• KOOS-JR
• functional outcomes
• history meniscus
• knee osteoarthritis
• meniscectomy
• total knee arthroplasty

• Humans
• Arthroplasty, Replacement, Knee/adverse effects
• Male
• Female
• Retrospective Studies
• Aged
• Meniscectomy/adverse effects
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Osteoarthritis, Knee/surgery
• Treatment Outcome
• Time Factors
• Reoperation/statistics & numerical data
• Knee Joint/surgery

• Degenerative meniscus tear
• McMurray’s test
• Mechanical symptom
• Synovitis

• 22C0601L1 Ministry of Science and ICT, South Korea

• Arthritis
• Arthroscopy
• Joint prosthesis
• Surgery
• Synovectomy

• Humans
• Arthritis, Rheumatoid
• Injections, Intra-Articular
• Knee Joint
• Pain
• Sepsis

Over the years, several studies demonstrated the crucial role of knee menisci in joint biomechanics. As a result, save the meniscus has become the new imperative nowadays, and more and more studies addressed this topic. The huge amount of data on this topic may create confusion in those who want to approach this surgery. The aim of this review is to provide a practical guide for treatment of meniscus tears, including an overview of technical aspects, outcomes in the literature and personal tips. Taking inspiration from a famous movie directed by Sergio Leone in 1966, the authors classified meniscus tears in three categories: The good, the bad and the ugly lesions. The inclusion in each group was determined by the lesion pattern, its biomechanical effects on knee joint, the technical challenge, and prognosis. This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a reader-friendly narrative review of an otherwise difficult topic. Furthermore, the authors provide a concise premise to deal with some aspects of menisci phylogeny, anatomy and biomechanics.

• Meniscus
• Meniscus anatomy
• Meniscus tear
• Meniscus repair
• Root lesion
• Ramp lesion

• artificial neural networks
• kinetic chain
• multilayer perceptron
• osteoarthritis
• patellofemoral joint
• vibroacoustic signal

• Acoustics
• Cartilage, Articular/pathology
• Humans
• Knee Joint
• Patellofemoral Joint
• Quality of Life

• 030/RID/2018/19 Ministry of Science and Higher Education

Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I—open kinetic chain, II—closed kinetic chain, and III—open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.

• RBF
• artificial neural network
• femoral-tibial joint
• kinetic chain
• multilevel perceptron
• osteoarthritis
• vibroacoustic signal

• Acoustics
• Cartilage, Articular/diagnostic imaging
• Cartilage, Articular/pathology
• Humans
• Knee Joint
• Osteoarthritis
• Signal Processing, Computer-Assisted

• Age Factors
• Anterior Cruciate Ligament Injuries/complications
• Athletic Injuries/etiology
• Black People
• Body Mass Index
• Female
• Humans
• Male
• Occupational Injuries/etiology
• Osteoarthritis, Knee/complications
• Quality-Adjusted Life Years
• Risk Factors
• Rupture/epidemiology
• Rupture/etiology
• Sex Factors
• Smoking/adverse effects
• Tibial Fractures/complications
• Tibial Meniscus Injuries/economics
• Tibial Meniscus Injuries/epidemiology
• Tibial Meniscus Injuries/etiology
• Tibial Meniscus Injuries/therapy
• White People

Low oxygen and mechanical loading may play roles in regulating the fibrocartilaginous phenotype of the human inner meniscus, but their combination in engineered tissues remains unstudied. Here, we investigated how continuous low oxygen (“hypoxia”) combined with dynamic compression would affect the fibrocartilaginous “inner meniscus-like” matrix-forming phenotype of human meniscus fibrochondrocytes (MFCs) in a porous type I collagen scaffold. Freshly-seeded MFC scaffolds were cultured for 4 weeks in either 3 or 20% O₂ or pre-cultured for 2 weeks in 3% O₂ and then dynamically compressed for 2 weeks (10% strain, 1 Hz, 1 h/day, 5 days/week), all with or without TGF-β3 supplementation. TGF-β3 supplementation was found necessary to induce matrix formation by MFCs in the collagen scaffold regardless of oxygen tension and application of the dynamic compression loading regime. Neither hypoxia under static culture nor hypoxia combined with dynamic compression had significant effects on expression of specific protein and mRNA markers for the fibrocartilaginous matrix-forming phenotype. Mechanical properties significantly increased over the two-week loading period but were not different between static and dynamic-loaded tissues after the loading period. These findings indicate that 3% O₂ applied immediately after scaffold seeding and dynamic compression to 10% strain do not affect the fibrocartilaginous matrix-forming phenotype of human MFCs in this type I collagen scaffold. It is possible that a delayed hypoxia treatment and an optimized pre-culture period and loading regime combination would have led to different outcomes.

• Arthroscopic meniscectomy
• Chondral lesion
• Knee malalignment
• Lateral meniscectomy
• Meniscal tears
• Total knee replacement

• Human engineered meniscus
• dynamic compression
• hypoxia
• mechanical loading
• transcriptome

First evidence indicates that the supplementation of specific collagen peptides is associated with a significant reduction in activity-related joint pain in young adults. The purpose of the current investigation was to confirm the efficacy of the same collagen peptides in a comparable study population. In total, 180 active men and women aged between 18 and 30 years with exercise-related knee pain but no diagnosed joint disease completed the trial over a period of 12 weeks. Participants were randomly assigned to the group receiving 5 g of specific collagen peptides (CP-G) or to the placebo group (P-G). For the primary outcome, changes in pain during or after exercise from pre- to post-intervention were assessed by the participants using the Visual Analog Scale (VAS). These changes were additionally evaluated by the examining physician by means of anamnesis and physical examination of the affected knee joint. As secondary outcomes, pain under resting conditions and after 20 squats were compared between the study groups. In addition, the mobility of the knee joint and the use of alternative therapies (e.g., ointments or physiotherapy) were recorded. The supplementation of specific collagen peptides derived from type I collagen with a mean molecular weight of 3 kDa led to a significantly (p = 0.024) higher reduction of exercise-induced knee pain (−21.9 ± 18.3 mm) compared with the placebo group (−15.6 ± 18.5 mm). These findings were consistent with the physician’s evaluation (−23.0 ± 19.2 mm vs. −14.6 ± 17.9 mm, p = 0.003). The decrease in pain under resting conditions and after squats did not significantly differ between the groups, as only a small number of participants suffered from pain under these conditions. Due to the clinically unremarkable baseline values, the mobility of the knee joint did not change significantly after the intervention. In conclusion, the current investigation confirmed that the oral intake of bioactive collagen peptides used in the current investigation led to a statistically significant reduction of activity-related joint pain in young active adults suffering from knee joint discomfort.

• VAS
• activity-related knee pain
• collagen peptides
• pain reduction
• range of motion

• Adult
• Arthralgia/diagnosis
• Arthralgia/etiology
• Arthralgia/physiopathology
• Arthralgia/therapy
• Collagen Type I/chemistry
• Double-Blind Method
• Exercise
• Female
• Humans
• Knee Joint/physiopathology
• Male
• Molecular Weight
• Pain Measurement
• Peptides/administration & dosage
• Peptides/chemistry
• Peptides/therapeutic use
• Physical Examination
• Placebos/therapeutic use
• Prospective Studies
• Range of Motion, Articular/physiology
• Rest
• Sports
• Time Factors
• Young Adult

• Knee arthroscopy
• Medial submeniscal flap tear
• Sleeper's sign
• Validity and diagnostic performance

• Dynamic extrusion
• Healthy knee
• High impact load
• MRI
• Meniscal extrusion
• Ultrasound

•

Arthroscopic minimum saucerization and inferior-leaf meniscectomy at 2-year follow-up.

Treatment of a horizontal tear of a complete discoid lateral meniscus (DLM) is still controversial. Preserving peripheral rim as a normal shape of the meniscus with single-leaf resection is a conventional treatment, however meniscal function could not be fully restored.

A 28-year old woman and a 34-year old woman experienced knee pain and had restricted knee extension. MRI showed horizontal tears of complete DLM in both patients. Arthroscopic minimum saucerization preserving more than 10 mm peripheral rim and inferior-leaf meniscectomy was performed. Two years after the surgery, the patient had no pain and no restriction of ROM. MRI showed the remaining superior-leaf maintained about half its width and no progression of coronal/sagittal extrusion.

As resecting more meniscal tissue has been considered to be a cause of degeneration or extrusion of the meniscus, arthroscopic minimum saucerization, preserving more meniscal tissue than standard saucerization, and inferior-leaf meniscectomy can be an alternative treatment option of horizontal tears of complete DLM with satisfying clinical and radiological results.

• Discoid lateral meniscus
• Horizontal tear
• Inferior-leaf meniscectomy
• Saucerization

• Dynamic extrusion
• Healthy knee
• MRI
• Meniscal extrusion
• Ultrasound
• Weight-bearing

• knee osteoarthritis
• orthopaedic surgery
• treatment

• Adult
• Aged
• Arthroscopy/adverse effects
• Arthroscopy/methods
• Female
• Finland
• Follow-Up Studies
• Humans
• Intention to Treat Analysis
• Male
• Meniscectomy/adverse effects
• Meniscectomy/methods
• Menisci, Tibial/surgery
• Middle Aged
• Patient Satisfaction/statistics & numerical data
• Postoperative Complications/epidemiology
• Recovery of Function
• Tibial Meniscus Injuries/surgery
• Treatment Outcome

• Sigrid Jusliuksen Sti
• The Academy of Finland
• Social Insurance Institution of Finland
• Jane ja Aatos Erkon Sti
• State funding for university-level health research for Helsinki University
• State funding for university-level health research for Tampere University

Meniscocapsular separation (MCS) is a lesion of the area which is attached from the peripheral section of the meniscus to the capsule and is seen less often than other meniscus injuries. The aim of this study was to investigate which of the different side applications of all-inside MCS repair of the meniscus was better in respect of clinical and functional results.

In this retrospective study, 53 patients with MCS pattern in their knee joints were treated with arthroscopic meniscus repair made with the all-inside method. The patients were separated into three groups according to the surface from which the fixation was applied: group 1, from the femoral joint surface of the meniscus (n = 17), group 2, from the tibial joint surface of the meniscus (n = 21) and group 3, from the femoral and tibial joint surfaces of the meniscus (n = 15). The participants were assessed using the subjective International Knee Documentation Committee Scoring (IKDC), Lysholm Knee Scale, Tegner Activity Level Scale, Barrett criteria and Kellgren–Lawrence classification after a 45 ± 12.1 months (range, 24–70 months) follow-up.

Postoperatively, all the groups exhibited significantly increased subjective IKDC score, Lysholm score and Tegner activity score compared with their preoperative results (p < 0.001). At 6 months postoperatively, a statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score and Lysholm score with group 2 showing better results than the other groups (p < 0.001). At the final follow-up examination, no statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score or Lysholm score. A statistically significantly lower level of pulling and stress sensation was determined in group 2 (p < 0.001).

MCS repair made with the all-inside method is successful clinically and functionally and in respect of MRI findings. In addition, it was seen that the fixation method applied from the tibial surface of the meniscus does not disturb the anatomic position of the meniscus in MCS repair. The tibial joint surface is the most appropriate area for suturation in all-inside repair of MCS.

Level IV.

• All-inside method
• Arthroscopi
• Meniscocapsular separation
• Meniscus repair

Numerous clinical examination maneuvers have been developed to identify meniscus tears of the knee. While meniscus injuries vary significantly in type and severity, no maneuvers have been developed that help to distinguish particular tear characteristics.

This nonconsecutive case series highlights a distinctive clinical finding that correlates with inferiorly displaced flap tears of the medial meniscus that become trapped in the medial gutter of the knee, as identified through magnetic resonance imaging (MRI) and arthroscopy.

Cohort study (diagnosis); Level of evidence, 3.

Eight patients with trapped medial meniscus tears were identified from a single surgeon’s academic orthopaedic sports medicine practice between January 2009 and January 2012. Each patient underwent clinical evaluation, MRI, and arthroscopic treatment for meniscus injury. Clinical notes, MRI images, radiology reports, and operative findings were reviewed and compared in a descriptive fashion.

Each patient displayed a positive clinical examination finding of medial knee pain inferior to the joint line with flexion and the application of valgus stress in the setting of a torn medial meniscus and intact medial collateral ligament (MCL). Preoperative MRI revealed a distinctive flap tear of the medial meniscus flipped inferiorly to lay trapped between the tibia and deep fibers of the MCL. On arthroscopy, flap tears were found displaced inferiorly and trapped in the medial gutter in 6 of the 8 patients. Displaced meniscal fragments in the remaining 2 patients were found within the medial compartment.

Inferiorly displaced flap tears of the meniscus that have been displaced to the medial gutter can be localized through a careful examination technique.

Early identification of this injury pattern may help reduce the likelihood that the trapped fragment will be missed during arthroscopy.

• examination
• knee
• meniscus tear

• arthroscopy
• horizontal tear
• meniscectomy
• meniscus

• Injury
• Ligament tear
• Patellofemoral
• Pediatrics

Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions.

Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers.

Clinical review.

Level 4.

The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction.

Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing.

Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.

• anterior cruciate ligament
• arthroscopy
• grafts
• knee
• reconstruction
• revision surgery

Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.

• Meniscus
• Meniscectomy
• Meniscal tear
• Meniscal repair
• Arthroscopic surgery

• Knee
• McMurry’s test
• Mechanical diagnosis and therapy
• Validity

• Double bucket-handle tear
• Double flipped meniscus sign
• Lateral meniscus

• eponyms
• history of sports medicine

To review the meniscus from a historical perspective especially on surgical management and general guidelines for arthroscopic meniscectomy procedures for various types of meniscal tears. We searched MEDLINE and PubMed for the years of 1980-2010 using the terms meniscus, meniscal repair, menisectomy, and arthroscopy. Orthopedic surgeons frequently encounter patients with pain or functional impairment of the knee joint and repair or resection of the injured meniscus is one of the most common orthopedic operative procedures. The object of meniscal surgery is to reduce pain, restore functional meniscus and prevent the development of degenerative osteoarthritis in the involved knee. Historically, total meniscectomy was a common procedure performed for meniscus tear symptoms. However, it has been reported that total meniscectomy has deleterious effects on the knee. In the past, the menisci were thought as a functionless remnant tissue. Currently, it is known that the meniscus is an important structure for knee joint function. Menisci provide several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint. It is widely accepted that the function of the meniscus can be preserved through minimal excision. An arthroscopic partial meniscectomy preserving more of the meniscus is preferred over total meniscectomy. In recent decades, this shift toward arthroscopic partial meniscectomy has led to the development of new surgical techniques.

• Arthroscopy
• Menisectomy
• Prognosis

• joint line
• meniscal cyst
• meniscal tear
• physical examination

• Body Fluids
• Humans
• Knee Injuries/complications
• Knee Injuries/diagnosis
• Knee Injuries/physiopathology
• Knee Joint/anatomy & histology
• Ligaments, Articular
• Medical History Taking
• Pain/etiology
• Palpation
• Range of Motion, Articular
• Tibial Meniscus Injuries