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Gronbeck KR, Tompkins MA. Functional testing following isolated meniscus repair may help to identify patients who need additional physical therapy prior to a return to activity. J ISAKOS 2024; 9:557-561. [PMID: 38616017 DOI: 10.1016/j.jisako.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Functional testing (FT), commonly used to evaluate dynamic knee function and provide objective information about how well a patient, has progressed in rehabilitation following an anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to determine whether a functional test could be used as an assessment tool for return to activity following isolated meniscus repair. METHODS The results of FT completed between 80 and 150 days post-operation (representing 4-months post-operative) in isolated meniscal repair patients were analysed for the involved limb, uninvolved limb, and limb symmetry index (LSI). Involved limb performance and LSI on FT were also recorded for a matched cohort of patients who underwent an isolated ACL reconstruction between 151 and 220 days post-operation (representing 6-months post-operative). The meniscus cohort was compared to the ACL cohort. RESULTS The meniscus cohort (n = 26) performed well (LSI of 88% or better) on all functional test exercises, including all hop tests. There were patients in the meniscus cohort who did not achieve 90% LSI on the FT at 4 months. There was no statistically significant difference in any of the tests between the meniscus and ACL (n = 39) cohorts. CONCLUSION A majority of isolated meniscal repair patients perform well on FT by 4 months post-operatively and similar to patients undergoing isolated ACL reconstruction at 6 months post-operatively. Not all patients performed well on FT at 4 months post-operatively; however so, there may be a role for FT in isolated meniscal repair patients, and those patients may need further physical therapy prior to a return to sports. LEVEL OF EVIDENCE III; Retrospective cohort study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyle R Gronbeck
- Sanford Health, Department of Emergency Medicine, Fargo, ND 58104, USA
| | - Marc A Tompkins
- TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431, USA; University of Minnesota Department of Orthopedic Surgery, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55455, USA; Gillette Specialty Healthcare, 200 University Av. E, St. Paul, MN 55101, USA.
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Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop 2023; 14:171-185. [PMID: 37155506 PMCID: PMC10122773 DOI: 10.5312/wjo.v14.i4.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
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.
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Affiliation(s)
- Roberto Simonetta
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, Enna 94100, Italy
| | - Michelangelo Palco
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | | | - Pier Paolo Mariani
- Department of Orthopaedic and Traumatology, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Roma 00135, Italy
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The role of patient characteristics and the effects of angiogenic therapies on the microvasculature of the meniscus: A systematic review. Knee 2022; 38:91-106. [PMID: 35964436 DOI: 10.1016/j.knee.2022.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics affect meniscal microvascularization and provide a structured overview of angiogenic therapies that influence meniscal neovascularization. METHODS A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane library and Emcare from inception to November 2021. Studies reporting on (1) Patient characteristics that affect meniscal microvascularization, or (2) Therapies that induce neovascularization in meniscal tissue were included. Studies were graded in quality using the Anatomical Quality Assessment (AQUA) tool. The study was registered with PROSPERO(ID:CRD42021242479). RESULTS Thirteen studies reported on patient characteristics and eleven on angiogenic therapies. The influence of Age, Degenerative knee, Gender, and Race was reported. Age is the most studied factor. The entire meniscus is vascularized around birth. With increasing age, vascularization decreases from the inner to the peripheral margin. Around 11 years, blood vessels are primarily located in the peripheral third of the menisci. There seems to be a further decrease in vascularization with increasing age in adults, yet conflicting literature exists. Degenerative changes of the knee also seem to influence meniscal vascularization, but evidence is limited. Angiogenic therapies to improve meniscal vascularization have only been studied in preclinical setting. The use of synovial flap transplantation, stem cell therapy, vascular endothelial growth factor, and angiogenin has shown promising results. CONCLUSION To decrease failure rates of meniscal repair, a better understanding of patient-specific vascular anatomy is essential. Translational clinical research is needed to investigate the clinical value of angiogenic therapies.
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Balance Evaluation and Gait Analysis After Arthroscopic Partial Meniscectomy. Indian J Orthop 2022; 56:1199-1205. [PMID: 35813534 PMCID: PMC9232682 DOI: 10.1007/s43465-022-00621-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose The purpose of this study is to investigate how walking and balance are affected at different time intervals after arthroscopic partial meniscectomy (APM). Methods Forty-five patients with APM and a healthy control group of 46 people were included in the study. Gait and bipedal balance analysis were performed to the patient group twice in 4 weeks and 12 weeks after surgery. Results In the gait analysis performed after 4 weeks, stance phase (SP), step time (ST), and total double support (TDS) were higher, and step length (SL), swing phase (SWP), cadence (C), and speed (V) in the patient group were lower. After 12 weeks, SP, TDS, and step width (SW) data were higher in the patient group and SWP was lower. In both measurements, the gait of the patient group is not symmetrical. In open-eye balance test, it was observed that the data of length of ellipse (LoE), area of ellipse (AoE), and path length of CoP (PL) were different after 4 weeks but these differences disappeared after 12 weeks. Width of ellipse (WoE), LoE, AoE, and PL data were different in the test performed with eyes closed after 4 weeks. In addition to the same data after 12 weeks, the medio-lateral direction (ML) was also higher than the patient group. Conclusion After 12 weeks, walking has not fully recovered. There was no difference in the balance analysis with eyes open, but the differences were still present in the eyes-closed analysis.
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Unal M, Aktan C, Levent A, Cetin M, Kose O, Sarikcioglu L. Variations of cross-sectional meniscal morphology between similar-sized menisci: implications on donor selection for meniscal allograft transplantation. Arch Orthop Trauma Surg 2022; 142:1099-1107. [PMID: 33950275 DOI: 10.1007/s00402-021-03909-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate the morphological variations in the cross-sectional anatomy of the meniscus between similar-sized matched menisci. MATERIALS AND METHODS Knee MRI of 329 patients with intact menisci were retrospectively reviewed, and the meniscal length (ML), meniscal width (MW), and cross-sectional dimensions (meniscal height and width) of the anterior, posterior horns, and the corpus were measured. Patients with similar-sized menisci who had less than 1 mm difference in ML and MW were matched. 330 male-to-male medial menisci (MM), 623 male-to-male lateral menisci (LM), 82 female-to-female MM, 233 female-to-female LM, 176 cross-gender MM, and 265 cross-gender LM unique combination of ideally matched pairs (total: 1709) were generated. The disparity in the cross-sectional dimensions, absolute difference, and the paired percent differences was statistically analyzed. RESULTS The ML and MW in all groups were statistically similar, with a predefined absolute difference of 1 mm both for ML and MW (paired percent difference < 5%). The cross-sectional segmental meniscal dimensions were similar within all groups, but the paired percent differences showed high variations between a mean of 12.1-21.5% and up to 150.9%. The paired percent difference of MM in each segmental dimension was similar among different gender combinations. However, segmental paired percent differences of LM showed statistical differences in anterior horn width (AHW) (p: 0.001) and posterior horn width (PHW) (p: 0.001). In subgroup comparisons, the paired percent difference of AHW was higher in the female-to-female group compared to cross-gender (p: 0.023) and male-to-male groups (p: 0.001). The paired percent difference of PHW was smaller in the male-to-male group compared to female-to-female and cross-gender groups (p: 0.001 for both). CONCLUSIONS Segmental cross-sectional anatomy showed wide variations despite strict matching in ML and MW. These variations were present in all gender combinations. The meniscal 3D shape is unique, but acceptable limits of similarity need further research. LEVEL OF EVIDENCE Retrospective study, Level III.
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Affiliation(s)
- Melih Unal
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey
| | - Cemil Aktan
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey
| | - Ali Levent
- Department of Orthopedics and Traumatology, Mehmet Akif Inan Education and Research Hospital, University of Health Sciences School of Medicine, Sanlıurfa, Turkey
| | - Mustafa Cetin
- Department of Radiology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Soğuksu mah. Kazım Karabekir Cd., Muratpaşa, 07100, Antalya, Turkey.
| | - Levent Sarikcioglu
- Department of Anatomy, Akdeniz University Medical Faculty, Antalya, Turkey
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Nakagawa K, Otsuki S, Murakami T, Okamoto Y, Okuno N, Wakama H, Sezaki S, Ikeda K, Okayoshi T, Neo M. Histological Analysis of the Wrapping Treatment for Meniscal Horizontal Tears in Rabbits. Cartilage 2021; 13:1551S-1561S. [PMID: 31466462 PMCID: PMC8804842 DOI: 10.1177/1947603519870838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate meniscal regeneration and prevent cartilage degeneration using wrapping treatment for meniscal horizontal tears that have been difficult to repair in rabbits. DESIGN Thirty knees from 15 Japanese white rabbits were divided into the horizontal (horizontal tears) or wrapping (horizontal tears with wrapping treatment) groups. Horizontal tears were created and wrapped with a sheet scaffold containing polyglycolic acid, polylactic acid, and polycaprolactone. The meniscus was stained with Safranin-O/Fast Green and evaluated with modified Pauli scores at 8, 12, and 16 weeks after implantation (n = 5). Cell morphology was determined with hematoxylin and eosin staining. Mature collagen was confirmed with Picrosirius Red staining. Furthermore, immunohistochemical analysis of inducible nitric oxide synthase (iNOS) for inflammation, Ki-67 for proliferation, and type II collagen for regeneration was performed. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with the Osteoarthritis Research Society International score at 8 and 16 weeks. RESULTS The wrapping group had significantly better regeneration than the horizontal group, especially at 16 weeks (P < 0.05). Wrapping treatment induced fibrochondrocyte-like cells at 16 weeks. After wrapping treatment, iNOS was overexpressed at 8 weeks, Ki-67 at 8 and 12 weeks, and type II collagen at 16 weeks. Cartilage degeneration in the wrapping group did not progress significantly compared with that in the horizontal group at 16 weeks (P < 0.05). CONCLUSIONS Wrapping treatment for meniscal horizontal tears induced meniscal regeneration as the sheet scaffold might induce intrinsic and extrinsic repair. Regaining the meniscal function by the wrapping treatment prevented cartilage degeneration.
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Affiliation(s)
- Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan,Shuhei Otsuki, Department of Orthopedic
Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka
569-8686, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shunsuke Sezaki
- Department of QOL Research Center
Laboratory, Gunze Limited, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
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Berni M, Marchiori G, Cassiolas G, Grassi A, Zaffagnini S, Fini M, Lopomo NF, Maglio M. Anisotropy and inhomogeneity of permeability and fibrous network response in the pars intermedia of the human lateral meniscus. Acta Biomater 2021; 135:393-402. [PMID: 34411754 DOI: 10.1016/j.actbio.2021.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
Within the human tibiofemoral joint, meniscus plays a key role due to its peculiar time-dependent mechanical characteristics, inhomogeneous structure and compositional features. To better understand the pathophysiological mechanisms underlying this essential component, it is mandatory to analyze in depth the relationship between its structure and the function it performs in the joint. Accordingly, the aim of this study was to evaluate the behavior of both solid and fluid phases of human meniscus in response to compressive loads, by integrating mechanical assessment and histological analysis. Cubic specimens were harvested from seven knee lateral menisci, specifically from anterior horn, pars intermedia and posterior horn; unconfined compressive tests were then performed according to three main loading directions (i.e., radial, circumferential and vertical). Fibril modulus, matrix modulus and hydraulic permeability of the tissue were thence estimated through a fibril-network-reinforced biphasic model. Tissue porosity and collagen fibers arrangement were assessed through histology for each region and related to the loading directions adopted during mechanical tests. Regional and strain-dependent constitutive parameters were finally proposed for the human lateral meniscus, suggesting an isotropic behavior of both the horns, and a transversely isotropic response of the pars intermedia. Furthermore, the histological findings supported the evidences highlighted by the compressive tests. Indeed, this study provided novel insights concerning the functional behavior of human menisci by integrating mechanical and histological characterizations and thus highlighting the key role of this component in knee contact mechanics and presenting fundamental information that can be used in the development of tissue-engineered substitutes. STATEMENT OF SIGNIFICANCE: This work presents an integration to the approaches currently used to model the mechanical behavior of the meniscal tissue. This study assessed in detail the regional and directional contributions of both the meniscal solid and fluid phases during compressive response, providing also complementary histological evidence. Within this updated perspective, both knee computational modeling and meniscal tissue engineering can be improved to have an effective impact on the clinical practice.
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Noufal A. A case report of a fingerlike meniscal exostosis. Int J Surg Case Rep 2021; 87:106353. [PMID: 34509874 PMCID: PMC8435916 DOI: 10.1016/j.ijscr.2021.106353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The menisci are intra-articular fibrocartilagenous structures that optimize the joint function. They have several functions. Meniscal malformations are rare and different in shape. The most common are classified in public and known classifications, but some are very rare like finger like exostosis, so it is useful to highlight these rare malformations, that helps in the development of typing and classification, and may explain some unclear mechanisms of injuries. PROPRIOCEPTION We know that meniscal tears in young people usually result from clear mechanical causes, like twisting or direct trauma, so we always need a cause, but when your patient does not explain a clear movement or mechanical trauma, you will ask and ask to conclude why. Yes, keep in mind that; it may be caused by a very rare congenital malformation. CASE PRESENTATION A 20 years old male patient presented with a history of left knee pain for 6 months. MRI revealed a horizontal tear with abnormal thickness in the posterior horn of the lateral meniscus. The primary arthroscopic examination discovered a horizontal tear in the PHLM with atypical downward directed fingerlike exostosis. By using an arthroscopic hock, grasper and scissors, the exostosis was removed, and the nearby tear was smoothed with the shaver. CLINICAL DISCUSSION Diagnosis of finger like exostosis is challenging and needs strong clinical suspicion because most of the time, it is not predictable and MRI signs may lead to unclear differential diagnosis. The presence of exostosis give a causative explanation of PHLM horizontal tear especially in absence of clear twisting or direct trauma. It may increase the forward directed pull forces of the nearest part of the meniscus during normal gait and gym exercises. CONCLUSION Fingerlike exostosis and other meniscal malformations should be in mind as rare cases. They may explain the presence of tears in young patients with no clear trauma.
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Zaffagnini S, Poggi A, Reale D, Andriolo L, Flanigan DC, Filardo G. Biologic Augmentation Reduces the Failure Rate of Meniscal Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:2325967120981627. [PMID: 33709004 PMCID: PMC7907660 DOI: 10.1177/2325967120981627] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 01/13/2023] Open
Abstract
Background Clinical results after isolated meniscal repair are not always satisfactory, with an overall failure rate of around 25%. To improve the success rate of meniscal repair, different biologic augmentation techniques have been introduced in clinical practice, but their real efficacy is still controversial. Purpose/Hypothesis To evaluate the safety, clinical results, and failure rate of biologic augmentation techniques for meniscal repair. The hypothesis was that biologic augmentation would improve the results of meniscal repair. Study Design Systematic review and meta-analysis of comparative studies. Methods A systematic review of the literature was performed in March 2020 of 3 electronic databases (PubMed, Scopus, and the Cochrane Library) regarding meniscal repair combined with biologic augmentation techniques. Articles combining biologic augmentation with other surgical procedures besides meniscal suture were excluded. The quality of the included studies was assessed using a modified Coleman Methodology Score, and the risk of bias was evaluated using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) and the RoB 2.0 (Revised Tool for Risk of Bias in Randomized Trials) for nonrandomized and randomized controlled trials, respectively. Results A total of 11 studies were included in the qualitative analysis: platelet-rich plasma (PRP) augmentation in 6 comparatives studies, fibrin clot augmentation in 2 case series, and mesenchymal stem cells augmentation in 2 case series and 1 case report. One severe adverse event of septic arthritis was reported for PRP 1 month after surgery. The quality of evidence evaluated with the modified Coleman Methodology Score was low overall. Five studies reporting on 286 patients (111 PRP augmentation, 175 control) were included in the quantitative synthesis. A significantly lower risk of failure was documented in the PRP augmentation group as compared with the control group: 9.9% (4.5%-19.1%) versus 25.7% (12.7%-38.7%) (P < .0005). Conclusion The literature on biologic meniscal augmentation is recent and scarce. Only a few comparative trials are available, all focusing on the potential of PRP. The meta-analysis documented that PRP is safe and useful in improving the survival rate, with a 9.9% rate of failure versus 25.7% for the control group. Further high-level studies are needed to confirm these findings and identify the most effective biologic augmentation strategy to improve the outcome of meniscal repair.
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Affiliation(s)
- Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Poggi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Reale
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Başar B, Başar G, Aybar A, Kurtan A, Başar H. The effects of partial meniscectomy and meniscal repair on the knee proprioception and function. J Orthop Surg (Hong Kong) 2020; 28:2309499019894915. [PMID: 31916489 DOI: 10.1177/2309499019894915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. METHODS The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. RESULTS Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. CONCLUSION In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.
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Affiliation(s)
- Betül Başar
- Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gökhan Başar
- Department of Physical Medicine and Rehabilitation, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Aybar
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akif Kurtan
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hakan Başar
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Akkaya M, Gursoy S, Ozberk N, Simsek ME, Korkusuz F, Bozkurt M. Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application. Musculoskelet Surg 2020; 106:145-153. [PMID: 32960435 DOI: 10.1007/s12306-020-00681-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the impact of biodegradable polyurethane meniscus scaffold implantation (BPMSI) on muscle strength and balance in comparison with the healthy contralateral knee in patients with irreparable medial meniscus defect. METHODS This observational and prospective case-cohort study was conducted with patients who had irreparable meniscal defects and underwent arthroscopic meniscus scaffold implantation. Surgeries were carried out on the medial meniscus of 16 right and 4 left knees. Visual analog scale (VAS) was used to assess the degree of pain relief. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm (LYS) score were used to evaluate the functional improvement at weeks 12, 24 and 36. Concentric and eccentric quadriceps and hamstring peak torque (PT) as well as the peak torque-to-body weight (PTB) ratio, anterior-posterior, mediolateral and overall stability indexes were assessed at the same time points. RESULTS Twenty male patients with a mean age and body mass index of 32.2 ± 8.8 years and 26.2 ± 4.2 kg/m2, respectively, were included in the study. The amount of pain decreased from 7.6 ± 1.5% to 2.9 ± 1.5% at postoperative week 36. Range of motion, Lysholm score and KOOS increased from 87.0ο ± 9.5ο to 115.0ο ± 15.1ο, 30.8 ± 4.3 to 81.5 ± 5.3 and 37.4 ± 5.3 to 74.1 ± 7.2, respectively. Concentric quadriceps and hamstring peak torque values and peak torque/body weight ratios were improved in the knees that received a meniscus scaffold implant. Anterior/posterior, medial/lateral, and overall stability indexes with or without biofeedback exhibited a slight improvement, which was not statistically significant. CONCLUSION BPMSI led to decreased pain and improved function at postoperative week 36. Although muscle strength almost returned to normal, balance parameters did not recover within 36 weeks after the procedure.
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Affiliation(s)
- M Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey.
| | - S Gursoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
| | - N Ozberk
- Department of Physical Treatment and Rehabilitation, Middle East Technical University Medical Center, 06100, Ankara, Turkey
| | - M E Simsek
- Department of Orthopedics and Traumatology, Lokman Hekim University, 06100, Ankara, Turkey
| | - F Korkusuz
- Department of Sports Medicine, Hacettepe University Medical Faculty, 06800, Ankara, Turkey
| | - M Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University Medical Faculty, Ankara Yildirim Beyazit University, 06100, Ankara, Turkey
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Butt U, Vuletić F, Stenhouse G, Hudetz D, Bradbury N. Meniscal scaffold for the treatment of partial meniscal defect-clinical and radiological outcomes in a two-year follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 45:977-983. [PMID: 32949258 DOI: 10.1007/s00264-020-04811-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of meniscal scaffolds is to fill the defect, allow regeneration of meniscal-like tissues, and to prevent long-term risk of cartilage wear and tear. The aim of this study was to evaluate clinical results after two years and magnetic resonance imaging (MRI) results a year after implantation of a meniscal scaffold. METHODS Fifteen patients were recruited into a prospective, single-arm, single-center study, and treated with meniscal scaffolds as a result of segmental meniscal defect due to previous partial meniscectomy. Patients were evaluated using functional knee scores used pre-operatively and 6, 12, and 24 months postoperatively. The radiological outcome was assessed using MRI at 12 months by evaluating scaffold size, morphology, and intensity according to the Genovese grading system. Cartilage assessment was completed according to The International Cartilage Repair Society (ICRS) score. RESULTS All patients completed a follow-up of 24 months. A statistically significant increase in mean levels of all functional scores was present in all patients. On the MRI, all but one of the patients presented an incorporated meniscal implant. In most of the patients (73%), the meniscal implant was a Genovese type III. Type II and III signal intensities were present in all scaffolds when compared with the residual meniscal tissue. A stable cartilage (ICRS) status was observed in 80% of the patients compared with the pre-operative cartilage scores. CONCLUSION In our case series of patients treated with the meniscal scaffold implant, we observed good clinical results at a two year follow-up. Furthermore, MRI findings suggest that meniscal scaffolds might have a beneficial effect on articular cartilage.
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Affiliation(s)
- Umer Butt
- AO Clinic (Institute of Trauma, Orthopaedics and Sports Injury), Nazimabad No.4, Karachi, Pakistan
- Circle Bath Hospital, Bath, UK
| | - Filip Vuletić
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia.
| | | | - Damir Hudetz
- Department of Orthopaedic Surgery, University Hospital 'Sveti Duh', Zagreb, Croatia
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Knee Joint and Quadriceps Dysfunction in Individuals With Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Meniscus Surgery: A Cross-Sectional Study. J Sport Rehabil 2020; 30:112-119. [PMID: 32234996 DOI: 10.1123/jsr.2018-0482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/01/2020] [Accepted: 01/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT While arthrogenous muscle inhibition associated with knee injuries is evident, the relative magnitude of functional deficiency related to each individual knee pathology is unclear. OBJECTIVE To compare the knee joint and quadriceps dysfunction among patients with anterior knee pain (AKP) without surgical history and those with surgical history (anterior cruciate ligament reconstruction [ACLR]; meniscus surgery) without current AKP, with matched healthy controls. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS A total of 66 patients with knee pathologies and 30 controls. MAIN OUTCOME MEASURES Pain perception and lower-extremity functional outcomes were assessed. Knee joint function was measured by replication tests. Quadriceps function was measured by strength, voluntary activation, and torque-generating capacity. RESULTS Patients with AKP reported greater pain perception compared with the other knee conditions (4.3 vs 0.1 of 10 in Numeric Pain Rating Scale, P < .0001). Compared with the controls: (1) patients with AKP showed a greater error on knee-flexion replications at 75° (2.9° vs 5.4°, P = .002), (2) patients with AKP and ACLR showed less quadriceps strength (AKP: 3.3 vs 2.6 N·m/kg, P = .002; ACLR: 3.3 vs 2.7 N·m/kg, P = .02) and voluntary activation (AKP: 0.982 vs 0.928, P < .0001; ACLR: 0.982 vs 0.946, P = .003), and (3) all knee pathologies reported lower scores on functional outcomes (79 vs 65 of 80 points in Lower-Extremity Functional Scale, P < .0001) and showed less quadriceps torque-generating capacity (10.7 vs 7.8 N·m/s/kg, P < .0001). Among the knee pathologies, patients with AKP showed less quadriceps voluntary activation compared with the patients with meniscus surgery (0.928 vs 0.964, P = .03). CONCLUSION As patients with AKP had an additional impairment in knee joint flexion replications and reported a less score in functional outcomes, knee pain may produce a greater impact on functional deficiency.
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Meniscus Matrix Remodeling in Response to Compressive Forces in Dogs. Cells 2020; 9:cells9020265. [PMID: 31973209 PMCID: PMC7072134 DOI: 10.3390/cells9020265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/02/2022] Open
Abstract
Joint motion and postnatal stress of weight bearing are the principal factors that determine the phenotypical and architectural changes that characterize the maturation process of the meniscus. In this study, the effect of compressive forces on the meniscus will be evaluated in a litter of 12 Dobermann Pinschers, of approximately 2 months of age, euthanized as affected by the quadriceps contracture muscle syndrome of a single limb focusing on extracellular matrix remodeling and cell–extracellular matrix interaction (i.e., meniscal cells maturation, collagen fibers typology and arrangement). The affected limbs were considered as models of continuous compression while the physiologic loaded limbs were considered as controls. The results of this study suggest that a compressive continuous force, applied to the native meniscal cells, triggers an early maturation of the cellular phenotype, at the expense of the proper organization of collagen fibers. Nevertheless, an application of a compressive force could be useful in the engineering process of meniscal tissue in order to induce a faster achievement of the mature cellular phenotype and, consequently, the earlier production of the fundamental extracellular matrix (ECM), in order to improve cellular viability and adhesion of the cells within a hypothetical synthetic scaffold.
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Lee JH, Lee DH, Park JH, Suh DW, Kim E, Jang KM. Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear. Knee Surg Relat Res 2020; 32:8. [PMID: 32660570 PMCID: PMC7219227 DOI: 10.1186/s43019-019-0027-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear. Level of evidence: Level III
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Hoon Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam, South Korea
| | - Eunseon Kim
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea. .,Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea.
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Merkely G, Ogura T, Ackermann J, Mestriner AB, Minas T, Gomoll AH. Open Meniscal Allograft Transplantation With Transosseous Suture Fixation of the Meniscal Body Significantly Decreases Meniscal Extrusion Rate Compared With Arthroscopic Technique. Arthroscopy 2019; 35:1658-1666. [PMID: 30979620 DOI: 10.1016/j.arthro.2018.11.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess and compare meniscal extrusion rates after lateral "bridge-in-slot" meniscal allograft transplantation (MAT) with arthroscopic versus open insertion. METHODS In this review of prospectively collected data, we analyzed data from patients who underwent arthroscopic or open lateral MAT. Patients who underwent concomitant distal femoral osteotomy, for whom 1-year postoperative magnetic resonance imaging was unavailable, or who underwent open lateral MAT without the use of transosseous sutures were excluded. Meniscal extrusion in the included patients was assessed by 2 independent examiners by measuring the absolute value and the relative percentage of extrusion on 1.5-T magnetic resonance images at 1-year follow-up. The number of MATs with radial displacement larger or smaller than 3 mm was determined. RESULTS A total of 20 patients met the inclusion criteria, of whom 10 underwent arthroscopic and 10 underwent open lateral MAT. No statistically significant differences were found in baseline demographic data. Absolute meniscal extrusion was similar between the groups (P = .091). A significantly larger relative percentage of extrusion (arthroscopic MAT, 31 ± 27 mm; open MAT, 10 ± 29 mm; 95% confidence interval, -0.4 to -0.02 mm; P = .03) and a significantly higher extrusion rate were found in patients treated with arthroscopic MAT than in those treated with open MAT (>3 mm in 5 patients [50%] with arthroscopic MAT and 0 patients with open MAT, P = .01). CONCLUSIONS This study identified similar absolute extrusion and significantly lower postoperative lateral meniscal extrusion rates after open MAT compared with arthroscopic MAT. Transosseous fixation of the meniscal body appears protective against meniscal extrusion after MAT. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Sports Medicine Center Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Jakob Ackermann
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Orthopedic and Traumatology Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Paley Orthopedic and Spine Institute, West Palm Beach, Florida, U.S.A
| | - Andreas H Gomoll
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
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Abstract
BACKGROUND Types of mechanoreceptors may differ between the medial and lateral menisci, suggesting that postural stability may differ between patients with medial and lateral meniscus tears. However, to date, postural stability has not been compared in patients with medial and lateral meniscus tears. This study used stabilometry to compare postural stability in patients with medial and lateral meniscus tears. METHODS Postural stability and thigh muscle strength were assessed in 24 patients with medial and 18 patients with lateral meniscus tears. Postural stability was determined by measuring the anteroposterior (APSI), mediolateral (MLSI), and overall (OSI) stability indices using stabilometry. Maximal torque (60°/s) of the quadriceps and hamstring was evaluated using an isokinetic testing device. RESULTS The three stability indices, OSI, APSI, and MLSI, in both involved and uninvolved knees were all significantly greater in patients with lateral than with medial meniscus tears. (P<0.001 for all OSI, APSI, and MLSI in both involved and uninvolved knees, except for P=0.005 for MLSI of involved knees). In patients with medial meniscus tears, both OSI (1.4±0.4 vs. 1.1±0.4, P=0.037) and MLSI (0.9±0.3 vs. 0.8±0.3, P=0.041) were significantly higher on the injured than the uninjured side. In patients with lateral meniscus tears, none of the stability indices differed significantly between injured and uninjured knee joints. CONCLUSION Postural stability of both the injured and uninjured knee joints was poorer in patients with lateral than with medial meniscus tears.
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Dangelmajer S, Familiari F, Simonetta R, Kaymakoglu M, Huri G. Meniscal Transplants and Scaffolds: A Systematic Review of the Literature. Knee Surg Relat Res 2017; 29:3-10. [PMID: 28231642 PMCID: PMC5336368 DOI: 10.5792/ksrr.16.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 02/06/2023] Open
Abstract
The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison.
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Affiliation(s)
- Sean Dangelmajer
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Catanzaro, Italy
| | - Roberto Simonetta
- Department of Orthopaedic and Trauma Surgery, C.O.T. Cure Ortopediche Traumatologiche, Messina, Italy
| | - Mehmet Kaymakoglu
- Department of Orthopaedic and Traumatology, Hacettepe University, Ankara, Turkey
| | - Gazi Huri
- Department of Orthopaedic and Traumatology, Hacettepe University, Ankara, Turkey
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Nemery E, Gabriel A, Piret J, Antoine N. Nociceptive and sympathetic innervations in the abaxial part of the cranial horn of the equine medial meniscus: an immunohistochemical approach. J Anat 2016; 229:791-799. [PMID: 27345299 DOI: 10.1111/joa.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/28/2022] Open
Abstract
In athletic horses, diseases leading to lameness are of great importance due to the loss of performance and the resultant economic concerns. Although stifle lesions are frequent in the hindlimb, due to the large size and complexity of the joint, and although meniscal tears have been identified as the most common soft tissue injuries in this joint, little is known about the mechanism that causes the painful sensation and thus the lameness. The aim of our study was to highlight any peripheral fibres involved in meniscal nociception in five macroscopically sound cranial horns of the equine medial meniscus, which has been one of the most common sites reported for equine meniscal injuries. Immunohistochemical stainings were performed using antibodies against Substance P in order to identify nociceptive fibres; against tyrosine hydroxylase for detecting postganglionic sympathetic fibres; and against glial fibrillary acidic proteins in order to identify Schwann cells. Our work highlights for the first time the presence of nociceptive and sympathetic fibres in equine menisci. They were found in the abaxial part of the cranial horn of the equine medial meniscus. This study suggests that when the abaxial part is injured, the meniscus itself could be the source of pain. These findings could provide a better understanding of the clinical presentation of horses with meniscal injury and contribute towards improving therapeutic strategies to alleviate pain in cases of equine meniscal injury.
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Affiliation(s)
- Elodie Nemery
- Anatomy Unit, Department of Morphology and Pathology, FARAH Research Center, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Annick Gabriel
- Anatomy Unit, Department of Morphology and Pathology, FARAH Research Center, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Joëlle Piret
- Histology Unit, Department of Morphology and Pathology, FARAH Research Center, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Nadine Antoine
- Histology Unit, Department of Morphology and Pathology, FARAH Research Center, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Nemery E, Gabriel A, Grulke S, Piret J, Toppets V, Antoine N. Mechanoreceptors in the Anterior Horn of the Equine Medial Meniscus: an Immunohistochemical Approach. Anat Histol Embryol 2015; 45:131-9. [PMID: 25904399 DOI: 10.1111/ahe.12181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
Abstract
Lameness due to stifle and especially meniscal lesions is frequent in equine species. In humans, mechanoreceptors involved in proprioceptive function are well studied. Given the high incidence of meniscal injuries in horses, and the lack of information concerning them in equine menisci, our objective was to study these corpuscles in six healthy anterior horns of the equine medial meniscus, which is the most common localisation reported for equine meniscal injuries. Immunohistochemical stainings were performed using antibodies against high molecular weight neurofilaments and glial fibrillary acidic proteins. From a purely fundamental point of view, our work highlights for the first time the presence of Ruffini, Pacini and Golgi corpuscles in equine meniscus. They were found, isolated or in clusters and always located at the vicinity of blood vessels, at the level of the anterior horn of the equine medial meniscus. This morphological approach could serve as a basis for clinical studies, to evaluate the impact of these corpuscles on the poor sportive prognosis in equine meniscal tears.
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Affiliation(s)
- E Nemery
- Anatomy Unit, Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster - B43a, Liège, B-4000, Belgium
| | - A Gabriel
- Anatomy Unit, Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster - B43a, Liège, B-4000, Belgium
| | - S Grulke
- Large Animal Surgical Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster -Equine Clinic B41, Liège, B-4000, Belgium
| | - J Piret
- Histology Unit, Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster - B43a, Liège, B-4000, Belgium
| | - V Toppets
- Histology Unit, Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster - B43a, Liège, B-4000, Belgium
| | - N Antoine
- Histology Unit, Department of Morphology and Pathology, Faculty of Veterinary Medicine, University of Liège, 20 Boulevard de Colonster - B43a, Liège, B-4000, Belgium
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Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears. Knee Surg Sports Traumatol Arthrosc 2015; 23:240-5. [PMID: 24037262 DOI: 10.1007/s00167-013-2675-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 09/05/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare postural stability in patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with associated meniscal tears. METHODS Quadriceps and hamstring muscle strength and their ratio, as well as the relationships of these parameters with postural stability, were compared in 23 patients with isolated ACL tears and 27 with combined ACL and medial meniscus tears. Postural stability was determined from the anterior-posterior, medial-lateral, and overall stability indices using the Biodex Stability System. RESULTS On both the involved and uninvolved sides, there were no differences in mean stability indices, including anterior-posterior, medial-lateral, and overall stability indices, in patients with isolated and combined ACL tears. In patients with isolated ACL tears, both overall (2.3 ± 1.2 vs. 1.8 ± 1.4, p = 0.033) and medial-lateral (1.2 ± 0.6 vs. 1.0 ± 0.5, p = 0.031) stability indices were significantly higher on the involved compared to the uninvolved side. These differences, however, were not observed in the combined ACL tear group. CONCLUSION No significant differences in postural instability on the affected and unaffected sides were observed in patients with isolated ACL tears and those with combined ACL and medial meniscus tears. These findings indicate that there is no need to reduce the goal of restoring proprioception in patients with combined compared with isolated ACL tears. LEVEL OF EVIDENCE III.
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Fox AJS, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2014; 28:269-87. [PMID: 25125315 DOI: 10.1002/ca.22456] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/23/2014] [Indexed: 12/22/2022]
Abstract
Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long-term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York
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Seitz AM, Galbusera F, Krais C, Ignatius A, Dürselen L. Stress-relaxation response of human menisci under confined compression conditions. J Mech Behav Biomed Mater 2013; 26:68-80. [DOI: 10.1016/j.jmbbm.2013.05.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/15/2013] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
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Beneka A, Malliou P, Gioftsidou A, Kofotolis N, Rokka S, Mavromoustakos S, Godolias G. Effects of instructional and motivational self-talk on balance performance in knee injured. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.776109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fox AJS, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health 2012; 4:340-51. [PMID: 23016106 PMCID: PMC3435920 DOI: 10.1177/1941738111429419] [Citation(s) in RCA: 362] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci-including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities. EVIDENCE ACQUISITION A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011. RESULTS This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs. CONCLUSIONS An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.
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Affiliation(s)
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Magyar MO, Knoll Z, Kiss RM. Effect of medial meniscus tear and partial meniscectomy on balancing capacity in response to sudden unidirectional perturbation. J Electromyogr Kinesiol 2012; 22:440-5. [DOI: 10.1016/j.jelekin.2012.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/12/2012] [Accepted: 01/14/2012] [Indexed: 10/14/2022] Open
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Abstract
It has become increasingly more evident that the meniscus plays an important role in contributing to knee joint longevity. Advances in surgical techniques by orthopaedic surgeons to repair traumatized menisci have led to better long term outcomes, decreasing the incidence of articular cartilage degeneration. Advances have also been made in rehabilitative techniques following meniscal repair. These techniques along with sound rehabilitation principles to include a criteria based progression have contributed to excellent outcomes and earlier return to function and sport. The role of the meniscus, recent advances in surgical repair and the current post-operative rehabilitation techniques employed by sports rehabilitation specialists today are discussed.
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Affiliation(s)
- John T. Cavanaugh
- Sports Rehabilitation & Performance Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Sarah E. Killian
- Sports Rehabilitation & Performance Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Al-Dadah O, Shepstone L, Donell ST. Proprioception following partial meniscectomy in stable knees. Knee Surg Sports Traumatol Arthrosc 2011; 19:207-13. [PMID: 20740274 DOI: 10.1007/s00167-010-1237-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 07/26/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE to investigate the proprioceptive function of patients with isolated meniscal tears of the knee before and after arthroscopic partial meniscectomy. METHODS one hundred subjects (50 patients who underwent a knee arthroscopy and 50 normal controls) were evaluated using single-leg dynamic postural stabilometry. All participants were assessed clinically and radiologically. Knee outcome scores were obtained for all subjects. RESULTS of the 50 patients arthroscoped, 34 were found to have meniscal tears. Twenty-nine of these patients were reassessed 3 months post-operatively. There was a significant proprioceptive deficit in subjects with meniscal tears when compared to their normal contra-lateral knee (P < 0.001) and the control group (P < 0.001). Partial meniscectomy resulted in a significant improvement in knee outcome scores but not proprioception measurements (n.s.). CONCLUSION patients with isolated meniscal tears were found to have a significant proprioceptive deficit which persisted following arthroscopic partial meniscectomy despite an otherwise successful clinical outcome.
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Affiliation(s)
- O Al-Dadah
- Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
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