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Solsona-Carcas D, Trenado-Molina J, Buesa-Estéllez A, López-Royo MP, Bellosta-López P. Physical Therapist Interventions Versus or Combined With Surgical Treatment in Nontraumatic Degenerative Meniscal Pathology: A Systematic Review and Network Meta-Analysis. Phys Ther 2024; 104:pzae007. [PMID: 38243408 DOI: 10.1093/ptj/pzae007] [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: 03/09/2023] [Revised: 09/05/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study aimed to synthesize the evidence from randomized clinical trials in people with nontraumatic degenerative meniscal pathology by comparing physical therapist interventions versus or combined with arthroscopic partial meniscectomy (APM). METHODS Seven electronic databases were searched. Methodological quality was evaluated using the Physiotherapy Evidence Database scale. Data synthesis was performed with random-effects network meta-analysis, and results were summarized using the standardized mean differences. RESULTS From 2103 studies, 10 randomized clinical trials comprising 1411 individuals were included. Ninety percent of the selected randomized clinical trials were classified as good quality according to the Physiotherapy Evidence Database scale. All interventions (physical therapist interventions, APM, and APM plus physical therapist interventions) showed reduced pain and physical impairments at 3-month follow-up. However, when a physical therapist intervention was included, greater reductions in pain at rest (APM vs physical therapist interventions: 0.73 [95% CI = 0.20 to 1.26]; APM vs APM plus physical therapist interventions: 0.59 [95% CI = 0.15 to 1.03]) and greater increases in the strength of knee extensor muscles (APM vs physical therapist interventions: 0.44 [95% CI = 0.07 to 0.80]; APM vs APM plus physical therapist interventions: 0.73 [95% CI = 0.29 to 1.16]) were observed at 3 months. By contrast, no differences were found between treatments beyond 3 months. CONCLUSION Physical therapist interventions based on exercise programs demonstrate superior short-term outcomes in pain reduction and knee extensor strength compared to surgical treatment. IMPACT For nontraumatic degenerative meniscal pathology, conservative treatment utilizing a physical therapist intervention approach should be prioritized as the first choice over surgical treatment. It offers comparable or superior short-term pain reduction and strength improvements, with a lower risk of side effects. In cases where surgery is deemed necessary, including postsurgical, physical therapist interventions are highly recommended to enhance muscle strength and alleviate pain.
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Affiliation(s)
- Daniel Solsona-Carcas
- Universidad San Jorge, Campus Universitario, Autovía Mudéjar, Villanueva de Gállego, Zaragoza, Spain
| | - Javier Trenado-Molina
- Universidad San Jorge, Campus Universitario, Autovía Mudéjar, Villanueva de Gállego, Zaragoza, Spain
| | - Almudena Buesa-Estéllez
- Universidad San Jorge, Campus Universitario, Autovía Mudéjar, Villanueva de Gállego, Zaragoza, Spain
| | - Maria Pilar López-Royo
- Universidad San Jorge, Campus Universitario, Autovía Mudéjar, Villanueva de Gállego, Zaragoza, Spain
- CIBERER-CB06/07/1036: Translational Research Unit, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autovía Mudéjar, Villanueva de Gállego, Zaragoza, Spain
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Damsted C, Skou ST, Hölmich P, Lind M, Varnum C, Jensen HP, Hansen MS, Thorlund JB. Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 38385220 DOI: 10.2519/jospt.2024.12245] [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: 02/23/2024]
Abstract
OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the "Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245.
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Duong V, Oo WM, Ding C, Culvenor AG, Hunter DJ. Evaluation and Treatment of Knee Pain: A Review. JAMA 2023; 330:1568-1580. [PMID: 37874571 DOI: 10.1001/jama.2023.19675] [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: 10/25/2023]
Abstract
Importance Approximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain. Observations Knee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching). Conclusions and Relevance Knee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.
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Affiliation(s)
- Vicky Duong
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Win Min Oo
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Australian IOC Research Centre, La Trobe University, Melbourne, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Rheumatology Department, Royal North Shore Hospital, St Leonards, Australia
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Randazzo E, Duerr R, Baria MR. Meniscus Root Tears: A Clinical Review. Curr Sports Med Rep 2022; 21:155-158. [PMID: 35522439 DOI: 10.1249/jsr.0000000000000959] [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: 11/21/2022]
Abstract
ABSTRACT Meniscus root tears are important to recognize early given their potentially devastating consequences on joint health. This injury results in the lost ability of the meniscus to transfer axial loads into hoop stress; therefore, it is functionally equivalent to a complete meniscectomy. This causes rapid progression of osteoarthritis and increased need to total knee arthroplasty in a previously healthy joint. Despite these consequences, root tears have only been discussed in the orthopedic literature in the last 10 to 15 years and have not been routinely integrated into nonoperative sports medicine education. It is important for all nonoperative sports medicine providers to properly diagnose and triage this injury early in its course to maximize joint preservation efforts. The goal of this manuscript is to review the anatomy, presentation, natural history, imaging, and treatment options for meniscal root tears.
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Affiliation(s)
- Elena Randazzo
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
| | - Robert Duerr
- Department of Orthopedic Surgery, The Ohio State University, Columbus, OH
| | - Michael R Baria
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
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Hou JH, Gong YL, Ma P, Chen X, Dong WT, Liu JJ, Liu BJ, Zhang CM. Comparative clinical outcomes of different therapies for traumatic meniscal tears in adults: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28557. [PMID: 35029222 PMCID: PMC8757970 DOI: 10.1097/md.0000000000028557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Meniscus tears are usually classified as degenerative or traumatic tears according to their pathogenesis. At present, traumatic meniscal tears are generally believed to have high healing potential. In recent years, multiple treatments have been described for traumatic meniscal tears, such as the inside-out technique, outside-in technique, all-inside technique, biological augmentation of meniscal repair, meniscectomy, and non-surgical treatment. However, the functional recovery of the knee joint and healing of the meniscus after treatment are quite different from the results reported in the literature, which requires more reliable evidence-based medical findings. This study will evaluate evidence from multiple types of research comparing different therapies for traumatic meniscal tears in adults. METHODS We will search the EMBASE, Cochrane Library (the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials [CENTRAL], Cochrane Methodology Register), PubMed, Web of Science (Science and Social Science Citation Index), China Knowledge Network, CBM, Wanfang data, and VIP electronic databases from their inception to August 10, 2021, with no language restrictions. We will also manually search Baidu and Google Scholar to identify randomized controlled studies, non-randomized controlled studies, and cohort studies on the treatment of traumatic meniscal tears. Two researchers will independently screen the literature, extract the data, and evaluate the quality of the studies. Software programs, including Microsoft Access, Excel, Stata (Version 15), WinBUGS (Version 1.4.3), and ADDIS (Version 1.16.8), were used to analyze and manipulate the data. RESULTS In this study, the main outcomes were physical function and healing rate, based on the Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score, Functional Recovery Scale, and clinical healing rate. The secondary indexes included total cost, cost-effectiveness ratio, incremental cost-effectiveness ratio, Tegner activity scale score, visual analogue scale, numerical rating scale, and meniscal tear complications. CONCLUSIONS This systematic review will provide reliable evidence-based findings for the clinical application of different therapies for traumatic meniscal tears in adults.
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Choi M, Lee SJ, Park CM, Ryoo S, Kim S, Jang JY, Kim HA. Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review. J Korean Med Sci 2021; 36:e292. [PMID: 34811974 PMCID: PMC8608923 DOI: 10.3346/jkms.2021.36.e292] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Meniscal tears are commonly observed in patients with knee osteoarthritis (OA), however, clinical significance of such lesions detected by magnetic resonance imaging is in many cases unclear. This study aimed to determine the clinical effectiveness of arthroscopic partial meniscectomy (APM) compared with non-operative care in patients with knee OA. METHOD We used existing systematic reviews with updates of latest studies. Three randomized controlled studies were selected, where two studies compared the effects of APM plus physical therapy (PT) with PT alone and one compared APM alone and PT alone. While 1 study exclusively included OA patients, 2 studies included 21.1 and 12% of patients with no radiographic OA. Patients with knee locking were unanimously excluded. RESULTS Upon comparison of APM plus PT and PT alone, there was no significant difference observed in knee function, physical activity, or adverse events. Knee pain was observed to be significantly lower in the APM plus PT group at 6 months, but there was no difference between the two groups at 12 and 24 months. With respect to the comparison between APM alone and PT alone, PT was non-inferior based on the criteria for knee function during 24 months; however, knee pain was significantly reduced in the APM alone group. CONCLUSIONS Our study showed that knee pain was significantly improved in the APM group compared to non-operative care group at 6 months and over 24 months. Our result was based on only 3 randomized controlled trials (RCTs) revealing a significant knowledge gap, hence demanding more high-quality RCTs in OA patients. TRIAL REGISTRATION PROSPERO Identifier: CRD42020215965.
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Affiliation(s)
- Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Su Jung Lee
- College of Nursing, Korea University, Seoul, Korea
| | - Chan Mi Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sunghyun Kim
- Korea Social Security Information Service, Seoul, Korea
| | - Ju Yeon Jang
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Abstract
Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.
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Affiliation(s)
- Bryan G Adams
- Department of Orthopedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Megan N Houston
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
| | - Kenneth L Cameron
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
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8
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Ozeki N, Kohno Y, Kushida Y, Watanabe N, Mizuno M, Katano H, Masumoto J, Koga H, Sekiya I. Synovial mesenchymal stem cells promote the meniscus repair in a novel pig meniscus injury model. J Orthop Res 2021; 39:177-183. [PMID: 32886427 PMCID: PMC7821148 DOI: 10.1002/jor.24846] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Stem cell therapy has potential for the treatment of degenerative meniscus injuries; however, an optimal animal model has not been established. Basic and clinical research show that synovial mesenchymal stem cells (MSCs) promote meniscus repair. The purposes of this study were to create a novel meniscus injury model in microminipigs and to investigate the effectiveness of synovial MSCs on meniscus healing in this model. The posterior portion of the medial meniscus in microminipigs was punctuated 200 times with a 23G needle. Allogenic synovial MSC suspension was placed on the injury site for 10 min for transplantation. The meniscus was evaluated histologically and via sagittal magnetic resonance imaging (MRI), radial MRI reconstructed in three dimensional, and T2 mapping at 1 and 8 weeks. Proteoglycan content stained with safranin-o disappeared 1 week after treatment in both the MSC and control groups but increased at 8 weeks only in the MSC group. Histological scores at 8 weeks were significantly higher in the MSC group than in the control group (n = 6). At 8 weeks, the T2 values of the MSC group were significantly closer to those of a normal meniscus than were those of the control group. High signal intensity areas of the MRIs and positive areas stained with picrosirius red coincided with meniscal lesions. In conclusion, we created a novel meniscus injury model in microminipigs. Evaluation via histology, MRIs, and polarized microscopy showed that transplantation of synovial MSCs improved meniscus healing.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Yuji Kohno
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Yoshihisa Kushida
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Naoto Watanabe
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hisako Katano
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | | | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
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Abstract
BACKGROUND Meniscus tear is one of the most familiar orthopedic injury, and it is also the leading cause of the dysfunction of knee joint. Recent efforts to improve the success rate of the meniscus repair surgery involve the addition of platelet-rich plasma (PRP). The aim of our experiment is to assess the clinical effects of arthroscopic repair of meniscal tears without or with PRP. METHODS This is a randomized and parallel-group superiority study. The study protocol is approved through the review committee of the corresponding institutions in PLA Army 80th Group Military Hospital. All patients will provide written informed consent to participate in the study. We implement our investigation on the basis of the ethical standards outlined in the Helsinki Declaration of 1964 and then report our outcomes according to the CONSORT statement of 2010. All the patients follow a same rehabilitation program. Patients are assessed at baseline (day before operation), 12 months and 24 months after the last time of injection; outcome assessments involve Ikeuchi score, Lysholm score, and the visual analogue scales for failure and pain rate. P value less than .05 indicates that there is statistical significance. RESULTS We suppose that arthroscopic PRP repair of meniscus tears results in improved pain and functional results owing to the release of bioactive molecules that may affect the healing of meniscus. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6175).
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Affiliation(s)
| | | | - Baozhen Lou
- Department of Anesthesiology, PLA Army 80th Group Military Hospital, Shandong, China
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Debecker N, Luyten M, Vandenabeele F, Bellemans J. The effect of anti-gravity training after meniscal or chondral injury in the knee. A systematic review. Acta Orthop Belg 2020; 86:422-433. [PMID: 33581026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Reduced impact loading or anti-gravity training has recently been introduced as a new tool in the rehabilitation of orthopaedic conditions that require restricted weight bearing. The purpose of this strategy is to speed up the functional rehabilitation while at the same time protect the healing structures from harmful effects associated with impact loading. Anti- gravity treadmills (AlterG ® ) and harness suspension devices seem to be the two most promising techniques. It is however today unclear how effective these devices are. The purpose of our study was therefore to perform a systematic literature review on the actual technology available and its effect on impact load reduction, as well as its effectiveness in accelerating functional recovery after meniscal and chondral injury to the knee. The results from our work demonstrate that only a limited number of studies are available, usually of moderate quality. The data suggest a variable effect on cartilage regeneration, and a potential for accelerated functional recovery in gait and running dynamics both with anti-gravity treadmill as well as suspension harness systems.
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Navarro RA, Adams AL, Lin CC, Fleming J, Garcia IA, Lee J, Black MH. Does Knee Arthroscopy for Treatment of Meniscal Damage with Osteoarthritis Delay Knee Replacement Compared to Physical Therapy Alone? Clin Orthop Surg 2020; 12:304-311. [PMID: 32904116 PMCID: PMC7449858 DOI: 10.4055/cios19114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/22/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUD To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty. METHODS Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores. A Cox proportional hazards model was used to estimate the risk of knee replacement surgery and greater healthcare utilization associated with KA vs. PT-only. RESULTS Among 7,026 patients (KA, 69%; PT-only, 31%), 27% had partial or total knee replacement surgery during follow-up. PT-only patients were older and more likely to be women and had more comorbidities. After accounting for differences between groups, the cumulative incidence of knee replacement was modestly but significantly higher for those who received KA than those who underwent PT-only (hazard ratio, 1.30; 95% confidence interval, 1.17-1.44; p < 0.001), although there was no significant difference in health service utilization, narcotic medication dispenses, or knee injections after initiating treatment. CONCLUSIONS For patients with meniscal damage complicated by OA, those who underwent KA were 30% more likely to have partial or total knee replacement surgery at any given time than those who had PT alone.
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Affiliation(s)
- Ronald A. Navarro
- Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Harbor City, CA, USA
| | - Annette L. Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Charles C. Lin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - John Fleming
- Torrance Orthopaedic and Sports Medicine Group, Torrance, CA, USA
| | - Ivan A. Garcia
- Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Janet Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Nishida Y, Hashimoto Y, Orita K, Nishino K, Kinoshita T, Nakamura H. Intra-Articular Injection of Stromal Cell-Derived Factor 1α Promotes Meniscal Healing via Macrophage and Mesenchymal Stem Cell Accumulation in a Rat Meniscal Defect Model. Int J Mol Sci 2020; 21:ijms21155454. [PMID: 32751701 PMCID: PMC7432222 DOI: 10.3390/ijms21155454] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
The stromal-cell-derived factor-1α (SDF-1) is well-known for playing important roles in the regeneration of tissue by enhancing cell migration. However, the effect of SDF-1 in meniscal healing remains unknown. The purpose of this study is to investigate the effects of intra-articular injection of SDF-1 on meniscus healing in a rat meniscal defect model. The intra-articular SDF-1 injection was performed at meniscectomy and one week later. Macroscopic and histological assessments of the reparative meniscus were conducted at one, two and six weeks after meniscectomy in rats. In the macroscopic evaluation, the SDF-1 group showed an increase in the size of the reparative meniscus at six weeks after meniscectomy compared to the phosphate-buffered saline (PBS) injection (no-treatment) group. Histological findings showed that intra-articular injection of SDF-1 enhanced the migration of macrophages to the site of the regenerative meniscus at one and two weeks after meniscectomy. CD68- and CD163-positive cells in the SDF-1 group at one week after meniscectomy were significantly higher than in the no-treatment group. CD163-positive cells in the SDF-1 group at two weeks were significantly higher than in the no-treatment group. At one week after meniscectomy, there were cells expressing mesenchymal-stem-cell-related markers in the SDF-1 group. These results indicate the potential of regenerative healing of the meniscus by SDF-1 injection via macrophage and mesenchymal stem cell accumulation. In the present study, intra-articular administration of SDF-1 contributed to meniscal healing via macrophage, CD90-positive cell and CD105-positive cell accumulation in a rat meniscal defect model. The SDF-1–CXCR4 pathway plays an important role in the meniscal healing process. For potential clinical translation, SDF-1 injection therapy seems to be a promising approach for the biological augmentation in meniscal injury areas to enhance healing capacity.
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Lee JK, Jung M, Yang JH, Song SY, Shin YS, Cha M, Jung D, Seo YJ. Repair versus nonrepair of medial meniscus posterior root tear: A systematic review of patients' selection criteria, including clinical and radiographic outcomes. Medicine (Baltimore) 2020; 99:e19499. [PMID: 32150112 PMCID: PMC7478593 DOI: 10.1097/md.0000000000019499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The general consensus regarding a rational choice among various treatment strategies for medial meniscus posterior root tears (MMPRTs) has yet to be clearly established. The purpose of this systematic review was to analyze patient selection criteria based on index arthrosis, as well as clinical and radiological outcomes after repair or nonrepair treatment in patients with MMPRTs. METHODS A systematic electronic search was performed with established medical databases. Data from the selected studies which were assessed using the modified Coleman methodology score were analyzed in terms of index arthrosis and degree of lower limb alignment, functional and radiologic outcomes after meniscus repair, partial meniscectomy, and conservative treatment. RESULTS In total, 17 studies and 655 patients (665 cases) were enrolled in this study, of which 42% (279 cases) underwent MMPRT repair and 58% (386 cases) were treated using a nonrepair strategy. The mean age and the mean follow-up period were 54.7 years and 32.5 months in the repair group, respectively, and 57.0 years and 49.3 months in the nonrepair group, respectively. Based on the clinical data available in this study, most of the MMPRT repairs were performed in patients with mild arthrosis, mild varus alignment, and mild chondral injury. Although data were limited, the percentage of patients with mild chondral injury was only 40% in the nonrepair group, implying that the nonrepair group may have more advanced arthrosis at the baseline. Based on the available Lysholm score across the studies, good functional outcomes were obtained in the repair group, whereas the results of the nonrepair treatment exhibited fair functional outcomes that were somewhat heterogenous. The radiologic outcomes of the mean 5 years' follow-up study showed that arthritic change could not be prevented by either nonrepair or repair treatment. CONCLUSIONS In general, MMPRT repair led to significant improvement in clinical outcomes. On the contrary, the nonrepair group also showed symptomatic relief in some selected cases, despite the somewhat heterogenous results. Given the subgroup analysis for the functional results reported in this review, strict patient selection is important to obtain satisfactory clinical outcomes, regardless of the treatment option selected.
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Affiliation(s)
- Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine
| | - Min Jung
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital
| | - Si Young Song
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do
| | - Young-Soo Shin
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-do, Republic of Korea
| | - Myoungsoo Cha
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do
| | - Dawoon Jung
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do
| | - Young-Jin Seo
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do
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Hershman EB, Jarvis JL, Mick T, Dushaj K, Elsner JJ. Direct treatment cost outcomes among patients with medial meniscus deficiency: results from a 24-month surveillance study. Curr Med Res Opin 2020; 36:427-437. [PMID: 31914326 DOI: 10.1080/03007995.2020.1713073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/26/2022]
Abstract
Objective: Meniscus deficiency is highly prevalent in the United States and represents a substantial societal cost burden. The objective of this case series was to evaluate and compare direct costs associated with treatment for acute or degenerative medial meniscus deficiency.Methods: Case series patients (n = 50) received either non-surgical therapy or an operative partial meniscectomy based on clinical assessment by the principal study investigator which included physical examination and MRI. Cumulative 24-month direct treatment costs were compared between non-surgical and operative cohorts. Direct treatment costs were calculated using billing record reimbursements for all medical services administered by the treating institution, and imputed for medical services prescribed by the treating physician but provided external to the treating institution.Results: At study initiation, 33 patients (67%) were treated with non-surgical care, and 17 patients (33%) received a partial medial meniscectomy. By 24 months, average direct treatment costs were highest for patients who received a partial medial meniscectomy at study initiation ($4488 ± $1265) compared to patients who received non-surgical care at study initiation ($4092 ± $7466), although differences in average direct treatment costs were not statistically significant across treatment cohorts (p = .830). Average direct treatment costs were highest for the subgroup of patients who initiated non-surgical therapy but received a subsequent total knee arthroplasty during the study period (n = 2; $32,197 ± $169).Conclusion: Findings from this case series suggests that patients with acute or degenerative meniscus deficiency incur substantial direct treatment costs related to their knee pathology, particularly for patients receiving total knee arthroplasty.
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Affiliation(s)
- Elliott B Hershman
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | | | - Travis Mick
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Kristina Dushaj
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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15
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Abstract
Meniscal injuries have posed a challenging problem for many years, especially considering that historically the meniscus was considered to be a structure with no important role in the knee joint. This led to earlier treatments aiming at the removal of the entire structure in a procedure known as a meniscectomy. However, with the current understanding of the function and roles of the meniscus, meniscectomy has been identified to accelerate joint degradation significantly and is no longer a preferred treatment option in meniscal tears. Current therapies are now focused to regenerate, repair, or replace the injured meniscus to restore its native function. Repairs have improved in technique and materials over time, with various implant devices being utilized and developed. More recently, strategies have applied stem cells, tissue engineering, and their combination to potentiate healing to achieve superior quality repair tissue and retard the joint degeneration associated with an injured or inadequately functioning meniscus. Accordingly, the purpose of this current review is to summarize the current available pre-clinical and clinical literature using stem cells and tissue engineering for meniscal repair and regeneration.
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Affiliation(s)
- George Jacob
- Department and Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (G.J.); (K.S.)
| | - Kazunori Shimomura
- Department and Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (G.J.); (K.S.)
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka 530-0043, Japan
- Global Centre for Medical Engineering and Informatics, Osaka University, Osaka 565-0871, Japan
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Guenoun D, Magalon J, de Torquemada I, Vandeville C, Sabatier F, Champsaur P, Jacquet C, Ollivier M. Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma. Diagn Interv Imaging 2019; 101:169-176. [PMID: 31727602 DOI: 10.1016/j.diii.2019.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/29/2019] [Revised: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this retrospective study was to describe our preliminary results of intra-meniscal administration of platelet rich plasma (PRP) in patients with degenerative meniscal tears of the knee. MATERIAL AND METHOD Ten patients with degenerative meniscal tears according to the Stoller classification and without knee osteoarthritis were included. There were 7 men and 3 women with a mean age of 40.4±13.6 [SD] years (range: 18-59 years). Patients were prospectively assessed at baseline and 3- and 6-months after intra meniscal PRP administration. Evaluation included the knee injury and osteoarthritis outcome score (KOOS), pain visual analog scale, and return to competition and training. MRI follow-up was performed 6 months after PRP administration. Adverse events were recorded. RESULTS Volume of injected PRP was standardized to 4.0mL. Adverse events during PRP administration was moderate pain in 8 patients (8/10; 80%). Mean KOOS total score significantly improved from 56.6±15.7 (SD) to 72.7±18.5 (SD) (P=0.0007). All six patients practicing sports regularly were able to recover competition or training. In seven patients who underwent MRI follow-up at 6 months, MRI showed stability of the meniscal tears and similar Stoller grades. CONCLUSION Intra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe. Further randomized controlled studies are needed to definitely confirm the effectiveness of this procedure.
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Affiliation(s)
- D Guenoun
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France.
| | - J Magalon
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - I de Torquemada
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - C Vandeville
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - F Sabatier
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - P Champsaur
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France
| | - C Jacquet
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
| | - M Ollivier
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
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Alessio-Mazzola M, Lovisolo S, Capello AG, Zanirato A, Chiarlone F, Formica M, Felli L. Management of ramp lesions of the knee: a systematic review of the literature. Musculoskelet Surg 2019; 104:125-133. [PMID: 31595426 DOI: 10.1007/s12306-019-00624-z] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature and to assess the clinical outcomes following meniscal ramp lesion treatment and anterior cruciate ligament (ACL) reconstruction. A consensus of the treatment of this pattern of tears is still lacking. METHODS A systematic review of the literature was performed with a comprehensive search on Medline through PubMed, CINAHL, Cochrane, Embase and Google Scholar databases. The PRISMA 2009 flowchart and checklist were considered to edit the review. The included studies were evaluated based on indications, management, surgical technique and clinical results. RESULTS Seven studies (two level II and five level IV evidence) were identified that met inclusion criteria, including a total of 509 patients. The overall main follow-up was 23.6 months. Treatment failure occurred in 8.3% of patients receiving ACL repair and ramp lesion treatment. The repair of ramp lesion is the most used approach in the literature. CONCLUSION There is a lack of literature focused on the management of ramp lesion and ACL injuries. The repair resulted in the most used approach with good clinical results and low failure rate. However, further high-quality studies evaluating the long-term outcomes of different surgical strategies are needed.
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Affiliation(s)
- M Alessio-Mazzola
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - S Lovisolo
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - A G Capello
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - A Zanirato
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - F Chiarlone
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Formica
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - L Felli
- Orthopedic Clinic, Department of Surgical Sciences (DISC), University of Genova, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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18
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Abstract
Previous research has shown that delays in pediatric anterior cruciate ligament (ACL) reconstruction are associated with increased prevalence of concomitant knee injuries and worse outcomes following surgery. However, few studies have described factors that may contribute to these delays and adverse outcomes. This study seeks to determine the effect of socioeconomic status on clinical outcomes following ACL reconstruction.A retrospective review of patients who underwent primary ACL reconstruction at a tertiary pediatric hospital between 2009 and 2015 was conducted. Variables included chronologic, demographic, and socioeconomic data, and postoperative complications. Socioeconomic status was measured using health insurance type and median household income levels derived from 2009 to 2015 US Census Bureau.A total of 127 patients (69 male, 58 female) were included. The mean age at time of surgery was 15.0 years. Overall, 68 patients had commercial insurance and 59 patients had government-assisted insurance. The mean household median income for patients with commercial insurance was $87,767 compared to $51,366 for patients with government-assisted insurance. Patients with government-assisted insurance plans demonstrated greater delays in time from injury to initial orthopaedic evaluation (P = .0003), injury to magnetic resonance imaging (MRI) examination (P = .021), injury to surgery (P < .0001), initial orthopaedic evaluation to surgery (P = .0036), and injury to return to play clearance, P = .044. Median household income was significantly related to time from injury to MRI examination (P = .0018), injury to surgery (P = .0017), and initial orthopaedic evaluation to surgery (P = .039). Intraoperatively, 81% of patients with government-assisted insurance had concomitant meniscal injuries compared 65% of patients with commercial insurance, P = .036. Postoperatively, 22% of patients with government-assisted insurance were found to have decreased knee range of motion ("stiffness") compared to 9% of patients with commercial insurance, P = .034.Pediatric patients who have government-assisted plans may experience delays in receiving definitive injury management and be at risk for postoperative complications. Our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and postoperative complications between government and commercial insurance types.Level of Evidence: III.
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Affiliation(s)
- Akash R Patel
- Children's Orthopaedic Center, Children's Hospital Los Angeles
| | | | - Ryan Smith
- Children's Orthopaedic Center, Children's Hospital Los Angeles
| | - Kavish Gupta
- Keck School of Medicine, University of Southern California
| | - Curtis D VandenBerg
- Children's Orthopaedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California
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Koch M, Hammer S, Fuellerer J, Lang S, Pfeifer CG, Pattappa G, Weber J, Loibl M, Nerlich M, Angele P, Zellner J. Bone Marrow Aspirate Concentrate for the Treatment of Avascular Meniscus Tears in a One-Step Procedure-Evaluation of an In Vivo Model. Int J Mol Sci 2019; 20:ijms20051120. [PMID: 30841560 PMCID: PMC6429139 DOI: 10.3390/ijms20051120] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022] Open
Abstract
Avascular meniscus tears show poor intrinsic regenerative potential. Thus, lesions within this area predispose the patient to developing knee osteoarthritis. Current research focuses on regenerative approaches using growth factors or mesenchymal stem cells (MSCs) to enhance healing capacity within the avascular meniscus zone. The use of MSCs especially as progenitor cells and a source of growth factors has shown promising results. However, present studies use bone-marrow-derived BMSCs in a two-step procedure, which is limiting the transfer in clinical praxis. So, the aim of this study was to evaluate a one-step procedure using bone marrow aspirate concentrate (BMAC), containing BMSCs, for inducing the regeneration of avascular meniscus lesions. Longitudinal meniscus tears of 4 mm in size of the lateral New Zealand White rabbit meniscus were treated with clotted autologous PRP (platelet-rich plasma) or BMAC and a meniscus suture or a meniscus suture alone. Menisci were harvested at 6 and 12 weeks after initial surgery. Macroscopical and histological evaluation was performed according to an established Meniscus Scoring System. BMAC significantly enhanced regeneration of the meniscus lesions in a time-dependent manner and in comparison to the PRP and control groups, where no healing could be observed. Treatment of avascular meniscus lesions with BMAC and meniscus suturing seems to be a promising approach to promote meniscus regeneration in the avascular zone using a one-step procedure.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Selma Hammer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Julian Fuellerer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Siegmund Lang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Christian G Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Girish Pattappa
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Markus Loibl
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
- Sporthopaedicum Regensburg/Straubing, Hildegard-von-Bingen-Str. 1, 93053, Regensburg, Germany.
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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20
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Kaminski R, Maksymowicz-Wleklik M, Kulinski K, Kozar-Kaminska K, Dabrowska-Thing A, Pomianowski S. Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Mol Sci 2019; 20:ijms20040856. [PMID: 30781461 PMCID: PMC6412887 DOI: 10.3390/ijms20040856] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 01/08/2023] Open
Abstract
Meniscal tears are the most common orthopaedic injuries, with chronic lesions comprising up to 56% of cases. In these situations, no benefit with surgical treatment is observed. Thus, the purpose of this study was to investigate the effectiveness and safety of percutaneous intrameniscal platelet rich plasma (PRP) application to complement repair of a chronic meniscal lesion. This single centre, prospective, randomized, double-blind, placebo-controlled study included 72 patients. All subjects underwent meniscal trephination with or without concomitant PRP injection. Meniscal non-union observed in magnetic resonance arthrography or arthroscopy were considered as failures. Patient related outcome measures (PROMs) were assessed. The failure rate was significantly higher in the control group than in the PRP augmented group (70% vs. 48%, P = 0.04). Kaplan-Meyer analysis for arthroscopy-free survival showed significant reduction in the number of performed arthroscopies in the PRP augmented group. A notably higher percentage of patients treated with PRP achieved minimal clinically significant difference in visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) symptom scores. Our trial indicates that percutaneous meniscal trephination augmented with PRP results in a significant improvement in the rate of chronic meniscal tear healing and this procedure decreases the necessity for arthroscopy in the future (8% vs. 28%, P = 0.032).
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Affiliation(s)
- Rafal Kaminski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
| | - Marta Maksymowicz-Wleklik
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
| | - Krzysztof Kulinski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
| | - Katarzyna Kozar-Kaminska
- Department of Medical Biology, The Stefan Cardinal Wyszynski Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland.
| | - Agnieszka Dabrowska-Thing
- Departament of Radiology, Centre of Postgraduate Medical Education in Warsaw, ul. Konarskiego 13, 05-400 Otwock, Poland.
| | - Stanislaw Pomianowski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
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Lee DY, Park YJ, Kim HJ, Nam DC, Park JS, Song SY, Kang DG. Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis. Arch Orthop Trauma Surg 2018; 138:1731-1739. [PMID: 29974216 DOI: 10.1007/s00402-018-2991-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The efficacy of arthroscopic meniscus surgery in old aged patients remains controversial. The purpose of the present study was to review published studies comparing arthroscopic meniscal surgery with conservative management to treat meniscal injuries in patients 40 years of age and older. MATERIALS AND METHODS Several electronic databases were queried for articles published until July 2017 that evaluated outcomes of arthroscopic meniscal surgery in patients aged 40 years and older. Data searches, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines, and the clinical outcomes were evaluated using various outcome values. The results are presented as the standard mean difference (SMD) for continuous outcomes with 95% confidence intervals (CIs). RESULTS Nine randomized controlled trials (RCTs) were included. There were no significant differences in clinical outcomes such as relief in knee pain (SMD = 0.01, 95% CIs = - 0.15 to 0.18, I2 = 38%) and improved knee function (SMD = 0.01, 95% CIs = - 0.19 to 0.21, I2 = 57%) between arthroscopic meniscal surgery and conservative management for degenerative meniscal tears. CONCLUSIONS The efficacy of arthroscopic surgery was not superior to conservative management in this type of patients. Therefore, arthroscopic meniscal surgery should not be recommended as a first choice of treatment for degenerative meniscal tears. In patients over 40 years of age, arthroscopic surgery should be cautiously considered for degenerative meniscal tears and only when there has not been a satisfactory response to conservative management.
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Affiliation(s)
- Dong-Yeong Lee
- The Armed Forces Daegu Hospital, Daegu, Republic of Korea
| | - Young-Jin Park
- Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Orthopaedic Surgery, Jinju, Republic of Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Institute for Evidence-based Medicine, Korea University, Seoul, Republic of Korea
| | - Dae-Cheol Nam
- Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Orthopaedic Surgery, Jinju, Republic of Korea
| | - Jin-Sung Park
- Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Orthopaedic Surgery, Jinju, Republic of Korea
| | - Sang-Youn Song
- Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Department of Orthopaedic Surgery, Jinju, Republic of Korea
| | - Dong-Geun Kang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Samjeongja-ro 11, Seongsan-gu, Changwon, Republic of Korea.
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22
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Sullivan JK, Irrgang JJ, Losina E, Safran-Norton C, Collins J, Shrestha S, Selzer F, Bennell K, Bisson L, Chen AT, Dawson CK, Gil AB, Jones MH, Kluczynski MA, Lafferty K, Lange J, Lape EC, Leddy J, Mares AV, Spindler K, Turczyk J, Katz JN. The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial. BMC Musculoskelet Disord 2018; 19:429. [PMID: 30501629 PMCID: PMC6271417 DOI: 10.1186/s12891-018-2327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. METHODS The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. DISCUSSION The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. TRIAL REGISTRATION The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.
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Affiliation(s)
- James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - James J. Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Clare Safran-Norton
- Department of Rehabilitation Services – Physical and Occupational Therapy, Brigham and Women’s Hospital, Boston, MA USA
| | - Jamie Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Swastina Shrestha
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Leslie Bisson
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Angela T. Chen
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Courtney K. Dawson
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Alexandra B. Gil
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Melissa A. Kluczynski
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Kathleen Lafferty
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Jeffrey Lange
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Emma C. Lape
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - John Leddy
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Aaron V. Mares
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kurt Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jennifer Turczyk
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
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Ortega-Orozco R, Rodríguez-Ávila NG, Miranda-Ramírez E, Casillas-Arista KS, Felipe-Gutiérrez J, Estrella-González CA, Huante-Pineda R. [Meniscal transplant: clinical and functional experience at one year follow-up]. Acta Ortop Mex 2018; 32:329-333. [PMID: 31184003] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In Mexico, the first meniscus transplant was performed in 2002. The objective was to describe the clinical evolution of patients with pain associated with postmenisectomy syndrome, who underwent meniscal allograft transplantation (MAT), with bony blocks via arthroscopy, with follow-up to one year. MATERIAL AND METHODS A retrospective cohort study with a one-year follow-up was conducted. We included patients with joint interlining pain secondary to partial or total menisectomy, between 15 and 55 years of age, of both sexes, who underwent MAT. The clinical evolution was evaluated with visual analogue scale (VAS), SF-36 and Lysholm scale; the results are described in frequencies, percentages and p value was significant at 0.05. RESULTS We included nine patients; eight men and one woman with an age of 31.3 years (16-52), the follow-up was 16.6 months (12-23). The preoperative VAS was 8.5 (6-10) and, at one year of follow-up, the average of this scale was 1.25 (0-5) (p 0.001). In the follow-up one year after the MAT, the Lysholm scale was on average 91 (68-100) and the SF-36 was on average 79.17 (65-92.92); three patients returned to their sports practice prior to the injury. CONCLUSION This is the first report in Mexico that describes the one year follow-up of the MAT; significant clinical improvement was demonstrated (p 0.001) with remission of pain in the knee with previous menisectomy and in some cases the return to sports practice.
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Affiliation(s)
- R Ortega-Orozco
- Medyarthros, Medicina Deportiva y Artroscópica. Guadalajara, Jalisco, México
- Servicio de Artroscopía y Medicina del Deporte, Hospital Civil de Guadalajara. Guadalajara, Jalisco, México
| | - N G Rodríguez-Ávila
- Benemérito Hospital Civil «Fray Antonio Alcalde». Guadalajara, Jalisco, México
| | - E Miranda-Ramírez
- Medyarthros, Medicina Deportiva y Artroscópica. Guadalajara, Jalisco, México
| | - K S Casillas-Arista
- Medyarthros, Medicina Deportiva y Artroscópica. Guadalajara, Jalisco, México
| | - J Felipe-Gutiérrez
- Medyarthros, Medicina Deportiva y Artroscópica. Guadalajara, Jalisco, México
| | | | - R Huante-Pineda
- Medyarthros, Medicina Deportiva y Artroscópica. Guadalajara, Jalisco, México
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Abstract
PURPOSE OF REVIEW Lack of vascularity in the human knee meniscus often leads to surgical removal (total or partial meniscectomy) in the case of severe meniscal damage. However, complete recovery is in question after such removal as the meniscus plays an important role in knee stability. Thus, meniscus tissue regeneration strategies are of intense research interest in recent years. RECENT FINDINGS The structural complexity and inhomogeneity of the meniscus have been addressed with processing technologies for precisely controlled three dimensional (3D) complex porous scaffold architectures, the use of biomolecules and nanomaterials. The regeneration and replacement of the total meniscus have been studied by the orthopedic and scientific communities via successful pre-clinical trials towards mimicking the biomechanical properties of the human knee meniscus. Researchers have attempted different regeneration strategies which contribute to in vitro regeneration and are capable of repairing meniscal tears to some extent. This review discusses the present state of the art of these meniscus tissue engineering aspects.
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Affiliation(s)
- Mamatha M Pillai
- Tissue Engineering Laboratory, PSG Institute of Advanced Studies, Coimbatore, 641004, India
| | - J Gopinathan
- Advanced Textile and Polymer Research Laboratory, PSG Institute of Advanced Studies, Coimbatore, 641004, India
| | - R Selvakumar
- Tissue Engineering Laboratory, PSG Institute of Advanced Studies, Coimbatore, 641004, India
| | - Amitava Bhattacharyya
- Nanoscience and Technology Lab, Department of Electronics and Communication Engineering, PSG College of Technology, Coimbatore, 641004, India.
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Abstract
The meniscus is the most commonly injured structure in the human knee. Meniscus deficiency has been shown to lead to advanced osteoarthritis (OA) due to abnormal mechanical forces, and replacement strategies for this structure have lagged behind other tissue engineering endeavors. The challenges include the complex 3D structure with individualized size parameters, the significant compressive, tensile and shear loads encountered, and the poor blood supply. In this progress report, a review of the current clinical treatments for different types of meniscal injury is provided. The state-of-the-art research in cellular therapies and novel cell sources for these therapies is discussed. The clinically available cell-free biomaterial implants and the current progress on cell-free biomaterial implants are reviewed. Cell-based tissue engineering strategies for the repair and replacement of meniscus are presented, and the current challenges are identified. Tissue-engineered meniscal biocomposite implants may provide an alternative solution for the treatment of meniscal injury to prevent OA in the long run, because of the limitations of the existing therapies.
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Affiliation(s)
- Bahar Bilgen
- Department of Orthopaedics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin St, Providence, RI, 02903, USA
- Providence VA Medical Center, Providence, RI, 02908, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin St, Providence, RI, 02903, USA
| | - Brett D Owens
- Department of Orthopaedics, Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin St, Providence, RI, 02903, USA
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Kaminski R, Kulinski K, Kozar-Kaminska K, Wielgus M, Langner M, Wasko MK, Kowalczewski J, Pomianowski S. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma. Biomed Res Int 2018; 2018:9315815. [PMID: 29713647 PMCID: PMC5866900 DOI: 10.1155/2018/9315815] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [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: 07/23/2017] [Revised: 11/10/2017] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The present study aimed to investigate the effectiveness and safety of platelet-rich plasma (PRP) application in arthroscopic repair of complete vertical tear of meniscus located in the red-white zone. METHODS This single center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 37 patients with complete vertical meniscus tears. Patients received an intrarepair site injection of either PRP or sterile 0.9% saline during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the two groups. The secondary endpoints were changes in the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analog scale (VAS) in the two groups at 42 months. RESULTS After 18 weeks, the meniscus healing rate was significantly higher in the PRP-treated group than in the control group (85% versus 47%, P = 0.048). Functional outcomes were significantly better 42 months after treatment than at baseline in both groups. The IKDC score, WOMAC, and KOOS were significantly better in the PRP-treated group than in the control group. No adverse events were reported during the study period. CONCLUSIONS The findings of this study indicate that PRP augmentation in meniscus repair results in improvements in both meniscus healing and functional outcome.
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Affiliation(s)
- Rafal Kaminski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Krzysztof Kulinski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Katarzyna Kozar-Kaminska
- Department of Medical Biology, Laboratory of Immunology, The Cardinal Stefan Wyszynski Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Monika Wielgus
- Department of Anesthesiology, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Maciej Langner
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Marcin K. Wasko
- Department of Radiology, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoortopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
| | - Stanislaw Pomianowski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland
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Abstract
BAKGRUNN Knesmerter er blant de vanligste årsaker til konsultasjoner for muskel- og skjelettplager. Siktemålet med denne artikkelen er dels å gi en oversikt over de siste par tiårs forskning på atraumatiske og degenerativt betingede kneplager, dels å vurdere hvorvidt den sedvanlige praksis for utredning og behandling er i samsvar med denne forskningen. KUNNSKAPSGRUNNLAG Artikkelen er basert på et utvalg av engelskspråklige studier av atraumatiske og degenerative knelidelser funnet ved søk i Medline, manuelle søk i artiklenes litteraturlister og litteraturforslag fra Mendeley. Studier av gonartrose, degenerativ meniskskade og kneplagers psykososiale kontekst ble vektlagt. RESULTATER Det er ofte dårlig samsvar mellom bildediagnostiske funn og det kliniske bildet, og ekstraartikulært utgangspunkt kan lett overses. Symptomgivende gonartrose kan som regel diagnostiseres klinisk. Ved behov for bildediagnostikk er stående røntgenbilder førstevalget. MR-undersøkelse benyttes ofte ukritisk ved mistanke om artrose og meniskskade, men undersøkelsen gir sjelden klinisk nyttig informasjon. Aktivitetsbaserte behandlingsformer gir minst like gode resultater som artroskopisk kirurgi ved degenerative knelidelser og bør være førstevalget. Atraumatiske kneplager er ofte assosiert med psykososiale problemer, særlig der det er beskjedne kliniske og radiologiske funn. FORTOLKNING Mange pasienter med kneplager blir utsatt for utredninger og behandlinger som samsvarer dårlig med nyere forskningsresultater. Både pasient og samfunn vil være tjent med en mer kunnskapsbasert tilnærming.
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Pach M, Horáček F. [Suture - the Current Trend of Medial Meniscus Lesion Treatment]. Acta Chir Orthop Traumatol Cech 2018; 85:62-69. [PMID: 30257772] [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: 06/08/2023]
Abstract
URPOSE OF THE STUDY The aim of this study was to summarise the current approaches to diagnostics and therapy of the medial meniscus tear, and to evaluate the short-term results of meniscus repair by outside-in and all-inside techniques. MATERIALS AND METHODS The study included 24 patients who underwent medial meniscus repair for vertical longitudinal tear 10 mm or longer in length localised in the rear two-thirds of meniscus in the red-red or red-white zone at the author's workplace between June 2012 and December 2014. As regards the method, either outside-in or all-inside techniques were used, or the combination of both. The Steadman technique was used in cases of LCA ruptures. Before the surgery standard radiographs of the knee joint of each patient were taken. The Lysholm Knee Score was used to evaluate the function of the knee pre- and postoperatively. The Barrett's criteria were used to evaluate the healing of repaired meniscus. The clinical success was defined as an absence of any of such criteria. The satisfaction of the patients was evaluated by the visual analogue scale (VAS). The patients were followed up for 13.5 (6-36) months. RESULTS The functional results presented by Lysholm Knee Score demonstrate the improvement of all patients. When comparing the score measured before and after the surgery, this score increased from 67.1 ± 11.4 (24-81) preoperatively to 90.4 ± 13.0 (34-100) postoperatively. The outcome was excellent in 11 patients (45.8 per cent), good in 12 patients (50.0 per cent), and poor in one patient (4.2 per cent). According to the Barrett's criteria, 19 repaired menisci were healed (79.2 per cent) = success rate. In five patients at least one of the monitored criteria was positive. In these cases, the result was considered a failure. Patient satisfaction averaged at 8.0 ± 1.5 (3-10). Only one patient with the concurrent anterior cruciate ligament (ACL) tear with poor functional result, positive Barrett's criteria and VAS 3 agrees with the proposed revision surgery. Regarding possible complications, no neurovascular injury, deep vein thrombosis (DVT) or deep infection were reported. DISCUSSION The results presented in this research correspond to the outcomes of other authors, in particular as regards the shortterm follow-up. Other authors state that even the long-term results of Lysholm Knee Score related to meniscus repair are considerably better than the results after meniscectomy. When assessing the Barrett's criteria, the success rate of 79.2 per cent (19 patients) was reached; therefore, the failure rate was 20.8 per cent (5 patients). These results are comparable with the results of other authors whose success rate of meniscus repair ranges between 60 and 90 per cent. Based on the assessment of the VAS patient's satisfaction, the average rate of 8.0 points (3-10) was reached. A similar average rate of the patient's satisfaction amounting to 8.35 ± 1 (6-10) was reached in a similar designated study of Keyhani et al. carried out in 2015. Regarding possible complications, no neurovascular injury, deep vein thrombosis (DVT) or deep infection were reported. Similar observation of the low complication rate can be seen in the research studies of other authors. CONCLUSIONS Our short-term follow-up revealed that the postoperative results of Lysholm Knee Score considerably improved, the satisfaction rate of the patients was high and the failure rate is entirely in line with the values stated in literature. The results of our study confirm that in the indicated cases the meniscus repair is an effective method of treatment of vertical longitudinal tears located in both RR and RW zones. The preserved meniscus is considerably supportive to ensure stability of the knee joint, in particular in the event of concurrent rupture of anterior cruciate ligament, and to prevent early osteoarthritic changes. Nevertheless, it is necessary to carry out further randomized clinical studies with a larger number of patients and a longerterm follow-up to confirm our results. Key words:meniscus tear, meniscus repair, outside-in and all-inside technique, evaluation of results.
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Affiliation(s)
- M Pach
- Ortopedické oddělení Nemocnice Břeclav
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29
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Rathcke MW, Lind M, Boesen MI, Nissen N, Boesen AP, Mygind-Klavsen B, Hölmich P. [Treatment of meniscal pathology]. Ugeskr Laeger 2017; 179:V05170361. [PMID: 28918786] [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: 06/07/2023]
Abstract
The menisci play a major role in knee function regarding joint movement, stability, load distribution and load transmission. Injuries to the menisci cause pain, and meniscal tears are a common reason for patient referral. In Denmark, partial meniscectomy increased significantly until 2010, and several studies have questioned the long-term effect of meniscectomy as an overall procedure. A Danish national clinical guideline on knee meniscal pathology was published in May 2016, and this article is a short summary of updated knowledge on meniscal pathology and relevant conclusions from the guideline.
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Skou ST, Lind M, Hölmich P, Jensen HP, Jensen C, Afzal M, Jørgensen U, Thorlund JB. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults. BMJ Open 2017; 7:e017436. [PMID: 28827270 PMCID: PMC5724132 DOI: 10.1136/bmjopen-2017-017436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Arthroscopic surgery is a very common orthopaedic procedure. While several trials have investigated the effect of knee arthroscopy for middle-aged and older patients with meniscal tears, there is a paucity of trials comparing meniscal surgery with non-surgical treatment for younger adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears. METHODS AND ANALYSIS This is a protocol for a multicentre, parallel-group RCT conducted at six hospitals across all five healthcare regions in Denmark. 140 patients aged 18-40 years with a clinical history and symptoms consistent with a meniscal tear, verified on MRI, found eligible for meniscal surgery by an orthopaedic surgeon will be randomly allocated to one of two groups (1:1 ratio). Participants randomised to surgery will undergo either arthroscopic partial meniscectomy or meniscal repair followed by standard postsurgical care, while participants allocated to exercise and education will undergo a 12-week individualised, supervised neuromuscular and strengthening exercise programme and patient education. The primary outcome will be difference in change from baseline to 12 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, function in sports and recreation and quality of life (Knee Injury and Osteoarthritis Outcome Score (KOOS4)) supported by the individual subscale scores allowing clinical interpretation. Alongside, the RCT an observational cohort will follow patients aged 18-40 years with clinical suspicion of a meniscal tear, but not fully eligible or declining to participate in the trial. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Regional Committees on Health Research Ethics for Southern Denmark. REGISTRATION DETAILS ClinicalTrials.gov (NCT02995551).
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Affiliation(s)
- Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Martin Lind
- Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Hölmich
- Department of Orthopaedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Peter Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten Jensen
- Department of Orthopaedic Surgery, Lillebælt Hospital in Kolding, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Muhammad Afzal
- Department of Orthopaedic Surgery, Næstved Hospital, Næstved, Denmark
| | - Uffe Jørgensen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA, Stuart MJ. Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2017; 25:383-389. [PMID: 27761625 DOI: 10.1007/s00167-016-4359-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [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: 07/28/2016] [Accepted: 10/10/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes. METHODS A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores. Baseline and final radiographs were reviewed and graded according to Kellgren-Lawrence scores. Baseline MRIs were reviewed for the presence of meniscal extrusion, subchondral oedema, and insufficiency fractures. Failure was defined as conversion to arthroplasty or severely abnormal patient subjective IKDC score. RESULTS Fifty-two patients (21M:31F) with a mean age of 58 ± 10 years were diagnosed with symptomatic MMPRTs clinically and confirmed by MRI and followed for a mean of 62 ± 30 months. Sixteen patients (31 %) underwent total knee arthroplasty at a mean of 30 ± 32 months after diagnosis with higher Kellgren-Lawrence grades associated with increased rates of arthroplasty (p = 0.01). Mean IKDC scores for the remaining patients were 61.2 ± 21 with significantly lower scores in females compared to males (75 ± 12 vs. 49 ± 20; p = 0.03). Mean Kellgren-Lawrence grades and rates of arthritis progressed over time on radiographs (1.5 ± 0.7 vs. 2.4 ± 1.0; p < 0.001 and 78 % vs. 51 %; p = 0.01). Overall, 87 % of patients failed non-operative treatment. CONCLUSIONS Non-operative treatment of medial meniscus posterior horn root tears is associated with poor clinical outcome, worsening arthritis, and a relatively high rate of arthroplasty at 5-year follow-up. Female gender was associated with lower subjective scores and higher rate of arthroplasty. The current study provides a natural history benchmark for clinical outcomes that can be expected in patients with medial meniscus posterior horn root tears undergoing non-operative treatment and helps in counselling patients with these types of injuries. LEVEL OF EVIDENCE IV.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Knee
- Braces
- Canes
- Crutches
- Disease Progression
- Female
- Follow-Up Studies
- Fractures, Stress/epidemiology
- Fractures, Stress/therapy
- Humans
- Injections, Intra-Articular
- Kaplan-Meier Estimate
- Magnetic Resonance Imaging
- Male
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/surgery
- Middle Aged
- Orthotic Devices
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/physiopathology
- Radiography
- Retrospective Studies
- Risk Factors
- Tibial Meniscus Injuries/epidemiology
- Tibial Meniscus Injuries/physiopathology
- Tibial Meniscus Injuries/therapy
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Patrick J Reardon
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Nick R Johnson
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Rohith Mohan
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Logan Peter
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Bochyńska AI, Hannink G, Verhoeven R, Grijpma DW, Buma P. The effect of tissue surface modification with collagenase and addition of TGF-β3 on the healing potential of meniscal tears repaired with tissue glues in vitro. J Mater Sci Mater Med 2017; 28:22. [PMID: 28025802 PMCID: PMC5187362 DOI: 10.1007/s10856-016-5832-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
The aim of the current in vitro study was to investigate if tissue surface modification with collagenase and addition of the TGF-β3 can increase the number of cells present in meniscus tears repaired with the use of newly developed tissue adhesives based on isocyanate-terminated block copolymers. Cylindrical explants were harvested from the inner part of bovine menisci. To simulate a full-thickness tear, the central core of the explants was removed and glued back into the defect, with or without incubation in collagenase solution prior to gluing. The repair constructs were then cultured with or without addition of TGF-β3, and assessed for their histological appearance. The histological staining of the constructs confirmed that both developed adhesives were not cytotoxic. After 28 days, meniscus cells were present in direct contact with the glues. The addition of TGF-β3 to the culture medium resulted in the presence of cells that formed a sheath inside the simulated tear and in increased cell numbers at the edges of annulus of the explants. In the group in which the tissue was incubated in collagenase and cultured in medium containing TGF-β3, thicker layers of cells were observed. These results suggest that repairing the torn meniscus with tissue adhesives after pre-treatment of the tissue with collagenase and stimulation with TGF-β3 is a very promising treatment method, especially when treating the inner avascular part of the meniscus. Nevertheless, longer-term in vitro and in vivo studies are needed to confirm the beneficial effects of this combination therapy.
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Affiliation(s)
- Agnieszka Izabela Bochyńska
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
- MIRA Institute for Biomedical Engineering and Technical Medicine, Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands.
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renate Verhoeven
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk W Grijpma
- MIRA Institute for Biomedical Engineering and Technical Medicine, Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands
- W.J. Kolff Institute, Department of Biomedical Engineering, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter Buma
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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van de Graaf VA, Scholtes VAB, Wolterbeek N, Noorduyn JCA, Neeter C, van Tulder MW, Saris DBF, de Gast A, Poolman RW. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study): protocol of a randomised controlled trial. BMJ Open 2016; 6:e014381. [PMID: 28003302 PMCID: PMC5223724 DOI: 10.1136/bmjopen-2016-014381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard treatment choice to conservative treatment alone could save over €30 millions of direct medical costs on an annual basis. Economic evaluation studies comparing surgery to conservative treatment are lacking. METHODS AND ANALYSIS A multicentre randomised controlled trial (RCT) with an economic evaluation alongside was performed to assess the (cost)-effectiveness of surgery and conservative treatment for meniscal tears. We will include 402 participants between 45 and 70 years with an MRI-confirmed symptomatic, non-obstructive meniscal tears to prove non-inferiority of conservative treatment. Block randomisation will be web-based. The primary outcome measure is a physical function, measured by the International Knee Documentation Committee 'Subjective Knee Form'. Furthermore, we will perform a cost-effectiveness and cost-utility analysis from societal perspective and a budget impact analysis from a societal, government and insurer perspective. Secondary outcomes include general health, quality of life, activity level, knee pain, physical examination, progression of osteoarthritis and the occurrence of adverse events. ETHICS AND DISSEMINATION This RCT will be performed in accordance with the Declaration of Helsinki and has been approved by the Ethics Committee (number NL44188.100.13). The results of this study will be reported in peer-reviewed journals and at international conferences. We further aim to disseminate our results to guideline committees. TRIAL REGISTRATION NUMBER NCT01850719.
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Affiliation(s)
| | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Julia C A Noorduyn
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | | | - Maurits W van Tulder
- Department of Health Sciences & EMGO+ Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniël B F Saris
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Arthur de Gast
- Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
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Babu J, Shalvoy RM, Behrens SB. Diagnosis and Management of Meniscal Injury. R I Med J (2013) 2016; 99:27-30. [PMID: 27706275] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Meniscal injury is a common cause for presentation to the emergency department or primary care physician's office. Meniscal injuries can be the result of a forceful, twisting event in a young athlete's knee or it can insidiously present in the older patient. Many patients with meniscal pathology appropriately undergo conservative management with a primary care physician while some may need referral to an orthopedist for operative intervention. Arthroscopic surgery to address the menisci is the most frequently performed procedure on the knee and one of the most regularly performed surgeries in orthopedic surgery.1 The purpose of this paper is to help elucidate the diagnosis and management of meniscal pathology resulting in knee pain. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].
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Affiliation(s)
- Jacob Babu
- Resident, Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI
| | - Robert M Shalvoy
- Executive Chief of Orthopedic Surgery & Sports Medicine, Care New England Health System, Assistant Professor of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Steve B Behrens
- Attending Orthopedic Surgeon, Care New England Health System, Providence, RI
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Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016; 354:i3740. [PMID: 27440192 PMCID: PMC4957588 DOI: 10.1136/bmj.i3740] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN Randomised controlled superiority trial. SETTING Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. PARTICIPANTS 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. MAIN OUTCOME MEASURES Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. RESULTS No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval -4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. CONCLUSION The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.Trial registration www.clinicaltrials.gov (NCT01002794).
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Affiliation(s)
- Nina Jullum Kise
- Department of Orthopaedic Surgery, Martina Hansens Hospital, PO box 823, N-1306 Sandvika, Norway
| | - May Arna Risberg
- Norwegian Research Centre for Active Rehabilitation, Oslo, Norway Division of Orthopaedic Surgery, Oslo University Hospital, Norway Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Silje Stensrud
- Norwegian Research Centre for Active Rehabilitation, Oslo, Norway
| | - Jonas Ranstam
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Sweden
| | - Lars Engebretsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway Faculty of Medicine, University in Oslo Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Tscholl PM, Duthon VB, Cavalier M, Menetrey J. [Current treatment strategy of meniscal lesions in athletes]. REVUE MEDICALE SUISSE 2016; 12:1284-1287. [PMID: 28665564] [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: 06/07/2023]
Abstract
The primary goal of meniscal treatment in elite athletes is to guarantee knee function for sports performance and to prevent osteoarthritic changes. The meniscus acts not only as cushion in the femorotibial joint but also as a major secondary stabilizer with its posterior medial and lateral horns. Therefore, the integrity of the meniscal tissue is crucial for knee function and needs to be preserved, especially when the meniscal lesion is found in the periphery (vascularized zone). For ideal tissue healing, a stable knee is prerequisite.Partial meniscectomy as little as possible is only performed, if the lesion cannot be sutured, is highly degenerative or localized in the non-vascularized (white-white) area which has low to none healing potential.
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Affiliation(s)
- Philippe M Tscholl
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, HUG, 1211 Genève 14
| | - Victoria B Duthon
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, HUG, 1211 Genève 14
- Centre de médicine de l'appareil locomoteur et du sport, Unité d'orthopédie et traumatologie du sport (UOTS), Swiss Olympic Medical Center, HUG, 1211 Genève 14
| | - Maxime Cavalier
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, HUG, 1211 Genève 14
| | - Jacques Menetrey
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, HUG, 1211 Genève 14
- Centre de médicine de l'appareil locomoteur et du sport, Unité d'orthopédie et traumatologie du sport (UOTS), Swiss Olympic Medical Center, HUG, 1211 Genève 14
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Porter AS. Problems With Large Joints: Knee Conditions. FP Essent 2016; 446:11-18. [PMID: 27403863] [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: 06/06/2023]
Abstract
As a large joint dependent on ligaments for stability and muscles and tendons for function, the knee is susceptible to a spectrum of acute and overuse injuries. Acute injuries involve the ligaments, menisci, and weight-bearing surfaces. Overuse injuries commonly affect the patellar tendon, iliotibial band, and patellofemoral complex. Acute and overuse knee injuries can be debilitating but most can be diagnosed and managed by family physicians. An appropriate history and physical examination are essential to guide diagnosis and management decisions. X-ray imaging often is required. Magnetic resonance imaging study, computed tomography scan, or ultrasonography also may be indicated to guide diagnosis and management. Knee injuries often improve with bracing, activity modification, weight loss, and physical therapy. Referral to an orthopedic subspecialist can be considered when these measures are not effective.
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Affiliation(s)
- Andrew St Porter
- University of Kansas School of Medicine Family and Community Medicine, 1010 N. Kansas, Wichita, KS 672147,
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Bochyńska AI, Hannink G, Grijpma DW, Buma P. Tissue adhesives for meniscus tear repair: an overview of current advances and prospects for future clinical solutions. J Mater Sci Mater Med 2016; 27:85. [PMID: 26970767 PMCID: PMC4789195 DOI: 10.1007/s10856-016-5694-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
Menisci are crucial structures in the knee joint as they play important functions in load transfer, maintaining joint stability and in homeostasis of articular cartilage. Unfortunately, ones of the most frequently occurring knee injuries are meniscal tears. Particularly tears in the avascular zone of the meniscus usually do not heal spontaneously and lead to pain, swelling and locking of the knee joint. Eventually, after a (partial) meniscectomy, they will lead to osteoarthritis. Current treatment modalities to repair tears and by that restore the integrity of the native meniscus still carry their drawbacks and a new robust solution is desired. A strong tissue adhesive could provide such a solution and could potentially improve on sutures, which are the current gold standard. Moreover, a glue could serve as a carrier for biological compounds known to enhance tissue healing. Only few tissue adhesives, e.g., Dermabond(®) and fibrin glue, are already successfully used in clinical practice for other applications, but are not considered suitable for gluing meniscus tissue due to their sub-optimal mechanical properties or toxicity. There is a growing interest and research field focusing on the development of novel polymer-based tissue adhesives, but up to now, there is no material specially designed for the repair of meniscal tears. In this review, we discuss the current clinical gold standard treatment of meniscal tears and present an overview of new developments in this field. Moreover, we discuss the properties of different tissue adhesives for their potential use in meniscal tear repair. Finally, we formulate recommendations regarding the design criteria of material properties and adhesive strength for clinically applicable glues for meniscal tears.
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Affiliation(s)
- A I Bochyńska
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biomaterials Science and Technology, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - G Hannink
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - D W Grijpma
- Department of Biomaterials Science and Technology, MIRA Institute, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, W.J. Kolff Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P Buma
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Swart NM, van Oudenaarde K, Reijnierse M, Nelissen RGHH, Verhaar JAN, Bierma-Zeinstra SMA, Luijsterburg PAJ. Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis. J Sci Med Sport 2016; 19:990-998. [PMID: 27129638 DOI: 10.1016/j.jsams.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 09/21/2015] [Revised: 03/16/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study evaluated the effectiveness of exercise therapy in patients with meniscal lesions. DESIGN Systematic review and meta-analysis. METHODS Nine databases were searched up to July 2015, including EMBASE and Medline OvidSP. Randomized and controlled clinical trials in adults with traumatic or degenerative meniscal lesions were considered for inclusion. Interventions had to consist of exercise therapy in non-surgical patients or after meniscectomy, and had to be compared with meniscectomy, no exercise therapy, or to a different type of exercise therapy. Primary outcomes were pain and function on short term (≤3 months) and long term (>3 months). Two researchers independently selected the studies, assessed the risk of bias, and extracted data. RESULTS Of the 1415 identified articles 14 articles describing 12 studies were included; all had some concerns about the risk of bias. There was no significant difference between exercise therapy and meniscectomy for pain (MD 0.27 [-4.30,4.83]) and function (SMD -0.32 [-0.68,0.03]). After meniscectomy, there was conflicting evidence for the effectiveness of exercise therapy when compared to no exercise therapy for pain and function. There was no significant difference between various types of exercise therapy for pain (MD 19.30 [-6.60,45.20]) and function (SMD 0.01 [-0.27,0.28]). CONCLUSIONS Exercise therapy and meniscectomy yielded comparable results on pain and function. Exercise therapy compared to no exercise therapy after meniscectomy showed conflicting evidence at short term, but was more effective on function at long term. The preferable type/frequency/intensity of exercise therapy remains unclear. The strength of the evidence was low to very low.
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Affiliation(s)
- N M Swart
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - K van Oudenaarde
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - R G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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40
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Katano H, Sekiya I, Muneta T. [Transplantation of synovial stem cells to promote healing after meniscal suture repair]. Nihon Rinsho 2015; 73 Suppl 5:514-518. [PMID: 30458588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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