations with cartilage loss and joint replacement in knee OA, but weak associations with knee pain. Systematic review PROSPERO registration number: CRD 42020210910.
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Affiliation(s)
- A Ghouri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | | | - A J Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - E Robinson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - C Murdoch
- Calderdale and Huddersfield NHS Foundation Trust, UK.
| | - S R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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13
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Kaiser JT, Damodar D, Udine MJ, Meeker ZD, McCormick JR, Wagner KR, Krych AJ, Chahla JA, Cole BJ. Meniscal Extrusion: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202208000-00001. [PMID: 35922395 DOI: 10.2106/jbjs.rvw.22.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Pathologic meniscal extrusion can compromise meniscal function, leading to increased contact forces in the tibiofemoral compartment and the acceleration of osteoarthritic changes. ➢ Extrusion is typically defined as radial displacement of ≥3 mm outside the tibial border and is best diagnosed via magnetic resonance imaging, although ultrasonography has also demonstrated encouraging diagnostic utility. ➢ Surgical management of meniscal extrusion is based on the underlying etiology, the patient's symptom profile, the preexisting health of the articular surface, and the risk of future chondral injury and osteoarthritis.
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Affiliation(s)
- Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Matthew J Udine
- University of South Florida College of Medicine, Tampa, Florida
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | | | - Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jorge A Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois
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14
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The lateral meniscal extrusion after repair with concomitant anterior cruciate ligament reconstruction at a mean follow-up of 3.5 years. J Orthop Sci 2022; 27:804-809. [PMID: 34030939 DOI: 10.1016/j.jos.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A meniscal repair is often performed on radial/flap or longitudinal tears of the lateral meniscus (LM) combined with anterior cruciate ligament reconstruction (ACLR). However, it is unknown if meniscal extrusion changes over time after repair. This study evaluated whether meniscal extrusion of the LM is maintained after repair or progresses with time using magnetic resonance imaging (MRI). METHODS Among 574 patients who underwent primary anatomic ACLR, 123 patients followed up for more than 2 years were retrospectively analyzed. Forty patients with concomitant radial/flap tears of the LM (group R), 43 with longitudinal LM tears (group L), and 40 with intact LM (group C, matched-control group) were included. Clinical findings (pain, range of motion, swelling, and anterior laxity), lateral joint space on radiograph, and meniscal extrusion on MRI were assessed. Lateral/posterior meniscal extrusions were examined preoperatively, within 3 weeks after surgery, and at the final follow-up, and the absolute values and relative values (the preoperative values as baseline) were assessed respectively. RESULTS There were no significant differences in the clinical and roentgenographic findings among the groups. No difference was observed in the relative values within 3 weeks after surgery among three groups, although the absolute values were larger in the repaired groups than in group C. At the final follow-up, however, the lateral extrusion in group L had progressed significantly, compared with that in group C (P = 0.033), while no significant difference was detected in the lateral extrusion between groups R and C (P = 0.177). The posterior extrusion in groups R and L had progressed significantly compared with that in group C (P < 0.001). CONCLUSIONS LM extrusion could not be improved even immediately after meniscal repair, and it progressed laterally and posteriorly for more than 2 years after surgery.
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15
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The post-traumatic meniscal extrusion, sign of meniscotibial ligament injury. A case series. Orthop Traumatol Surg Res 2022; 108:103226. [PMID: 35123034 DOI: 10.1016/j.otsr.2022.103226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Medial meniscal extrusion (ME) has been found to be associated to anterior cruciate ligament (ACL) injury. Post-traumatic extrusion is mainly attributed to meniscotibial ligament (MTL) tear. The aim of this retrospective study was to assess the incidence of MTL tear associated with meniscal extrusion, evaluate arthroscopic findings and the associated clinical findings. HYPOTHESIS The medial meniscal extrusion, when associated to ACL injury, is related to a tear of the MTL. PATIENTS AND METHODS Patients who underwent to primary or revision ACL reconstruction with associated medial meniscal rise and/or meniscotibial tear or insufficiency were retrospectively identified over a 5-year period (from 2015 to 2019). Twenty-four patients were included in this study with preoperative magnetic resonance imaging (MRI) carried out at our institution Each MRI was evaluated by the senior author for the presence of meniscal extrusion and also for the additional pathology of meniscotibial ligament. Patient medical records were reviewed to obtain demographic information, including age, gender, and arthrometric evaluation of anteroposterior laxity. RESULTS All included patients underwent arthroscopic ACL reconstruction using autograft tissue, (19 primary and in 5 revision ACL reconstruction). The mean age was 31.2 years (range: 15-57; SD: 12.3 years) at the time of surgery. ME was identified at MRI in all cases preoperatively and confirmed arthroscopically. No correlation was found between meniscal extrusion and anteroposterior translation (ρ=-0.270; p=0.202). Neither between having more than 3mm of extrusion and gender (χ2=0.80; p=0.371), acute/chronic lesion (χ2=0.91; p=0.341) and primary/revision reconstructions (χ2=0.83; p=0.364). In the last three patients, arthroscopic treatment of meniscal extrusion was carried out through outside-in repair of medial meniscus at its capsular junction. Reduction of meniscal extrusion has been verified by MRI, performed at 3-month follow-up. DISCUSSION A high prevalence of ME was found at MRI in patients with ACL injury and MTL tear. Therefore, ME may be associated to acute or chronic ligamentous injury involving the MTL, and its tear can be considered as the main determinant of extrusion. Further research is needed to increase evidence concerning MTL incidence and surgical outcomes. LEVEL OF EVIDENCE IV, retrospective case series.
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16
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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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17
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Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment. Life (Basel) 2022; 12:life12040603. [PMID: 35455094 PMCID: PMC9032096 DOI: 10.3390/life12040603] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.
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18
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Gajjar SM, Solanki KP, Shanmugasundaram S, Kambhampati SBS. Meniscal Extrusion: A Narrative Review. Orthop J Sports Med 2021; 9:23259671211043797. [PMID: 34778470 PMCID: PMC8573502 DOI: 10.1177/23259671211043797] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Meniscal extrusion, referred to as an external displacement of the meniscus, is a commonly encountered but often overlooked magnetic resonance imaging finding in the knee joint. Meniscal extrusion alters the biomechanical properties of the meniscus, leading to accelerated cartilage degeneration and early osteoarthritic changes. The literature contains discrepancies about meniscal extrusion on topics ranging from definition to diagnosis. This narrative review outlines the pathogenesis, natural history, diagnosis, and treatment of meniscal extrusion. Purpose: To review the current literature on meniscal extrusion, from pathogenesis to treatment, and to provide recommendations for future research. Study Design: Narrative review. Methods: A computer-based search of the PubMed, Ovid Medline, and Cochrane Library databases was used to perform a comprehensive literature review on meniscal extrusion. A total of 81 studies was ultimately included in the review. Results: The literature review highlighted the current ambiguity in definition, difficulty in clinical diagnosis, and low level of awareness of this condition. This review covers all aspects related to meniscal extrusion and identifies many of its lesser known aspects. Conclusion: In the current literature, meniscal extrusion remains a lesser known albeit common condition because of its relatively silent nature along with lack of knowledge among orthopaedic surgeons. Further studies are warranted to provide better understanding and management of this condition.
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Affiliation(s)
- Shreyash M Gajjar
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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19
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van der Voet JA, Wesselius D, Zhang F, Vroegindeweij D, Oei EH, Bierma-Zeinstra SMA, Englund M, Runhaar J. Factors associated with longitudinal change of meniscal extrusion in overweight women without clinical signs of osteoarthritis. Rheumatology (Oxford) 2021; 60:5175-5184. [PMID: 33693533 DOI: 10.1093/rheumatology/keab228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To identify variables associated with longitudinal change in meniscal extrusion, which might be used as possible targets for knee osteoarthritis (KOA) prevention. METHODS In a high-risk population of middle-aged overweight women, meniscal extrusion was assessed with magnetic resonance imaging (1.5 T, coronal proton density, in-plane resolution 0.5 mm2, Sante DICOM Editor) at baseline and after 30 months. Outcomes were the absolute change in medial and lateral extrusion (mm) and relative change in extrusion (%). Based upon literature, 11 factors were hypothesized to be associated with longitudinal change. Generalized estimating equations were used to model the effect on meniscal change (P <0.05). RESULTS In total, 677 knees of 343 women were available for analysis, with a mean age of 55.7 years (+/-3.2) and a mean BMI of 32.3 kg/m2 (+/-4.2). The greatest change in meniscal extrusion appeared medially with incident meniscal tear (4.4%; absolute 0.9 mm (95% CI: 0.3, 1.5; P =0.004); relative 14.5% (4.4, 24.7; 0.005)). Varus malalignment was associated with an increase of medial extrusion of 0.6 mm (37.6%; 0.1, 1.0; 0.009). A 5 kg/m2 higher baseline BMI was associated with absolute and relative increase of medial extrusion of 0.2 mm and 2.96% (0.1, 0.3; <0.001 and 1.3, 4.8; 0.002). Less explicit but significant changes in extrusion appeared with longitudinal change in BMI. CONCLUSION Meniscal tears, varus malalignment and BMI were significantly associated with change in meniscal extrusion in middle-aged overweight women, providing viable therapeutic targets to prevent or reduce extrusion and thereby decelerate KOA development.
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Affiliation(s)
- Jan A van der Voet
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam.,Department of Radiology, Alrijne Hospital, Leiderdorp
| | - Daan Wesselius
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fan Zhang
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | | | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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20
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Hong CY, Lee CG, Kim DH, Cho YS, Kim KY, Ryu SY, Song HS. Work-Related Risk Factors of Knee Meniscal Tears in Korean Farmers: A Cross-Sectional Study. Saf Health Work 2020; 11:485-490. [PMID: 33329915 PMCID: PMC7728704 DOI: 10.1016/j.shaw.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/12/2023] Open
Abstract
Background Meniscal tears are among the major risk factors for knee osteoarthritis progression. This study aimed to investigate the relationship between meniscal tears and work-related factors in the farming occupation. Methods The participants included 486 farmers (238 men and 248 women), aged 40–69 years, who were among the 550 farmers registered in the Korea Farmer's Knee Cohort (KFKC). Data such as those on gender, age, body mass index (BMI), mechanical axis, cumulative heavy-lifting working time (CLWT), cumulative squatting working time (CSWT), and previous knee injury history were collected from the questionnaire, along with whole leg radiographic findings. Two radiologists assessed the magnetic resonance images of both knees to confirm the presence of meniscal tears. The factors related to meniscal tears were analyzed by multiple logistic regression. Results A total of 54.5% of the farmers (48.7% of men and 60.1% of women) had meniscal tears. These tears were associated with gender, age, and BMI. We also identified an association between meniscal tears and CSWT, an especially important factor in farming [10,000–19,999 working hours, odds ratio = 2.16, 95% confidence interval (CI): 1.14-4.07, ≥20,000 working hours, odds ratio = 2.35, 1.45-3.80]. However, mechanical axis, knee injury history, and CLWT were not significantly related to meniscal tears. Conclusion This study's findings show that squatting for long periods, as an occupational factor, is related to meniscal tears.
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Affiliation(s)
- Chae Young Hong
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Chul Gab Lee
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Dong Hwi Kim
- Department of Orthopedic Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Yong Soo Cho
- Department of Radiology, Chosun University Hospital, Gwangju, South Korea
| | - Kweon Young Kim
- Department of Rehabilitation Medicine, Chosun University Hospital, Gwangju, South Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Han Soo Song
- Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, South Korea
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21
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Wang X, Jing L, Wang X, Li Z, Li Z, Zhang Z, Yang J. Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study. Medicine (Baltimore) 2020; 99:e23351. [PMID: 33217878 PMCID: PMC7676584 DOI: 10.1097/md.0000000000023351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to analyze the relationship between medial posterior tibial slope (MPTS) and medial meniscus slope (MMS) with the location of meniscal lesions. We hypothesize that meniscuses with greater MPTS and MMS are more likely to have lesions in posterior horn.A total of 292 patients underwent arthroscopic surgery between January 2014 to September 2019 due to knee osteoarthritis (OA) and meniscal lesions were reviewed. Based upon the location of meniscal tears, patients were categorized as group B (tears in posterior horn) and group A (other sites). MPTS and MMS were measured from magnetic resonance imaging (MRI) slices. Osteoarthritis grade was evaluated in anteroposterior radiographs by the criteria defined by Kellgeren and Lawrence. Demographic data, OA grade, MPTS, and MMS for the 2 groups were compared and analyzed.The group A had 29 (39%) male and 45 (61%) female subjects with a mean age of 57.07 ± 6.79 years. Group B consists of 74 (34%) male and 144 (66%) female subjects with a mean age of 58.90 ± 7.594 years. (P = .067 and P = .458 for age and sex, respectively). In group A, 31 knees (42%) were determined to be Kellgren-Lawrence grade one, 32 knees (43%) grade two, and 11 knees (15%) grade three. In group B, 86 knees (39%) were categorized in grade one, 85 knees (39%) in grade two, and 47 knees (26%) in grade three (P = .085). The mean MPTS was 5.06 ± 2.11 degree for group A and 6.15 ± 2.37 degree for group B (P = .001). The mean MMS for group A was lower than group B (1.38 ± 2.12 degree vs 3.14 ± 2.92 degree; P < .000)This study demonstrated that increased MPTS and MMS may be considered as the risk factors for medial meniscal posterior horn tears.
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Affiliation(s)
- Xiaotan Wang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine
| | - Lizhong Jing
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
| | - Xiaole Wang
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
| | - Zhen Li
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou
| | - Zhuang Li
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Zhiwei Zhang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine
| | - Jiushan Yang
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
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Sgroi M, Gninka J, Fuchs M, Seitz AM, Reichel H, Kappe T. Chondral lesions at the medial femoral condyle, meniscal degeneration, anterior cruciate ligament insufficiency, and lateral meniscal tears impair the middle-term results after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:3488-3496. [PMID: 32036398 DOI: 10.1007/s00167-020-05883-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of the present study was to analyse which clinical, radiological and arthroscopic findings are able to predict the postoperative outcome after arthroscopic partial meniscectomy. Furthermore, the present study aimed to investigate the postoperative outcome after partial meniscectomy in patients with degenerative meniscal lesions. METHODS A total of 91 patients with a follow-up period of 34.7 ± 11.4 months after arthroscopic partial meniscectomy were included in this retrospective study. Clinical, radiological, and arthroscopic data were analysed at the time of follow-up. The multivariable linear regression analysis for postoperative outcome, based on the Western Ontario Meniscal Evaluation Tool (WOMET), included age, gender, body mass index, physical activity, presence of cartilage lesions, leg alignment, grade of radiographic osteoarthritis, location of meniscal lesions, meniscal extrusion, meniscal degeneration, presence of an anterior cruciate ligament tears as well as bone marrow lesions. RESULTS WOMET and WOMAC scores showed a significant improvement of 45.0 ± 48.1 points (CI 34.9-55.1; p ≤ 0.0001) and 75.1 ± 69.3 points (CI 60.6-89.6; p = 0.001) within the follow-up period. Multivariable linear regression analysis showed that poor preoperative WOMET scores (p = 0.001), presence of cartilage lesions at the medial femoral condylus (p = 0.001), meniscal degeneration (p = 0.008), the presence of an anterior cruciate ligament lesion (p = 0.005), and lateral meniscal tears (p = 0.039) were associated with worse postoperative outcomes. Patients with femoral bone marrow lesions had better outcome (p = 0.038). CONCLUSION Poor preoperative WOMET scores, presence of cartilage lesions at the medial femoral condylus, meniscal degeneration, concomitant anterior cruciate ligament lesions as well as lateral meniscal tears are correlated with worse postoperative outcomes after arthroscopic partial meniscectomy. Patients with femoral bone marrow lesions femoral are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. Despite justified recent restrictions in indication, arthroscopic partial meniscectomy seems to effectively reduce pain and alleviate symptoms in carefully selected patients with degenerative meniscal tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mirco Sgroi
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany. .,, 89075, Ulm, Germany.
| | - Johanna Gninka
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Michael Fuchs
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
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Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surg Sports Traumatol Arthrosc 2020; 28:3599-3605. [PMID: 31332493 DOI: 10.1007/s00167-019-05612-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to describe meniscus extrusion, present imaging characteristics, and provide clinical correlations for patients with isolated meniscus extrusion. METHODS Of the 3244 MRI reports identified as having meniscus extrusion, 20 patients were identified to have isolated meniscus extrusion (0.62%). Patients with moderate to severe chondromalacia, meniscus tears, intra-articular fractures, tumours, and ligament tears were excluded. Radiographs were reviewed and graded using Kellgren-Lawrence (K-L) scores. MRI's were reviewed for the extent of extrusion and whether or not the meniscotibial ligament was intact. Clinical presentation and management were recorded. RESULTS The study population consisted of 12 females and 8 males with a mean age of 40.5, diagnosed with meniscus extrusion and minimal concomitant knee pathology. 68% of patients were considered symptomatic as their knee pain correlated with the side of their meniscus extrusion and no other reason for pain was identified. The mean amount of meniscus extrusion was 2.5 mm (SD ± 1.1 mm) with 45% (9 of 20) having 3 + mm of extrusion. Meniscotibial ligament abnormality was identified in 65% of cases (13 of 20). Patients with 3 + mm of meniscus extrusion were much more likely to have associated meniscotibial ligament abnormality (100%, 9 of 9) compared to those with < 3 mm of extrusion (36%, 4 of 11) (RR 2.75, p = 0.048). The mean K-L grade obtained at the initial visit was 0.9 (95% CI 0.7-1.4) and the mean K-L grade obtained on final follow-up was 1.3 (95% CI 0.8-2.8) (n.s.) at a mean of 44.7 months. No correlation was found between K-L grade, gender, age, acute injury, and BMI in relation to meniscotibial ligament abnormality or amount of meniscal extrusion. CONCLUSIONS Meniscus extrusion often occurs in the presence of significant knee pathology, predominantly with meniscus tears or osteoarthritis. Isolated meniscus extrusion is a rare occurrence that may present clinically with knee pain, commonly to the side in which the extrusion occurs. In patients with three or more millimetres of meniscus extrusion, an intact meniscus and minimal knee pathology, meniscotibial ligament abnormality is likely. This may provide an opportunity to treat the meniscotibial ligament abnormality with meniscus centralisation technique and decrease the amount of meniscus extrusion.
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Liu Y, Du G, Li X. Threshold for lateral meniscal body extrusion on MRI in middle-aged and elderly patients with symptomatic knee osteoarthritis. Diagn Interv Imaging 2020; 101:677-683. [DOI: 10.1016/j.diii.2020.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/03/2020] [Accepted: 05/30/2020] [Indexed: 12/12/2022]
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Dean RS, DePhillipo NN, Monson JK, LaPrade RF. Peripheral Stabilization Suture to Address Meniscal Extrusion in a Revision Meniscal Root Repair: Surgical Technique and Rehabilitation Protocol. Arthrosc Tech 2020; 9:e1211-e1218. [PMID: 32874903 PMCID: PMC7451443 DOI: 10.1016/j.eats.2020.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/29/2020] [Indexed: 02/03/2023] Open
Abstract
Meniscal root tears are an increasingly recognized condition. These tears can cause the meniscus to become extruded outside the joint, which can diminish the biomechanical functionality of the meniscus. Anatomic repair of the meniscal root has previously been described, but this surgical procedure may not adequately address severe extrusion of the meniscal tissue. Additionally, when a primary anatomic repair fails, meniscal extrusion can increase, which can possibly accelerate joint degeneration if untreated. Therefore, the purpose of this Technical Note is to describe our surgical technique for revision medial meniscal root repair with a peripheral stabilization suture to address medial meniscal root tears with severe meniscal extrusion.
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Affiliation(s)
| | - Nicholas N. DePhillipo
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A
- Oslo Sports Trauma Research Institute, Oslo, Norway
| | | | - Robert F. LaPrade
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A
- Address correspondence to Robert F. LaPrade, M.D., Ph.D., Twin Cities Orthopedics, 4010 W 65th St, Edina, MN 55435, U.S.A.
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Casper‐Taylor ME, Barr AJ, Williams S, Wilcox RK, Conaghan PG. Initiating factors for the onset of OA: A systematic review of animal bone and cartilage pathology in OA. J Orthop Res 2020; 38:1810-1818. [PMID: 31975435 PMCID: PMC7383628 DOI: 10.1002/jor.24605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
There is controversy over whether bone or cartilage is primarily involved in osteoarthritis (OA) pathogenesis; this is important for targeting early interventions. We explored evidence from animal models of knee OA by preforming a systematic review of PubMed, Scopus, and Web of Science for original articles reporting subchondral bone and cartilage pathology in animal models with epiphyseal closure. Extracted data included: method of induction; animal model; cartilage and bone assessment and method; meniscal assessment; skeletal maturity; controls; and time points assessed. Quality scoring was performed. The best evidence was synthesized from high-quality skeletally mature models, without direct trauma to tissues of interest and with multiple time points. Altogether, 2849 abstracts were reviewed. Forty-seven papers were included reporting eight different methods of inducing OA, six different species, six different methods of assessing cartilage, five different bone structural parameters, and four assessed meniscus as a potential initiator. Overall, the simultaneous onset of OA in cartilage and bone was reported in 82% of datasets, 16% reported bone onset, and 2% reported cartilage onset. No dataset containing meniscal data reported meniscal onset. However, using the best evidence synthesis (n = 8), five reported simultaneous onset when OA was induced, while three reported bone onset when OA occurred spontaneously; none reported cartilage onset. In summary, there is a paucity of well-designed studies in this area which makes the conclusions drawn conjectures rather than proven certainties. However, within the limitation of data quality, this review suggests that in animal models, the structural onset of knee OA occurs either in bone prior to cartilage pathology or simultaneously.
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Affiliation(s)
- Michelle E. Casper‐Taylor
- School of Mechanical Engineering, Institute of Medical and Biological EngineeringUniversity of LeedsLeedsUK
| | - Andrew J. Barr
- NIHR Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - Sophie Williams
- School of Mechanical Engineering, Institute of Medical and Biological EngineeringUniversity of LeedsLeedsUK
| | - Ruth K. Wilcox
- School of Mechanical Engineering, Institute of Medical and Biological EngineeringUniversity of LeedsLeedsUK
| | - Philip G. Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
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Determining a Threshold of Medial Meniscal Extrusion for Prediction of Knee Pain and Cartilage Damage Progression Over 4 Years: Data From the Osteoarthritis Initiative. AJR Am J Roentgenol 2020; 216:1318-1328. [PMID: 32755218 DOI: 10.2214/ajr.20.23864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND. The extent of medial meniscal extrusion (MME) that is associated with structural and symptomatic progression of knee osteoarthritis has not been defined yet. OBJECTIVE. The purpose of our study was to investigate MRI-based thresholds of MME that are associated with structural progression of knee degenerative disease and symptoms over a period of 4 years. METHODS. We studied 328 knees of 235 participants that were randomly selected from the Osteoarthritis Initiative cohort. MME was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3 T. Knee pain and cartilage abnormalities were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and the cartilage whole-organ MRI score (WORMS). General estimating equations with logistic regression models were used to correlate baseline MME and changes in pain (WOMAC) and cartilage damage (WORMS). ROC analyses were performed to determine the area under the ROC curve (AUROC). Individual thresholds were determined by maximizing the product of sensitivity and specificity. RESULTS. The AUROC for predicting progression of knee pain, medial compartment cartilage damage, and medial tibial cartilage damage were 0.71, 0.70, and 0.72, respectively, and the individual thresholds for MME were 2.5, 2.7, and 2.8 mm. A single threshold of 2.5 mm was determined by maximizing the mean of the product of sensitivity and specificity of the three outcome variables (knee pain progression, medial compartmental cartilage damage progression, and medial tibial cartilage damage progression). CONCLUSION. MME was associated with knee pain and cartilage damage progression over 4 years. A single threshold of 2.5 mm was found to be the most useful threshold for predicting knee pain, medial compartment cartilage damage progression, and tibial cartilage damage progression over 4 years. CLINICAL IMPACT. This threshold could be used to standardize the diagnostic criterion of extrusion and to better characterize the risk for subsequent structural and symptomatic progression of knee osteoarthritis.
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Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1092-1098. [PMID: 31489460 DOI: 10.1007/s00167-019-05701-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Assessment of medial meniscus extrusion (MME) has become increasingly popular in clinical practice to evaluate the dynamic meniscus function and diagnose meniscus pathologies. The purpose of this biomechanical study was to investigate the correlation between MME and the changes in joint contact pressure in varus and valgus alignment. It was hypothesized that varus alignment would result in significantly higher MME along with a higher joint contact pressure in the medial compartment. METHODS Eight fresh-frozen human cadaveric knees were axially loaded, with a 750 N compressive load, in full extension with the mechanical axis shifted to intersect the tibial plateau at 30% and 40% (varus), 50% (neutral), 60% and 70% (valgus) of its width (TPW). Tibiofemoral peak contact pressure (PCP), mean contact pressure (MCP) and contact area (CA) were determined using pressure-sensitive films. MME was obtained via ultrasound at maximum load. RESULTS MME was significantly increased from valgus (1.32 ± 0.22 mm) to varus alignment (3.16 ± 0.24 mm; p < 0.001). Peak contact pressure at 30% TPW varus alignment was significantly higher compared to 60% TPW valgus (p = 0.018) and 70% TPW valgus (p < 0.01). MME significantly correlated with PCP (r = 0.56; p < 0.001) and MCP (r = 0.47, p < 0.01) but not with CA (r = 0.23; n.s.). CONCLUSION MME was significantly increased in varus alignment, compared to neutral or valgus alignment, with an intact medial meniscus. It was also significantly correlated with PCP and MCP within the medial compartment. However, valgus malalignment and neutral axis resulted in reduced MME and contact pressure. Lower limb alignment must be taken into account while assessing MME in clinical practice. LEVEL OF EVIDENCE Controlled laboratory study.
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US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Eur Radiol 2020; 30:3996-4004. [PMID: 32140818 DOI: 10.1007/s00330-020-06749-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA) through a 5-year follow-up. METHODS Overall, 472 participants and 944 knees were eligible. MME (mm) was measured at the baseline, and KOA was radiographically evaluated at both baseline and 5-year follow-up by Kellgren-Lawrence grade (KLG). Radiographic KOA (ROA) was defined as the knee showing KLG ≥ 2. Incident ROA (iROA) was defined if the baseline KLG of 0-1 increased to KLG ≥ 2 in 5 years. Progressive ROA (pROA) was defined if the baseline KLG of 2-3 worsened to a higher grade in 5 years. Receiver operating characteristic (ROC) curve and generalized estimating equations were used for analysis. RESULTS Of 574 non-ROA knees at the baseline, 43 knees (7.5%) developed iROA; of 370 ROA knees, 47 knees (12.7%) developed pROA. Based on the ROC curves, 4 mm was the optimal cutoff to detect the risk of iROA (area under curve [AUC] 0.639 [right knee]; AUC 0.641 [left knee]) and that of pROA (AUC 0.750 [right knee]; AUC 0.863 [left knee]). Multiple regression analysis showed that the 4-mm cutoff of MME was significantly associated with both the prevalence of iROA (regression coefficient [B] 1.909; p ≤ 0.001; adjusted odds ratio [aOR] 6.746) and that of pROA (B 1.791; p ≤ 0.001; aOR 5.993). CONCLUSIONS On ultrasonography, the participants with more extruded medial meniscus showed a higher prevalence of both iROA and pROA. Ultrasonography could identify patients who had a risk of developing KOA. KEY POINTS • Through a 5-year follow-up, the current cohort study was conducted to clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA). • More extruded medial meniscus evaluated by ultrasonography was associated with the development of radiographic KOA. • Ultrasonography could identify the patients who had a risk of developing KOA, and the 4-mm cutoff of MME was optimal to detect this risk.
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Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Saris DBF, Levy BA, Stuart MJ, Krych AJ. Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison of Nonoperative Management, Partial Meniscectomy, and Repair. Am J Sports Med 2020; 48:128-132. [PMID: 31765234 DOI: 10.1177/0363546519888212] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear (MMPRT) treated with nonoperative management, partial meniscectomy, or repair. PURPOSE/HYPOTHESIS The purpose was to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either nonoperative management, partial meniscectomy, or transtibial pull-through repair for an MMPRT. We hypothesized that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with nonoperative management or partial meniscectomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscal laterality, age, sex, and Kellgren-Lawrence (K-L) grades to patients treated nonoperatively or with a partial meniscectomy. Progression to arthroplasty rates, International Knee Documentation Committee and Tegner scores, and radiographic outcomes were analyzed between groups. RESULTS Forty-five patients were included in this study (15 nonoperative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean of 74 months (nonoperative, 4/15; partial meniscectomy, 9/15; meniscal repair, 0/15; P = .0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre- to postoperatively (nonoperative, 1.0; partial meniscectomy, 1.1; meniscal repair, 0.1; P = .001). CONCLUSION Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared with nonoperative management and partial meniscectomy in a matched cohort based on patient characteristics.
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Affiliation(s)
| | - Nicholas I Kennedy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Meniscal injuries are common in patients with varus or valgus malalignment, but consensus is lacking as to when surgery should address the meniscal injury only and when it should be combined with an osteotomy. Several factors need to be evaluated to provide the most appropriate treatment in each case. Here we highlight the most relevant literature on the subject and suggest a rationale for surgical treatment.
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Affiliation(s)
- Pablo Eduardo Gelber
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Bjorn Barenius
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Intitutet, Solnavägen 1, Solna, Stockholm 17177, Sweden
| | - Simone Perelli
- ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Özdemir M, Turan A. Correlation Between Medial Meniscal Extrusion Determined by Dynamic Ultrasound and Magnetic Resonance Imaging Findings of Medial-Type Knee Osteoarthritis in Patients With Knee Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2709-2719. [PMID: 30828848 DOI: 10.1002/jum.14976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of our study was to investigate the relationship between medial meniscal extrusion (MME) determined by dynamic ultrasound (US) and magnetic resonance imaging findings of medial-type knee osteoarthritis (OA). METHODS Single knees of 102 patients with knee pain were assessed by radiography, dynamic US, and magnetic resonance imaging. All knee radiographs were interpreted and grouped according to the Kellgren-Lawrence (KL) scale. Medial meniscal extrusion in non-weight-bearing and weight-bearing positions and the difference of these values (ΔMME) were measured by dynamic US. The medial tibiofemoral compartments of all knees were evaluated and grouped according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Mean values of non-weight-bearing MME, weight-bearing MME, and ΔMME ± standard deviations for groups formed according to the KL scale and WORMS system were compared. RESULTS We demonstrated that different from non-weight-bearing MME, weight-bearing MME was significantly correlated with not only high grades but also lower grades of cartilage damage and subchondral bone marrow lesions in medial-type knee OA. Although the difference in non-weight-bearing MME between cartilage status groups 1 and 2 was not significant (P = .071), there were significant differences in of weight-bearing MME between groups 1 and 2, between groups 2 and 3, and between groups 3 and group 4 (P = .003, .002, and .032, respectively). CONCLUSIONS We found statistically significant associations between MME values and the severity of the OA findings according to both the KL scale and WORMS system. We offer dynamic US as an initial tool for the diagnosis and a screening method to estimate the severity of knee OA.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
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Byrne C, Alkhayat A, Bowden D, Murray A, Kavanagh E, Eustace S. Degenerative tears of the posterior horn of the medial meniscus: correlation between MRI findings and outcome following intra-articular steroid/bupivacaine injection of the knee. Clin Radiol 2019; 74:488.e1-488.e8. [DOI: 10.1016/j.crad.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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Svensson F, Felson DT, Zhang F, Guermazi A, Roemer FW, Niu J, Aliabadi P, Neogi T, Englund M. Meniscal body extrusion and cartilage coverage in middle-aged and elderly without radiographic knee osteoarthritis. Eur Radiol 2019; 29:1848-1854. [PMID: 30280250 PMCID: PMC6420611 DOI: 10.1007/s00330-018-5741-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/20/2017] [Accepted: 10/18/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine meniscal extrusion and cartilage coverage on magnetic resonance (MR) images and factors associated with these parameters in knees of middle-aged and elderly persons free from radiographic tibiofemoral osteoarthritis (OA). METHODS Seven hundred eighteen persons, free of radiographic tibiofemoral OA, aged 50-90 years from Framingham, MA, USA, were included. We measured meniscal extrusion on 1.5 T MRI of both knees to evaluate both medial and lateral meniscal body extrusion and cartilage coverage. We also determined meniscal morphology and structural integrity. The multivariable association with age, body mass index (BMI), and ipsilateral meniscal damage was also evaluated. RESULTS The mean meniscal body extrusion medially was 2.7 mm and laterally 1.8 mm. The tibial cartilage coverage was about 30% of ipsilateral cartilage surface (both compartments). The presence of ipsilateral meniscal damage was associated with more extrusion in only the medial compartment, 1.0 mm in men and 0.6 mm in women, and less cartilage coverage proportion, -5.5% in men and -4.6% in women. CONCLUSIONS Mean medial meniscal body extrusion in middle-aged or older persons without radiographic tibiofemoral OA approximates the commonly used cutoff (3 mm) to denote pathological extrusion. Medial meniscal damage is a factor associated with medial meniscal body extrusion and less cartilage coverage. KEY POINTS • Medial meniscal extrusion in middle-aged/older persons without OA is around 3 mm. • Lateral meniscal extrusion in middle-aged/older persons without OA is around 2 mm. • Meniscal damage is associated with medial meniscal extrusion and less cartilage coverage.
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Affiliation(s)
- Fredrik Svensson
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
| | - David T Felson
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Fan Zhang
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Frank W Roemer
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jingbo Niu
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Piran Aliabadi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tuhina Neogi
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
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Patterson BE, Culvenor AG, Barton CJ, Guermazi A, Stefanik JJ, Morris HG, Whitehead TS, Crossley KM. Worsening Knee Osteoarthritis Features on Magnetic Resonance Imaging 1 to 5 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:2873-2883. [PMID: 30179520 PMCID: PMC6379915 DOI: 10.1177/0363546518789685] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury is a well-established risk factor for the long-term development of radiographic osteoarthritis (OA). However, little is known about the early degenerative changes (ie, <5 years after injury) of individual joint features (ie, cartilage, bone marrow), which may be reversible and responsive to interventions. PURPOSE To describe early degenerative changes between 1 and 5 years after ACL reconstruction (ACLR) on magnetic resonance imaging (MRI) and explore participant characteristics associated with these changes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Seventy-eight participants (48 men; median age, 32 years; median body mass index [BMI], 26 kg/m2) underwent 3.0-T MRI at 1 and 5 years after primary hamstring autograft ACLR. Early tibiofemoral and patellofemoral OA features were assessed with the MRI Osteoarthritis Knee Score. The primary outcome was worsening (ie, incident or progressive) cartilage defects, bone marrow lesions (BMLs), osteophytes, and meniscal lesions. Logistic regression with generalized estimating equations evaluated participant characteristics associated with worsening features. RESULTS Worsening of cartilage defects in any compartment occurred in 40 (51%) participants. Specifically, worsening in the patellofemoral and medial and lateral tibiofemoral compartments was present in 34 (44%), 8 (10%), and 10 (13%) participants, respectively. Worsening patellofemoral and medial and lateral tibiofemoral BMLs (14 [18%], 5 [6%], and 10 [13%], respectively) and osteophytes (7 [9%], 8 [10%], and 6 [8%], respectively) were less prevalent, while 17 (22%) displayed deteriorating meniscal lesions. Worsening of at least 1 MRI-detected OA feature, in either the patellofemoral or tibiofemoral compartment, occurred in 53 (68%) participants. Radiographic OA in any compartment was evident in 5 (6%) and 16 (21%) participants at 1 and 5 years, respectively. A high BMI (>25 kg/m2) was consistently associated with elevated odds (between 2- and 5-fold) of worsening patellofemoral and tibiofemoral OA features. CONCLUSION High rates of degenerative changes occur in the first 5 years after ACLR, particularly the development and progression of patellofemoral cartilage defects. Older patients with a higher BMI may be at particular risk and should be educated about this risk.
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Affiliation(s)
- Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joshua J Stefanik
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Hayden G Morris
- Park Clinic Orthopaedics, St Vincent's Private Hospital, Melbourne, Victoria, Australia
| | | | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: Detection, evaluation and clinical implications. Eur J Radiol 2018; 102:115-124. [PMID: 29685524 DOI: 10.1016/j.ejrad.2018.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
The menisci play an important role in knee kinematics. Their unique anatomy allows them to channel forces generated during knee movements through the larger tibio-femoral condylar surfaces while simultaneously resisting deleterious hoop stresses. Although physiologic meniscal extrusion occurs with every knee joint movement, pathologic meniscal extrusion subjects the knee to persistent and excessive load transmission. This renders the knee structures susceptible to injury or exacerbates worsening of existing knee joint internal derangement. Detection and quantification of meniscus extrusion is important given its association with underlying pathological processes and internal derangements such as cartilage loss, osteoarthritis and meniscal tears. The medial and lateral menisci vary in size, attachments and load transmission, and the medial meniscus is more susceptible to injury. In this article, the authors illustrate the role of meniscus kinematics, and the identification and quantification of medial meniscal extrusion. Multimodality imaging appearances and implications of presence of medial meniscal extrusion in different knee joint pathologies are discussed with review of the relevant literature.
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Affiliation(s)
- Nayanatara Swamy
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Avneesh Chhabra
- Department of Radiology & Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
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Sanchez BJ, Baker RT. Conservative Management of Possible Meniscal Derangement Using the Mulligan Concept: A Case Report. J Chiropr Med 2017; 16:308-315. [PMID: 29276463 DOI: 10.1016/j.jcm.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/16/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022] Open
Abstract
Objective The purpose of this case study was to report on the immediate effects of the combined use of mobilizations with movement and the "squeeze" technique on a patient with knee stiffness, popping, and swelling. Clinical Features The patient presented with right knee stiffness, swelling, and a popping sensation of insidious onset. Clinical examination revealed pain with terminal knee extension and flexion, joint line tenderness, a positive Apley's compression test, and a positive Thessaly's test at 20° of knee flexion. A working diagnosis was established of a meniscal pathology with the differential diagnoses of meniscal derangement and synovial plica. Intervention and Outcome The patient received 3 total treatments using the Mulligan concept over the course of 11 days. The treatments included the application of a tibia internal rotation mobilization with movement and the "squeeze" technique to the affected knee. Patient outcomes, including the Disablement in the Physically Active Scale, the Patient-Specific Functional Scale, and the Numeric Rating Scale for pain, were collected throughout the course of treatment. The patient reported a minimal clinically important difference on the Numeric Rating Scale for pain after each treatment and on all outcomes after the third treatment. The patient reported improvement on her follow-up visit 4 days after the third treatment; the results of a clinical exam and patient outcomes supported a complete discharge after 3 treatments. Conclusion This patient responded favorably to use of the Mulligan concept as a manual therapy technique for the treatment of symptoms related to possible meniscal derangement.
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Affiliation(s)
| | - Russell T Baker
- Department of Movement Sciences, University of Idaho, Moscow, Idaho
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Hada S, Ishijima M, Kaneko H, Kinoshita M, Liu L, Sadatsuki R, Futami I, Yusup A, Takamura T, Arita H, Shiozawa J, Aoki T, Takazawa Y, Ikeda H, Aoki S, Kurosawa H, Okada Y, Kaneko K. Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis. Arthritis Res Ther 2017; 19:201. [PMID: 28899407 PMCID: PMC5596458 DOI: 10.1186/s13075-017-1411-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 08/29/2017] [Indexed: 11/27/2022] Open
Abstract
Background Medial meniscal extrusion (MME) is associated with progression of medial knee osteoarthritis (OA), but no or little information is available for relationships between MME and osteophytes, which are found in cartilage and bone parts. Because of the limitation in detectability of the cartilage part of osteophytes by radiography or conventional magnetic resonance imaging (MRI), the rate of development and size of osteophytes appear to have been underestimated. Because T2 mapping MRI may enable us to evaluate the cartilage part of osteophytes, we aimed to examine the association between MME and OA-related changes, including osteophytes, by using conventional and T2 mapping MRI. Methods Patients with early-stage knee OA (n = 50) were examined. MRI-detected OA-related changes, in addition to MME, were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. T2 values of the medial meniscus and osteophytes were measured on T2 mapping images. Osteophytes surgically removed from patients with end-stage knee OA were histologically analyzed and compared with findings derived by radiography and MRI. Results Medial side osteophytes were detected by T2 mapping MRI in 98% of patients with early-stage knee OA, although the detection rate was 48% by conventional MRI and 40% by radiography. Among the OA-related changes, medial tibial osteophyte distance was most closely associated with MME, as determined by multiple logistic regression analysis, in the patients with early-stage knee OA (β = 0.711, p < 0.001). T2 values of the medial meniscus were directly correlated with MME in patients with early-stage knee OA, who showed ≥ 3 mm of MME (r = 0.58, p = 0.003). The accuracy of osteophyte evaluation by T2 mapping MRI was confirmed by histological analysis of the osteophytes removed from patients with end-stage knee OA. Conclusions Our study demonstrates that medial tibial osteophyte evaluated by T2 mapping MRI is frequently observed in the patients with early-stage knee OA, showing close association with MME, and that MME is positively correlated with the meniscal degeneration.
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Affiliation(s)
- Shinnosuke Hada
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Haruka Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mayuko Kinoshita
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Lizu Liu
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Sadatsuki
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ippei Futami
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Anwajan Yusup
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomohiro Takamura
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Arita
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Jun Shiozawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takako Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuji Takazawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroshi Ikeda
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisashi Kurosawa
- Department of Orthopaedics, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yasunori Okada
- Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Kim SJ, Choi CH, Chun YM, Kim SH, Lee SK, Jang J, Jeong H, Jung M. Relationship Between Preoperative Extrusion of the Medial Meniscus and Surgical Outcomes After Partial Meniscectomy. Am J Sports Med 2017; 45:1864-1871. [PMID: 28350516 DOI: 10.1177/0363546517697302] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous study has examined arthritic change after meniscectomy with regard to extrusion of the medial meniscus. PURPOSE (1) To determine the factors related to preoperative meniscal extrusion; (2) to investigate the relationship between medial meniscal extrusion and postoperative outcomes of partial meniscectomy, and to identify a cutoff point of meniscal extrusion that contributes to arthritic change after partial meniscectomy in nonosteoarthritic knees. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 208 patients who underwent partial meniscectomy of the medial meniscus between January 2000 and September 2006 were retrospectively reviewed. The extent of extrusion and severity of degeneration of the medial meniscus as shown on preoperative MRI were evaluated. The minimum follow-up duration was 7 years. Clinical function was assessed with the Lysholm knee scoring scale, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Tapper and Hoover grading system. Radiological evaluation was conducted by use of the IKDC radiographic assessment scale. Regression analysis was performed to identify factors affecting preoperative extrusion of the medial meniscus and factors influencing follow-up results after partial meniscectomy. Receiver operating characteristic curve was used to identify a cutoff point for the extent of meniscal extrusion that was associated with arthritic change. RESULTS The mean ± SD preoperative Lysholm knee score was 65.0 ± 6.3 and the mean IKDC subjective score was 60.1 ± 7.5. The mean follow-up functional scores were 93.2 ± 5.1 ( P < .001) for the Lysholm knee score and 89.0 ± 6.2 for the IKDC subjective score ( P < .001). Preoperative extent of meniscal degeneration ( P < .001) and preoperative pattern of meniscal tear ( P < .001) were related to preoperative meniscal extrusion. Preoperative extrusion of the meniscus showed a tendency to increase as the extent of intrameniscal degeneration increased, and the medial meniscus was extruded more in patients with horizontal, horizontal flap, and complex tears. The preoperative extent of meniscal extrusion had a statistically significant correlation with follow-up Lysholm knee score (coefficient = -0.10, P = .002), IKDC subjective score (coefficient = -0.09, P = .007), Tapper and Hoover grade (odds ratio = 1.05, P < .001), and IKDC radiographic grade (odds ratio = 1.13, P < .001) at the mean follow-up period of 88.6 months. The cutoff point for the relative value of preoperative meniscal extrusion associated with arthritic change was 34.6% (sensitivity = 69.3%; specificity = 82.7%; accuracy = 77.9%). CONCLUSION The preoperative extent of intrameniscal degeneration and the preoperative patterns of meniscal tear including horizontal, horizontal flap, and complex tears were associated with preoperative extrusion of the medial meniscus. The preoperative extrusion of the medial meniscus was negatively correlated with outcomes of partial meniscectomy. The preoperative extent of meniscal extrusion can be used as a predictive factor for osteoarthritis in partial meniscectomy.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Chong Hyuk Choi
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Keon Lee
- Department of Orthopaedic Surgery, Gwangmyung Sungae Hospital, Gyeonggi, Republic of Korea
| | - Jinyoung Jang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Howon Jeong
- Department of Orthopaedic Surgery, Sungae Hospital, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:1076-1083. [PMID: 28216311 DOI: 10.1016/j.joca.2017.02.792] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 01/27/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Whether meniscal extrusion and bone marrow lesions (BMLs) are independently associated with the risk of knee osteoarthritis (OA) is unknown. METHODS Data was extracted from the Osteoarthritis Initiative (OAI) cohort. Participants were grouped according to the absence (Kellgren-Lawrence (KL) grade ≤ 1, n = 2120) or presence (KL ≥ 2, n = 2249) of radiographic OA (ROA). Baseline meniscal extrusion and tibial BMLs were assessed. Tibial plateau cartilage volume was assessed at baseline and 72 months, while radiographic disease was assessed at baseline and 48 months. Total knee replacement (TKR) was assessed at 72 months. RESULTS In those with ROA, the presence of a baseline meniscal extrusion (independent of BMLs) was associated with accelerated cartilage volume loss (medial tibia: -2.1%/annum vs -1.5%; lateral: -2.6%/annum vs -1.6%; both P < 0.001), progressive ROA and TKR (Odds ratio (OR) range 1.4-1.8; 95% CI range 1.1-2.9). The presence of a baseline BML was associated with accelerated cartilage volume loss (medial tibia: -2.1%/annum vs -1.6%; lateral: -1.9%/annum vs -1.6%; P ≤ 0.02), progressive ROA and joint replacement (OR range 1.5-2.4; 95% CI range 1.1-3.4). In those with no ROA, a baseline medial meniscal extrusion was associated with accelerated cartilage volume loss (medial tibia: -2.1%/annum vs -1.2%, P < 0.001), and a baseline medial BML with incident ROA (OR 1.7, 95% CI 1.1 to 2.9). CONCLUSIONS The presence of baseline meniscal extrusion and BMLs are associated with incident and progressive knee of each other (OA) and represent important structural targets for the treatment and prevention of knee OA.
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McDaniel D, Tilton E, Dominick K, Flory K, Ernest T, Johnson JC, Main DC, Kondrashov P. Histological characteristics of knee menisci in patients with osteoarthritis. Clin Anat 2017; 30:805-810. [DOI: 10.1002/ca.22920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Dalton McDaniel
- Kirksville College of Osteopathic Medicine; A.T. Still University; Kirksville Missouri
| | - Emily Tilton
- Kirksville College of Osteopathic Medicine; A.T. Still University; Kirksville Missouri
| | - Kathryn Dominick
- Kirksville College of Osteopathic Medicine; A.T. Still University; Kirksville Missouri
| | - Kale Flory
- Kirksville College of Osteopathic Medicine; A.T. Still University; Kirksville Missouri
| | - Taylor Ernest
- Kirksville College of Osteopathic Medicine; A.T. Still University; Kirksville Missouri
| | - Jane C. Johnson
- A.T. Still Research Institute, A.T. Still University; Kirksville Missouri
| | | | - Peter Kondrashov
- Department of Anatomy; Kirksville College of Osteopathic Medicine, A.T. Still University; Kirksville Missouri
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Long-term assessment of meniscal extrusion after meniscal repair. Orthop Traumatol Surg Res 2017; 103:373-376. [PMID: 28163243 DOI: 10.1016/j.otsr.2016.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/14/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic meniscal repair limits the medium-term risk of radiological osteoarthritis. Magnetic resonance imaging (MRI) cannot provide an accurate assessment of meniscal healing but may show harbingers of osteoarthritis such as meniscal extrusion. The objective of this study was to assess long-term meniscal extrusion after meniscal repair. HYPOTHESIS Arthroscopic meniscal suture is not followed by meniscal extrusion and can, therefore, provide good knee function in the long-term. METHODS Consecutive patients who underwent arthroscopic meniscal suture on a stable or stabilised knee were included retrospectively. MRI was performed to measure absolute meniscal extrusion (AME), relative meniscal extrusion (RME), anterior sagittal extrusion (ASE), posterior sagittal extrusion (PSE), coronal cartilage coverage index (cCCI), and sagittal cartilage coverage index (sCCI). RESULTS After a mean follow-up of 8.8±0.87 years, there was no evidence of meniscal extrusion in these patients with stable or stabilised knees: AME, 1.7±1.03 and 2.3±0.93mm, RME, 17±0.10% and 28±0.12%, ASE, 2.52±1.43 and 1.71±2.42mm, PSE, 0.29±3.49 and 0.22±2.35mm, cCCI, 23±0.08% and 20±0.09%, and sCCI, 49±0,10% and 53±0.09%. CONCLUSION In the long-term after meniscal repair, osteoarthritis is limited and meniscal function seems preserved. LEVEL OF EVIDENCE IV, retrospective study.
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Evaluation of the size and position of the insertion of the anterior medial meniscus root in varus osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:362-367. [PMID: 26740086 DOI: 10.1007/s00167-015-3963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Recent studies have suggested radial displacement of the medial meniscus as a cause of varus knee osteoarthritis (OA). Two anatomical studies reported that such displacement may be associated with anterior insertion of the medial meniscus anterior horn. It was aimed to evaluate the location and area of this insertion in patients with advanced knee OA. METHODS Medial meniscus anterior horn insertions were classified into four types, as described in a previously reported classification during 225 total knee arthroplasty (TKA) in 184 patients. The incidence rates of insertion type were compared with previously reported rates in nearly normal or non-arthritic knees. The insertion surface area was also measured during 158 TKAs. RESULTS Of the 225 knees, 82 (36.4 %), 93 (41.3 %), 35 (15.6 %), and 15 (6.7 %) were classified as I, II, III, and IV, respectively. An anteriorly inserted anterior horn was not more frequent in advanced varus OA knees than in previously reported nearly normal or non-arthritic knees. The insertion surface areas were 57.5 ± 18.9, 56.1 ± 16.0, and 56.4 ± 14.4 mm2 for types I, II, and III, respectively; these areas did not differ significantly. CONCLUSION Since the incidence of an anteriorly inserted medial meniscus anterior horn was not higher in advanced varus OA knees than in normal or non-arthritic knees, an anteriorly inserted anterior horn may have little or no effect on the aetiology of varus OA knees. This study provides some information for clarifying the aetiology of knee OA. LEVEL OF EVIDENCE IV.
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Meniscal allograft subluxations are not associated with preoperative native meniscal subluxations. Knee Surg Sports Traumatol Arthrosc 2017; 25:200-206. [PMID: 27696125 DOI: 10.1007/s00167-016-4336-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the relationship between preoperative subluxation of the original menisci and postoperative graft subluxation after lateral meniscal allograft transplantation (MAT). METHODS Forty patients who underwent isolated lateral MATs in meniscus-deficient knees with a low-grade chondral lesion (≤ICRS grade 2) were assessed. Lateral subluxation of the native meniscus before meniscectomy and those of remaining meniscal tissue before MAT were measured on mid-coronal MRI scans taken at each time point. Postoperative meniscal subluxation was assessed using MRI at 6 months postoperatively, when the full rehabilitation protocols were completed. Correlation analyses were conducted to determine the associations between each of two preoperative lateral displacements and the postoperative graft subluxation. RESULTS The mean lateral subluxations before primary meniscectomy and before MAT were 0.3 ± 1.0 mm and 0.2 ± 0.8 mm, respectively. At 6 months postoperatively, it was 2.3 ± 1.9 mm. There were no significant correlations between the preoperative subluxation at the two preoperative time points and the postoperative extrusion (Spearman rho 2-sided test: ρ = - 0.058, (n.s.) for the native meniscus; Pearson r 2-sided test, r = 0.309, (n.s.) for the remaining meniscal rim). Between the postoperative nonextruded and extruded groups, there were no significant differences for the preoperative subluxations. CONCLUSIONS There are no associations between preoperative lateral subluxation of the native menisci and postoperative subluxation of meniscal transplants in patients who undergo MAT on the lateral compartment with low-grade arthritic changes. The extrusion phenomenon may be a distinct feature of transplanted menisci rather than an individual characteristic of meniscal displacement. Surgeons need to keep in mind that graft extrusion in nonarthritic knees might occur during transplantation. LEVEL OF EVIDENCE IV.
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Strauss EJ, Day MS, Ryan M, Jazrawi L. Evaluation, Treatment, and Outcomes of Meniscal Root Tears. JBJS Rev 2016; 4:01874474-201608000-00004. [DOI: 10.2106/jbjs.rvw.15.00082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ahedi HG, Aitken DA, Blizzard LC, Ding CHH, Cicuttini FM, Jones G. Correlates of Hip Cartilage Defects: A Cross-sectional Study in Older Adults. J Rheumatol 2016; 43:1406-12. [PMID: 27252427 DOI: 10.3899/jrheum.151001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Knee cartilage defects are a key feature of osteoarthritis (OA) but correlates of hip defects remain unexplored. The aims of this cross-sectional study were to describe the correlates of hip cartilage defects. METHODS The study included 194 subjects from the Tasmanian Older Adult Cohort who had right hip short-tau inversion recovery magnetic resonance imaging (MRI). Hip cartilage defects were assessed and categorized as grade 0 = no defects, grade 1 = focal blistering or irregularities on cartilage or partial thickness defect, and grade 2 = full thickness defect. Hip pain was determined by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Hip structural changes were measured on MRI, and hip radiographic OA (ROA) was assessed. Leg strength and physical activity were assessed using dynamometer and pedometers, respectively. Data were analyzed using log binomial and linear regression. RESULTS Of 194 subjects, 24% (n = 48) had no defects, 34% (n = 66) had grade 1, and 41% (n = 80) had grade 2. In multivariable analyses, any hip defects were associated with greater hip pain [prevalence ratio (PR) 1.20, 95% CI 1.02-1.35] and lower mean leg strength (men; mean ratio 0.83, 95% CI 0.67-0.98). Grade 1 defects were associated with hip bone marrow lesions (BML; PR 1.42, 95% CI 1.03-1.96) and high cartilage signal (men; PR 1.84, 95% CI 1.27-2.70), but not with hip pain or other structural findings. Grade 2 defects were associated with greater hip pain (PR 1.40, 95% CI 1.09-1.80), hip BML (PR 1.45, 95% CI 1.15-1.85), hip effusion cross-sectional area (PR 1.14, 95% CI 1.01-1.30), hip ROA (men; PR 1.60, 95% CI 1.13-2.25), and steps/day (PR 0.97, 95% CI 0.96-0.99). CONCLUSION Grade 2 defects in both sexes and grade 1 defects (mostly in men) are associated with clinical, demographic, and structural factors relevant for OA. Damage to the hip cartilage could be one of the major causes of rapid disease progression and pathophysiology of hip defects. The topic needs further study.
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Affiliation(s)
- Harbeer G Ahedi
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania
| | - Dawn A Aitken
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania
| | - Leigh C Blizzard
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania
| | - Chang-Hai H Ding
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania
| | - Flavia M Cicuttini
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania
| | - Graeme Jones
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.H.G. Ahedi, BAMS, PgdipBioMedSc, Menzies Institute for Medical Research, University of Tasmania; D.A. Aitken, PhD, Menzies Institute for Medical Research, University of Tasmania; L.C. Blizzard, PhD, Menzies Institute for Medical Research, University Of Tasmania; C.H. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; F.M. Cicuttini, PhD, FRACP, FAFPHM, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania.
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Landsmeer MLA, Runhaar J, van der Plas P, van Middelkoop M, Vroegindeweij D, Koes B, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA. Reducing progression of knee OA features assessed by MRI in overweight and obese women: secondary outcomes of a preventive RCT. Osteoarthritis Cartilage 2016; 24:982-90. [PMID: 26748391 DOI: 10.1016/j.joca.2015.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the preventive effects of a randomized controlled trial on progression of Magnetic Resonance Imaging (MRI) features of knee osteoarthritis (OA) in overweight and obese women. DESIGN In a 2 × 2 factorial design, 2.5 years effects of a diet and exercise program and of glucosamine sulphate (double-blind, placebo-controlled) were evaluated in 407 middle-aged women with body mass index (BMI) ≥ 27 kg/m(2) without clinical signs of knee OA at baseline (ISRCTN 42823086). MRIs were scored with the MRI Osteoarthritis Knee Score (MOAKS). Progression was defined for bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities and meniscal extrusion. Analyses on knee level were performed over the four intervention groups using adjusted Generalized Estimating Equations (GEE). RESULTS 687 knees of 347 women with mean age 55.7 years (±3.2 SD) and mean BMI 32.3 kg/m(2) (±4.2 SD) were analyzed. Baseline prevalence was 64% for BMLs, 70% for cartilage defects, 24% for osteophytes, 66% for meniscal abnormalities and 52% for meniscal extrusions. The diet and exercise program + placebo intervention showed significantly less progression of meniscal extrusion compared to placebo only (12% vs 22%, OR 0.50, 95% CI [0.27-0.92]). The interventions did not result in significant differences on other OA MRI features. CONCLUSIONS In subjects at high risk for future knee OA development, a diet and exercise program, glucosamine sulphate and their combination showed small and mainly non-significant effects on the progression of OA MRI features. Only progression of meniscal extrusion was significantly diminished by the diet and exercise program.
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Affiliation(s)
- M L A Landsmeer
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P van der Plas
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - D Vroegindeweij
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - B Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Lee BS, Bin SI, Kim JM, Kim JH, Han GW. Proper Cartilage Status for Meniscal Allograft Transplantation Cannot Be Accurately Determined by Patient Symptoms. Am J Sports Med 2016; 44:646-51. [PMID: 26792703 DOI: 10.1177/0363546515621909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Candidates for meniscal allograft transplantation (MAT) often already have a significant cartilage lesion when they present with a symptomatic knee. However, the level of symptoms required for MAT to be performed is poorly defined, leading to difficulties in selecting patients and the potential for further cartilage loss. PURPOSE To evaluate if various clinical evaluation scores reflect the articular cartilage status of the lateral compartment preoperatively in symptomatic, lateral meniscus-deficient knees. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 113 consecutive patients who underwent lateral MAT were reviewed. All patients were preoperatively assessed by the most common patient-reported outcome measures (PROMs), including the visual analog scale (VAS) for pain, Lysholm knee scale, International Knee Documentation Committee (IKDC) subjective form, and Tegner activity scale. The maximum grade from the International Cartilage Repair Society (ICRS) scale on either femoral or tibial articular cartilage was used for a correlation analysis between PROMs and ICRS grades and a comparison of PROMs between patients with low-grade (ICRS grade ≤2) and high-grade (ICRS grade 3 or 4) cartilage degeneration. RESULTS More than half of the patients had high-grade cartilage degeneration, even though their mean VAS pain score was low (3.1 ± 1.3). There were no significant relationships between ICRS grades and PROMs, except for the IKDC subjective score, which was weakly associated with the ICRS grade (Spearman ρ test, 2-sided, ρ = -.200, P = .034). When comparing patients with low-grade versus high-grade cartilage degeneration, there were no differences in PROMs except for the Lysholm score (67.8 ± 14.7 vs 62.3 ± 13.9, respectively; P = .044). Notably, 37 of 58 patients (63.8%) with high-grade chondral lesions only felt pain during severe exertion. CONCLUSION Mild or tolerable symptoms did not necessarily mean that articular cartilage was well preserved in patients undergoing MAT. The study findings suggest a need for close observation and greater caution concerning possible chondral damage in the treatment of meniscus-deficient knees.
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Affiliation(s)
- Bum-Sik Lee
- Department of Orthopedic Surgery, College of Medicine, Catholic University, Incheon St Mary's Hospital, Incheon, South Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Jae Hyan Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Geun-Won Han
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
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Wang X, Jin X, Han W, Cao Y, Halliday A, Blizzard L, Pan F, Antony B, Cicuttini F, Jones G, Ding C. Cross-sectional and Longitudinal Associations between Knee Joint Effusion Synovitis and Knee Pain in Older Adults. J Rheumatol 2015; 43:121-30. [PMID: 26568597 DOI: 10.3899/jrheum.150355] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the cross-sectional and longitudinal associations between knee regional effusion synovitis and knee pain in older adults. METHODS Data from a population-based random sample (n = 880, mean age 62 yrs, 50% women) were used. Baseline knee joint effusion synovitis was graded (0-3) using T2-weighted magnetic resonance imaging (MRI) in the suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess. Effusion synovitis of the whole joint was defined as a score of ≥ 2 in any subregion. Other knee structural (including cartilage, bone marrow, and menisci) lesions were assessed by MRI at baseline. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire at baseline and 2.6 years later. Multivariable analyses were performed after adjustment for age, sex, body mass index, and other structural lesions. RESULTS The prevalence of effusion synovitis was 67%. Suprapatellar pouch effusion synovitis was significantly and independently associated with increased total and nonweight-bearing knee pain in both cross-sectional and longitudinal analyses (for an increase in total knee pain of ≥ 5, RR 1.26 per grade, 95% CI 1.04-1.52), and increased weight-bearing knee pain in longitudinal analysis only. Effusion synovitis in posterior femoral recess and central portion were independently associated with increases in nonweight-bearing pain (RR 1.63 per grade, 95% CI 1.32-2.01 and RR 1.29 per grade, 95% CI 1.01-1.65, respectively) in longitudinal analyses only. CONCLUSION Knee joint effusion synovitis has independent associations with knee pain in older adults. Suprapatellar pouch effusion synovitis is associated with nonweight-bearing and weight-bearing knee pain, while posterior femoral recess and central portion effusion synovitis are only associated with nonweight-bearing pain.
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Affiliation(s)
- Xia Wang
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Xingzhong Jin
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Weiyu Han
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Yuelong Cao
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Andrew Halliday
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Leigh Blizzard
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Faming Pan
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Benny Antony
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Flavia Cicuttini
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Graeme Jones
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
| | - Changhai Ding
- From the Menzies Institute for Medical Research, University of Tasmania; Department of Radiology, Royal Hobart Hospital, Hobart, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China; Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Epidemiology and Biostatistics, School of Public Health, and the Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, China.X. Wang, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University; Y. Cao, MD, Menzies Institute for Medical Research, University of Tasmania, and Research Institute of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; A. Halliday, MD, Department of Radiology, Royal Hobart Hospital; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Pan, MD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University; B. Antony, PhD, Student, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, PhD, Department of Epidemiology and Preventive Medicine, Monash University; G. Jones, MD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, Menzies Institute for Medical Research, University of Tasmania, and Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, and Department of
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