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Benhenneda R, Alajji M, Portet A, Sonnery-Cottet B, Fayard JM, Thaunat M. Repair of radial tears of the lateral meniscus on a stable knee: Results at a minimum follow-up of 2 years. Orthop Traumatol Surg Res 2024; 110:103877. [PMID: 38582222 DOI: 10.1016/j.otsr.2024.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION In younger patients, meniscal repair is recommended for isolated lateral meniscus tears that are most often due to acute trauma. But there is little published data on the outcomes of repairing this specific type of lesion. The goal of this study was to evaluate the clinical outcomes, report the failure rate of repairing radial tears of the lateral meniscus in stable knees and determine the risk factors for failure. MATERIALS AND METHODS All patients who had a stable knee and underwent arthroscopic repair of a radial lateral meniscus tear between April 2013 and December 2019 were reviewed retrospectively. Failure was defined as revision surgery for recurrence of symptoms (pain, locking) with intraoperative confirmation that the meniscus did not heal. The following data were collected: demographics (age, sex, BMI), time to surgery, clinical outcome scores (Tegner, Lysholm, IKDC), surgical details (repair technique, lesion zone, number of sutures). RESULTS Thirty patients were included having a mean age of 20.1years (14-31). The follow-up ranged from 24 to 110months (mean 66.8±25.2). An all-inside repair was done in 6 patients (20%); an outside-in technique was done in 17 patients (57%) and a combination of all-inside and outside-in was done in 7 patients (23%). Four patients (13%) had a recurrence of their symptoms later on, while participating in sports. All the recurrences were at the initial tear site. The time to revision surgery was 16, 19, 24 and 37months in these four patients (mean 24±9). All the other patients were able to resume sports at their pre-injury level. Significant improvement in the IKDC, Lysholm and Tegner functional scores were found between the preoperative and postoperative assessments. No statistically significant risk factors for failure were identified. DISCUSSION The functional healing rate after repair of a radial lateral meniscus tear in a stable knee was 86% at a mean follow-up of 5years, with the surgical technique having no impact on the long-term result. Most of the failures occurred within 2years of the repair procedure. We recommend repairing these tears as they have considerable healing potential. LEVEL OF EVIDENCE IV; retrospective observational cohort study.
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Affiliation(s)
- Rayane Benhenneda
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
| | - Mohammad Alajji
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Adrien Portet
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Bertrand Sonnery-Cottet
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Jean-Marie Fayard
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Mathieu Thaunat
- Ramsay Santé, hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
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Dancy ME, Marigi EM, Krych AJ, Werner BC, Camp CL. Impact of Biologic Augmentation on Revision Surgery Rates After Meniscus Repair: A Matched-Cohort Analysis of 3420 Patients. Orthop J Sports Med 2023; 11:23259671231186990. [PMID: 37655247 PMCID: PMC10467383 DOI: 10.1177/23259671231186990] [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: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 09/02/2023] Open
Abstract
Background Platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have gained popularity in recent years as biologic approaches to potentially augment healing after meniscus repair. There have been few studies comparing outcomes in patients undergoing meniscus repair with versus without biologic augmentation and, furthermore, little clarity on the role of biologic augmentation for meniscus repairs performed with concomitant anterior cruciate ligament reconstruction (ACLR). Purpose To determine the association of BMAC or PRP augmentation with revision surgery after both isolated meniscus repair and meniscus repair performed concomitantly with ACLR. Study Design Cohort study; Level of evidence, 3. Methods The PearlDiver Mariner dataset was queried to identify all patients who underwent primary meniscus repair, both with and without concomitant ACLR, and who received ipsilateral BMAC or PRP at the time of surgery. Patients who underwent similar surgery but without BMAC or PRP augmentation were then identified and matched in a 5:1 ratio according to age, sex, body mass index, and various comorbidities to 3 separate BMAC/PRP augmentation groups: overall cohort (with and without ACLR), repair with concomitant ACLR, and isolated repair. The primary outcome was revision meniscus surgery (meniscectomy or revision meniscus repair). Results Overall, 3420 patients (570 with BMAC/PRP augmentation; 2850 matched controls without augmentation) were included. There were no significant differences in the reported demographics or comorbidities between any of the BMAC/PRP groups and their respective matched controls (P > .05 for all comparisons). There was no difference in revision rate between BMAC/PRP-augmented isolated meniscus repairs and matched controls (P = .235). Patients who underwent BMAC/PRP-augmented meniscus repair with concomitant ACLR experienced a significantly lower incidence of revision surgery compared with matched controls without BMAC/PRP augmentation (5.2% vs 7.9% respectively; odds ratio, 0.41; 95% CI, 0.27-0.63; P < .001), but the number of revisions was relatively small. Conclusion There was no association between BMAC or PRP augmentation and the incidence of revision surgery after isolated primary meniscus repair. There was a statistically significant decrease in the rate of revision meniscus surgery when BMAC or PRP was used to augment meniscus repairs in the setting of concurrent ACLR; however, the overall revision rates were small.
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Affiliation(s)
- Malik E. Dancy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erick M. Marigi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher L. Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Mukherjee P, Roy S, Ghosh D, Nandi SK. Role of animal models in biomedical research: a review. Lab Anim Res 2022; 38:18. [PMID: 35778730 PMCID: PMC9247923 DOI: 10.1186/s42826-022-00128-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The animal model deals with the species other than the human, as it can imitate the disease progression, its’ diagnosis as well as a treatment similar to human. Discovery of a drug and/or component, equipment, their toxicological studies, dose, side effects are in vivo studied for future use in humans considering its’ ethical issues. Here lies the importance of the animal model for its enormous use in biomedical research. Animal models have many facets that mimic various disease conditions in humans like systemic autoimmune diseases, rheumatoid arthritis, epilepsy, Alzheimer’s disease, cardiovascular diseases, Atherosclerosis, diabetes, etc., and many more. Besides, the model has tremendous importance in drug development, development of medical devices, tissue engineering, wound healing, and bone and cartilage regeneration studies, as a model in vascular surgeries as well as the model for vertebral disc regeneration surgery. Though, all the models have some advantages as well as challenges, but, present review has emphasized the importance of various small and large animal models in pharmaceutical drug development, transgenic animal models, models for medical device developments, studies for various human diseases, bone and cartilage regeneration model, diabetic and burn wound model as well as surgical models like vascular surgeries and surgeries for intervertebral disc degeneration considering all the ethical issues of that specific animal model. Despite, the process of using the animal model has facilitated researchers to carry out the researches that would have been impossible to accomplish in human considering the ethical prohibitions.
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Affiliation(s)
- P Mukherjee
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - S Roy
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - D Ghosh
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
| | - S K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India.
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Biological augmentation of meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1915-1926. [PMID: 35258647 DOI: 10.1007/s00167-021-06849-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re-operation rates of biologically augmented meniscal repairs. METHODS PubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post-operative rehabilitation, patient reported outcome measures, and length of follow-up were recorded, reviewed, and analyzed by two independent reviewers. RESULTS Of 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8-27.0% with PRP augmentation, 0.0-28.5% with fibrin clot augmentation, 0.0-12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post-operative rehabilitation protocols. CONCLUSION Patients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair. LEVEL OF EVIDENCE IV.
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Meniscus Repair Techniques. Sports Med Arthrosc Rev 2021; 29:e34-e43. [PMID: 34398120 DOI: 10.1097/jsa.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.
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Rocha de Faria JL, Pavão DM, Padua VBCD, Sousa EBD, Guimarães JM, Gomes BA, Mozella ADP. Outside-in Continuous Meniscal Suture Technique of the Knee. Arthrosc Tech 2020; 9:e1547-e1552. [PMID: 33134058 PMCID: PMC7587458 DOI: 10.1016/j.eats.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/07/2020] [Indexed: 02/03/2023] Open
Abstract
The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the "Meniscus 4-All suture device." The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.
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Affiliation(s)
- José Leonardo Rocha de Faria
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
- Address correspondence to José Leonardo Rocha de Faria, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Av. Brasil, 500, São Cristovão, Rio de Janeiro, RJ, Brazil. CEP: 20940-070.
| | - Douglas Mello Pavão
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | | | - Eduardo Branco de Sousa
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - João Matheus Guimarães
- Research and Teaching Division, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Berliet Assad Gomes
- Medical Science Faculty of the State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan de Paula Mozella
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
- Medical Science Faculty of the State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Van Genechten W, Verdonk P, Krych AJ, Saris DB. Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Massen FK, Inauen CR, Harder LP, Runer A, Preiss S, Salzmann GM. One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up. Orthop J Sports Med 2019; 7:2325967119853773. [PMID: 31223628 PMCID: PMC6566484 DOI: 10.1177/2325967119853773] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome. Purpose To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure. Study Design Case series; Level of evidence, 4. Methods From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively. Results A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 (P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 (P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores. Conclusion Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.
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Affiliation(s)
- Felix Kurt Massen
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Cyril Raphael Inauen
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Laurent Pascale Harder
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Armin Runer
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Stefan Preiss
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
| | - Gian Max Salzmann
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland. F.K.M. and C.R.I. contributed equally to this work
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Kaminski R, Kulinski K, Kozar-Kaminska K, Wasko MK, Langner M, Pomianowski S. Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Arthroscopy 2019; 35:1500-1508.e1. [PMID: 30902532 DOI: 10.1016/j.arthro.2018.11.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effectiveness and safety of meniscal repair in 2 groups of patients: meniscal repair with biological augmentation using a bone marrow venting procedure (BMVP) of the intercondylar notch versus meniscal repair only. METHODS This single-center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 40 patients (21 menisci in control, 23 in BMVP group) with complete vertical meniscus tears. Patients underwent all-inside and outside-in meniscal repair and a concomitant BMVP of the intercondylar notch or meniscal repair alone during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the 2 groups assessed during a second-look arthroscopy (at week 35). The secondary endpoints were changes in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale in the 2 groups at 30 months. RESULTS After 36 weeks, the meniscus healing rate was significantly higher in the BMVP-treated group than in the control group (100% vs. 76%, P = .0035). Functional outcomes were significantly better 30 months after treatment than at baseline in both groups. The International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale scores were significantly better in the BMVP-treated group than in the control group. No adverse events were reported during the study period. CONCLUSIONS Our blinded, prospective, randomized, controlled trial on the role of BMVP augmentation in meniscus repair, indicates that BMVP augmentation results in a significant improvement in the rate of meniscus healing (100% vs. 76%, P = .0035). The risk of adverse events related to augmentation with BMVP of the arthroscopic meniscal repair is very low. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Rafal Kaminski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland.
| | - Krzysztof Kulinski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Katarzyna Kozar-Kaminska
- Department of Medical Biology, The Stefan Cardinal Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Marcin K Wasko
- Departament of Radiology, The Medical Centre of Postgraduate Education in Warsaw, Otwock, Poland
| | - Maciej Langner
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Stanislaw Pomianowski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
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Vaquero-Picado A, Rodríguez-Merchán EC. Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. EFORT Open Rev 2018; 3:584-594. [PMID: 30595844 PMCID: PMC6275851 DOI: 10.1302/2058-5241.3.170059] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated. Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated. Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR. Tears in the peripheral third are more likely to heal than those in the inner thirds. Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR. ‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques. Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes. Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment. Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.
Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059
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12
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Salzmann GM, Niemeyer P, Hochrein A, Stoddart MJ, Angele P. Articular Cartilage Repair of the Knee in Children and Adolescents. Orthop J Sports Med 2018; 6:2325967118760190. [PMID: 29568785 PMCID: PMC5858627 DOI: 10.1177/2325967118760190] [Citation(s) in RCA: 30] [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] [Indexed: 12/16/2022] Open
Abstract
Articular cartilage predominantly serves a biomechanical function, which begins in utero and further develops during growth and locomotion. With regard to its 2-tissue structure (chondrocytes and matrix), the regenerative potential of hyaline cartilage defects is limited. Children and adolescents are increasingly suffering from articular cartilage and osteochondral deficiencies. Traumatic incidents often result in damage to the joint surfaces, while repetitive microtrauma may cause osteochondritis dissecans. When compared with their adult counterparts, children and adolescents have a greater capacity to regenerate articular cartilage defects. Even so, articular cartilage injuries in this age group may predispose them to premature osteoarthritis. Consequently, surgery is indicated in young patients when conservative measures fail. The operative techniques for articular cartilage injuries traditionally performed in adults may be performed in children, although an individualized approach must be tailored according to patient and defect characteristics. Clear guidelines for defect dimension–associated techniques have not been reported. Knee joint dimensions must be considered and correlated with respect to the cartilage defect size. Particular attention must be given to the subchondral bone, which is frequently affected in children and adolescents. Articular cartilage repair techniques appear to be safe in this cohort of patients, and no differences in complication rates have been reported when compared with adult patients. Particularly, autologous chondrocyte implantation has good biological potential, especially for large-diameter joint surface defects.
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Affiliation(s)
- Gian M Salzmann
- Lower Extremity Orthopaedics, Musculoskeletal Center, Schulthess Clinic, Zurich, Switzerland.,Gelenkzentrum Rhein-Main, Wiesbaden, Germany
| | | | | | - Martin J Stoddart
- Musculoskeletal Regeneration Program, AO Research Institute Davos, AO Foundation, Davos, Switzerland
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.,Sporthopaedicum Regensburg, Regensburg, Germany
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13
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Williams LB, Adesida AB. Angiogenic approaches to meniscal healing. Injury 2018; 49:467-472. [PMID: 29395218 DOI: 10.1016/j.injury.2018.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
Meniscal injuries commonly result in osteoarthritis causing long term morbidity, lifelong treatment, joint replacement and significant financial burden to the Canadian healthcare system. Injuries to the outer third of the meniscus often heal well due to adequate blood supply. Healing of injuries in the inner two thirds of the meniscus are often critically retarded due to a lack of blood flow necessitating partial meniscectomy in many instances. Localized angiogenesis in the inner meniscus has yet to be achieved despite a belief that vascularization of these lesions corresponds with meniscal healing. This review briefly summarizes the growth factors that have been assessed for a role in meniscal healing and points to a significant knowledge gap in our understanding of meniscal healing.
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Affiliation(s)
- Lynn B Williams
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Adetola B Adesida
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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14
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Brooks KR. Vertical Lasso and Horizontal Lasso Sutures for Repair of Horizontal Cleavage and Horizontal Oblique Meniscal Tears: Surgical Technique and Indications. Arthrosc Tech 2017; 6:e1767-e1773. [PMID: 29416965 PMCID: PMC5797710 DOI: 10.1016/j.eats.2017.06.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/27/2017] [Indexed: 02/03/2023] Open
Abstract
Horizontal cleavage and horizontal oblique meniscal tears have traditionally been treated with partial meniscectomy. Recent research has shown the deleterious long-term effects of meniscectomy in these patients regarding the development of osteoarthritis. Meniscal preservation is thus the preferred method of surgical treatment in patients with these tears. However, traditional repair techniques using inside-out sutures or suture anchor-based devices do not address the horizontally aligned nature of these particular tears and thus do not compress the meniscal tissue in the correct plane. The recent development of an arthroscopic suture-passing system now allows surgeons to place arthroscopic sutures in any pattern or direction. This allows surgeons to treat tears of any type with sutures ideally placed to repair the given tears. This Technical Note describes and demonstrates 2 all-suture, all-inside, arthroscopic meniscus repair techniques to treat these challenging horizontal tear types. The repair techniques are named the vertical lasso and horizontal lasso.
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Affiliation(s)
- Kenneth R. Brooks
- Address correspondence to Kenneth R. Brooks, M.D., Houston Methodist Orthopedics and Sports Medicine, Houston Methodist St. John Hospital, 2020 NASA Pkwy, Ste 230, Nassau Bay, TX 77058, U.S.A.Houston Methodist Orthopedics and Sports MedicineHouston Methodist St. John Hospital2020 NASA PkwySte 230Nassau BayTX77058U.S.A.
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Brzezinski A, Ghodbane SA, Patel JM, Perry BA, Gatt CJ, Dunn MG. * The Ovine Model for Meniscus Tissue Engineering: Considerations of Anatomy, Function, Implantation, and Evaluation. Tissue Eng Part C Methods 2017; 23:829-841. [PMID: 28805136 DOI: 10.1089/ten.tec.2017.0192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Meniscus injuries represent one of the most-common intra-articular knee injuries. The current treatment options include meniscectomy and allograft transplantation, both with poor long-term outcomes. Therefore, there is a need for regenerative techniques to restore meniscal function. To preclinically test scaffolds for meniscus replacement, large animal models need to be established and standardized. This review establishes the anatomical and compositional similarities between human and sheep menisci and provides guidance for implantation and evaluation of such devices. The ovine meniscus represents a scaled-down version of the human meniscus, with only slight structural differences that can be addressed during device fabrication. Implantation protocols in sheep remain a challenge, as the meniscus cannot be visualized with the arthroscopic-assisted procedures commonly performed in human patients. Thus, we recommend the appropriate implantation protocols for meniscus visualization, ligamentous restoration, and surgical fixation of both total and partial meniscus replacement devices. Last, due to the lack of standardization in evaluation techniques, we recommend a comprehensive battery of tests to evaluate the efficacy of meniscus replacement implants. We recommend other investigators utilize these surgical and testing techniques to establish the ovine model as the gold standard for preclinical evaluation of meniscus replacement devices.
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Affiliation(s)
- Andrzej Brzezinski
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Salim A Ghodbane
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Jay M Patel
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Barbara A Perry
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Charles J Gatt
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Michael G Dunn
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
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16
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Woodmass JM, LaPrade RF, Sgaglione NA, Nakamura N, Krych AJ. Meniscal Repair: Reconsidering Indications, Techniques, and Biologic Augmentation. J Bone Joint Surg Am 2017; 99:1222-1231. [PMID: 28719562 DOI: 10.2106/jbjs.17.00297] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jarret M Woodmass
- 1Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota 2The Steadman Clinic, Steadman Philippon Research Institute, Vail, Colorado 3Department of Orthopedics, Northwell Health System, Great Neck, New York 4Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
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17
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Dean CS, Chahla J, Matheny LM, Mitchell JJ, LaPrade RF. Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:1341-1348. [PMID: 28298056 DOI: 10.1177/0363546516686968] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal repair in the setting of anterior cruciate ligament (ACL) reconstruction has demonstrated superior outcomes compared with isolated meniscal repair. Limited evidence exists for the effects of biological augmentation in isolated meniscal repair, particularly as compared with meniscal repair with concomitant ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and survivorship of meniscal repair in 2 cohorts of patients: meniscal repair with biological augmentation using a marrow venting procedure (MVP) of the intercondylar notch, and meniscal repair with concomitant ACL reconstruction. We hypothesized that the clinical outcomes and survivorship of meniscal repair with concomitant ACL reconstruction would be improved compared with meniscal repair with biological augmentation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Inclusion criteria were skeletally mature patients aged ≥16 years who underwent inside-out meniscal repair and either a concomitant MVP of the intercondylar notch or ACL reconstruction. Patients were excluded from this study if they were skeletally immature, underwent meniscus root or radial tear repair, or underwent meniscal repair with concurrent ligamentous reconstruction not limited to the ACL. At the preoperative evaluation and a minimum 2 years after the index meniscal repair procedure, patients were administered a subjective questionnaire. Differences in outcome scores, survivorship, and failure rates between the cohorts were assessed. Failure was defined as reoperation with meniscectomy or revision meniscal repair. RESULTS There were 109 patients (52 female, 57 male) who met the inclusion criteria for this study. There were 37 knees in cohort 1 (isolated meniscal repair plus MVP) and 72 knees in cohort 2 (meniscal repair plus ACL reconstruction). The failure status was known in 95 patients, and patient-reported outcome scores were obtained in 89 (82%) patients. Both cohorts demonstrated a significant improvement in all outcome scores, and there was no significant difference in any of the preoperative or postoperative outcome measures. The overall failure rate was 9.5% (9/95). There were 4 (12.9%) failures in cohort 1 and 5 failures (7.8%) in cohort 2, with no significant difference in failures between the cohorts ( P = .429). There was a significant association between failure and female sex ( P = .001). CONCLUSION The most important finding in this study was that there was no difference in outcomes in meniscal repair performed with biological augmentation using an MVP versus that performed concomitantly with ACL reconstruction. The similar outcomes reported for meniscal repair with an MVP and meniscal repair with ACL reconstruction may be partly attributed to biological augmentation.
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Affiliation(s)
- Chase S Dean
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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