Arthroscopic Partial Medial Meniscectomy Research Articles

Three-dimensional bone morphology is a risk factor for medial postmeniscectomy syndrome: A retrospective cohort study.

The study aims to identify differences in tibiofemoral joint morphology between responders (R group, no pain) to arthroscopic partial medial meniscectomy (APMM) versus medial postmeniscectomy syndrome patients (MPMS group, recurrent pain at 2 years postmeniscectomy) in a clinically neutrally aligned patient population. The second aim was to build a morphology-based predictive algorithm for response to treatment (RTT) in APMM. Two patient groups were identified from a large multicentre database of meniscectomy patients at 2 years of follow-up: the R group included 120 patients with a KOOS pain score > 75, and the MPMS group included 120 patients with a KOOS pain score ≤ 75. Statistical shape models (SSMs) of distal femur, proximal tibia and tibiofemoral joint were used to compare knee morphology. Finally, a predictive model was developed to predict RTT, with the SSM-derived morphologic variables as predictors. No differences were found between the R and MPMS groups for patient age, sex, height, weight or cartilage status. Knees in the MPMS group were significantly smaller, had a wider femoral notch and a smaller medial femoral condyle. A morphology-based predictive model was able to predict MPMS at 2 years follow-up with a sensitivity of 74.9% (95% confidence interval [CI]: 74.4%-75.4%) and a specificity of 81.0% (95% CI: 80.6%-81.5%). A smaller tibiofemoral joint, a wider intercondylar notch and smaller medial femoral condyle were observed shape variations related to medial postmeniscectomy syndrome. These promising results are a first step towards a knee morphology-based clinical decision support tool for meniscus treatment. Case-control study. Level IIIb.

Comparison of Quality of Life in Patients Operated for Knee Surgery via Conventional Method and Arthroscopy: An Original Research.

To assess physical activity and knee function, the two methods of conventional supervised exercise and the arthroscopic partial meniscectomy trailed by exercise were evaluated after a nontraumatic meniscal (medial) tear that was confirmed on magnetic resonance imaging (MRI). One hundred adult subjects were assessed for the current prospective research. The pain in the knee was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale (LKSS), Tegner Activity Scale (TAS), and Visual Analogue Scale (VAS). All the parameters were compared at the start of the study and 2 and 6 months after the intervention. All the data were compared using the analysis of variance (ANOVA) with P < 0.05 considered as significant. According to the outcome scores, exercising by itself did not result in a larger improvement than an arthroscopic partial medial meniscectomy. There was a significant reduction in discomfort, improved function, and satisfaction for subjects in the two groups (P < 0.0001). After six months, 40% of the subjects reported that the activity levels were similar to the incidence of the injury. The quality of life was reported to be comparable in the arthroscopy subjects and the conventional group subjects. Hence, arthroscopy can be delayed for the meniscal tear in the adult subjects who are best managed by the conservatively managed.

Minimally Invasive Polarization Sensitive Optical Coherence Tomography (PS-OCT) for assessing Pre-OA, a pilot study on technical feasibility

ObjectiveEfforts to develop chondroprotective approaches to halt osteoarthritis (OA) progression have recently increased. Current imaging techniques are critical in managing advanced OA, but greater resolution is needed to identify reversible stages (pre-OA). Optical coherence tomography (OCT) is a micron scale imaging technology widely used in ophthalmology, cardiology, and neurology. We previously demonstrated that polarization sensitive OCT (PS-OCT) can identify pre-OA in vitro, in animals, and in open surgical fields. This feasibility study examines performing intraarticular PS-OCT using a flexible endocatheter introduced through a stiff 18-gauge spinal needle. Results are critical for designing larger clinical trials examining minimally invasive PS-OCT's ability to identify pre-OA. DesignFifteen patients undergoing arthroscopic partial medial meniscectomy were selected to confirm their risk for rapid progression to OA. Magnetic resonance imaging (MRI) was obtained at time 0 and at 2.5 years to determine if significant OA developed over this short period and for correlation with time zero PS-OCT results. ResultsOver half of the patients developed frank OA by 2.65 ​± ​0.28 years. All cartilage surfaces were successfully imaged by PS-OCT, but endocatheter redesign is needed. Normal to severely abnormal areas by PS-OCT (all normal by MRI) were successfully identified. PS-OCT assessments were promising for predicting OA progression (p ​< ​0.008). However, the study's low power prevented definite conclusions regarding predictive value. ConclusionsThis pilot study produced at least two outcomes critical for future larger trial designs: medial meniscectomy patients are well-suited for studying PS-OCT's ability to predict future OA and substantial endocatheter redesign is needed.

Ipsilateral chondral lesions worsen the long-term prognosis following arthroscopic partial medial meniscectomy.

The effect of knee cartilage defects that are detected during partial meniscectomy remains controversial in terms of the long-term prognosis on knee function. This study aimed to investigate the effect of concurrent medial compartment focal cartilage lesions on the long-term prognosis of knee function in patients who underwent arthroscopic partial medial meniscectomy for traumatic medial meniscal tears. This retrospective study analyzed 46 patients who underwent arthroscopic partial medial meniscectomy between 1991 and 2008 by a single surgeon. Twenty-one patients who underwent arthroscopic partial medial meniscectomy due to traumatic meniscal tear had focal chondral lesions only at the medial compartment, and these patients were assigned to group A. Twenty-five patients who had no cartilage lesions in any compartments were assigned to group B. The age, sex, body mass index (BMI), follow-up time, age at the time of surgery, clinical and radiological scores, and perioperative arthroscopy findings were analyzed. The mean follow-up time was 20 ± 3.7years. No significant difference was found in the demographic data, and the average age of the patients at the time of operation was 35 ± 9.5years. Both groups had improved Lysholm score at the last follow-up. Although no difference was found between the groups during the preoperative period, group B had a higher Lysholm score at the last follow-up than group A. The mean International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) scores at the last follow-up were significantly higher in group B. The mean Kellgren-Lawrence grades in the operated knees of group A were higher than those of group B. In group A, a negative correlation was found between the BMI and postoperative Lysholm (r = - 0.461, p = 0.03) IKDC (r = - 0.433, p = 0.05) and KOOS (r = - 0.565, p = 0.008) scores. In group B, no correlation was found between BMI and any score. Among patients who underwent arthroscopic partial medial meniscectomy with an average follow-up of 20years, those with concurrent focal cartilage defect in the medial compartment had clinically and radiologically worse outcomes than patients without any cartilage defect. Therefore, orthopedic surgeons should be meticulous before performing any arthroscopic partial medial meniscectomy in case of concurrent cartilage lesion. Level III.

Results of Medial Collateral Ligament percutaneous fenestration versus Arthroscopic release in arthroscopic partial medial meniscectomy

Results of Medial Collateral Ligament percutaneous fenestration versus Arthroscopic release in arthroscopic partial medial meniscectomy

Gene expression in meniscus tears at the time of arthroscopic partial meniscectomy predicts osteoarthritis progression

Objectives:While meniscus tears are associated with an increased risk of developing knee osteoarthritis (OA), it is not possible to predict which patients are at the highest risk for developing OA. Gene signature in meniscus resected at the time of arthroscopic partial meniscectomy may provide insight into an individual’s risk of OA progression. The purpose of this study is to test the hypothesis that gene signatures at the time of arthroscopic partial meniscectomy predict radiographic progression of OA.Methods:Meniscus fragments were collected from 40 patients at the time of clinically indicated isolated arthroscopic partial medial meniscectomy. Gene expression was assessed by quantitative real-time PCR using a panel of 28 candidate genes with known roles in cartilage homeostasis, OA, extracellular-matrix degradation and obesity. Radiographs obtained prior to surgery and at final follow-up were graded by a musculoskeletal radiologist. The association of meniscus gene expression at the time of surgery with progression of radiographic OA was determined.Results:Gene expression in meniscus resected at arthroscopic partial medial meniscectomy and radiographic data at baseline and mean follow-up of 6.2 ± 1.3 years were available for 31 patients (77.5%). The cohort consisted of 45.2% females with a mean age of 48.5 ± 9.2 years and mean body mass index of 28.1 ± 5.1 kg/m2. Gene expression was associated with radiographic progression of OA (Table 1). Patients without OA progression had significantly higher expression of seven genes, namely MMP9 (5.1-fold, P=0.002), IL8 (2.9-fold, P=0.016), CCL3 (3.7-fold, P=0.032), CCL3L1 (4.5-fold, P=0.008), CXCL6 (6.2-fold, P=0.010), LEP (5.2-fold, P=0.004) and RETN (46-fold, P=0.008). Patients with progression showed very low expression of these genes (Figure 1). When segregating patients based on severity of OA progression, there was significantly increased expression of three genes (MMP9, CXCL6, LEP) among patients without any radiographic OA progression. There was an increased expression of CXCL6 (9.5-fold, P=0.042), LEP (4.3-fold, P=0.047) and MMP9 (5.0-fold, P=0.023) among those without any radiographic OA progression compared to those with rapid progression in the medial compartment. There was also an increased expression of MMP9 among patients without progression compared to those with progression in the lateral and/or patellofemoral compartments (7.2-fold, P=0.038).Conclusions:Our findings suggest that gene expression in the meniscus at the time of arthroscopic partial meniscectomy is associated with the risk for OA progression. Elevated expression of the aforementioned genes in non-progressors may reflect a potentially chondroprotective response. Further studies including additional genes, larger cohorts and extended follow-up are warranted to better characterize this association. Ultimately, this line of investigation could facilitate the development of more sensitive methods to determine the risk for OA progression among patients with meniscal injury and approaches to delay or prevent OA in this population.

Effect of exercise on knee joint contact forces in people following medial partial meniscectomy: A secondary analysis of a randomised controlled trial

BackgroundArthroscopic partial meniscectomy may cause knee osteoarthritis, which may be related to altered joint loading. Previous research has failed to demonstrate that exercise can reduce medial compartment knee loads following meniscectomy but has not considered muscular loading in their estimates. Research questionWhat is the effect of exercise compared to no intervention on peak medial tibiofemoral joint contact force during walking using an electromyogram-driven neuromusculoskeletal model, following medial arthroscopic partial meniscectomy? MethodsThis is a secondary analysis of a randomized controlled trial (RCT). 41 participants aged between 30–50 years with medial arthroscopic partial meniscectomy within the past 3–12 months, were randomly allocated to either a 12-week, home-based, physiotherapist-guided exercise program or to no exercise (control group). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired during self-selected normal- and fast-paced walking at baseline and follow-up. An electromyogram-driven neuromusculoskeletal model estimated medial compartment contact forces (body weight). Linear regression models evaluated between-group differences (mean difference (95% CI)). ResultsThere were no significant between-group differences in the change (follow-up minus baseline) in first peak medial contact force during self-selected normal- or fast-paced walking (0.07 (−0.08 to 0.23), P = 0.34 and 0.01 (−0.19 to 0.22), P = 0.89 respectively). No significant between-group difference was found for change in second peak medial contact force during normal- or fast-paced walking (0.09 (−0.09 to 0.28), P = 0.31 and 0.02 (−0.17 to 0.22), P = 0.81 respectively). At the individual level, variability was observed for changes in first (range −26.2% to +31.7%) and second (range −46.5% to +59.9%) peak tibiofemoral contact force. SignificanceThis is the first study to apply electromyogram-driven neuromusculoskeletal modelling to an exercise intervention in a RCT. While our results suggest that a 12-week exercise program does not alter peak medial knee loads after meniscectomy, within-participant variability suggests individual-specific muscle activation patterns that warrant further investigation.

Partial Medial Meniscectomy Using Needle Arthroscopy and a Standardized Local Anesthetic Protocol

Needle arthroscopic procedures of the knee offer potential advantages over standard arthroscopic procedures. The small size of the instruments allows for surgery without the use of a scalpel or suture, potentially decreased recovery times, and potentially reduced complication rates compared with traditional arthroscopy. In some patients, the procedure can be performed without the use of either general anesthesia or sedation. The purpose of this article is to provide a standardized technique guide for needle arthroscopic partial medial meniscectomy under local anesthesia.

Radiographic Prognostic Factors Relevant to Surgical Outcomes of Arthroscopic Partial Medial Meniscectomy in Elderly Patients with Mild Osteoarthritis.

The aim of this study was to investigate radiographic factors relevant to predict surgical outcomes of arthroscopic partial meniscectomy (APM) in elderly patients with mild osteoarthritis (Kellgren-Lawrence grades 1 and 2). Data of 172 consecutive patients aged >70 years who underwent arthroscopic meniscal surgery were reviewed retrospectively. The patients who met the inclusion criteria were classified into two groups based on the minimal clinically important difference value of the Lysholm knee scoring scale comparing the score of the last visit with that of the preoperative period: group 1 (with clinically significant improvement) and group 2 (without clinically important change). Radiographic factors assessed on X-ray and magnetic resonance images were evaluated using bivariate and logistic regression analyses. A total of 73 patients were included in this study. Bivariate analysis revealed that the extent of meniscus extrusion (p = 0.031), meniscus extrusion ratio (p = 0.001), and grade of meniscus degeneration (p = 0.019) were significantly different between the groups. Multivariate logistic regression analysis showed that the meniscus extrusion ratio was the most important independent predictive factor for surgical outcomes with clinically important changes (coefficient = 0.159, p = 0.009). On receiver operating characteristic (ROC) curve analysis, the cutoff point of the meniscus extrusion ratio discriminating the two groups was 34.2% (sensitivity: 79.3%; specificity: 68.6%; accuracy: 72.6%). Meniscus extrusion ratio was the most relevant predictive factor for discriminating patients with clinically important change. Meniscus extrusion ratio, with the cutoff point of 34.2%, could serve as a guide to determine whether to perform APM in elderly patients with mild osteoarthritis. This is a Level IV, therapeutic case series study.

Early tibial subchondral bone texture changes after arthroscopic partial meniscectomy in knees without radiographic OA: A prospective cohort study.

Arthroscopic partial meniscectomy (APM) may lead to changes in underlying trabecular bone (TB) structure potentially promoting the development of knee joint osteoarthritis. Our aim was to investigate if there are early changes occurring in tibial subchondral TB texture in the leg undergoing medial APM compared with the unoperated non-injured contra-lateral leg. The bone texture was measured as the medial-to-lateral ratio of fractal dimensions (FD) calculated for regions selected on weight-bearing anteroposterior tibiofemoral x-rays. Twenty-one subjects before and 12 months after APM were included from 374 patients scheduled for unilateral medial APM. The medial-to-lateral ratio was calculated for horizontal, vertical, and roughest FDs respectively. Higher FD means higher bone roughness. Each FD was calculated over a range of scales using a variance orientation transform method. Mean values of medial-to-lateral horizontal FD calculated for APM knees at follow-up were higher than those at baseline. For unoperated knees the values were lower. The difference in the horizontal FD change from baseline to follow-up between APM and contra-lateral legs was 0.028 (95% CI, 0.004-0.052). The bone roughness changes may reflect the increase in peak knee adduction moment (KAM) and KAM impulse during walking reported for the same cohort in a previous study. They may also reflect early signs of osteoarthritis development and thus, we speculate that individuals with increased bone texture roughness ratio after APM might be at higher risk of knee osteoarthritis development.

There Is No Difference in Radiographic Outcomes After Average 9 Years After Arthroscopic Partial Medial Meniscectomy for Both Posterior Horn Tears and Posterior Horn Root Tears

To compare the serial changes in radiographic outcomes in terms of the mechanical axis (MA) angle and medial joint space width (JSW) between medial meniscus posterior root tear (MM PRT) and non-root tear (MM NRT) after arthroscopic partial meniscectomy (APM). Patients who underwent APM for degenerative MM PRT or MM NRT from January 1999 to July 2012 were retrospectively reviewed. One hundred ten patients each in the MM PRT group and the MM NRT group, who were matched through propensity score matching (adjusting for confounding factors such as age, sex, body mass index, anatomic axis, cartilage state of the medial compartment, and follow-up period), were included in the study. The MA angle on weightbearing whole-leg radiographs and the medial JSW on weightbearing 45° flexion posteroanterior radiographs were measured to evaluate the radiographic outcomes. The serial changes were compared between radiographs taken before surgery, at postoperative 3 to 5years, and at postoperative 5years to the last follow-up. The linear mixed model was used to compare the changes in radiographic outcomes during the follow-up period between groups. The 2 groups were balanced with standardized mean differences of <0.2 after propensity score matching. Both the MM PRT and NRT groups showed increased varus alignment after surgery. However, there was no significant difference in the change in the MA angle during the follow-up period between groups (P= .182). The medial JSW also showed progression of joint space narrowing after surgery in both groups; however, there was no significant difference in the change in medial JSW during the follow-up period between groups (P= .270). The radiographic outcomes after partial meniscectomy in terms of the MA angle and medial JSW show comparable results between degenerative MM PRT and NRT after proper matching of confounding factors. Level III, retrospective comparative study.

Radiographic and Clinical Evidence for Osteoarthritis at Medium-Term Follow-up after Arthroscopic Partial Medial Meniscectomy.

The purpose of this study is to assess if incident radiographic osteoarthritis (OA) is associated with clinical OA symptoms at midterm follow-up after arthroscopic partial medial meniscectomy (APMM). A total of 44 patients (43% females, mean age 50.1 ± 2.8 years, minimum 5.6-year follow-up) with isolated medial meniscal tears and no-to-mild preoperative radiographic OA underwent APMM. Incident radiographic OA was assessed using the modified Kellgren-Lawrence (K-L) classification. Patients completed the Knee Injury and Osteoarthritis Outcomes Score (KOOS), and subscale thresholds for assessment of a symptomatic knee (KOOS OA criteria) and for Patient non-Acceptable Symptom State (PASS-N) following anterior cruciate ligament reconstruction (ACL-R) were calculated. Incident medial compartment OA occurred in 50% of patients. Morbidly obese patients (body mass index ≥35 kg/m2) were more likely to demonstrate incident radiographic OA (100% vs. 41%, P = 0.002). Forty-three percent of patients met KOOS OA criteria, while 77% were PASS-N. Females were more likely to meet KOOS OA criteria (73% vs. 21%, P = 0.009). Patients with incident radiographic OA in any compartment were more likely than those without radiographic OA to meet KOOS OA criteria (71% vs. 17%, P = 0.008). Patients with preoperative K-L grade 2 changes in any compartment were more likely to meet KOOS OA criteria than those without K-L grade 2 changes in any compartment (83% vs. 35%, P = 0.037). Roughly half of APMM patients will have incident radiographic OA within 6 years of APMM, and this risk increases with obesity. Females and patients with incident radiographic OA are more likely to meet clinical thresholds for OA.

Massive complex Baker’s cyst treatment with open excision and arthroscopic partial meniscectomy: a case report

&lt;p class="abstract"&gt;Baker’s cyst is known to be associated with intra articular pathologies such as meniscus tears, chondral lesions, synovitis, synovial plica and cruciate ligament injuries. Complex Baker’s cyst excision alone is known to have high chance of recurrence. Combined treatment strategies that addresses intra-articular pathologies with excision of the cyst and closure of the valve, are thought to reduce chances of recurrence of such cysts. We present a case of massive complex Baker’s cyst treated with arthroscopic partial medial meniscectomy, synovectomy, open cystectomy and closure of the valve.&lt;/p&gt;

Outside-In Deep Medial Collateral Ligament Release During Arthroscopic Medial Meniscus Surgery

Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

Immediate effect of valgus bracing on knee joint moments in meniscectomised patients: An exploratory study.

Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. Within-participant design. Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. The peak knee flexion moment increased during brace condition for forward lunge (mean difference [95% CI]) 0.54 [0.27-0.82] (Nm/(BW×HT)%), p<0.001 and one-leg rise (mean difference 0.45 [95% CI 0.08-0.82] (Nm/(BW×HT)%), p=0.022). No other significant differences were found between conditions in any of the included tasks. A significant effect of the knee brace was detected in terms of an increase in peak knee flexion moment during the more demanding tasks such as forward lunge and one-leg rise. This increase implies enhanced stability of the knee provided by the brace, which may induce increased knee function and knee-related confidence during strenuous tasks. Future research is required to explore the structural implications.

Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: a prospective cohort study

Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg. We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4)kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS). Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38Nm/BM*HT% 95% CI 0.01 to 0.76 (P=0.049) and 0.20 Nm*s/BM*HT% 95% CI 0.10 to 0.30 (P<0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95% CI 14.5 to 31.0 (P<0.01)). A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms.

Early postoperative cartilage evaluation by magnetic resonance imaging using T2 mapping after arthroscopic partial medial meniscectomy

PurposeThis study was performed to quantitatively evaluate postoperative changes in cartilage by T2 mapping after arthroscopic partial medial meniscectomy. Material and MethodsThe study enrolled 17 patients with 20 knees that underwent arthroscopic partial medial meniscectomy. MRI was performed preoperatively and at six months postoperatively, with subjects evaluated by T2 mapping of the central part of the medial condyle of the femur in the sagittal plane. Regions of interest (ROIs) were set at 10 points between the point of intersection of the anatomical axis of the femur and the articular surface of the medial condyle and posterior area approximately 90 degrees to the anatomical axis. Pre- and postoperative T2 values at each ROI were evaluated. ResultsPostoperative T2 values were significantly longer than preoperative values at approximately 20, 30, 40, and 50 degrees to the anatomical axis of the femur. The maximum change between pre- and postoperative T2 values was +6.65% at 30 degrees to the anatomical axis. ConclusionsMechanical stress at positions approximately 20, 30, 40, and 50 degrees relative to the anatomical axis of the femur increased soon after arthroscopic medial meniscectomy. These findings indicate the start of degeneration, via disorganization of collagen arrays, of the articular cartilage and increased water content.

Neuromuscular Exercise post Partial Medial Meniscectomy: Randomized Controlled Trial.

This study aimed to evaluate the effects of a 12-wk, home-based, physiotherapist-guided neuromuscular exercise program on the knee adduction moment (an indicator of mediolateral knee load distribution) in people with a medial arthroscopic partial meniscectomy (APM) within the past 3-12 months. An assessor-blinded, randomized controlled trial including people age 30-50 yr with no to mild pain after medial APM was conducted. Participants were randomly allocated to either a 12-wk neuromuscular exercise program that targeted neutral lower limb alignment or a control group with no exercise. The exercise program included eight individual sessions with one of seven physiotherapists in private clinics, together with home exercises. Primary outcomes were the peak external knee adduction moment during normal-paced walking and during one-leg sit-to-stand. Secondary outcomes included additional measures of knee joint load distribution, patient-reported outcomes, maximal knee and hip muscle strength, and physical function measures. Of 62 randomized participants, 60 (97%) completed the trial. There were no significant between-group differences in the change in peak knee adduction moment during normal-paced walking (mean difference (95% confidence interval), 0.22 (-0.11 to 0.55) N·m/body weight × height %, P =0.19) or during one-leg sit-to-stand (-0.01 (-0.33 to 0.31) N·m/body weight × height %, P = 0.95). There were also no significant between-group differences for any of the secondary outcomes. In patients 3-12 months after a medial APM, a neuromuscular exercise program did not alter the peak knee adduction moment, a key predictor of osteoarthritis structural disease progression. (Australia and New Zealand Clinical Trials Registry, #ACTRN12612000542897.).

Why arthroscopic partial meniscectomy?

"Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear" published in the New England Journal of Medicine on December 26, 2013 draws the conclusion that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. This result argues against the current practice of performing arthroscopic partial meniscectomy (APM) in patients with a degenerative meniscal tear. Since the number of APM performed has been increasing, the information provided by this study should lead to a change in clinical care of patients with a degenerative meniscus tear.

Changes in knee joint loading indices from before to 12 month after arthroscopic partial medial meniscectomy

Changes in knee joint loading indices from before to 12 month after arthroscopic partial medial meniscectomy