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Chen Z, Li A, Shi R, Wang L, Cao Z, Mao N, Luo Z, Tan H. Reconstruction of medial meniscus posterior portion deficiency in pigs with an autologous patellar tendon graft: an experimental study. J Orthop Surg Res 2024; 19:225. [PMID: 38576008 PMCID: PMC10996223 DOI: 10.1186/s13018-024-04684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE This study was performed to investigate the effectiveness of two surgical procedures, autologous patellar tendon graft reconstruction and trans-tibial plateau pull-out repair, using a pig model. The primary focus was to assess the repair capability of medial meniscus posterior portion (MMPP) deficiency, the overall structural integrity of the meniscus, and protection of the femoral and tibial cartilage between the two surgical groups. The overall aim was to provide experimental guidelines for clinical research using these findings. METHODS Twelve pigs were selected to establish a model of injury to the MMPP 10 mm from the insertion point of the tibial plateau. They were randomly divided into three groups of four animals each: reconstruction (autologous tendon graft reconstruction of the MMPP), pull-out repair (suture repair of the MMPP via a trans-tibial plateau bone tunnel), and control (use of a normal medial meniscus as the negative control). The animals were euthanized 12 weeks postoperatively for evaluation of the meniscus, assessment of tendon bone healing, and gross observation of knee joint cartilage. The tibial and femoral cartilage injuries were evaluated using the International Society for Cartilage Repair (ICRS) grade and Mankin score. Histological and immunohistochemical staining was conducted on the meniscus-tendon junction area, primary meniscus, and tendons. The Ishida score was used to evaluate the regenerated meniscus in the reconstruction group. Magnetic resonance imaging (MRI) was used to evaluate meniscal healing. RESULTS All 12 pigs recovered well after surgery; all incisions healed without infection, and no obvious complications occurred. Gross observation revealed superior results in the reconstruction and pull-out repair groups compared with the control group. In the tibial cartilage, the reconstruction group had ICRS grade I injury whereas the pull-out repair and control groups had ICRS grade II and III injury, respectively. The Mankin score was significantly different between the reconstruction and control groups; histological staining showed that the structure of the regenerated meniscus in the reconstruction group was similar to that of the original meniscus. Immunohistochemical staining showed that the degree of type I and II collagen staining was similar between the regenerated meniscus and the original meniscus in the reconstruction group. The Ishida score was not significantly different between the regenerated meniscus and the normal primary meniscus in the reconstruction group. MRI showed that the MMPP in the reconstruction and pull-out repair groups had fully healed, whereas that in the control group had not healed. CONCLUSION Autologous patellar tendon graft reconstruction of the MMPP can generate a fibrocartilage-like regenerative meniscus. Both reconstruction and pull-out repair can preserve the structural integrity of the meniscus, promote healing of the MMPP, delay meniscal degeneration, and protect the knee cartilage.
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Affiliation(s)
- Zhian Chen
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Anxu Li
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Rongmao Shi
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Ling Wang
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Zijian Cao
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Neng Mao
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Zhihong Luo
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
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Zhong J, Lee NJ, Crutchfield C, Mueller J, Ahmad C, Trofa D, Lynch TS. Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis. Eur J Orthop Surg Traumatol 2024; 34:1597-1607. [PMID: 38363347 DOI: 10.1007/s00590-024-03848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. METHODS This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were compared using bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. RESULTS There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5 h (p < 0.001), length of stay (LOS) ≥ 1 day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30 days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). CONCLUSION M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.
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Affiliation(s)
- Jack Zhong
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA.
- Department of Orthopaedic Surgery, New York University Langone Health, New York, 10010, USA.
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Connor Crutchfield
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Christopher Ahmad
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - David Trofa
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - T S Lynch
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, 48202, USA
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Bian Y, Cai X, Wang H, Xu Y, Lv Z, Feng B, Weng X. Short-Term but Not Long-Term Knee Symptoms and Functional Improvements of Tissue Engineering Strategy for Meniscus Defects: A Systematic Review of Clinical Studies. Arthroscopy 2024; 40:983-995. [PMID: 37414105 DOI: 10.1016/j.arthro.2023.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To investigate the up-to-date clinical outcomes of tissue-engineered meniscus implants for meniscus defects. METHODS A search was performed by 3 independent reviewers on PubMed, MEDLINE, EMBASE, and Cochrane from 2016 to June 18, 2023, with the term "meniscus" with all the following terms: "scaffolds," "constructs," "implant," and "tissue engineering." Inclusion criteria included "Clinical trials" and "English language articles" that involved isolated meniscus tissue engineering strategies for meniscus injuries. Only Level I to IV clinical studies were considered. The modified Coleman Methodology score was used for quality analysis of included clinical trials. The Methodological Index for Non-Randomized Studies was employed for analysis of the risk of study bias and methodological quality. RESULTS The search identified 2,280 articles, and finally 19 original clinical trials meeting the inclusion criteria were included. Three types of tissue-engineered meniscus implants (CMI-Menaflex, Actifit, and NUsurface) have been clinically evaluated for meniscus reconstruction. Lack of standardized outcome measures and imaging protocols limits comparison between studies. CONCLUSIONS Tissue-engineered meniscus implants can provide short-term knee symptom and function improvements, but no implants have been shown to propose significant long-term benefits for meniscus defects. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuejie Cai
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yiming Xu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Moler C, Cross KM, Kaur M, Bruce Leicht A, Hart J, Diduch D. Influence of Graft Type and Meniscal Involvement on Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:79-87. [PMID: 38169456 DOI: 10.1123/jsr.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
CONTEXT The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. DESIGN This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. METHODS This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. RESULTS BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P = .02). Hamstring tendon: ACLR-only (P = .03) and ACLR-resect (P = .003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). CONCLUSIONS The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery.
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Affiliation(s)
- Casey Moler
- UVA Orthopedic Center Therapy Services, University of Virginia, Charlottesville, VA, USA
| | - Kevin M Cross
- UVA Orthopedic Center Therapy Services, University of Virginia, Charlottesville, VA, USA
| | - Mandeep Kaur
- Department of Physical Therapy and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Amelia Bruce Leicht
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Joe Hart
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA
| | - David Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Poboży T, Konarski W, Poboży K, Domańska J, Konarska K. Evaluation of Remodeling and Extrusion of Polyurethane Meniscal Implants after Meniscus Reconstruction using Ultrasonography. Curr Med Imaging 2024; 20:1-8. [PMID: 38389345 DOI: 10.2174/0115734056281005231030070341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/07/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Meniscal tears are among the most common indications for knee arthroscopy. Artificial polyurethane scaffolds have demonstrated efficacy in reducing pain and promoting the growth of normal meniscal tissue, with high absorption rates facilitating full tissue regeneration. AIMS This study aimed to evaluate the remodeling of polyurethane meniscal implants post-reconstruction using ultrasonography. This imaging technique not only assesses changes in implant properties, such as echogenicity, but also the shape changes during functional examination. METHODS The assessment of meniscal extrusion, comparing size at rest and under weight-bearing, is an indirect parameter that provides insight into the physical properties of the remodeling implant, with greater extrusion indicating reduced stiffness and inferior physical properties of the meniscus. Ultrasonography has the valuable advantage of allowing for assessment of the blood supply to the meniscus through Power Doppler imaging. RESULTS The presence of vessels within the meniscal implants serves as evidence of ongoing remodeling. The study included 35 patients (13 female, 22 male; mean age 41.6 years, range 18-66) who underwent arthroscopic meniscal reconstruction with polyurethane implants, with an average time from surgery of 2.8 years (range 0.3-4.5 years). Results showed complete (29.7%), significant (45.9%), or moderate (16.2%) remodeling into natural meniscal tissue in 91.8% of the implants. CONCLUSION The mean values of extrusion in the supine position and during 90-degree flexion were significantly greater in the operated limb (2.603) compared to the contralateral limb (1.978; t(35) = 2.442; P < 0.05). No significant differences in extrusion were found between the limbs in a standing position, indicating favorable physical properties of the polyurethane meniscal implants. Further ultrasonography studies of meniscal scaffolds are deemed relevant.
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Affiliation(s)
- Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, Ciechanów 06-400, Poland
| | - Wojciech Konarski
- 1Department of Orthopedic Surgery, Ciechanów Hospital, Ciechanów 06-400, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, Warsaw 01-938, Poland
| | - Julia Domańska
- Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Warsaw 02-507, Poland
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, Legionowo 05-120, Poland
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Zhang T, Shi X, Li M, Hu J, Lu H. Optimized Allogenic Decellularized Meniscal Scaffold Modified by Collagen Affinity Stromal Cell-Derived Factor SDF1α for Meniscal Regeneration: A 6- and 12-Week Animal Study in a Rabbit Model. Am J Sports Med 2024; 52:124-139. [PMID: 38164676 DOI: 10.1177/03635465231210950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Total meniscectomy for treating massive meniscal tears may lead to joint instability, cartilage degeneration, and even progressive osteoarthritis. The meniscal substitution strategies for advancing reconstruction of the meniscus deserve further investigation. HYPOTHESIS A decellularized meniscal scaffold (DMS) modified with collagen affinity stromal cell-derived factor (C-SDF1α) may facilitate meniscal regeneration and protect cartilage from abrasion. STUDY DESIGN Controlled laboratory study. METHODS The authors first modified DMS with C-SDF1α to fabricate a new meniscal graft (DMS-CBD [collagen-binding domain]). Second, they performed in vitro studies to evaluate the release dynamics, biocompatibility, and differentiation inducibility (osteogenic, chondrogenic, and tenogenic differentiation) on human bone marrow mesenchymal stem cells. Using in vivo studies, they subjected rabbits that received medial meniscectomy to a transplantation procedure to implement their meniscal graft. At postoperative weeks 6 and 12, the meniscal regeneration outcomes and chondroprotective efficacy of the new meniscal graft were evaluated by macroscopic observation, histology, micromechanics, and immunohistochemistry tests. RESULTS In in vitro studies, the optimized DMS-CBD graft showed notable biocompatibility, releasing efficiency, and chondrogenic inducibility. In in vivo studies, the implanted DMS-CBD graft after total meniscectomy promoted the migration of cells and extracellular matrix deposition in transplantation and further facilitated meniscal regeneration and protected articular cartilage from degeneration. CONCLUSION The new meniscal graft (DMS-CBD) accelerated extracellular matrix deposition and meniscal regeneration and protected articular cartilage from degeneration. CLINICAL RELEVANCE The results demonstrate that the DMS-CBD graft can serve as a potential meniscal substitution after meniscectomy.
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Affiliation(s)
- Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Xin Shi
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Muzhi Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Jianzhong Hu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
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Nielsen TG, Sørensen OG, Lind M. Single- or two-stage revision after failed ACL reconstruction: No differences in re-revision rates and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2024; 32:89-94. [PMID: 38226705 DOI: 10.1002/ksa.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The surgeons' choice of a single-stage or a two-stage procedure in revision anterior cruciate ligament reconstruction (ACLr) is based on the possibility of reuse of the tibia and femoral bone tunnels after primary ACLr. The purpose of this study was to compare failure rates and clinical outcomes following single-stage and two-stage ACL revisions in a cohort of patients from The Danish Knee Ligament Reconstruction Registry. METHODS Patients identified from 2005 to 2022 with ACL revision and met the following criteria: minimum 2-year follow-up, isolated ACL revision and registered single- or two-stage ACL revision. The primary outcome was ACL re-revision rate. Secondary outcomes were arthrometer sagittal knee laxity (side-to-side difference) and pivot shift (rotational stability difference) evaluated at 1-year follow up. RESULTS One thousand five hundred seventy-four ACL revisions were included in the study (1331 = single-stage and 243 = two stage). Baseline characteristics showed no difference in relation to age, gender, knee laxity, pivot shift, meniscus injury, cartilage damage or injury mechanism between the two groups. Significant differences were found in relation to the type of graft. No statistical difference in 2-years revision rates between single-stage group 2.79 (95% CI 2.03-3.84) and two-stage group 2.93 (95% CI 1.41-6.05) was found. No significant difference was seen in knee laxity and pivot shift between stage-groups at 1-year follow up. Both groups demonstrated significant improvements in knee stability from baseline to 1-year follow-up. CONCLUSION The present study found that ACL revision outcomes were similar in terms of rerevision rates and knee laxity for patients managed with a single- or a two-stage surgical strategy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Torsten Grønbech Nielsen
- Sports Traumatology, Orthopedic Department, Aarhus University Hospital, Jylland, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Jylland, Denmark
| | - Ole Gade Sørensen
- Sports Traumatology, Orthopedic Department, Aarhus University Hospital, Jylland, Denmark
| | - Martin Lind
- Sports Traumatology, Orthopedic Department, Aarhus University Hospital, Jylland, Denmark
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Werner D, Jorgensen A, Post A, Weaver B, Tao M, Wichman CS, Wellsandt E. Short-term fear of movement improves less after anterior cruciate ligament reconstruction with concomitant meniscus repair. Phys Ther Sport 2024; 65:102-106. [PMID: 38103357 DOI: 10.1016/j.ptsp.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Psychological response is important in return-to-sport decisions for athletes recovering from anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare psychological response after ACLR with a concomitant meniscus repair compared to isolated ACLR. METHODS Thirty-five individuals completed the Tampa Scale of Kinesiophobia (TSK) and Anterior Cruciate Ligament Return-to-Sport after Injury (ACL-RSI) scale before ACLR and 2, 4, and 6 months after ACLR. Participants were dichotomized based on presence of concomitant meniscus repair (Yes/No). Separate group X time repeated measures analyses of variance were conducted for both scales. RESULTS Participants were 65.7% female, 19.1 ± 4.7 years old with BMI of 24.9 ± 4.4 kg/m2. Sixteen individuals had an isolated ACLR with 19 individuals having an ACLR with concomitant meniscus repair. For the TSK, there was a group × time interaction effect(p = 0.028), with improvement in TSK scores for the isolated ACLR group (ACLR:2 months = 24.8 ± 3.7; 4 months = 22.0 ± 5.7; 6 months: 19.9 ± 5.9; Meniscus Repair:2 months = 25.5 ± 4.7; 4 months = 24.1 ± 5.0; 6 months: 23.8 ± 4.7). Six months after ACLR, TSK scores were worse in the meniscus repair group(p = 0.036). For the ACL-RSI, there was no interaction(p = 0.07). CONCLUSION Concomitant meniscus repair with ACLR results in less post-operative improvement in kinesiophobia through 6 months after ACLR compared to isolated ACLR.
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Affiliation(s)
- David Werner
- Office of Graduate Studies, University of Nebraska Medical Center, USA; Physical Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, USA.
| | - Alyx Jorgensen
- Office of Graduate Studies, University of Nebraska Medical Center, USA; Physical Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, USA
| | - Brittany Weaver
- Department of Orthopaedic Surgery and Rehabilitation, College of Medicine, University of Nebraska Medical Center, USA
| | - Matthew Tao
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, USA; Department of Orthopaedic Surgery and Rehabilitation, College of Medicine, University of Nebraska Medical Center, USA
| | - Christopher S Wichman
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, USA
| | - Elizabeth Wellsandt
- Physical Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, USA; Department of Orthopaedic Surgery and Rehabilitation, College of Medicine, University of Nebraska Medical Center, USA.
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Al-Gburi M, Kristiansen JB, Christensen KB, Krogsgaard MR. Functional performance tests, clinical measurements, and patient-reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5905-5912. [PMID: 37947829 PMCID: PMC10719130 DOI: 10.1007/s00167-023-07648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The results after anterior cruciate ligament reconstruction (ACLR) are evaluated by laxity measures, functional tests, and patients' perception by patient-reported outcome measures (PROMs). It is not known, if one of these evaluation instruments is representative or if outcome scores from all must be reported to obtain a full evaluation of the condition. The aim was to study the correlations between these three types of outcomes 1 year after primary ACLR. METHOD All adult patients (range 18-45 years) who had an ACLR between 1.1.2019 and 31.12.2021 were offered 1-year follow-up by an independent observer. Preoperative information about knee laxity and peroperative information about the condition of menisci and cartilage were registered. At 1-year follow-up clinical and instrumented knee stability and function assessed by four different hop tests were registered. Patients completed four PROMs (the Subjective International Knee Documentation Committee (IKDC) score, the Knee Numeric-Entity Evaluation Score (KNEES-ACL), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm score) and Tegner activity scale and answered anchor questions regarding satisfaction and willingness to repeat the operation. RESULTS A total of 190 adults attended the 1-year follow-up and 151 had all assessments. There were only a few positive and weak correlations between performance tests and PROMS and between clinical measurements and PROMS (r = 0.00-0.38), and the majority were of negligible strength. Tegner score had in general the highest correlation (low to moderate). The highest correlation was 0.53 (moderate) between the anchor question about patient satisfaction and Lysholm/IKDC scores. There was no difference in the correlations depending on meniscal condition. CONCLUSIONS In ACLR patients there was no clinically relevant correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. Therefore, one type of outcome cannot represent the others. This is an argument for always to include and report all three types of outcomes, and conclusions based on one type of outcome may not be sufficient. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mustafa Al-Gburi
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark.
| | - Jakob Bredahl Kristiansen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Karl Bang Christensen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Michael Rindom Krogsgaard
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
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Lv H, Deng G, Lai J, Yu Y, Chen F, Yao J. Advances in 3D Bioprinting of Biomimetic and Engineered Meniscal Grafts. Macromol Biosci 2023; 23:e2300199. [PMID: 37436941 DOI: 10.1002/mabi.202300199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
The meniscus plays a crucial role in loads distribution and protection of articular cartilage. Meniscal injury can result in cartilage degeneration, loss of mechanical stability in the knee joint and ultimately lead to arthritis. Surgical interventions provide only short-term pain relief but fail to repair or regenerate the injured meniscus. Emerging tissue engineering approaches based on 3D bioprinting provide alternatives to current surgical methods for meniscus repair. In this review, the current bioprinting techniques employed in developing engineered meniscus grafts are summarized and discuss the latest strategies for mimicking the gradient structure, composition, and viscoelastic properties of native meniscus. Recent progress is highlighted in gene-activated matrices for meniscus regeneration as well. Finally, a perspective is provided on the future development of 3D bioprinting for meniscus repair, emphasizing the potential of this technology to revolutionize meniscus regeneration and improve patient outcomes.
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Affiliation(s)
- Haiyuan Lv
- Department of Bone and Joint Surgery & Guangxi Key Laboratory of Regenerative Medicine, International Joint Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Guotao Deng
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Jiaqi Lai
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Yin Yu
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Fei Chen
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Jun Yao
- Department of Bone and Joint Surgery & Guangxi Key Laboratory of Regenerative Medicine, International Joint Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
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11
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LaPrade RF, LaPrade CM, Kennedy NI. Editorial Commentary: Meniscal Extrusion. Arthroscopy 2023; 39:2499-2501. [PMID: 37981390 DOI: 10.1016/j.arthro.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 11/21/2023]
Abstract
With the improved recognition of meniscal root tears over the past decade, it has become clear that root repairs are necessary in most patients indicated for a repair to prevent the further progression of osteoarthritis. Root repairs are cost beneficial to and prevent the early need for a total knee arthroplasty. As further postoperative follow-up occurs for root repairs, we have found that most patients have significantly improved patient-reported outcomes, while it is still clear that further clinical outcome study as well as further refinement of surgical technique is necessary. The next thing that we have to investigate is how to prevent recurrent meniscal extrusion after a root repair. Nonanatomic repair significantly alters tibiofemoral biomechanics and results in notably increased meniscal extrusion. In contrast, biomechanical studies show anatomic repair of the meniscus attachment within 1 cm of the meniscus attachment site restores joint loading close to normal.
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Sproul D, Agarwal A, Malyavko A, Mathur A, Kreulen RT, Thakkar SC, Best MJ. Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:5823-5829. [PMID: 37938327 DOI: 10.1007/s00167-023-07653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. METHODS A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. RESULTS There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). CONCLUSIONS This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. LEVEL OF EVIDENCE Level III, prognostic trial.
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Affiliation(s)
- David Sproul
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA.
| | - Amil Agarwal
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Alisa Malyavko
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Abhay Mathur
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - R Timothy Kreulen
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Matthew J Best
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
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Kahan JB, Burroughs P, Petit L, Schneble CA, Joo P, Moran J, Modrak M, Mclaughlin W, Nasreddine A, Grauer JN, Medvecky MJ. Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction. PLoS One 2023; 18:e0294964. [PMID: 38015977 PMCID: PMC10684064 DOI: 10.1371/journal.pone.0294964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). METHODS Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. RESULTS In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). CONCLUSION The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.
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Affiliation(s)
- Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Logan Petit
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - William Mclaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Adam Nasreddine
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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Ingelsrud LH, Terluin B, Thorlund JB, Pedersen JR, Roos EM. Knee Injury and Osteoarthritis Outcome Score Interpretation Thresholds at 3 and 12 Months After Arthroscopic Meniscal Surgery. What Changes, and What Stays the Same? J Orthop Sports Phys Ther 2023; 53:685-702. [PMID: 37787579 DOI: 10.2519/jospt.2023.11993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
OBJECTIVE: To evaluate the change in minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) from 3 to 12 months following arthroscopic meniscus surgery. DESIGN: Retrospective cohort study. METHODS: We included patients from the Knee Arthroscopy Cohort Southern Denmark who had meniscus surgery between 2013 and 2015. We calculated the interpretation threshold values for MIC, PASS, and TF using an anchor-based adjusted predictive modeling method. Thresholds at 3 and 12 months postoperatively were compared to evaluate changes over time. RESULTS: The proportions of people who reported a clinically relevant improvement, or their symptoms being acceptable, increased by 10% to 15% points from 3 to 12 months after surgery. MIC thresholds for the 5 KOOS subscales remained stable from 3 to 12 months with statistically nonsignificant differences (95% confidence intervals) ranging from -0.3 (-3.0, 2.6) to -2.4 (-6.1, 1.3). All PASS thresholds except for quality of life (QOL) decreased by -6.5 (-11.8, -1.5) to -3.7 (-7.1, -0.4) points, indicating that higher symptom levels were accepted at 12 months. In contrast, the proportion reporting their treatment to have failed remained stable over time (19% and 17%). For QOL, a 7.4 (2.0, 13.2) higher TF threshold at 12 months suggested that improved QOL was required to not consider that the treatment had failed. CONCLUSION: More patients reported being improved at 1 year compared to at 3 months following meniscus surgery. The KOOS MIC thresholds were stable over time, whereas time-specific PASS values should be applied after meniscus surgery. J Orthop Sports Phys Ther 2023;53(11):685-702. Epub 3 October 2023. doi:10.2519/jospt.2023.11993.
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Wei W, Zhang Y, Li R, Ni J, Wang D, Zhang S, Shi Z. Efficacy of meniscus suture absorbability on meniscus healing success rate via second-look arthroscopy after meniscal repair: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:717. [PMID: 37684657 PMCID: PMC10485939 DOI: 10.1186/s12891-023-06602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/03/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing. METHODS This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. INCLUSION CRITERIA (1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described. EXCLUSION CRITERIA (1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1. RESULTS Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)]. CONCLUSION In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing. TRIAL REGISTRATION The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).
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Affiliation(s)
- Wang Wei
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Yi Zhang
- Department of Orthopaedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruiying Li
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Jianlong Ni
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Dongjian Wang
- Second Department of Orthopaedics, Shaanxi Sengong Hospital, Xi'an, China
| | - Sanpeng Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Zhibin Shi
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China.
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Deviandri R, Daulay MC, Iskandar D, Kautsar AP, Lubis AMT, Postma MJ. Health-economic evaluation of meniscus tear treatments: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3582-3593. [PMID: 36637478 PMCID: PMC10435400 DOI: 10.1007/s00167-022-07278-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. METHODS Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. RESULTS Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. CONCLUSION Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- R Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia.
- Division of Orthopedics, Arifin Achmad Hospital, Pekanbaru, Indonesia.
| | - M C Daulay
- Division of Orthopedics, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - D Iskandar
- Faculty of Pharmacy, Universitas Bhakti Kencana, Bandung, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - A P Kautsar
- Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - A M T Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - M J Postma
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Yang L, Chiu CH, Hsu KY, Chuang CA, Chen ACY, Chan YS, Yang CP. Using Single Peroneal Longus Tendon Graft for Segmental Meniscus Transplantation and Revision Anterior Cruciate Ligament Combined Anterolateral Reconstruction. Medicina (Kaunas) 2023; 59:1497. [PMID: 37629787 PMCID: PMC10456414 DOI: 10.3390/medicina59081497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
This case report describes a new approach to segmental meniscal reconstruction using a peroneal longus autograft in a patient with recurrent traumatic medial meniscus tear and anterior cruciate ligament reconstruction (ACLR) failure. While allograft meniscal transplantation is the preferred method for treating meniscal deficiency, its high cost and various legal regulations have limited its widespread use. Autologous tendon grafts have been proposed as a substitute for allograft meniscus transplantation, but their initial results were poor, leading to little progress in this area. However, recent animal experiments and clinical studies have demonstrated promising results in using autologous tendon grafts for meniscal transplantation, including improvements in pain and quality of life for patients. Further research is needed to evaluate the effectiveness of segmental meniscal reconstruction using autologous tendon grafts, but it could potentially lead to more accessible and cost-effective treatment options for patients with meniscal deficiency.
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Affiliation(s)
- Ling Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Keelung 204, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taoyuan 333, Taiwan; (L.Y.); (C.-H.C.); (K.-Y.H.); (C.-A.C.); (A.C.-Y.C.)
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
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Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Zhao WB, Tu F, Wang H. An Improved Transosseous Pullout Suture Technique for Arthroscopic Repair of a Meniscus Root Tear. Curr Med Sci 2023; 43:779-783. [PMID: 37580612 DOI: 10.1007/s11596-023-2756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE This study aimed to explore the clinical efficiency of an improved transosseous pullout suture technique for arthroscopic repair of a meniscus root tear. METHODS From January 2017 to January 2021, 53 patients with posterior meniscus root tears combined with anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL) tears were collected. Totally, in 29 patients (group A), the 2.0 mm modified pullout tunnel method was used to suture the posterior meniscus root, while 24 patients (group B) were treated with the traditional 4.5 mm pullout tunnel method. In group A, 20 patients had lateral meniscus posterior root (LMPR) combined with ACL tears, 5 patients had LMPR combined with ACL and PCL tears, and 4 patients had medial meniscus posterior root (MMPR) combined with ACL tears. In group B, 19 patients had LMPR combined with ACL tears, 3 patients had LMPR combined with ACL and PCL tears, and 2 patients had MMPR combined with ACL tears. The improvement of the Lysholm and VAS scores and the incidence of complications in group A and group B before the operation, 1 month and 3 months after the operation, and after the final follow-up were compared. RESULTS Preoperative Lysholm score was 26.0±5.6 in group A and 26.7±5.8 in group B (P>0.05). One-month postoperative Lysholm score was 66.5±5.7 in group A and 54.3±2.4 in group B (P<0.001). Three-month postoperative Lysholm score was 81.1±7.2 in group A and 73.2±9.7 in group B (P<0.05). Lysholm scores after the final follow-up was 90.3±5.6 in group A and 90.0±5.0 in group B (P>0.05). Preoperative VAS score was 6.3±1.4 in group A and 6.3±1.2 in group B (P>0.05). One-month postoperative VAS score was 1.8±0.7 in group A and 2.4±0.9 in group B (P<0.05). Three-month postoperative VAS score was 0.7±0.6 in group A and 0.8±0.6 in group B (P>0.05). VAS score after the final follow-up was 0.2±0.4 in group A and 0.3±0.5 in group B (P>0.05). CONCLUSION The improved transosseous pullout suture technique using a smaller 2.0 mm bone tunnel can virtually eliminate the risk of conflict with other bone tunnels and facilitate the management of bone tunnels in multiple ligament injuries, while also diminishing suture abrasion caused by the windshield wiper effect. The technique achieves good clinical efficacy.
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Affiliation(s)
- Wen-Bin Zhao
- Department of Orthopedic Surgery, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Feng Tu
- Department of Orthopedic Surgery, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Hao Wang
- Department of Orthopedic Surgery, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Pasic N, Storaci H, Guzman R, Debaun M, Maruyama M, Hall K, Salazar BP, Dragoo JL. A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques. Am J Sports Med 2023; 51:2366-2373. [PMID: 37358235 DOI: 10.1177/03635465231179960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Meniscus root tears are associated with chondral injury, early degenerative change, and a high conversion rate to total knee arthroplasty. It is well-established that meniscus root tears lead to decreased femorotibial contact area, increased peak contact pressures, and increased stress on the articular cartilage. PURPOSE To evaluate the biomechanical characteristics of the all-inside meniscus root repair procedure and compare it with the previously described transtibial technique. STUDY DESIGN Controlled laboratory study. METHODS Nine paired cadaveric knees were prepared by removing skin, subcutaneous tissues, quadriceps muscles, patella, and patellar tendon, while leaving the capsule in place. Pressure-mapping sensors were inserted, and specimens underwent compressive loading to obtain peak pressures, mean pressures, and femorotibial contact area in the medial and lateral compartments. Tests were performed as static compression tests with the knee locked at 0° of flexion. Compression testing was performed in 3 states: meniscus intact, meniscus root cut, and after meniscus root repair with an all-inside repair technique. Additionally, testing was completed on 9 pairs of cadaveric knees to compare stiffness and maximal load to failure between the all-inside and transtibial meniscus root repair techniques. RESULTS In the medial compartment, there were significant increases in median peak pressures and median mean pressures in the root cut state as compared with the intact state (+636 kPA [95% CI, 246 to 1026] and +190 kPA [95% CI, 49 to 330], respectively). All-inside meniscus root repair restored median peak pressures and median mean pressures to approach those of the intact meniscus (+311 kPA [95% CI, -79 to 701] and +137 kPA [95% CI, -3 to 277]). In the lateral compartment, there were also significant increases in median peak pressures and median mean pressures in the root cut state as compared with the intact state (+718 kPA [95% CI, 246 to 1191] and +203 kPA [95% CI, 51 to 355]). All-inside meniscus root repair restored median peak pressures and median mean pressures such that they were not significantly different from the intact state (+322 kPA [95% CI, -150 to 795] and +18 kPA [95% CI, -134 to 171]). There was no difference between repair techniques regarding load to failure (P = .896). Transtibial meniscus root repair had significantly more stiffness (mean ± SD, 24.8 ± 9.3 N/mm) as compared with the all-inside meniscus root repair technique (13.6 ± 3.8 N/mm, P = .015). CONCLUSION All-inside meniscus root repair reduced median peak and mean pressures to those of the native intact meniscus with the knee in extension in the cadaveric model. When compared with a transtibial meniscus root repair technique, all-inside repair demonstrated decreased stiffness and a similar load to failure. CLINICAL RELEVANCE All-inside meniscus root repair restored mean and peak femorotibial pressures to those of the intact meniscus. Additionally, it offers a technically easier technique for management of meniscus root tears.
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Affiliation(s)
- Nicholas Pasic
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Boulder, Colorado, USA
| | - Hunter Storaci
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Roberto Guzman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Malcolm Debaun
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Kimberly Hall
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Brett P Salazar
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Jason L Dragoo
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Boulder, Colorado, USA
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Petersen W, Guenther D, Imhoff AB, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stoehr A, Stoffels T, Häner M, Hees T, Mehl J, Ellermann A, Krause M, Mengis N, Eberle C, Müller PE, Best R, Lutz PM, Achtnich A. Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2023; 31:1665-1674. [PMID: 35445329 PMCID: PMC10089999 DOI: 10.1007/s00167-022-06960-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established. METHODS The consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement. RESULTS Of the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2). CONCLUSION This consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Wolf Petersen
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheimer Str. 200, 51109, Köln, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stoehr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Martin Häner
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Tilman Hees
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Pascual-Leone N, Mackie AT, Gross PW, Kelly AM, Green DW, Fabricant PD. Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients. J Pediatr Orthop 2023; 43:193-197. [PMID: 36728260 DOI: 10.1097/bpo.0000000000002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR. METHODS This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05. RESULTS A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006). CONCLUSIONS This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated. LEVEL OF EVIDENCE Level IV; retrospective cohort study.
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Affiliation(s)
- Nicolas Pascual-Leone
- Hospital for Special Surgery, New York, NY
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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23
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Yang F, Maimaitimin M, He Z, Zhang X, Huang H, Wang J. The Cartilage Protective Effect of Labrum Reconstruction Using Meniscus Allograft Compared with Labrum Resection in a Porcine Model. Cartilage 2023; 14:76-85. [PMID: 36484319 PMCID: PMC10076893 DOI: 10.1177/19476035221141419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to verify the femoral head cartilage protective effect of labral reconstruction in a porcine model. METHODS Twelve pigs (24 hips) were divided into 3 groups: labrum defect group, lateral meniscus (LM) allograft group, and LM allograft wrapped with acellular peritoneum matrix (LM-APM) group before undergoing bilateral hip surgery. The pigs were sacrificed at 12 and 24 weeks postoperatively, while the femoral head cartilage was retrieved and then subjected to imaging measurement, macroscopic observations, and biomechanical and histological assessment. RESULTS Imaging measurement and macroscopic observations revealed that the defect area of the labrum was filled in LM and LM-APM allograft groups after 24 weeks, whereas the labrum defect remained at 24 weeks in the control group. The femoral head cartilage corresponding to the area of labral resection in the labral defect group had worse macroscopic Osteoarthritis Research Society International (OARSI) scores, uneven and discontinuous cartilage on hematoxylin and eosin (H&E) staining and Safranin O staining, decreased histopathology OARSI Osteoarthritis Cartilage Histopathology Assessment System (OOCHAS) scores, and decreased elastic modulus and hardness at 12 and 24 weeks after surgery compared with the meniscus allograft groups. CONCLUSION This study demonstrated that the LM allograft with or without APM for labral reconstruction had a chondroprotective effect on the femoral head in a porcine model.
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Affiliation(s)
- Fan Yang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Maihemuti Maimaitimin
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Ziyi He
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Hongjie Huang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Jianquan Wang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
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Rosenberg SI, Ouweleen AJ, Hall TB, Patel NM. Are Neighborhood Conditions Associated With Surgical Delays and Meniscus Tears in Children and Adolescents Undergoing ACL Reconstruction? Clin Orthop Relat Res 2023; 481:281-288. [PMID: 36103207 PMCID: PMC9831176 DOI: 10.1097/corr.0000000000002368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Markers of a patient's social determinants of health, including healthcare insurance and median household income based on ZIP Code, have been associated with the interval between injury and ACL reconstruction (ACLR) as well as the presence of concomitant meniscus tears in children and adolescents. However, the aforementioned surrogate indicators of a patient's social determinants of health may not reflect all socioeconomic and healthcare resources affecting the care of ACL injuries in children and adolescents. The use of multivariate indices such as the Child Opportunity Index (COI) may help to better identify patients at risk for increased risk for delay between ACL injury and surgery, as well as the incidence of meniscus tears at the time of surgery. The COI is a summative measure of 29 indicators that reflect neighborhood opportunities across three domains: education, health and environment, and social and economic factors. COI scores range from 0 to 100 (100 being the highest possible score), as well as five categorical scores (very low, low, moderate, high, and very high) based on quintile rankings. QUESTIONS/PURPOSES To investigate the relationship between neighborhood conditions and the treatment of ACL injuries in children and adolescents via the COI, we asked: (1) Is a lower COI score associated with a longer delay between ACL injury and surgery? (2) Does a higher proportion of patients with lower COI scores have meniscus tears at the time of ACLR? METHODS In this retrospective, comparative study, we considered data from 565 patients, 18 years or younger, who underwent primary ACLR at an urban, tertiary children's hospital between 2011 and 2021. Of these patients, 5% (31 of 565) did not have a clearly documented date of injury, 2% (11 of 565) underwent revision reconstructions, and 1% (5 of 565) underwent intentionally delayed or staged procedures. Because we specifically sought to compare patients who had low or very low COI scores (lowest two quintiles) with those who had high or very high scores (highest two quintiles), we excluded 18% (103 of 565) of patients with moderate scores. Ultimately, 73% (415 of 565) of patients with COI scores in either the top or bottom two quintiles were included. Patient addresses at the time of surgery were used to determine the COI score. There were no differences between the groups in terms of gender. However, patients with high or very high COI scores had a lower median (IQR) age (15 years [2.6] versus 17 years [1.8]; p < 0.001) and BMI (23 kg/m 2 [6.1] versus 25 kg/m 2 [8.8]; p < 0.001), were more commonly privately insured (62% [117 of 188] versus 22% [51 of 227]; p < 0.001), and had a higher proportion of patients identifying as White (67% [126 of 188] versus 6.2% [14 of 227]; p < 0.001) compared with patients with low or very low COI scores. Medical records were reviewed for demographic, preoperative, and intraoperative data. Univariate analyses focused on the relationship of the COI and interval between injury and surgery, frequency of concomitant meniscus tears, and frequency of irreparable meniscus tears treated with partial meniscectomy. Multivariable regression analyses were used to determine factors that were independently associated with delayed surgery (longer than 60 and 90 days after injury), presence of concomitant meniscal injuries, and performance of meniscectomy. Multivariable models included insurance and race or ethnicity to determine whether COI was independently associative after accounting for these variables. RESULTS Patients with a high or very high COI score had surgery earlier than those with a low or very low COI score (median [IQR] 53 days [53] versus 97 days [104]; p < 0.001). After adjusting for insurance and race/ethnicity, we found that patients with a low or very low COI score were more likely than patients with a high or very high COI score to have surgery more than 60 days after injury (OR 2.1 [95% CI 1.1 to 4.0]; p = 0.02) or more than 90 days after injury (OR 1.8 [95% CI 1.1 to 3.4]; p = 0.04). Furthermore, patients with low or very low COI scores were more likely to have concomitant meniscus tears (OR 1.6 [95% CI 1.1 to 2.5]; p = 0.04) compared with patients with high or very high COI scores. After controlling for insurance, race/ethnicity, time to surgery, and other variables, there was no association between COI and meniscectomy (OR 1.6 [95% CI 0.9 to 2.8]; p = 0.12) or presence of a chondral injury (OR 1.7 [95% CI 0.7 to 3.9]; p = 0.20). CONCLUSION As the COI score is independently associated with a delay between ACL injury and surgery as well as the incidence of meniscus tears at the time of surgery, this score can be useful in identifying patients and communities at risk for disparate care after ACL injury. The COI score or similar metrics can be incorporated into medical records to identify at-risk patients and dedicate appropriate resources for efficient care. Additionally, neighborhoods with a low COI score may benefit from improvements in the availability of additional and/or improved resources. Future studies should focus on the relationship between the COI score and long-term patient-reported functional outcomes after ACL injury, identification of the specific timepoints in care that lead to delayed surgery for those with lower COI scores, and the impact of community-based interventions in improving health equity in children with ACL injury. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Tyler B. Hall
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neeraj M. Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Orthopaedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Jildeh TR, Buckley P, Abbas MJ, Akioyamen NO, Abbas L, Montgomery JC, Okoroha KR. Availability of Consumer Prices for Arthroscopic Meniscus Surgery. J Surg Orthop Adv 2023; 32:83-87. [PMID: 37668642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
The purpose is to examine the availability of consumer pricing information for arthroscopic meniscal surgery in the United States. Secondary objectives were comparing the price of meniscal repair to meniscectomy and regional pricing differences. Orthopaedic sports medicine clinics were sorted by state and randomly selected from American Orthopaedic Society for Sports Medicine's online directory. Following standardized script, each clinic was called a maximum of three times to obtain pricing information for meniscal surgery. A total of 1,008 distinct orthopaedic sport medicine practices were contacted. Six (6%) clinics were able to provide complete bundle pricing, and 183 (18.2%) clinics were able to provide physician-only fees for either meniscectomy or meniscal repair. Physician-only fees and bundle pricing were significantly less for meniscal repairs as compared to meniscectomies. There were no geographic regional differences in pricing for physician-only fees. There is a paucity of information regarding price transparency for arthroscopic meniscal surgery. (Journal of Surgical Orthopaedic Advances 32(2):083-087, 2023).
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Affiliation(s)
| | - Patrick Buckley
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | - Muhammad J Abbas
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan
| | | | - Leena Abbas
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
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McCullough MC, Minasian R, Tanabe K, Rodriguez S, Kulber D. Functional Outcomes for Basilar Joint Arthroplasty with Meniscus Allograft Compared with Trapeziectomy Alone. Hand (N Y) 2023; 18:89-97. [PMID: 33789510 PMCID: PMC9806542 DOI: 10.1177/1558944721999730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce the risk of scaphoid impingement, the senior author developed an interposition arthroplasty technique using meniscal allograft. We hypothesize that the use of meniscus improves outcomes and subsequent functionality compared with trapeziectomy alone. METHODS Twenty-three patients with Eaton stage III-IV CMC osteoarthritis underwent arthroplasty with meniscal allograft, and 7 patients underwent trapeziectomy alone. Preoperative Disabilities of the Arm, Shoulder, and Hand (DASH), pain, grip and pinch strength, and range of motion scores were compared with postoperative scores at 6 weeks, 6 months, and 1 year. RESULTS The study group consisted of 17 women and 6 men, and the control group consisted of 5 women and 2 men. The mean age was similar at 61.4 (48-72) years and 65.7 (56-78) years for the study and control groups, respectively. The DASH scores dropped by 61.8% in the study group compared with 38.8% in the control group (<0.01), whereas pain decreased 86.0% and 69.8%, respectively (P < .01). Strength and range of motion improvement was similar between the groups. Subsidence of the joint space was 1% in the study group compared with 18.4% in the control group. There were no surgical complications in either group. CONCLUSIONS Joint resurfacing with meniscal allograft represents a viable joint salvage option in severe cases of CMC arthritis. Early results suggest that, compared with trapeziectomy alone, the approach results in greater reduction in subjective pain and disability scores, similar improvement in strength measures and range of motion, and less subsidence.
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Deng T, Li X, Guo Z, Guo S, Zhou Y, Zhang W, Zhang Y. Management Strategies and Imaging Observation of Early and Delayed Intelligent Treatment of Meniscus Sports Injury under Knee Osteoarthroscopy. Scanning 2022; 2022:8716823. [PMID: 36111266 PMCID: PMC9448593 DOI: 10.1155/2022/8716823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Objective To investigate the meniscus characteristics of knee osteoarthritis and its guiding significance for minimally invasive surgery. Methods A total of 100 patients with knee meniscus sports injuries who were treated in our hospital from January 2019 to January 2022 were selected as the research subjects and were grouped according to the interval between injury and surgery, with an interval of 2 months: the early group (53 cases) within 2 months and the delayed group (47 cases) with an interval of more than 2 months. The distribution of intraoperative complications in the two groups was observed and recorded, and the changes in pain degree, joint range of motion, knee joint function, and quality of life scores before and after operation were compared between the two groups. Results The postoperative VAS score, range of motion, Lysholm score, IKDC knee subjective function score, and quality of life score were significantly improved in both groups (P < 0.05). The incidence of intra-articular cartilage injury in the delayed group was significantly higher than that in the early group (P < 0.05). The patellofemoral cartilage injury was the main part of intra-articular cartilage injury in the two groups, and the incidence of patellofemoral cartilage injury in the delayed group was significantly higher than that in the early group (P < 0.05). The cartilage damage was mainly cartilage damage, and the grades I-II and III-IV cartilage damages were significantly increased in the extension group. Conclusion Meniscal injury in knee osteoarthritis has certain microscopic characteristics. In this paper, the microscopic classification of meniscus injury in knee osteoarthritis is helpful to guide microscopic surgery and improve the minimally invasive knee osteoarthritis effect of surgical treatment.
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Affiliation(s)
- Tong Deng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xu Li
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhe Guo
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Shuang Guo
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yan Zhou
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Zhang
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ying Zhang
- Beijing Jishuitan Hospital, Beijing 100035, China
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Tanaka A, Tsujii A, Shimomura K, Yonetani Y, Hamada M. Two Uncommon Complications Related to Suture Knots After Meniscal All-Inside Suture Repair: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00028. [PMID: 36040073 DOI: 10.2106/jbjs.cc.22.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 17-year-old male patient suffered a radial lateral meniscus tear and underwent an arthroscopic all-inside suture repair. After 7 months, the patient experienced catching. Magnetic resonance imaging and computed tomography revealed an intra-articular loose body without calcification, which was removed surgically. The excised specimen was histopathologically confirmed to be a necrotic meniscus fragment with a suture knot. In addition, cartilage damage because of suspected impingement by a residual suture knot was observed. After removing the loose body and knot, the patient's symptoms were relieved, and he returned to sports. CONCLUSION Suture knot-related complications should be considered while performing meniscal repairs.
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Affiliation(s)
- Ayaka Tanaka
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Shimomura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Masayuki Hamada
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan
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Kluyskens L, Debieux P, Wong KL, Krych AJ, Saris DBF. Biomaterials for meniscus and cartilage in knee surgery: state of the art. J ISAKOS 2022; 7:67-77. [PMID: 35543667 DOI: 10.1136/jisakos-2020-000600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration. The literature was reviewed over the last 5 years on clinically used meniscus and cartilage repair biomaterials, such as Collagen Meniscal Implant, Actifit, NUsurface, TruFit, Agili-C and MaioRegen. There are clinical advantages for these biomaterials and the application of these treatment options should be considered individually. Standardised evaluation protocols are needed for biological and mechanical assessment and comparison between different scaffolds, and long-term randomised independent clinical trials with large study numbers are needed to provide more insight into the use of these biomaterials. Surgeons should become familiar and stay up to date with evolving repair options to improve their armamentarium for meniscal and cartilage defects.
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Affiliation(s)
- Louis Kluyskens
- Orthopedics, AZ Monica Antwerpen, Antwerpen, Belgium; Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
| | - Pedro Debieux
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil; Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Keng Lin Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore; Department of Orthopaedic Surgery, National University of Singapore, Singapore
| | - Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA; Department of Orthopedic Surgery, University Medical Centre, Utrecht, Netherlands.
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30
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Alrosan B, Alkhameed F, Faieq B. COMPARISON OF THE METHODS OF SUTURING AND RESECTION OF MENISCUS TEAR IN COMBINATION WITH ACL RECONSTRUCTION. Georgian Med News 2022:15-20. [PMID: 35417857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aim - in patients with knee meniscus injury, compare the therapeutic effectiveness of the use of meniscus suturing with anterior cruciate ligament (ACL) surgery with meniscus resection in combination with anterior cruciate ligament surgery to improve the treatment of such pathologies. The study examined patients (n=66) with knee meniscus injury who received surgical treatment in the traumatology department of the State Budgetary Healthcare Institution of the Moscow region "City Clinical Hospital № 12 of the Moscow City Health Department". The patients were randomized by gender, age, clinical, biochemical and instrumental data and divided into 2 groups. The first group (n=33) - patients underwent resection of the anterior meniscus with simultaneous plasty of the anterior cruciate ligament (in 17 (51.6%) - medial, and in 16 (48.4%) - lateral), the age group was 26.8±6.33 years, the proportion of men was 19 (57.6%), and women - 14 (42.4%). The second group (n=33) - patients underwent suturing of the meniscus with ACL plastic surgery (in 23 (69.7%) - medial, and in 10 (30.3) - lateral), age - 27.2± 4.56 years, men - 18 (54.6%), women - 15 (45.4%). This work includes clinical, arthroscopic, ultrasound, X-ray and magnetic resonance research methods. The obtained results of clinical and instrumental research methods indicate that the use of both surgical techniques showed statistically significant positive results. At the same time, the use of stitching techniques in the restoration of the injured knee joint revealed the best results relative to the resection type of surgery: good progress was 75.8-100.0% (p<0.05), and unsatisfactory - 24.4-15.1% (p<0.05). In patients with an alternative (resection) method, the data were 60.7-72.8 and 40.0-27.7% (p<0.05), respectively. Comparative analysis showed that the therapeutic effectiveness of the stitching technique is better than resection: good progress was higher by 19.6% (p<0.05), and unsatisfactory less - by 17.9% (p<0.05). The above indicates that arthroscopic stitching demonstrates high reliability of use in the rupture of the meniscus of the knee joint.
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Affiliation(s)
- B Alrosan
- 1RUDN, Medical Institute, Department of Traumatology and Orthopedics, Moscow; Russia
| | | | - B Faieq
- 3N.P. Ogarev Mordovian State University, Russia
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31
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Fan B, Ye J, Xu B, Sun Z, Zhang J, Song S, Wang X, Song Y, Zhang Z, Jiang D, Yu J. Study on feasibility of the partial meniscal allograft transplantation. Clin Transl Med 2022; 12:e701. [PMID: 35088938 PMCID: PMC8796274 DOI: 10.1002/ctm2.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/02/2022] Open
Abstract
Since the meniscus is an important stabilizing structure of the knee joint and has a significant role in load-bearing and shock absorption, so the complete structural and functional reconstructions of the teared menisci should be done not only after partial meniscectomy but also post total meniscectomy. So far, animal experiments and good clinical practice have showed that TMAT after total meniscectomy has partially solved the problem of structural and functional reconstructions after total meniscectomy. However, partial meniscectomy will also lead to accelerated knee degeneration, and its proportion is much higher than that of patients with total meniscectomy. Herein, the feasibility of PMAT after partial meniscectomy was investigated for the first time by using the 40% posterior horn meniscectomy model of the medial meniscus in Beagle dogs, and also for the first time, TMAT group and the total meniscectomy group were used as control groups. Compared with the TMAT, the transcriptomics evaluation, scanning electron microscope observation, histological regeneration and structure, biomechanical property, inflammation environment, and the knee function post PMAT were more similar to that of normal meniscus was first reported. This study provides a PMAT scheme with clinical translational value for the complete structural and functional reconstruction of the patients with partial meniscectomy and fills the gap in the field of teared meniscus therapy on the basis of quite well clinical applications of the meniscus repair and the TMAT.
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Affiliation(s)
- Bao‐Shi Fan
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Jing Ye
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Bing‐Bing Xu
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Ze‐Wen Sun
- Department of Sports MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoShandongChina
| | - Ji‐Ying Zhang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Shi‐Tang Song
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Xin‐Jie Wang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Yi‐Fan Song
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Zheng‐Zheng Zhang
- Department of OrthopedicsSun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Dong Jiang
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
| | - Jia‐Kuo Yu
- Sports Medicine DepartmentBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijingChina
- Peking University Institute of Sports Medicine, Peking University Third Hospital, beijing, ChinaBeijingChina
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32
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Wang D, Gonzalez-Leon E, Rodeo SA, Athanasiou KA. Clinical Replacement Strategies for Meniscus Tissue Deficiency. Cartilage 2021; 13:262S-270S. [PMID: 34802295 PMCID: PMC8808868 DOI: 10.1177/19476035211060512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022] Open
Abstract
Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity for regeneration. Loss of meniscus tissue has been associated with early-onset knee osteoarthritis due to an increase in joint contact pressures in meniscectomized knees. Clinically available replacement strategies range from allograft transplantation to synthetic implants, including the collagen meniscus implant, ACTIfit, and NUSurface. Although short-term efficacy has been demonstrated with some of these treatments, factors such as long-term durability, chondroprotective efficacy, and return to sport activities in young patients remain unpredictable. Investigations of cell-based and tissue-engineered strategies to treat meniscus tissue deficiency are ongoing.
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Affiliation(s)
- Dean Wang
- Department of Orthopedic Surgery,
University of California, Irvine, Orange, CA, USA
| | - Erik Gonzalez-Leon
- Department of Biomedical Engineering,
University of California, Irvine, Irvine, CA, USA
| | - Scott A. Rodeo
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
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33
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Wang W. Artificial Intelligence in Repairing Meniscus Injury in Football Sports with Perovskite Nanobiomaterials. J Healthc Eng 2021; 2021:4324138. [PMID: 34367536 PMCID: PMC8342178 DOI: 10.1155/2021/4324138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
Knee meniscus injuries are more likely to occur in young adults in clinical practice, and their lower age of onset and greater impact on joint function after injury also put forward higher requirements for the treatment and rehabilitation of meniscus injuries. With the rapid development of artificial intelligence technology and arthroscopic minimally invasive technology, arthroscopic meniscus plasty and perovskite nanobiomaterial repair have gradually replaced the previous open meniscus surgery of the knee joint and has become the main method of meniscus injury treatment, and the perovskite nanobiomaterial repair technique that incorporates artificial intelligence technology is also gradually being applied. Therefore, this article studies the role of perovskite nanobiomaterials in the repair of meniscus injuries in football sports and analyzes the biological characteristics of the inner and outer meniscus to provide help to improve the healing rate of meniscus injuries. The study selected six male meniscus-injured patients (meniscus injuries caused by football sports) and obtained six injured menisci. The same cross section of the same part of the meniscus was analyzed inside and outside the meniscus. At the same time, a meniscal injury step was performed on the patient. The biological characteristics of perovskite nano-biomaterials in the repair of meniscus injuries in football sports were compared and analyzed, and the patient's gait before and after surgery was also compared. Experiments have shown that the percentage of the postoperative support phase of the affected limb is significantly higher than that before surgery (P < 0.05), the percentage of the postoperative support phase and flatfoot phase decreased compared with that before surgery, and the gait cycle parameters of both lower extremities improved after surgery, obviously (P < 0.05). It explains that the arthroscopic repair of perovskite nanobiomaterials combined with the artificial intelligence technology to repair the meniscus anterior angle injury is simple and does not require special equipment, has fewer complications, is safe and reliable, and has a high clinical healing rate and a high patient satisfaction rate after surgery. The curative effect is significant; artificial intelligence technology and the application of perovskite nanobiomaterials provide more possibilities for meniscus repair.
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Affiliation(s)
- Wei Wang
- Department of Physical Education, Chongqing University of Technology, Chongqing 400054, China
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34
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Collins KH, Schwartz DJ, Lenz KL, Harris CA, Guilak F. Taxonomic changes in the gut microbiota are associated with cartilage damage independent of adiposity, high fat diet, and joint injury. Sci Rep 2021; 11:14560. [PMID: 34267289 PMCID: PMC8282619 DOI: 10.1038/s41598-021-94125-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/30/2021] [Indexed: 12/02/2022] Open
Abstract
Lipodystrophic mice are protected from cartilage damage following joint injury. This protection can be reversed by the implantation of a small adipose tissue graft. The purpose of this study was to evaluate the relationship between the gut microbiota and knee cartilage damage while controlling for adiposity, high fat diet, and joint injury using lipodystrophic (LD) mice. LD and littermate control (WT) mice were fed a high fat diet, chow diet, or were rescued with fat implantation, then challenged with destabilization of the medial meniscus surgery to induce osteoarthritis (OA). 16S rRNA sequencing was conducted on feces. MaAslin2 was used to determine associations between taxonomic relative abundance and OA severity. While serum LPS levels between groups were similar, synovial fluid LPS levels were increased in both limbs of HFD WT mice compared to all groups, except for fat transplanted animals. The Bacteroidetes:Firmicutes ratio of the gut microbiota was significantly reduced in HFD and OA-rescued animals when compared to chow. Nine novel significant associations were found between gut microbiota taxa and OA severity. These findings suggest the presence of causal relationships the gut microbiome and cartilage health, independent of diet or adiposity, providing potential therapeutic targets through manipulation of the microbiome.
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Affiliation(s)
- Kelsey H Collins
- Department of Orthopaedic Surgery, Washington University, Couch Building Room 3213, 4523 Clayton Avenue, St Louis, MO, 63110, USA
- Shriners Hospitals for Children, St. Louis, MO, USA
- Center of Regenerative Medicine, Washington University, St. Louis, MO, USA
| | - Drew J Schwartz
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin L Lenz
- Department of Orthopaedic Surgery, Washington University, Couch Building Room 3213, 4523 Clayton Avenue, St Louis, MO, 63110, USA
- Shriners Hospitals for Children, St. Louis, MO, USA
| | - Charles A Harris
- Division of Endocrinology, Washington University, St. Louis, MO, USA
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University, Couch Building Room 3213, 4523 Clayton Avenue, St Louis, MO, 63110, USA.
- Shriners Hospitals for Children, St. Louis, MO, USA.
- Center of Regenerative Medicine, Washington University, St. Louis, MO, USA.
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Jeon SH, Kwon GH, Kim MS. Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic meniscus surgery: A case report. Medicine (Baltimore) 2021; 100:e25372. [PMID: 33787641 PMCID: PMC8021312 DOI: 10.1097/md.0000000000025372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery. PATIENT CONCERNS The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing. DIAGNOSIS On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins. INTERVENTIONS After 3 days of low-molecular-weight heparin 1 mg/kg every 12 hours, treatment was changed to an oral drug, dabigatran, for 6 months. OUTCOMES There were no PTE or DVT findings on computed tomography at 6 months postoperative. The patient did not complain of symptoms related to PTE or DVT at 6 months after the operation, has returned to work, and is living without discomfort. LESSIONS The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of ∼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
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Affiliation(s)
- Sang Hyun Jeon
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Geon Ho Kwon
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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He YJ, Liang X, Zhang XX, Li SS, Sun Y, Li TF. PTH1-34 inhibited TNF-α expression and antagonized TNF-α-induced MMP13 expression in MIO mice. Int Immunopharmacol 2021; 91:107191. [PMID: 33359852 DOI: 10.1016/j.intimp.2020.107191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
This study aims to investigate the effects and mechanisms of parathyroid hormone [1-34] (PTH1-34) on TNF-α-stimulated mice chondrocytes, as well as cartilage from a meniscus injury induced osteoarthritis (MIO) mice model. The C57BL/6J mice received medial meniscectomy, and then administrated with PTH1-34. The results showed that PTH1-34 administration decreased secondary allodynia and the pain-related transcripts. The IHC, ELISA, Micro-CT imaging and histopathology analysis revealed the significantly improved subchondral plate thickness and bone porosity, the reduced pro-inflammatory cytokines in serum and joint fluid. In vitro, mice chondrocyte was treated with TNF-α or co-cultured with synovial cells. The results showed that TNF-α markedly upregulated the MMP13 expression, and the ERK1/2, NF-κB or PI3K signaling pathway inhibitors could reverse the induction effect of TNF-α on expression of MMP13 in chondrocytes. PTH1-34 alone has no effect on the expression of MMP13 and NF-κB signaling pathways, but the PTH1-34 could reverse the induction effect of TNF-α on MMP13 expression and NF-κB signaling pathway activation in chondrocytes. In addition, PTH1-34 administration inhibited the expression of TNF-α and MMP13, and chondrocyte viability, while the PKA repressor reversed the effect of PTH1-34 in chondrocytes co-cultured with synovial cells. In conclusion, PTH1-34 has an obvious analgesic and anti-inflammatory effect, inhibits the matrix synthesis and alleviates the progression of osteoarthritis. In vitro, PTH1-34 inhibited TNF-α expression and antagonized TNF-α-induced MMP13 expression via the PKA pathway and the NF-κB signaling pathways, respectively.
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Affiliation(s)
- Yu-Jie He
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Xu Liang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Xin-Xin Zhang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Shan-Shan Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Yue Sun
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Tian-Fang Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
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Merkely G, Minas T, Ogura T, Ackermann J, Barbieri Mestriner A, Gomoll AH. Safety, Feasibility, and Radiographic Outcomes of the Anterior Meniscal Takedown Technique to Approach Chondral Defects on the Tibia and Posterior Femoral Condyle: A Matched Control Study. Cartilage 2021; 12:62-69. [PMID: 30380907 PMCID: PMC7755970 DOI: 10.1177/1947603518809409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Takedown of the anterior meniscus to facilitate exposure of the cartilage defects located on the tibial plateau and/or posterior femoral condyle with subsequent reattachment is being performed clinically; however, clinical evidence is lacking to support the safety of this technique. The aim of this study was therefore to investigate whether meniscal extrusion develops after patients undergo meniscus takedown and transosseous refixation during autologous chondrocyte implantation (ACI). DESIGN We analyzed data from 124 patients with a mean follow-up of 6.8 ± 2.5 years. Sixty-two patients who underwent (ACI) with anterior meniscus takedown and refixation by the senior surgeon (TM), were compared with a matched control group of patients who underwent ACI without meniscus takedown. Meniscal extrusion was investigated by measuring the absolute value and the relative percentage of extrusion (RPE) on 1.5-T magnetic resonance images (MRI) at final follow-up. The number of menisci with radial displacement greater or lesser than 3 mm was determined. In cases where a preoperative MRI was available, both pre- and postoperative meniscal extrusion was evaluated (n = 30) in those patients undergoing meniscal takedown. RESULTS There was no significant difference in either absolute meniscus extrusion, RPE, or extrusion rate in patients with and without meniscus takedown. Among patients with meniscal takedown and both pre- and postoperative MRI scans, absolute meniscus extrusion, RPE, and extrusion rate showed no significant differences. CONCLUSION Meniscal takedown and subsequent transosseous refixation is a safe and effective technique for exposure of the tibial plateau and posterior femoral condyle.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Traumatology, Semmelweis University, Budapest, Hungary
- Gergo Merkely, Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Street #112, Chestnut Hill, Boston, MA 02467, USA.
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Paley Orthopedic and Spine Institute, West Palm Beach, FL, USA
| | - Takahiro Ogura
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Sports Medicine Center, Funabashi Orthopedic Hospital, Funabashi, Chiba, Japan
| | - Jakob Ackermann
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andreas H. Gomoll
- Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Hospital for Special Surgery, New York, New York, USA
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Akkaya M, Gursoy S, Ozberk N, Simsek ME, Korkusuz F, Bozkurt M. Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application. Musculoskelet Surg 2020; 106:145-153. [PMID: 32960435 DOI: 10.1007/s12306-020-00681-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the impact of biodegradable polyurethane meniscus scaffold implantation (BPMSI) on muscle strength and balance in comparison with the healthy contralateral knee in patients with irreparable medial meniscus defect. METHODS This observational and prospective case-cohort study was conducted with patients who had irreparable meniscal defects and underwent arthroscopic meniscus scaffold implantation. Surgeries were carried out on the medial meniscus of 16 right and 4 left knees. Visual analog scale (VAS) was used to assess the degree of pain relief. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm (LYS) score were used to evaluate the functional improvement at weeks 12, 24 and 36. Concentric and eccentric quadriceps and hamstring peak torque (PT) as well as the peak torque-to-body weight (PTB) ratio, anterior-posterior, mediolateral and overall stability indexes were assessed at the same time points. RESULTS Twenty male patients with a mean age and body mass index of 32.2 ± 8.8 years and 26.2 ± 4.2 kg/m2, respectively, were included in the study. The amount of pain decreased from 7.6 ± 1.5% to 2.9 ± 1.5% at postoperative week 36. Range of motion, Lysholm score and KOOS increased from 87.0ο ± 9.5ο to 115.0ο ± 15.1ο, 30.8 ± 4.3 to 81.5 ± 5.3 and 37.4 ± 5.3 to 74.1 ± 7.2, respectively. Concentric quadriceps and hamstring peak torque values and peak torque/body weight ratios were improved in the knees that received a meniscus scaffold implant. Anterior/posterior, medial/lateral, and overall stability indexes with or without biofeedback exhibited a slight improvement, which was not statistically significant. CONCLUSION BPMSI led to decreased pain and improved function at postoperative week 36. Although muscle strength almost returned to normal, balance parameters did not recover within 36 weeks after the procedure.
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Affiliation(s)
- M Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey.
| | - S Gursoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
| | - N Ozberk
- Department of Physical Treatment and Rehabilitation, Middle East Technical University Medical Center, 06100, Ankara, Turkey
| | - M E Simsek
- Department of Orthopedics and Traumatology, Lokman Hekim University, 06100, Ankara, Turkey
| | - F Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06800, Ankara, Turkey
| | - M Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
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Billières J, Menetrey J. [Indications and results of meniscal transplantation]. Rev Med Suisse 2020; 16:1428-1431. [PMID: 32833358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Meniscectomy in a young active patient can lead to poor outcomes with pain, decreased function and long-term osteoarthritis. Meniscal allograft transplantation (MAT) has therefore been developed to address this issue. We now have 30 years of experience with this technique which is no longer considered experimental and new indications have been added. MAT allows restoration of joint biomechanics, pain relief, improvement in knee function and stability, and reduce cartilage degeneration. This is a comprehensive review of the role of menisci, the indications and principles of MAT, as well as these results.
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Affiliation(s)
| | - Jacques Menetrey
- Centre de médecine du sport et de l'exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, 1206 Genève et Service de chirurgie orthopédique, HUG, 1211 Genève 14
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Haunschild ED, Huddleston HP, Chahla J, Gilat R, Cole BJ, Yanke AB. Platelet-Rich Plasma Augmentation in Meniscal Repair Surgery: A Systematic Review of Comparative Studies. Arthroscopy 2020; 36:1765-1774. [PMID: 32057981 DOI: 10.1016/j.arthro.2020.01.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/04/2019] [Accepted: 01/18/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature on meniscal repair surgery and assess functional and radiographic outcomes of platelet-rich plasma (PRP)-augmented repair compared with standard repair techniques. METHODS A systematic review of the literature was completed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, MEDLINE, Embase, and Cochrane databases. The inclusion criteria included all human studies testing PRP augmentation of meniscal repair written in the English language. All cadaveric, animal, and basic science studies were excluded from review. The quality of the included publications was assessed prior to data extraction through the Jadad score. Risk of bias was further determined by Methodological Index for Non-randomized Studies (MINORS) and Cochrane risk-of-bias assessments. Heterogeneity in outcomes reported across studies was evaluated using I2 statistic calculations. RESULTS A total of 5 studies (1 with Level I evidence; 1, Level II; and 3, Level III) met the inclusion criteria for this review, all comparing PRP augmentation of meniscal repair surgery versus meniscal repair with no augmentation. Overall quality and risk of bias in the included studies varied substantially (Jadad score, 1-5; Methodological Index for Non-randomized Studies score, 7-18). Three comparative studies found no significant difference in outcome or failure, whereas the other two showed a significant improvement in PRP-augmented repairs at final follow-up. Two studies assessed healing with postoperative magnetic resonance imaging or second-look arthroscopy, with both showing significantly improved outcomes in the PRP-treated groups (P < .01 and P = .048). PRP preparation techniques and composition differed among all studies and were inconsistently reported. CONCLUSIONS In early and limited investigations, there is insufficient evidence to support PRP augmentation of meniscal repair surgery improving functional and radiographic outcomes and resulting in lower failure rates compared with standard repair techniques. There is considerable heterogeneity in the reporting and preparation of PRP used for augmentation. LEVEL OF EVIDENCE Level III, systematic review of Level I to III studies.
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Affiliation(s)
| | | | - Jorge Chahla
- Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A..
| | - Adam B Yanke
- Midwest Orthopedics at Rush University, Chicago, Illinois, U.S.A
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Kurnaz R, Balta O. Effect of platelet-rich plasma and platelet-rich fibrin matrix on healing of vertical meniscal tears in a rabbit model. Acta Orthop Traumatol Turc 2020; 54:186-195. [PMID: 32254035 DOI: 10.5152/j.aott.2020.02.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) on the healing of vertical medial meniscal tears in a rabbit model. METHODS The study was conducted on 72 New Zealand mature rabbits aged more than 6 months. Rabbits were randomly assigned to six groups: control (C) group, meniscal repair (MR) group, PRP group, PRFM group, MR+PRP group, and MR+PRFM group, with 12 rabbits in each group. A 5-mm full-thickness vertical tear was created in the avascular zone of the medial meniscus corpus in the right knee of all rabbits. The respective treatment for each group was given to the meniscal tear in each rabbit. Histological evaluation of healing was performed 6 and 12 weeks after surgery. RESULTS Defect filling and collagen formation remained low in the C group. However, in all other groups, there was no significant difference in the 6th week. In the 12th week, similar results as those obtained in the 6th week were obtained. In the C group, there was a difference in defect filling and cell type. This difference was that the defect filling and collagen formation remained low in the 12th week. No significant difference was observed between MR, MR + PRP and MR + PRFM groups. The MR group significantly differed from the other groups in the defect-filling rate and cell type; however, the use of PRP and PRFM did not provide an obvious benefit. CONCLUSION The contradictory results obtained in previous studies emphasize the need for further research on the use of PRP in meniscal recovery and repair. We believe that if surgery is indicated, repair is absolutely necessary to improve the healing of the tissue in meniscal tears. Studies using human meniscal tissue for meniscal injury and those that evaluate clinical applications of PRP are warranted.
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Affiliation(s)
- Recep Kurnaz
- Department of Orthopaedics and Traumatology, Eskişehir Acıbadem Hospital, Eskişehir, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University, School of Medicine, Tokat, Turkey
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Valter R, Godeau D, Leclerc A, Descatha A, Fadel M. Influence of severe knee pain, meniscus surgery and knee arthroplasty on physical ability: an observational study of 114 949 adults in the CONSTANCES cohort. BMJ Open 2019; 9:e031549. [PMID: 31843828 PMCID: PMC6924791 DOI: 10.1136/bmjopen-2019-031549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The knee is one of the major sites of musculoskeletal pain, yet few large-scale studies have evaluated the impact of knee disorders on physical limitations. Our objective was to describe this impact in a large-scale population study. METHODS We included subjects of working age from the CONSTANCES cohort, from its inception. Four groups were distinguished according to their medical history: whether they had knee arthroplasty (KA), meniscus surgery, severe knee pain, or none of these. Outcomes assessed for physical limitations were self-reported limitations in the last 6 months due to health problems, limitation on carrying 5 kg on 10 m and a 3-metre length rapid gait speed test (for participants aged >45). Associations between knee groups and patients' characteristics and physical limitations were analysed using logistic regression. Robust associations were deemed relevant if their ORs were higher than 2 and their p value lower than 0.0001. RESULTS Of the 114 949 individuals, 99 052 (86.2%) were in the 'no pain and no surgery' group, 14 740 (12.8%) were in the severe knee pain group, 1019 (0.89%) had meniscus surgery and 138 (0.12%) had KA. Severe knee pain and KA groups showed a similar profile (they were less at work, reported more deterioration in their health and had more limitations). CONCLUSION Almost 14% of the sample had knee disorders. Subjects reporting severe knee pain or who had KA reported more important physical limitations then subjects who reported neither severe knee pain nor knee surgery.
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Affiliation(s)
- Remi Valter
- Occupational Health Unit, Poincaré University Hospital, AP-HP (Paris Hospital) UVSQ, Garches, Île-de-France, France
- UMS 011, UMR-S 1168, Versailles St-Quentin Univ - Paris Saclay Univ, Versailles, Île-de-France, France
- VIMA : Aging and chronic diseases. Epidemiological and public health approaches, U1168, Inserm, Villejuif, F-94807, Île-de-France, France
| | - Diane Godeau
- Occupational and Environmental Diseases Unit, AP-HP (Paris Hospital) Hôpital Avicenne, University hospital Paris Seine-Saint-Denis, Bobigny, F-93009, Île-de-France, France
- Paris 13 University Sorbonne, Paris, Île-de-France, France
| | - Annette Leclerc
- UMS 011 Population-based Epidemiologic Cohorts Unit, Inserm, Villejuif, Île-de-France, France
| | - Alexis Descatha
- UMS 011, UMR-S 1168, Versailles St-Quentin Univ - Paris Saclay Univ, Versailles, Île-de-France, France
- VIMA : Aging and chronic diseases. Epidemiological and public health approaches, U1168, Inserm, Villejuif, F-94807, Île-de-France, France
- UMS 011 Population-based Epidemiologic Cohorts Unit, Inserm, Villejuif, Île-de-France, France
- Irset (Institut de recherche en santé, environnement et travail) - UMR_S1085, Univ Angers, CHU Angers, Univ Rennes, Inserm, Angers, F-49000, Pays de la Loire, France
| | - Marc Fadel
- Occupational Health Unit, Poincaré University Hospital, AP-HP (Paris Hospital) UVSQ, Garches, Île-de-France, France
- UMS 011, UMR-S 1168, Versailles St-Quentin Univ - Paris Saclay Univ, Versailles, Île-de-France, France
- VIMA : Aging and chronic diseases. Epidemiological and public health approaches, U1168, Inserm, Villejuif, F-94807, Île-de-France, France
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Chen M, Feng Z, Guo W, Yang D, Gao S, Li Y, Shen S, Yuan Z, Huang B, Zhang Y, Wang M, Li X, Hao L, Peng J, Liu S, Zhou Y, Guo Q. PCL-MECM-Based Hydrogel Hybrid Scaffolds and Meniscal Fibrochondrocytes Promote Whole Meniscus Regeneration in a Rabbit Meniscectomy Model. ACS Appl Mater Interfaces 2019; 11:41626-41639. [PMID: 31596568 DOI: 10.1021/acsami.9b13611] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Regeneration of an injured meniscus continues to be a scientific challenge due to its poor self-healing potential. Tissue engineering provides an avenue for regenerating a severely damaged meniscus. In this study, we first investigated the superiority of five concentrations (0%, 0.5%, 1%, 2%, and 4%) of meniscus extracellular matrix (MECM)-based hydrogel in promoting cell proliferation and the matrix-forming phenotype of meniscal fibrochondrocytes (MFCs). We found that the 2% group strongly enhanced chondrogenic marker mRNA expression and cell proliferation compared to the other groups. Moreover, the 2% group showed the highest glycosaminoglycan (GAG) and collagen production by day 14. We then constructed a hybrid scaffold by 3D printing a wedge-shaped poly(ε-caprolactone) (PCL) scaffold as a backbone, followed by injection with the optimized MECM-based hydrogel (2%), which served as a cell delivery system. The hybrid scaffold (PCL-hydrogel) clearly yielded favorable biomechanical properties close to those of the native meniscus. Finally, PCL scaffold, PCL-hydrogel, and MFCs-loaded hybrid scaffold (PCL-hydrogel-MFCs) were implanted into the knee joints of New Zealand rabbits that underwent total medial meniscectomy. Six months postimplantation we found that the PCL-hydrogel-MFCs group exhibited markedly better gross appearance and cartilage protection than the PCL scaffold and PCL-hydrogel groups. Moreover, the regenerated menisci in the PCL-hydrogel-MFCs group had similar histological structures, biochemical contents, and biomechanical properties as the native menisci in the sham operation group. In conclusion, PCL-MECM-based hydrogel hybrid scaffold seeded with MFCs can successfully promote whole meniscus regeneration, and cell-loaded PCL-MECM-based hydrogel hybrid scaffold may be a promising strategy for meniscus regeneration in the future.
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Affiliation(s)
- Mingxue Chen
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Zhaoxuan Feng
- School of Material Science and Engineering , University of Science and Technology Beijing , No. 30 Xueyuan Road, Haidian District , Beijing 100083 , People's Republic of China
| | - Weimin Guo
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Orthopaedic Surgery, First Affiliated Hospital , Sun Yat-sen University , No. 58 Zhongshan Second Road, Yuexiu District , Guangzhou , Guangdong 510080 , People's Republic of China
| | - Dejin Yang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Shuang Gao
- Academy for Advanced Interdisciplinary Studies , Peking University , No. 5 Yiheyuan Road, Haidian District , Beijing 100871 , People's Republic of China
| | - Yangyang Li
- Academy for Advanced Interdisciplinary Studies , Peking University , No. 5 Yiheyuan Road, Haidian District , Beijing 100871 , People's Republic of China
| | - Shi Shen
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Bone and Joint Surgery , The Affiliated Hospital of Southwest Medical University , No. 25 Taiping Road , Luzhou 646000 , People's Republic of China
| | - Zhiguo Yuan
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Bo Huang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
- Department of Bone and Joint Surgery , The Affiliated Hospital of Southwest Medical University , No. 25 Taiping Road , Luzhou 646000 , People's Republic of China
| | - Yu Zhang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Mingjie Wang
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Xu Li
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Libo Hao
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Jiang Peng
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Shuyun Liu
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital , Peking University Fourth School of Clinical Medicine , No. 31 Xinjiekou East Street, Xicheng District , Beijing 100035 , People's Republic of China
| | - Quanyi Guo
- Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA , Institute of Orthopedics , No. 28 Fuxing Road, Haidian District , Beijing 100853 , People's Republic of China
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Kwon H, Brown WE, Lee CA, Wang D, Paschos N, Hu JC, Athanasiou KA. Surgical and tissue engineering strategies for articular cartilage and meniscus repair. Nat Rev Rheumatol 2019; 15:550-570. [PMID: 31296933 PMCID: PMC7192556 DOI: 10.1038/s41584-019-0255-1] [Citation(s) in RCA: 320] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
Injuries to articular cartilage and menisci can lead to cartilage degeneration that ultimately results in arthritis. Different forms of arthritis affect ~50 million people in the USA alone, and it is therefore crucial to identify methods that will halt or slow the progression to arthritis, starting with the initiating events of cartilage and meniscus defects. The surgical approaches in current use have a limited capacity for tissue regeneration and yield only short-term relief of symptoms. Tissue engineering approaches are emerging as alternatives to current surgical methods for cartilage and meniscus repair. Several cell-based and tissue-engineered products are currently in clinical trials for cartilage lesions and meniscal tears, opening new avenues for cartilage and meniscus regeneration. This Review provides a summary of surgical techniques, including tissue-engineered products, that are currently in clinical use, as well as a discussion of state-of-the-art tissue engineering strategies and technologies that are being developed for use in articular cartilage and meniscus repair and regeneration. The obstacles to clinical translation of these strategies are also included to inform the development of innovative tissue engineering approaches.
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Affiliation(s)
- Heenam Kwon
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Cassandra A Lee
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
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Chung KS, Ha JK, Kim YS, Kim JH, Ra HJ, Kong DH, Wang PW, Choi CH, Kim JG. National Trends of Meniscectomy and Meniscus Repair in Korea. J Korean Med Sci 2019; 34:e206. [PMID: 31432650 PMCID: PMC6698454 DOI: 10.3346/jkms.2019.34.e206] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Meniscus surgeries are frequently performed in orthopaedics. However, their current status is not well known in many countries, including Korea. This study aimed to investigate the national trends of meniscus surgery in Korea. METHODS Information from the national database was acquired through the Korean Health Insurance Review and Assessment Service from 2010 to 2017. All cases coded as meniscectomy or meniscus repair were included. The total number and incidence of cases of meniscus surgery per 100,000 persons were determined, and the results were stratified by age and gender. The meniscus repair ratio for the total number of meniscus surgeries was evaluated. RESULTS The total number and incidence of meniscectomy cases were 65,752 and 137, respectively, in 2010, which increased to 74,088 and 154, respectively, in 2017. The number of meniscectomies increased by 12.67% in 8 years. The total number and incidence of meniscus repair cases were 9,055 and 18, respectively, in 2010, which increased to 14,947 and 31 in 2017. The number of meniscus repairs increased by 65.04%. The meniscus repair ratio was 12.1% in 2010, which increased to 16.8% in 2017. The highest peak was noted for patients who underwent meniscus surgeries in their 50s and 60s. Meniscectomy was performed more frequently in women (57%) than in men (43%), whereas repair was performed more frequently in men (54%) than in women (46%) over the study period. CONCLUSION The total number and incidence of meniscus surgeries increased from 2010 to 2017; the number and incidence of meniscus repair procedures increased more rapidly than those of meniscectomy, with the peak treatment age for both surgeries being in the 50s and 60s. The current study will contribute to understanding the epidemiology of meniscus surgery, its prevention, and cost-saving measures in Korea.
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Affiliation(s)
- Kyu Sung Chung
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Ku Ha
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
| | - Yoon Seok Kim
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Korea
| | - Ho Jong Ra
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Doo Hwan Kong
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Pei Wei Wang
- Department of Orthopaedic Surgery, Sports Medical Center and Sports Medical Research Institute, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Choong Hyeok Choi
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Sports Center, Myong-Ji Hospital, Seoul, Korea
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López-Lorente ÁI, Wang P, Stein S, Balko J, Lu R, Dürselen L, Mizaikoff B. Surface analysis of sheep menisci after meniscectomy via infrared attenuated total reflection spectroscopy. J Biophotonics 2019; 12:e201800429. [PMID: 30887689 DOI: 10.1002/jbio.201800429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/03/2019] [Accepted: 03/17/2019] [Indexed: 06/09/2023]
Abstract
Menisci are very important fibrocartilaginous tissue, which maintain biomechanical functions and physiological stabilization of knee joint. Meniscectomy is known as a surgery to recover partial functions from acute meniscus tears. However, the late consequences of total or partial meniscectomy include signs of osteoarthritis and even ligament instability. Infrared attenuated total reflection (IR-ATR) spectroscopy is a very useful technique, which can reveal molecular characteristics via the analysis of vibrational bands. The present study has employed IR-ATR spectroscopy to investigate sheep menisci samples after meniscectomy in a label-free fashion. Several differences of peak absorbance change and peak shift were observed between the native healthy samples and the meniscectomy samples in distinct IR wavenumber regions, such as amide I band, amide II band, C-H bending band as well as the sugar band region. Combining the results from the collagen protein IR spectra, it can be speculated that six months after meniscectomy collagen fibrils on the incision lose its ordered arrangement and a decrease in the triple helical structure of collagen fibril is observed. In addition, the collagen fibrils and proteoglycan content might also be slight varied after meniscectomy.
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Affiliation(s)
- Ángela I López-Lorente
- Departamento de Química Analítica, Instituto Universitario de Investigación en Química Fina y Nanoquímica IUNAN, Universidad de Córdoba, Campus de Rabanales, Córdoba, Spain
| | - Pei Wang
- Institute for Analytical and Bioanalytical Chemistry, Ulm University, Albert-Einstein-Allee, Ulm, Germany
| | - Svenja Stein
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Jonas Balko
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Rui Lu
- Jiangsu Key Laboratory of Chemical Pollution Control and Resources Reuse, School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Boris Mizaikoff
- Institute for Analytical and Bioanalytical Chemistry, Ulm University, Albert-Einstein-Allee, Ulm, Germany
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47
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Kluytmans A, Tummers M, van der Wilt GJ, Grutters J. Early Assessment of Proof-of-Problem to Guide Health Innovation. Value Health 2019; 22:601-606. [PMID: 31104741 DOI: 10.1016/j.jval.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although the relevance of both push and pull factors is acknowledged in models of innovation, needs, broadly defined, are rarely considered, whereas supply-driven innovation in publicly funded health systems carries the risk that it may not match the underlying problems experienced by patients and consumers. OBJECTIVES To explore a mixed-methods, multistakeholder approach that focuses on pertinent problems when assessing the potential value of an innovation as applied to a case of surgical innovation in meniscus surgery. METHODS Through interviews of stakeholders (n = 11) we sought to identify current problems of meniscus surgery in the Netherlands. On the basis of the subsequent problem definitions, we used stakeholder and literature input to quantify the room for improvement and stakeholder engagement to uncover possible barriers and facilitators to the implementation of the proposed innovation. RESULTS Despite being enthusiastic about the ingenuity of the proposed innovation and seeing some potential for cost saving, most stakeholders (n = 10) agreed that there are no major problems in current meniscus surgery meriting the innovation. They even discerned pragmatic barriers that would challenge the potential cost savings. CONCLUSIONS By adopting a problem-oriented multistakeholder approach to early health technology assessment, we were able to estimate the potential value of an innovation in its social context, finding that, beyond the initial enthusiasm, the proposed innovation was unlikely to resolve the problems distinguished by the stakeholders. We concluded that our multistakeholder, mixed-methods approach to early health technology assessment is feasible and helps foster more demand-driven innovations.
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Affiliation(s)
- Anouck Kluytmans
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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48
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Chou WY, Cheng JH, Wang CJ, Hsu SL, Chen JH, Huang CY. Shockwave Targeting on Subchondral Bone Is More Suitable than Articular Cartilage for Knee Osteoarthritis. Int J Med Sci 2019; 16:156-166. [PMID: 30662339 PMCID: PMC6332487 DOI: 10.7150/ijms.26659] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/29/2018] [Indexed: 11/05/2022] Open
Abstract
Our study compared the effects of extracorporeal shockwave therapy (ESWT) on the subchondral bone and the articular cartilage in the treatment of early osteoarthritis (OA) of rat knee. The rats were divided into 5 groups which included Sham group, Meniscus group (ESWT applied on medial meniscus), OA group (arthrotomy and medial menisectomy (MMx) and anterior cruciate ligament transection (ACLT), T(M) group (arthrotomy and MMx and ACLT followed by ESWT on medial tibial subchondral bone) and Articular cartilage group (arthrotomy and MMx and ACLT followed by ESWT on medial articular cartilage). Evaluations included the pathological changes of the synovium, articular cartilage and subchondral bone, and compared with ESWT on the meniscus, medial tibial subchondral bone and articular cartilage. The ESWT (0.25 mJ/mm² and 800 impulses) did not cause any damages on the cartilage of the meniscus and the tissue of the joint when compared with Sham group. Among the treatment of osteoarthritic groups (OA, T(M) and Articular cartilage groups), T(M) group showed significant in pathological examination, micro-CT analysis, cartilage grading score and grading of synovium changes by compared with OA and Articular cartilage groups (P < 0.05) in the treatment of early OA knee. In immunohistochemical analysis, T(M) group significantly increased the expression of TGF-β1 but reduced DMP-1, MMP-13 and ADAMTS-5 in the cartilage by compared with OA group and Articular cartilage group (P < 0.05). Our results showed that subchondral bone was an excellent target than articular cartilage for ESWT on early knee osteoarthritis.
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Affiliation(s)
- Wen-Yi Chou
- Section of Sports Medicine, Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jai-Hong Cheng
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Jen Wang
- Section of Sports Medicine, Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shan-Ling Hsu
- Section of Sports Medicine, Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Hung Chen
- Section of Sports Medicine, Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Yiu Huang
- Section of Sports Medicine, Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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49
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Clatworthy M, Sauer S, Roberts T. Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:124-129. [PMID: 30003286 DOI: 10.1007/s00167-018-5036-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/25/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE It is proposed that central femoral ACL graft placement better controls rotational stability. This study evaluates the consequence of changing the femoral tunnel position from the AM position drilled transtibially to the central position drilled transportally. The difference in ACL graft failure is reported. METHODS This prospective consecutive patient single surgeon study compares the revision rates of 1016 transtibial hamstring ACL reconstructions followed for 6-15 years with 464 transportal hamstring ACL reconstructions followed for 2-6 years. Sex, age, graft size, time to surgery, meniscal repair and meniscectomy data were evaluated as contributing factors for ACL graft failure to enable a multivariate analysis. To adjust for the variable follow-up a multivariate hazard ratio, failure per 100 graft years and Kaplan-Meier survivorship was determined. RESULTS With transtibial ACLR 52/1016 failed (5.1%). With transportal ACLR 32/464 failed (6.9%). Significant differences between transportal and transtibial ACLR were seen for graft diameter, time to surgery, medial meniscal repair rates and meniscal tissue remaining after meniscectomy. Adjusting for these the multivariate hazard ratio was 2.3 times higher in the transportal group (p = 0.001). Central tunnel placement resulted in a significantly 3.5 times higher revision rate compared to an anteromedial tunnel placement per 100 graft years (p = 0.001). Five year survival was 980/1016 (96.5%) for transtibial versus 119/131 (90.5%) for transportal. Transportal ACLR also showed a significantly higher earlier failure rate with 20/32 (61%) of the transportal failing in the first year compared with 14/52 (27%) for transtibial. (p = 0.001.) CONCLUSION: Transportal central femoral tunnel ACLR has a higher failure rate and earlier failure than transtibial AM femoral tunnel ACLR. LEVEL OF EVIDENCE Level II-prospective comparative study.
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50
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Hagmeijer MH, Vonk LA, Kouwenhoven JW, Custers RJ, Bleys RL, Krych AJ, Saris DB. Surgical Feasibility of a One-Stage Cell-Based Arthroscopic Procedure for Meniscus Regeneration: A Cadaveric Study. Tissue Eng Part C Methods 2018; 24:688-696. [PMID: 30398399 PMCID: PMC7615694 DOI: 10.1089/ten.tec.2018.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPACT STATEMENT Meniscus injury remains the most common indication for orthopedic surgery, but loss of functioning meniscus tissue is strongly correlated with development of early osteoarthritis. However, current clinical options for tissue engineering of the meniscus are limited. This study demonstrates the feasibility of combining human meniscus cells with mesenchymal stromal cells to enhance a meniscus scaffold for meniscus regeneration in a one-stage solution for partial meniscal deficiency.
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Affiliation(s)
- Michella H. Hagmeijer
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lucienne A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan-Willem Kouwenhoven
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald L. Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel B.F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
- MIRA Institute for Technical Medicine, University Twente, Enschede, The Netherlands. Investigation performed at the University Medical Center Utrecht, Utrecht, The Netherlands
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