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Mihoubi F, Tordjman M, Khaled W, Guerini H, Thevenin F, Campagna R, Pluot E, Drapé JL, Feydy A. Overview of Meniscal Injuries. Semin Musculoskelet Radiol 2025; 29:403-416. [PMID: 40393499 DOI: 10.1055/s-0045-1806794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
The menisci play a crucial role in knee stability, load distribution, and shock absorption. Their anatomical structure is linked to the way they perform. Meniscal injuries are common in both athletic and nonathletic populations, accounting for > 60% of all reported knee injuries, making them the most common type of knee injury resulting from acute trauma or degenerative changes. Meniscal tears typically result from a combination of axial loading and rotational force. The medial meniscus is the most affected. Tears can be classified based on their location, pattern, and stability, influencing treatment decisions. The three patterns are horizontal tear (simple or complex with a flap), vertical or longitudinal tear (simple, bucket-handle, or specific case meniscal ramp tear), and radial tear (simple, parrot beak, and specific case meniscal root tears). Some diagnostic pitfalls are anatomical variants, ligamentous or tendinous structures, or variations in signal or meniscal shape.
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Affiliation(s)
- Fadila Mihoubi
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Leonard de Vinci Imaging Center, Paris, France
| | - Mickael Tordjman
- Department of Radiology, Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wassef Khaled
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Leonard de Vinci Imaging Center, Paris, France
| | - Henri Guerini
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Leonard de Vinci Imaging Center, Paris, France
| | - Fabrice Thevenin
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Leonard de Vinci Imaging Center, Paris, France
| | - Raphael Campagna
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Etienne Pluot
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Jean-Luc Drapé
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
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Medina G, Leite CB, Merkely G, Lattermann C. Medial Meniscus Allograft Transplantation: Bone Plug Technique With Anatomic Anterior and Posterior Horn Fixation. Arthrosc Tech 2025; 14:103260. [PMID: 40207314 PMCID: PMC11977132 DOI: 10.1016/j.eats.2024.103260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/07/2024] [Indexed: 04/11/2025] Open
Abstract
Meniscus preservation is crucial for avoiding cartilage degeneration after symptomatic meniscal tears. Despite efforts, meniscal repair procedures may fail, which requires a partial or total meniscectomy. Meniscus allograft transplantation (MAT) presents a viable solution, offering symptom alleviation, enhanced knee function, and potential osteoarthritis progression delay. Although MAT can address both lateral and medial compartments, medial MAT poses greater challenges as the result of its intricate attachments and limited mobility. The medial meniscus's unique anatomy, including attachments to the intermeniscal ligament, deep medial collateral ligament, capsule, and the anterior cruciate ligament, demands meticulous transplantation techniques. Refinements in surgical techniques are ongoing, emphasizing the importance of anatomical precision, particularly in positioning the anterior and posterior horns of the medial meniscus. Here, we present a bone plug technique for medial MAT, prioritizing the accurate anatomical attachment of the anterior horns of the allograft to improve surgical outcomes.
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Affiliation(s)
- Giovanna Medina
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Chilan B.G. Leite
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Gergo Merkely
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Christian Lattermann
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
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Perelli S, Conte P, Pizza N, Morales‐Avalos R, Kon E, Grassi A, Zaffagnini S, Monllau JC. Meniscal extrusion: Proposal for a novel qualitative classification. J Exp Orthop 2025; 12:e70126. [PMID: 39741910 PMCID: PMC11685843 DOI: 10.1002/jeo2.70126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/30/2024] [Accepted: 11/05/2024] [Indexed: 01/03/2025] Open
Abstract
Meniscal extrusion (ME), defined as the radial displacement of the meniscal body outside the margins of the tibial plateau, has been seen as an independent and relevant predictor of intra-articular knee degeneration. Nonetheless, available classifications for ME are exclusively quantitative assessments not considering the context in which extrusion is identified. Indeed, ME can be the result of several different conditions spanning from acute tears to chronic degeneration and its definition cannot be only dependent on the numeric calculation of the radial displacement of the meniscal body. Furthermore, growing evidence supports the existence of a paraphysiological ME resulting from joint loading, limb malalignment, anatomical abnormalities of the meniscal attachments to the femur and tibia or a nonpathological finding after meniscal allograft transplantation. It is therefore clear that an exclusively quantitative assessment of ME cannot be sufficient since this condition can develop in such different clinical scenarios. For this reason, a novel qualitative classification for ME is proposed, differentiating between three distinct conditions: a paraphysiological ME, a pathological ME and ME related to degenerative conditions. Furthermore, a comprehensive review of the present literature has been conducted to report the most relevant and updated evidence on the topic highlighting the difference in the clinical management of each different category. Level of Evidence Not applicable.
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Affiliation(s)
- Simone Perelli
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery ServiceUniversitat Pompeu Fabra, Hospital del MarBarcelonaSpain
| | - Pietro Conte
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- IRCCS Humanitas Research HospitalRozzanoMilanoItaly
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanoItaly
| | - Nicola Pizza
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Rodolfo Morales‐Avalos
- Department of Physiology, Laboratory of Biomechanics, School of MedicineUniversidad Autónoma de Nuevo LeónMonterreyMexico
| | - Elizaveta Kon
- IRCCS Humanitas Research HospitalRozzanoMilanoItaly
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanoItaly
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica IIIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica IIIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Joan Carles Monllau
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery ServiceUniversitat Pompeu Fabra, Hospital del MarBarcelonaSpain
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Boksh K, Shepherd DET, Espino DM, Shepherd J, Ghosh A, Aujla R, Boutefnouchet T. Assessment of meniscal extrusion with ultrasonography: a systematic review and meta-analysis. Knee Surg Relat Res 2024; 36:33. [PMID: 39468705 PMCID: PMC11514433 DOI: 10.1186/s43019-024-00236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/07/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the imaging of choice for meniscal extrusion (ME). However, they may underappreciate the load-dependent changes of the meniscus. There is growing evidence that weight-bearing ultrasound (WB US) is more suitable, particularly in revealing occult extrusion. We therefore perform a systematic review and meta-analysis on the validity and reliability of US in diagnosing extrusion. Furthermore, we explored whether it detects differences in extrusion between loaded and unloaded positions and those with pathological (osteoarthritis and meniscal injury) and healthy knees. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Data pertaining to intra- and interrater reliability of US in measuring meniscal extrusion (ME), its correlation with magnetic resonance imaging (MRI), and head-to-head comparison of potential factors to influence ME were included [loading versus unloading position; osteoarthritis (OA) or pathological menisci (PM) versus healthy knees; mild versus moderate-severe knee OA]. Pooled data were analyzed by random or fixed-effects models. RESULTS A total of 31 studies were included. Intraclass correlation coefficients (ICC) for intra- and interrater reliability were minimum 0.94 and 0.91, respectively. The correlation between US and MRI was (r = 0.76). US detected ME to be greater in the loaded position in all knees (healthy, p < 0.00001; OA, p < 0.00001; PM, p = 0.02). In all positions, US detected greater extrusion in OA (p < 0.0003) and PM knees (p = 0.006) compared with healthy controls. Furthermore, US revealed greater extrusion in moderate-severe OA knees (p < 0.00001). CONCLUSIONS This systematic review suggests ultrasonography can play an important role in the measurement of meniscal extrusion, with results comparable to that of MRI. However, to what extent it can differentiate between physiological and pathological extrusion requires further investigation, with an absolute cutoff value yet to be determined. Nevertheless, it is an appropriate investigation to track the progression of disease in those with meniscal pathologies or osteoarthritis. Furthermore, it is a feasible investigation to evaluate the meniscal function following surgery. LEVEL OF EVIDENCE IV, Systematic review of level III-IV evidence.
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Affiliation(s)
- Khalis Boksh
- Department of Biomedical Engineering, University of Birmingham, Birmingham, UK.
- Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Duncan E T Shepherd
- Department of Biomedical Engineering, University of Birmingham, Birmingham, UK
| | - Daniel M Espino
- Department of Biomedical Engineering, University of Birmingham, Birmingham, UK
| | - Jenna Shepherd
- Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Arijit Ghosh
- Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Randeep Aujla
- Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tarek Boutefnouchet
- Department of Biomedical Engineering, University of Birmingham, Birmingham, UK
- Department of Trauma & Orthopaedics, University Hospitals of Birmingham NHS Trust, Birmingham, UK
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Ichiba A, Ito E, Kino K. Extrusion of the anterior segment of the medial meniscus extrusion initiates knee osteoarthritis: evaluation using magnetic resonance imaging. J Exp Orthop 2023; 10:135. [PMID: 38091190 PMCID: PMC10719179 DOI: 10.1186/s40634-023-00693-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Meniscus extrusion contributes to the progression of knee osteoarthritis (OA). It is not clear which site of the medial meniscus (MM) extrusion (MME) is greatest. Moreover, the relationship between sites of MME and progression of OA has not yet been elucidated. The purpose of this study was to determine which sites of MME that showed the greatest extrusion and to investigate the relationship between the presence of MM tears and MME, the relationship between the progression of OA and MME. METHODS A cohort of 111 patients were studied retrospectively. The OA grade was classified using the Kellgren-Lawrence (K-L) grade. MME was measured at 13 positions from the anterior to the posterior segment using magnetic resonance imaging (MRI) with slices perpendicular to the MM (radial MRI). The relationship between the K-L grade and the site of the MME was investigated. The patients were grouped as follows: The patients over 40-years-old were grouped as follows: patients with the K-L grade ≤1 and without a MM tear (Group En (early, no meniscus tear)); patients with the K-L grade ≤1 with a MM tear (Group Ep (early, positive meniscus tear)); patients with the K-L grade ≥2 and without a MM tear (Group An (advanced, no meniscal tear)); patients over-40 years-old with the K-L grade ≥2 and with a MM tear (Group Ap (advanced, positive meniscus tear)). And patients between 15 and 39-years-old with no abnormal findings on MRI were defined as control group (Group C). RESULTS In the Groups En and Ep, MME was greatest in the anterior segment, and was greater in Group Ep than in Group En. In Groups Ap and Group C, extrusion was greatest in the middle segment. CONCLUSION The results suggest that MME predominantly occurred in the anterior segment with increasing age, after that, MM extruded at the middle segment with progression of OA and MM tear. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Atsushi Ichiba
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan.
| | - Eichi Ito
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan
| | - Keiichiro Kino
- Department of Orthopaedic Surgery, Shinkawabata Hospital, 2-31-1, Ichimonbashi, Nagaokakyo city, Kyoto, 617-0825, Japan
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Luco JB, Di Memmo D, Gomez Sicre V, Nicolino TI, Costa-Paz M, Astoul J, Garcia-Mansilla I. Clinical, imaging, arthroscopic, and histologic features of bilateral anteromedial meniscofemoral ligament: A case report. World J Methodol 2023; 13:359-365. [PMID: 37771874 PMCID: PMC10523243 DOI: 10.5662/wjm.v13.i4.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The anteromedial meniscofemoral ligament (AMMFL) is a very rare entity, commonly unrecognized and underreported. Although it was not proved to be a cause of anterior knee pain, concerns have been raised on the relationship between the presence of this structure and medial meniscus injury secondary to its abnormal motion. Regarding histologic examination, some studies have shown meniscus-like fibrocartilage, while others have identified it as ligament-like collagenous fibrous connective tissue. CASE SUMMARY We report the case of a 34-year-old ballerina with an AMMFL associated with a torn medial meniscus of both knees. Surgery was performed to treat the meniscal injury and two biopsies of each AMMFL were taken in different locations to define the histopathological composition. Histologic examination revealed fibrocartilaginous tissue compatible with meniscus. Follow-up evaluation one year after surgery evidenced full remission of symptoms and the patient had resumed her athletic activities. CONCLUSION Clinical, magnetic resonance imaging, arthroscopic, and histological features have been carefully described to better characterize the AMMFL.
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Affiliation(s)
- Juan Bautista Luco
- Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Damian Di Memmo
- Department of Radiology, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Valentina Gomez Sicre
- Department of Pathology, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Tomas Ignacio Nicolino
- Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Matias Costa-Paz
- Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Juan Astoul
- Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Ignacio Garcia-Mansilla
- Division of Knee, Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
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Green JR, Mahalingaiah PKS, Gopalakrishnan SM, Liguori MJ, Mittelstadt SW, Blomme EAG, Van Vleet TR. Off-target pharmacological activity at various kinases: Potential functional and pathological side effects. J Pharmacol Toxicol Methods 2023; 123:107468. [PMID: 37553032 DOI: 10.1016/j.vascn.2023.107468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/16/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
In drug discovery, during the lead optimization and candidate characterization stages, novel small molecules are frequently evaluated in a battery of in vitro pharmacology assays to identify potential unintended, off-target interactions with various receptors, transporters, ion channels, and enzymes, including kinases. Furthermore, these screening panels may also provide utility at later stages of development to provide a mechanistic understanding of unexpected safety findings. Here, we present a compendium of the most likely functional and pathological outcomes associated with interaction(s) to a panel of 95 kinases based on an extensive curation of the scientific literature. This panel of kinases was designed by AbbVie based on safety-related data extracted from the literature, as well as from over 20 years of institutional knowledge generated from discovery efforts. For each kinase, the scientific literature was reviewed using online databases and the most often reported functional and pathological effects were summarized. This work should serve as a practical guide for small molecule drug discovery scientists and clinical investigators to predict and/or interpret adverse effects related to pharmacological interactions with these kinases.
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Affiliation(s)
- Jonathon R Green
- Departments of Preclinical Safety, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States.
| | | | - Sujatha M Gopalakrishnan
- Drug Discovery Science and Technology, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States
| | - Michael J Liguori
- Departments of Preclinical Safety, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States
| | - Scott W Mittelstadt
- Departments of Preclinical Safety, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States
| | - Eric A G Blomme
- Departments of Preclinical Safety, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States
| | - Terry R Van Vleet
- Departments of Preclinical Safety, AbbVie, 1 North Waukegan Road, North Chicago, IL 60064, United States
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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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An anatomical study of the meniscal roots of the knee: landmarks for its surgical reconstruction and implications for knee surgeons. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:971-977. [PMID: 35780197 DOI: 10.1007/s00276-022-02979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this anatomical study was to describe the anatomy of the meniscal roots and their relationships with respect to the main adjacent structures in order to improve their surgical reconstruction. METHODS Fourteen knees were included. The mean age of the donors was 92 years (range 89-96). We studied the general characteristics of the anterior and posterior roots of the medial meniscus and lateral meniscus by measuring their widths at their base and area. We investigated the relations between anterior and posterior roots of the medial and lateral menisci with respect to the anterior and posterior cruciate ligaments (ACL and PCL). RESULTS The mean width of the anterior root of the lateral meniscus was 10.5 ± 1.4 mm. The mean width of the anterior root of the medial meniscus was 10 ± 1.5 mm. The mean width of the posterior root of lateral meniscus was 11.4 ± 1.4 mm. The mean width of the posterior root of medial meniscus was 10.5 ± 1.0 mm. The mean distance between the anterior cruciate ligament and the anterior root of lateral meniscus was 9.8 ± 2.9 mm, for the medial meniscus it was 15.9 ± 3.4 mm. The mean distance between the posterior cruciate ligament and the posterior root of the lateral meniscus was 11.5 ± 2.7 mm, for the medial meniscus, it was 11 ± 2.6 mm. CONCLUSION The anterior and posterior meniscal roots have precise landmarks, and this article contributes to define the location of the meniscal roots with respect to their adjacent anatomical structures: ACL, PCL and intercondylar tubercle. Having precise measures of the distances between the meniscus roots and these structures allows knee surgeons to perform ACL reconstruction, meniscal root repair and meniscal allograft transplantation.
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Liu Y, Du G, Liu J. Meniscal anterior and posterior horn heights are associated with MRI-defined knee structural abnormalities in middle-aged and elderly patients with symptomatic knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:218. [PMID: 35260117 PMCID: PMC8903164 DOI: 10.1186/s12891-022-05143-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Meniscal morphological changes are associated with knee OA. However, the correlation of meniscal height and OA-related knee structural abnormalities is still not well understood. The purpose of present study is to investigate whether and how meniscal anterior and posterior horn heights are associated with structural abnormalities in knees with symptomatic OA. Methods Our sample consisted of 106 patients (61 female, aged 40–73 years) with symptomatic knee OA. Kellgren-Lawrence system was used for radiographic evaluation. On sagittal sequence, medial meniscal posterior horn height (MPH), lateral meniscal anterior horn height (LAH) and lateral meniscal posterior horn height (LPH) were measured on the middle slice through the medial/lateral compartment. Knee structural abnormalities were assessed using the modified whole-organ magnetic resonance imaging score (WORMS). Associations between meniscal anterior and posterior horn heights and knee structural abnormalities were assessed using linear regression analysis. Results Higher MPH was significantly associated with higher WORMS score for medial meniscal anterior horn lesion (P = 0.016) but did not have a statistical association with other WORMS parameters. Increased LAH was statistically correlated with decreased WORMS scores for lateral compartmental cartilage lesions (P = 0.001–0.004) and lateral compartmental bone marrow edema patterns (BMEPs) (P = 0.021–0.027). Moreover, LPH was negatively associated with WORMS scores for lateral compartmental cartilage lesions (P = 0.007–0.041) and lateral compartmental BMEPs (P = 0.022–0.044). Additionally, higher MPH was statistically associated with lower trochlea cartilage WORMS score and higher LAH was significantly correlated with higher WORMS score for trochlea subarticular cysts. Conclusions Changes of LAH and LPH were inversely associated with the severity of lateral compartmental cartilage lesions and BMEPs, while higher MPH was only significantly correlated with more severe medial meniscal anterior horn lesions. Besides, MPH and LAH were also significantly associated with patellofemoral structural abnormalities. The present study provided novel information for understanding the role of meniscal morphological changes in knee OA, which would be helpful in identifying and evaluating knees with or at risks for OA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05143-w.
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Affiliation(s)
- Yao Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiying Du
- Department of Radiology, Teda International Cardiovascular Hospital, Tianjin, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China. .,Department of Radiology Quality Control Center, Changsha, China.
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Mariani PP, Battaglia MJ, Torre G. Anomalous insertion of anterior and posterior horns of medial meniscus. Case report. BMC Musculoskelet Disord 2021; 22:823. [PMID: 34560880 PMCID: PMC8464142 DOI: 10.1186/s12891-021-04696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Anatomical variations of the attachment of medial meniscus are a common finding. However, anomalies of the posterior horn are extremely rare. Only two cases of posterior root anomaly have been described prior to the routine use of arthroscopy for evaluation and treatment of meniscal pathology. In this report, we present an anomaly of both the anterior and posterior roots of the medial meniscus that posed both a diagnostic and therapeutic dilemma. Case presentation The patient is young male soccer player who is currently 16 years of age and began having the atraumatic onset of pain and symptoms that limited performance starting at age 14 and was referred for failure of response to nonoperative treatment. Diagnostic arthroscopy revealed the presence of an anteromedial meniscofemoral ligament whereas the posterior root showed no bony attachment. The radiographic and arthroscopic findings are described. The clinical decision was made after to proceed with observation, reassurance, and gradual return to full activity with physiotherapy guidance. Discussion and conclusion The absence of injury, the mild complaints reported by the patient, his age, skeletal immaturity, and remaining growth led us to adopt a conservative approach to treating this anatomic variant and currently the patient is able to participate fully in sports without symptoms or restrictions.
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Affiliation(s)
- Pier Paolo Mariani
- Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, University of Rome Foro Italico, Rome, Italy.
| | | | - Guglielmo Torre
- Orthopaedic and Trauma Department, Campus Bio-Medico University of Rome, Rome, Italy
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Abstract
Meniscal allograft transplantation provides treatment options for patients with a meniscus-deficient knee with lifestyle-limiting symptoms in the absence of advanced degenerative changes. Meniscal transplantation helps to restore the native biomechanics of the involved knee, which may provide chondroprotective effects and restoring additional knee stability. Improvements in pain, function, and activity level have been seen in appropriately selected patients undergoing transplantation. Although various surgical implantation options exist, the majority focus on reproducing native attachments of the meniscal roots to allow near normal mechanics. Although meniscal transplantation may serve as a salvage procedure for symptomatic patients with a meniscus-deficient knee, it may prevent or delay the necessity of a more invasive arthroplasty procedure.
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13
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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14
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Abstract
The importance of the menisci in providing joint stability and their role in load transmission within the knee are well understood. A growing body of literature has emerged on 2 distinct injury patterns to these crucial anatomic structures, ramp lesions and root tears. Ramp lesions may be characterized as tears at the posterior meniscocapsular junction, while root tears involve bony or soft tissue avulsion of the meniscal insertions at the anterior or posterior intercondylar regions. In this 2-part review, we present an overview of the current available literature on ramp lesions and meniscal root tears, summarizing the unique anatomic considerations, etiology, biomechanics, management decisions, clinical outcomes pertinent to these very distinct injuries.
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Traumatic avulsion of the anterior medial meniscus root combined with PCL injury: a case report. BMC Musculoskelet Disord 2020; 21:642. [PMID: 32998737 PMCID: PMC7528235 DOI: 10.1186/s12891-020-03671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Avulsion of the anterior medial meniscus root (AMMR) has a low incidence rate, especially when it is combined with posterior cruciate ligament (PCL) injury, which hasn’t been reported in any literature to date. The aim of this study was to share our experience in the diagnosis and treatment of a patient with traumatic avulsion of AMMR combined with PCL injury. Case presentation This article reports a 26-year-old male patient diagnosed with traumatic avulsion of the AMMR with PCL injury. After arthroscopic surgery, he achieved remission of symptoms and recovery of functions. Conclusions Anterior meniscus root injuries are relatively rare. Its diagnosis can be made preliminarily based on clinical manifestations, physical examinations, and magnetic resonance imaging (MRI), and then confirmed by arthroscopic exploration. Arthroscopic suture anchor fixation of the injured anterior meniscus horn shows a good therapeutic effect.
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16
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Chien A, Weaver JS, Kinne E, Omar I. Magnetic resonance imaging of the knee. Pol J Radiol 2020; 85:e509-e531. [PMID: 33101555 PMCID: PMC7571514 DOI: 10.5114/pjr.2020.99415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/23/2020] [Indexed: 01/11/2023] Open
Abstract
Knee pain is frequently seen in patients of all ages, with a wide range of possible aetiologies. Magnetic resonance imaging (MRI) of the knee is a common diagnostic examination performed for detecting and characterising acute and chronic internal derangement injuries of the knee and helps guide patient management. This article reviews the current clinical practice of MRI evaluation and interpretation of meniscal, ligamentous, cartilaginous, and synovial disorders within the knee that are commonly encountered.
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Affiliation(s)
| | | | | | - Imran Omar
- Northwestern University Feinberg School of Medicine, USA
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17
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Shimozaki K, Nakase J, Oshima T, Asai K, Toyooka K, Ohno N, Miyati T, Tsuchiya H. Investigation of extrusion of the medial meniscus under full weight-loading conditions using upright weight-loading magnetic resonance imaging and ultrasonography. J Orthop Sci 2020; 25:652-657. [PMID: 31590943 DOI: 10.1016/j.jos.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/08/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Meniscal morphology under full weight-loading conditions is currently unknown. This study aimed to evaluate extrusion in the medial meniscus between unloaded and upright-loaded conditions in healthy adults using upright magnetic resonance imaging (MRI) and ultrasonography and to investigate the relationship between MRI and ultrasonography in upright-loaded conditions. METHODS Eighteen healthy adult volunteers (13 men and 5 women) participated in the study. MRI and ultrasonography were performed with patients in the supine, double-leg upright (DLU), and single-leg upright (SLU) positions. Medial, anterior, and posterior extrusions of the medial meniscus against the tibial edge were evaluated and compared across the three positions. Medial extrusion correlations between MRI and ultrasonography were examined. Demographic data and hip-knee-ankle (HKA) angles were measured and correlated with changes in the medial extrusion. The medial meniscal extrusions detected via MRI and ultrasonography were compared across the three positions. Correlations were examined using Pearson's correlation coefficients. RESULTS Negative correlations were found between the change in medial extrusion of the medial meniscus and HKA angle (MRI: r = -0.52, ultrasonography: r = -0.51). Although no significant differences among the three conditions were observed for the anterior and posterior extrusions of the medial meniscus, the medial extrusion of the medial meniscus was significantly greater in DLU and SLU positions than that in the supine position for MRI and ultrasonography (P < 0.05). Positive correlations for the medial extrusion of the medial meniscus were found between MRI and ultrasonography in all three positions (supine: r = 0.74, DLU; r = 0.71, SLU; r = 0.61). CONCLUSIONS Although no significant differences in anterior and posterior extrusions of the medial meniscus were seen across the studied positions, the medial meniscus was found to undergo significant medial extrusion during upright weight-loading conditions. The strong correlation between MRI and ultrasonography highlighted the usefulness of ultrasonography. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa-shi, Ishikawa-ken, 920-0942, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa-shi, Ishikawa-ken, 920-0942, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
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18
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Constitutive modeling of menisci tissue: a critical review of analytical and numerical approaches. Biomech Model Mechanobiol 2020; 19:1979-1996. [PMID: 32572727 DOI: 10.1007/s10237-020-01352-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
Menisci are fibrocartilaginous disks consisting of soft tissue with a complex biomechanical structure. They are critical determinants of the kinematics as well as the stability of the knee joint. Several studies have been carried out to formulate tissue mechanical behavior, leading to the development of a wide spectrum of constitutive laws. In addition to developing analytical tools, extensive numerical studies have been conducted on menisci modeling. This study reviews the developments of the most widely used continuum models of the meniscus mechanical properties in conjunction with emerging analytical and numerical models used to study the meniscus. The review presents relevant approaches and assumptions used to develop the models and includes discussions regarding strengths, weaknesses, and discrepancies involved in the presented models. The study presents a comprehensive coverage of relevant publications included in Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, Springer, and Scopus databases. This review aims at opening novel avenues for improving menisci modeling within the framework of constitutive modeling through highlighting the needs for further research directed toward determining key factors in gaining insight into the biomechanics of menisci which is crucial for the elaborate design of meniscal replacements.
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19
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Magnetic resonance imaging of the meniscal roots. Skeletal Radiol 2020; 49:661-676. [PMID: 31915856 DOI: 10.1007/s00256-020-03374-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/02/2023]
Abstract
The meniscal roots and supporting structures anchor the menisci to the tibial plateau and resist hoop stress, thereby preventing radial displacement of the menisci and secondary degenerative tibiofemoral compartment changes that may occur if this is compromised. The anatomy of the four meniscal roots and their supporting structures on magnetic resonance imaging (MRI) will be outlined in this review article, as well as the imaging appearances of meniscal root-related pathology, namely meniscal root degeneration and tears, meniscal extrusion and tibial plateau cystic lesions.
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20
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Abstract
Meniscus root tears biomechanically disrupt normal joint loading and lead to joint overload with the possible development of spontaneous osteonecrosis of the knee and early-onset osteoarthritis. Proper identification and treatment of meniscal root tears has been proven to restore joint loading and improve patient outcomes.
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Affiliation(s)
| | - Marc Strauss
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Robert F LaPrade
- Twin Cities Orthopedics, 4060 West 65th Street, Edina, MN 55435, USA.
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21
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22
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Nagashima M, Otani T, Takeshima K, Seki H, Ishii K. Benign Neglect of Anomalous Insertion of the Anterior Horn of the Medial Meniscus as an Incidental Finding During Knee Arthroscopy. Arthrosc Sports Med Rehabil 2019; 2:e1-e6. [PMID: 32266352 PMCID: PMC7120835 DOI: 10.1016/j.asmr.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/14/2019] [Indexed: 11/02/2022] Open
Abstract
Purpose To evaluate the clinical results following arthroscopic surgery in patients with anomaly of the anterior horn of the medial meniscus (AHMM) that was found unexpectedly during surgery and discuss whether resection is necessary in patients without anteromedial knee pain (AMKP). Methods Between May 2014 and April 2017, a total of 387 knee arthroscopies in 379 patients were performed. Among these, 11 knees in 11 patients showed an anomalous insertion of the AHMM (incidence, 2.8%), and all 11 patients were included in this study. For these 11 patients, medical records including preoperative diagnosis, arthroscopic findings, and pre- and postoperative clinical evaluations were analyzed. Results None of the patients complained of AMKP before arthroscopy. Two patients were diagnosed with lateral meniscus injury and the other 9 patients were diagnosed with medial meniscus injury. All anomalies of the AHMM were found incidentally during arthroscopic surgery. The anomaly formed a band-like structure arising from the anterior portion of the medial meniscus and was attached to the anterior aspect of the ACL and femoral intercondylar notch. All 11 patients underwent partial meniscectomy, but anomalies of the AHMM were not resected. One patient was excluded from clinical evaluation, as that patient required subsequent total knee arthroplasty due to osteoarthritis. For the other 10 patients, mean follow-up was 36.8 months (range, 26-61 months). Knee pain was relieved, and none developed postoperative AMKP. Mean Lysholm score improved significantly from 55.9 to 91.2 (P < .001). Conclusions The incidence of the anomaly was 2.8% in our study. If the patient has no AMKP before arthroscopic surgery, anomaly of the AHMM is a silent lesion that does not warrant resection. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Masaki Nagashima
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba
| | - Toshiro Otani
- Institute for Integrated Sports Medicine Keio University School of Medicine, Tokyo, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba
| | - Hiroyuki Seki
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba
| | - Ken Ishii
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Chiba
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23
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Franke J, Mueckner K, Alt V, Schnettler R, Franke AP, Griewing S, Hohendorff B. Anterior intermeniscal ligament: frequency in MRI studies and spatial relationship to the entry point for intramedullary tibial nailing related to the risk of iatrogenic violation. Eur J Trauma Emerg Surg 2018; 46:1085-1092. [PMID: 30269211 DOI: 10.1007/s00068-018-1019-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anterior knee pain is the most common complication after intramedullary tibial nailing. Often, the cause is multifactorial and individually different. Violation of the anterior intermeniscal ligament (AIL) during intramedullary tibial nailing might be a possible origin of postsurgical anterior knee pain. Both the importance and function of the AIL remain somewhat ambivalent, and even the figures quoted in the literature for its existence in the population vary drastically. Our aim was to verify the estimated frequency of the AIL in the literature by retrospectively analysing the data of MRI studies conducted at our hospital. In addition, we attempted to assess the potential risk of AIL violation during intramedullary tibial nailing, based on the spatial arrangement. METHODS Two independent examiners analysed the images generated in 351 MRI studies conducted at our hospital between June 2013 and May 2014. All cases who did not reveal any previous knee-joint injury or osteoarthritis of the knee were allocated to group I. All other cases were included in group II. To estimate the potential risk of AIL injury during the nailing procedure, the distance between the AIL and the theoretical entry point for intramedullary nailing was measured. RESULTS We identified the AIL on the images of nearly all patients (96.5%) in group I. In group II, the presence of the AIL was confirmed in only 51.4% of cases (p < 0.001). The average distance between the AIL and theoretical entry point for intramedullary tibial nailing was 10.1 mm (range 3.48-18.88 mm). CONCLUSIONS Because we were able to confirm the presence of the AIL in nearly all patients without a history of knee joint injuries or osteoarthrosis, we presume that the AIL may play a role in knee joint function. Violation of the AIL during intramedullary nailing appears likely due to the close position of the AIL in relation to the entry point for the inserted nail. As a result and due to its rich sensory innervation, a connection between AIL violation during tibial nailing and postoperative onset of anterior knee pain seems likely. To eliminate one risk factor of anterior knee pain development and in view of the unresolved issues of AIL function, violation of the ligament during any operative procedure should be avoided.
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Affiliation(s)
- Joerg Franke
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany.
| | - Kersten Mueckner
- Department of Radiology Clinic Dr. Hancken, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany
| | - Volker Alt
- Department of Trauma, Hand and Reconstructive Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 6, 35385, Giessen, Germany
| | - Reinhard Schnettler
- Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 6, 35385, Giessen, Germany
| | - Anissa Paulina Franke
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany
| | - Sebastian Griewing
- Justus-Liebig-University Giessen, Rudolf-Buchheim-Strasse 6, 35385, Giessen, Germany
| | - Bernd Hohendorff
- Department of Trauma and Orthopaedic Surgery, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Germany
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25
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Kim YM, Joo YB. Anteromedial Meniscofemoral Ligament of the Anterior Horn of the Medial Meniscus: Clinical, Magnetic Resonance Imaging, and Arthroscopic Features. Arthroscopy 2018; 34:1590-1600. [PMID: 29402584 DOI: 10.1016/j.arthro.2017.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the clinical, arthroscopic, and magnetic resonance imaging (MRI) findings of knees with anomalous insertion of the anterior horn of the medial meniscus (AHMM) into the intercondylar notch via an anteromedial meniscofemoral ligament (AMMFL). METHODS A total of 2,503 arthroscopic knee surgeries performed from July 2003 to October 2016 were reviewed retrospectively to identify knees with an AMMFL. Medical records, arthroscopic photographs, and MRI of identified cases were analyzed. Meniscus width and extrusion were measured on MRI. Fifty patients with a normal meniscus were selected as a control group. RESULTS A total of 13 (0.52%) patients had an AMMFL with insertion at the intercondylar notch. All cases were diagnosed incidentally during arthroscopy. The characteristics of knee pain were related to surgical pathology. Arthroscopic examination revealed the AMMFL as a band-like structure covering the anterior cruciate ligament. In all cases, the AHMM had no bony attachment to the tibia, and increased mobility was observed on probing of the AHMM. The medial meniscus (MM) was significantly larger than the general size in 8 cases (61.5%). Twelve knees (92.3%) had meniscus tears. On MRI, the AMMFL appeared as a low-signal linear structure arising at the AHMM and coursing superiorly along the anterior cruciate ligament. The mean MM width was greater than that in the control group at the mid-body (P = .030), anterior horn (P = .002), and posterior horn (P = .001). CONCLUSIONS All cases of AMMFL were found incidentally during arthroscopic surgery, and the AMMFL was a silent lesion. There was no significant meniscal extrusion, although the AHMM had no bony attachment. This is because the AMMFL may act as an anchor for the AHMM. Therefore, the AMMFL should not always be removed. The MM with an AMMFL tended to be larger than the typical MM and may be related to some degree of hypermobility, which raises the risk of meniscal tears. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Ouko I, Kigera J, Ongeti K, Pulei A. Variations in the attachments of the medial meniscal anterior horn: a descriptive cadaveric study. INTERNATIONAL ORTHOPAEDICS 2018; 42:2343-2347. [PMID: 29453584 DOI: 10.1007/s00264-018-3831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Meniscal tears are common in Kenya, with prevalence rates ranging from 45 to 78% of intracapsular knee pathology. Diagnosis of these injuries relies on the use of both clinical signs and symptoms as well as radiological investigations. In a few instances, radiological detection could be difficult, partly because of variant attachment patterns of the medial meniscal anterior horn. Some of these unusual attachments of the anterior horn of the medial meniscus could even be mistaken for meniscal tears. There is also evidence that these variations differ from population to population. This study, therefore, aimed to determine the variant bony and ligamentous attachments of the medial meniscal anterior horn in a sample Kenyan population. METHODS The study was conducted at the Department of Human Anatomy, University of Nairobi. Thirty-one male and female unpaired medial menisci were obtained from cadaveric specimen. The bony and ligamentous attachments were identified and recorded and photomacrographs taken. RESULTS The bony attachments different from the classical textbook attachment accounted for 54.8% of the medial meniscal anterior horns. The anterior intermeniscal ligament was present in 62.3% while 16.2% showed attachment to the anterior cruciate ligament. Twenty-nine percent (29%) of the medial menisci studied did not have any ligamentous attachments. CONCLUSIONS The bony and ligamentous attachments of the medial meniscal anterior horn are highly variable presenting unique diagnostic and therapeutic challenges. A new classification of ligamentous attachments is thus proposed.
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Affiliation(s)
- Innocent Ouko
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
| | - James Kigera
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Kevin Ongeti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Anne Pulei
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
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27
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Szopinski KT, Adamczyk P. Interposition of the transverse ligament of the knee into a fracture of the tibial plateau: a case report. Skeletal Radiol 2018; 47:1011-1014. [PMID: 29392335 PMCID: PMC5960482 DOI: 10.1007/s00256-018-2883-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/02/2023]
Abstract
Interposition of the transverse ligament of the knee between fragments of an intercondylar eminence fracture was diagnosed using magnetic resonance imaging (MRI) in a 11-year-old boy after a sports injury. The interposition was confirmed and corrected during arthroscopy. We report what we believe to be the first published case of isolated interposition of the transverse ligament in a minimally displaced fracture of the tibial eminence.
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Affiliation(s)
- Kazimierz T. Szopinski
- Gamma Medical Center, Broniewskiego 3, 01-785 Warszawa, Poland ,0000000113287408grid.13339.3bDepartment of Dental and Maxillofacial Radiology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warszawa, Poland
| | - Pawel Adamczyk
- Gamma Medical Center, Broniewskiego 3, 01-785 Warszawa, Poland
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Evaluation of the size and position of the insertion of the anterior medial meniscus root in varus osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:362-367. [PMID: 26740086 DOI: 10.1007/s00167-015-3963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Recent studies have suggested radial displacement of the medial meniscus as a cause of varus knee osteoarthritis (OA). Two anatomical studies reported that such displacement may be associated with anterior insertion of the medial meniscus anterior horn. It was aimed to evaluate the location and area of this insertion in patients with advanced knee OA. METHODS Medial meniscus anterior horn insertions were classified into four types, as described in a previously reported classification during 225 total knee arthroplasty (TKA) in 184 patients. The incidence rates of insertion type were compared with previously reported rates in nearly normal or non-arthritic knees. The insertion surface area was also measured during 158 TKAs. RESULTS Of the 225 knees, 82 (36.4 %), 93 (41.3 %), 35 (15.6 %), and 15 (6.7 %) were classified as I, II, III, and IV, respectively. An anteriorly inserted anterior horn was not more frequent in advanced varus OA knees than in previously reported nearly normal or non-arthritic knees. The insertion surface areas were 57.5 ± 18.9, 56.1 ± 16.0, and 56.4 ± 14.4 mm2 for types I, II, and III, respectively; these areas did not differ significantly. CONCLUSION Since the incidence of an anteriorly inserted medial meniscus anterior horn was not higher in advanced varus OA knees than in normal or non-arthritic knees, an anteriorly inserted anterior horn may have little or no effect on the aetiology of varus OA knees. This study provides some information for clarifying the aetiology of knee OA. LEVEL OF EVIDENCE IV.
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Shimodaira H, Tensho K, Akaoka Y, Takanashi S, Kato H, Saito N. Remnant-Preserving Tibial Tunnel Positioning Using Anatomic Landmarks in Double-Bundle Anterior Cruciate Ligament Reconstruction. Arthroscopy 2016; 32:1822-30. [PMID: 27134191 DOI: 10.1016/j.arthro.2016.01.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 01/17/2016] [Accepted: 01/27/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess (1) if 6 anatomic landmarks (ALs) could be arthroscopically confirmed with remnant preservation and (2) if creating tibial tunnels using these landmarks reduces individual variation and improves reproducibility in double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS We retrospectively reviewed data of patients who chronologically underwent double-bundle ACL reconstruction by either referencing the footprint after remnant dissection (non-AL group) or subsequently with the ALs (AL group). Using operative videos, 3 independent observers judged whether they could confirm 6 ALs (medial intercondylar ridge, medial and lateral intercondylar tubercles, anterior horn of lateral meniscus, Parsons' knob, and L-shaped ridge) in 20 patients randomly selected from the AL group. We then compared tunnel positions between the 2 groups, measured from the anterior and medial borders of the proximal tibia and expressed as percentage of the total depth and width of the proximal tibia using 3-dimensional computed tomography. RESULTS One hundred four patients (non-AL group, n = 54; AL group, n = 50) were included. All 6 ALs were arthroscopically confirmed in most cases (89.7% to 100%). The mean percentages of the anteroposterior (AP) depth for anteromedial (AM) tunnel, mediolateral (ML) width for AM tunnel, AP depth for posterolateral (PL) tunnel, and ML width for PL tunnel, respectively, were 27.8% ± 6.6%, 46.7% ± 2.8%, 41.4% ± 7.3%, and 46.1% ± 2.6% for the non-AL group and 30.7% ± 4.5%, 45.7% ± 2.2%, 45.2% ± 4.5%, and 46.9% ± 2.1% for the AL group, revealing significantly less variation in the AL group compared with the non-AL group, excluding the ML width of the PL tunnel (P = .007, .046, .002, .209, respectively). CONCLUSIONS Six landmarks could be reliably confirmed in cases with remnant preservation, and creating tibial tunnels using these landmarks were reproducible and resulted in less individual variation. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Yusuke Akaoka
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Seiji Takanashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoto Saito
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University School of Medicine, Matsumoto, Japan
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Strauss EJ, Day MS, Ryan M, Jazrawi L. Evaluation, Treatment, and Outcomes of Meniscal Root Tears. JBJS Rev 2016; 4:01874474-201608000-00004. [DOI: 10.2106/jbjs.rvw.15.00082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bolog NV, Andreisek G. Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them. Insights Imaging 2016; 7:385-98. [PMID: 26883139 PMCID: PMC4877346 DOI: 10.1007/s13244-016-0472-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. An accurate interpretation of the knee depends on several factors, starting with technical aspects including radiofrequency coils, imaging protocol and magnetic field strength. The use of dedicated high-resolution orthopaedic coils with a different number of integrated elements is mandatory in order to ensure high homogeneity of the signal and high-resolution images. The clinical imaging protocol of the knee includes different MRI sequences with high-spatial resolution in all orientations: sagittal, coronal, and axial. Usually, the slice thickness is 3 mm or less, even with standard two-dimensional fast spin echo sequences. A common potential reason for pitfalls and errors of interpretation is the unawareness of the normal tibial attachments and capsular attachment of the menisci. Complete description of meniscal tears implies that the radiologist should be aware of the patterns and the complex classification of the lesions. TEACHING POINTS • Technical factors may influence MRI interpretation. • Unawareness of the normal meniscal anatomy may lead to errors of interpretation. • Description of meniscal tears implies the knowledge of meniscal tear classification.
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Affiliation(s)
- Nicolae V Bolog
- Phoenix Swiss Med, Mittelweg 29, 4142, Munchenstein, Switzerland.
| | - Gustav Andreisek
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Watson JN, Wilson KJ, LaPrade CM, Kennedy NI, Campbell KJ, Hutchinson MR, Wijdicks CA, LaPrade RF. Iatrogenic injury of the anterior meniscal root attachments following anterior cruciate ligament reconstruction tunnel reaming. Knee Surg Sports Traumatol Arthrosc 2015; 23:2360-2366. [PMID: 24850241 DOI: 10.1007/s00167-014-3079-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 05/10/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether reaming of anterior cruciate ligament (ACL) reconstruction tibial tunnels with a 10-mm-diameter reamer would result in injury to the anterior roots of the medial and lateral menisci in an in vitro model when using a tibial aiming device at two settings (40° and 60°). METHODS Three-dimensional footprints of the ACL and the anterior roots of the menisci were measured for 12 human cadaveric tibias. Measurements were taken before and after attempted reaming of an ACL tibial reconstruction tunnel in the calculated ACL centre using a tibial aiming device set at two angles (40° and 60°). RESULTS Iatrogenic injury to the anterior root of the medial meniscus caused by overlap with the reamed tibial tunnel was found in 3/6 specimens in Group 1 (40°) and 0/6 specimens in Group 2 (60°). The average area of iatrogenic injury in Group 1 was 9.6 mm(2) (8.6 % of the root). There was iatrogenic injury to the anterior root of the lateral meniscus in 4/6 specimens for both groups. The average area of iatrogenic injury was 20.5 mm(2) (28.8 %) for Group 1 and 16.2 mm(2) (25.9 %) for Group 2. CONCLUSIONS Reaming of ACL tibial reconstruction tunnels carries a risk of iatrogenic injury to the anterior meniscus roots, even when tunnels are reamed based on guide pin placement in the calculated centre of the ACL. Reaming at varying tibial aiming device angle settings can affect the obliquity of the tunnel aperture and cause iatrogenic injury to the anterior meniscal roots. Caution should be exercised clinically to avoid iatrogenic injury to both the anterior meniscal roots while reaming tibial tunnels during ACL reconstructions.
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Affiliation(s)
- Jonathan N Watson
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Katharine J Wilson
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Christopher M LaPrade
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Nicholas I Kennedy
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Kevin J Campbell
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Mark R Hutchinson
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Coen A Wijdicks
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA. .,The Steadman Clinic, Vail, CO, USA.
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Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R. Meniscal Root Tear Repair: Why, When and How? Orthop Rev (Pavia) 2015; 7:5792. [PMID: 26330993 PMCID: PMC4508558 DOI: 10.4081/or.2015.5792] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/02/2015] [Accepted: 03/27/2015] [Indexed: 11/23/2022] Open
Abstract
The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging. In addition, the most common surgical techniques, together with the clinical outcomes, are described.
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Affiliation(s)
| | - Pietro Pellegrino
- Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy
| | - Andrea D'Amelio
- Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy
| | - Umberto Cottino
- Department of Orthopedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin , Italy
| | - Roberto Rossi
- Department of Orthopedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin , Italy
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Ellman MB, James EW, LaPrade CM, LaPrade RF. Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture. Knee Surg Sports Traumatol Arthrosc 2015; 23:1188-91. [PMID: 24643359 DOI: 10.1007/s00167-014-2941-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/09/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED This paper presents the first reported case of iatrogenic injury to the anterior medial meniscal root attachment following intramedullary nailing for a tibial shaft fracture. The patient experienced a closed right tibia-fibula fracture 7 years prior to presentation, which was treated with a reamed intramedullary nail. The nail was removed 3 years after the index surgery due to chronic anterior knee pain, which persisted following hardware removal. At presentation, the patient was diagnosed with an anterior horn medial meniscal root tear likely secondary to insertion of the intramedullary nail through the anatomic footprint of the anterior medial root. After undergoing a medial meniscus anterior horn root repair, the patient was asymptomatic and resumed normal activities. LEVEL OF EVIDENCE Case report, Level IV.
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Alici T, Esenyel CZ, Esenyel M, Imren Y, Ayanoglu S, Cubuk R. Relationship between meniscal tears and tibial slope on the tibial plateau. Eurasian J Med 2015; 43:146-51. [PMID: 25610183 DOI: 10.5152/eajm.2011.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 10/13/2011] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The geometry of the tibial plateau has a direct influence on the translation and the screw home biomechanics of the tibiofemoral joint. Little information on the relationship between the tibial slope and meniscal lesions is available. The objective of this retrospective study was to examine the effect of the tibial slope on the medial and lateral meniscus lesions in patients with intact ACLs. MATERIALS AND METHODS The MRIs and lat roentgenograms of 212 patients with meniscus lesions were examined to determine the possible effect of the tibial slope on meniscal tears. First, the anatomic axis of the proximal tibia was established. Then, the angle between the line drawn to show the tibial slopes (medial and lateral) and the line drawn perpendicular to the proximal tibial anatomic axis was established on MRI. The patients with previously detected meniscus lesions were classified into three categories: patients with only medial meniscal tear (Group 1, 90 patients); patients with only lateral meniscal tear (Group 2, 15 patients); and patients with both medial and lateral meniscal tear (Group 3, 19 patients). Group 4 had no meniscal tear (88 patients). The MRIs of the patients who had applied to the Orthopedic Outpatient Clinic with patellofemoral pain and no meniscal tear were included as the control group. RESULTS The average tibial slope of the medial tibial plateau was 3.18° in group 1, 3.64° in group 2, 3° in group 3, and 3.27° in group 4. The average tibial slope of the lateral tibial plateau was 2.88° in group 1, 3.6° in group 2, 2.68 in group 3, and 2.91 in group 4. The tibial slope on the medial tibial plateau was significantly larger than the lateral tibial plateaus in group 1 and group 4 (p<0.05). In group 2, there was no statistically significant difference between the tibial slopes of the two sides (p>0.05). In addition, the tibial slope on the lateral side of group 2 was significantly larger than that of groups 1, 3, and 4 (p<0.05). CONCLUSION An increase in the tibial slopes, especially on the lateral tibial plateau, seems to increase the risk of meniscal tear.
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Affiliation(s)
- Tugrul Alici
- Department of Orthopedics and Traumatology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - Cem Zeki Esenyel
- Clinic of Orthopedics and Traumatology, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Meltem Esenyel
- Clinic of Physical Therapy and Rehabilitation, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Yunus Imren
- Clinic of Orthopedics and Traumatology, Vakif Gureba Education and Research Hospital, Istanbul, Turkey
| | - Semih Ayanoglu
- Clinic of Orthopedics and Traumatology, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Rahmi Cubuk
- Department of Radiology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
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Feucht MJ, Minzlaff P, Saier T, Lenich A, Imhoff AB, Hinterwimmer S. Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc 2015; 23:146-51. [PMID: 23455390 DOI: 10.1007/s00167-013-2462-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.
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Affiliation(s)
- Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany,
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Śmigielski R, Becker R, Zdanowicz U, Ciszek B. Medial meniscus anatomy-from basic science to treatment. Knee Surg Sports Traumatol Arthrosc 2015; 23:8-14. [PMID: 25536949 DOI: 10.1007/s00167-014-3476-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/06/2014] [Indexed: 11/25/2022]
Abstract
This paper focuses on the anatomical attachment of the medial meniscus. Detailed anatomical dissections have been performed and illustrated. Five zones can be distinguished in regard to the meniscus attachments anatomy: zone 1 (of the anterior root), zone 2 (anteromedial zone), zone 3 (the medial zone), zone 4 (the posterior zone) and the zone 5 (of the posterior root). The understanding of the meniscal anatomy is especially crucial for meniscus repair but also for correct fixation of the anterior and posterior horn of the medial meniscus.
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Affiliation(s)
- Robert Śmigielski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland,
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Abstract
Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments.
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Affiliation(s)
- Sanjeev Bhatia
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Christopher M LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Michael B Ellman
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | - Robert F LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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40
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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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Berhouet J, Marty F, Rosset P, Favard L. Meniscus matching: evaluation of direct anatomical, indirect radiographic, and photographic methods in 10 cadaver knees. Orthop Traumatol Surg Res 2013; 99:291-7. [PMID: 23562647 DOI: 10.1016/j.otsr.2012.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION When performing meniscus transplantation, allograft size must be carefully matched to the host knee anatomy. The radiographic method devised by Pollard et al. is the current reference standard for meniscus size matching. The primary objective of this study was to compare the accuracy of radiographic measurement according to Pollard, direct anatomic measurement, and photographic measurement. HYPOTHESIS Anatomic and photographic allograft size measurement is as reliable as radiographic host-knee sizing according to Pollard et al. MATERIALS AND METHODS Three methods for measuring meniscal width and length based on reliable landmarks were assessed in 10 cadaver knees: direct measurement of anatomic specimens, measurement of photographs, and the radiographic method described by Pollard et al. RESULTS No significant differences were found between the anatomic and radiographic methods, whereas the anatomic and photographic methods produced significantly different results. Compared to the anatomic method, mean overall measurement error was 7.9% for the radiographic method and 24.1% for the photographic method. DISCUSSION The photographic method used in everyday practice during allograft harvesting is not reliable. Correcting for magnification bias might improve the performance of the photographic method. The radiographic method described by Pollard et al. is acceptable, with a margin of error of about 10%, which is considered tolerable. In practice, however, the radiographic method is burdensome to use. CONCLUSION The best measurement method is direct measurement of the specimen during allograft harvesting. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- J Berhouet
- Tours François Rabelais University, Trousseau Teaching Hospital Center, Department of orthopaedics and trauma surgery, 1C, avenue de République, 37170 Chambray-les-Tours, France.
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Abstract
OBJECTIVE The goal of this article is to summarize the literature about the diagnosis of meniscal tears on MRI including the normal appearance of the meniscus and the appearance of the various types of meniscal tears. In addition, I discuss my experience with the causes of errors in the MR diagnosis of meniscal abnormalities and the nuances of meniscal abnormalities that can mimic a meniscal tear. CONCLUSION MRI is a highly accurate imaging method for diagnosing meniscal tears. To avoid errors in diagnosing meniscal tears, those interpreting MR examinations of the knee need to be aware of the attachments of the menisci and the normal variations in meniscal anatomy that may resemble a meniscal tear. In addition, by being aware of the patterns of meniscal tears, it is easier to diagnose the less common tears.
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Proffen BL, McElfresh M, Fleming BC, Murray MM. A comparative anatomical study of the human knee and six animal species. Knee 2012; 19:493-9. [PMID: 21852139 PMCID: PMC3236814 DOI: 10.1016/j.knee.2011.07.005] [Citation(s) in RCA: 259] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/03/2011] [Accepted: 07/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Animal models are an indispensable tool for developing and testing new clinical applications regarding the treatment of acute injuries and chronic diseases of the knee joint. Therefore, the purpose of this study was to compare the anatomy of the intra-articular structures of the human knee to species commonly used in large animal research studies. METHODS Fresh frozen cow (n=4), sheep (n=3), goat (n=4), dog (n=4), pig (n=5), rabbit (n=5), and human (n=4) cadaveric knees were used. Passive range of motion and intra-articular structure sizes of the knees were measured, the structure sizes normalized to the tibial plateau, and compared among the species. RESULTS Statistically significant differences in the range of motion and intra-articular structure sizes were found among all the species. Only the human knee was able to attain full extension. After normalization, only the pig ACL was significantly longer than the human counterpart. The tibial insertion site of the ACL was split by the anterior lateral meniscus attachment in the cow, sheep, and pig knees. The sheep PCL had two distinct tibial insertion sites, while all the other knees had only one. Furthermore, only in human knees, both lateral meniscal attachments were located more centrally than the medial meniscal attachments. CONCLUSIONS/CLINICAL RELEVANCE Despite the relatively preserved dimensions of the cruciate ligaments, menisci, and intercondylar notch amongst human and animals, structural differences in the cruciate ligament attachment sites and morphology of the menisci between humans and animals are important to consider when selecting an animal model.
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Affiliation(s)
- Benedikt L Proffen
- Department of Orthopaedic Surgery, Children's Hospital of Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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Kwon OS, Park MJ, Tjoumakaris FP. Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee. Orthopedics 2011; 34:e772-5. [PMID: 22049962 DOI: 10.3928/01477447-20110922-33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Marginal fractures of the medial tibial plateau have been reported in the literature as a secondary type of Segond fracture. Some reports described this entity in the setting of combined injuries such as root avulsions of the medial meniscus, complete disruption of the posterior cruciate ligament (PCL), partial tear of the anterior cruciate ligament (ACL), and tears of the medial meniscus and medial collateral ligament. It has been postulated that medial marginal fractures are secondary to compression of the medial aspect of the femoral condyle and tibial plateau with a corresponding posterolateral corner injury. However, this mechanism of injury may not always be as straightforward.This article presents a case of an alternate injury pattern in a skeletally immature patient. A 16-year-old boy sustained a varus force and twisting injury to his knee, resulting in radiographic evidence of multiple avulsion fractures of the knee, including a fibular epiphyseal avulsion fracture and medial and lateral Segond fractures. Usually, the avulsion fractures serve as markers for significant ligamentous injuries in adult patients, but our patient had minimal injury to the PCL, ACL, and posterolateral corner. Further physical examination and imaging studies revealed an anterior horn root avulsion, meniscocapsular separation, and anterior cortical rim fracture. A combination of imaging modalities helped us further characterize the injury pattern to devise the optimal surgical plan, especially the fixation of the anterior cortical fracture of the tibia.
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Affiliation(s)
- Oh Soo Kwon
- Department of Orthopedic Surgery, The Catholic University of Korea, South Korea
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Ozcanli H, Keles N, Gocmen-Mas N, Ozenci AM, Aydin AT. Relation of discoid lateral meniscus and cord-like anterior intermeniscal ligament: morphological and clinical study. Surg Radiol Anat 2011; 33:673-8. [PMID: 21404043 DOI: 10.1007/s00276-011-0803-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 03/03/2011] [Indexed: 11/25/2022]
Abstract
Discoid lateral meniscus is a rare disorder and its association with other variations in the knee joint has been reported. The anterior intermeniscal ligament has also been described as connecting the anterior convex margin of the lateral meniscus to the anterior horn of the medial meniscus. In the normal population, it was observed at 53-94%. Although the functional properties of the anterior intermeniscal ligament are not yet clarified, two distinct types of the ligament have been described according to their morphological characteristics as cord-like and membranous types. The purpose of this study was to evaluate any possible association between morphologic types of anterior intermeniscal ligament and discoid lateral meniscus. A retrospective study was designed; 20 discoid lateral menisci were operated using routine arthroscopic examination. Upon arthroscopic examination the thickness of the ligament and associated morphological changes were recorded systematically. The cord-like anterior intermeniscal ligament was an associated structure in 15 of the 20 knees with discoid lateral meniscus (75%). Patients with discoid lateral meniscus apparently have cord-like type anterior intermeniscal ligament, thus we conclude that cord-like type of anterior intermeniscal ligament is a frequent accompanying structure to discoid lateral meniscus and may have a potential stabilizing effect on its anterior stability.
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Affiliation(s)
- Haluk Ozcanli
- Faculty of Medicine, Department of Orthopedics, Akdeniz University, 07070, Antalya, Turkey
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Abstract
Anomalies associated with a discoid medial meniscus have been described. However, the clinical relevance of these anomalies has not been previously reported. Therefore, we report the clinical relevance of some of these anomalies based on our experience with a 21-year-old soldier with a 3-month history of medial right knee pain. Magnetic resonance imaging (MRI) revealed bilateral discoid medial menisci, cupping of the medial tibial plateau, and an abnormal anteroinferior transposition of the anterior horn of the meniscus. Partial meniscectomy was performed in the usual manner and the meniscus reshaped, including its anteromedial corner.
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Affiliation(s)
- Jin Hwan Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
Magnetic resonance imaging has evolved into a highly accurate modality in detecting meniscal injuries and provides the essential anatomic detail to help guide treatment options in this age of meniscal preservation. Accurate interpretation requires a thorough understanding of meniscal anatomy and function, anatomic variants, technical factors, typical appearance of tear patterns on magnetic resonance imaging, associated ligamentous injuries, causes of misdiagnoses, and the importance of correlation with the clinical examination.
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Kale A, Kopuz C, Dikici F, Demir MT, Corumlu U, Ince Y. Anatomic and arthroscopic study of the medial meniscal horns' insertions. Knee Surg Sports Traumatol Arthrosc 2010; 18:754-9. [PMID: 19760397 DOI: 10.1007/s00167-009-0907-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 08/19/2009] [Indexed: 12/01/2022]
Abstract
The insertions of the menisci to the tibia are the most important restraints to extrusion from the knee joint, and are vital for the functional integrity of the menisci. The aim of the present study was to determine variations of tibial insertions of the medial menisci (MM) in newborn cadavers macroscopically and in adults by arthroscopy. Neonatal part of this study was performed on 40 knee joints of 20 Caucasian neonatal cadavers. Adult part was performed on 41 Caucasian adults, whose ages were between 17 and 66 unilaterally by arthroscopy. In neonatal cadavers, according to its insertion, anterior horn of MM was classified in five groups and type 4, in which it was inserted to the transverse ligament, was determined the most frequent one (45%) and posterior horn of MM was classified in three groups and type 3, in which it was inserted to both the posterior intercondylar area of tibia and medial tubercle of intercondylar eminence was determined the most frequent one (50%). In adults, anterior end of MM was most frequently inserted to both anterior intercondylar area of tibia and transverse ligament (76%) and posterior horn of MM was inserted to the posterior intercondylar area of tibia in all of them. This study provides comparative information about insertion of the MM for neonatals and adults, not to evaluate the variants of the insertion of the MM as a tear of the anterior cruciate ligament or a meniscal tear and not to complicate arthroscopy.
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Affiliation(s)
- Aysin Kale
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey.
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