Bucket Handle Research Articles

Characterization of Synovial Cytokine Patterns in Bucket-Handle and Posterior Horn Meniscal Tears.

The specific etiology of meniscal tears, including the mechanism of lesion, location, and orientation, is considered for its contribution to subsequent joint cytokine responsiveness, healing outcomes, and by extension, appropriate lesion-specific surgical remediation. Meniscal repair is desirable to reduce the probability of development of posttraumatic osteoarthritis (PTOA) which is strongly influenced by the coordinate generation of pro- and anti-inflammatory cytokines by the injured cartilage. We now present biochemical data on variation in cytokine levels arising from two particular meniscal tears: bucket-handle (BH) and posterior horn (PH) isolated meniscal tears. We selected these two groups due to the different clinical presentations. We measured the concentrations of TNF-α, IL-1β, IL-6, IL-8, and IL-10 in knee synovial fluid of 45 patients with isolated meniscal lesions (BH tear, n = 12; PH tear, n = 33). TNF-α levels were significantly (p < 0.05) greater in the BH group compared with the PH group, whereas IL-1β levels were significantly greater (p < 0.05) in the PH group compared with the BH group. Both BH and PH groups were consistent in presenting a positive correlation between concentrations of IL-6 and IL-1β. A fundamental difference in IL-10 responsiveness between the two groups was noted; specifically, levels of IL-10 were positively correlated with IL-6 in the BH group, whereas in the PH group, levels of IL-10 were positively correlated with IL-1β. Collectively, our data suggest a possible influence of the meniscal tear pattern to the articular cytokine responsiveness. This differential expression of inflammatory cytokines may influence the risk of developing PTOA in the long term.

Impact of Socioeconomic Status on Concomitant Injuries and Access to Care following Anterior Cruciate Ligament Rupture

Objectives:The primary aim of this study was to further define the impact of socioeconomic factors on the timing of ACL reconstruction. The secondary goal was to determine if these variables were associated with bucket handle tears of the meniscus at the time of surgery.Methods:All patients undergoing ACL reconstruction at our institution from October 2015 through November 2018 were sent a survey to determine socioeconomic variables, income, primary language, and education level. A chart review was then performed for insurance status, dates of injury, first visit with orthopeadics, and surgery, intraoperative pathology, and length of follow-up. Univariate analysis was performed, as well as multivariate regression analysis to select independent predictors of outcome variables. A multiple linear regression model with stepwise backward elimination was used for continuous outcome variables. Multivariate logistic analysis was used for the presence of a bucket handle meniscal tear at the time of surgery.Results:Univariate analysis was utilized to determine how insurance type, language spoken, education level, and family income affected: (1) the time from initial injury to clinic visit, (2) number of repeat injuries, and (3) frequency of bucket-handle meniscal tears (Table 1). Speaking a language other than English was associated with significantly longer times to seeing an orthopedic surgeon, more repeat injuries, and a higher likelihood of bucket-handle meniscal tears. Lower educational level correlated with longer wait times and more bucket-handle meniscal tears. Family income level less than $100,000 per year was also associated with a greater incidence of bucket-handle meniscal tears. Multivariate regression analysis was performed to further assess for independent predictors of outcomes. Patients on Medicaid saw an orthopaedic surgeon 39.4 weeks later than those on private insurance (P=0.012). English speakers saw an orthopaedic surgeon 55.68 weeks earlier than Spanish speakers (P=0.027), and patients with a college degree saw a surgeon 36 weeks earlier than patients without a college degree (P=0.023). Non-English speakers had an increased risk of having a bucket handle tear at the time of surgery (OR=4.62; 95CI%=1.677-21.33). Patients with an annual household income less than $100,000 were more likely to have a bucket handle tear (OR=7.37; 95CI%=1.20-53.39). English speakers had an average of 0.8 less instability episodes before surgery (P<0.001); income greater than $100,000/year had 0.25 less instability episodes before surgery (P=.040).Conclusions:Patients with government insurance and who were non-English-speaking experienced later access to care and later surgery after orthopaedic surgery evaluation. Non-English-speaking patients also experienced higher rates of repeat injury, instability, and bucket handle medial meniscus tears. Patients without a college degree also experienced later access to care. Patients with a household income less than $100,000 per year experienced higher rates of instability and bucket handle medial meniscus tears. Delayed access to orthopaedic care longer than 13 weeks was associated with higher rates of meniscus tears, and after 30 weeks bucket handle meniscus tears were significantly increased. These findings may inform the orthopaedic and broader medical communities of the impact of lower socioeconomic status on patients’ access to care and higher rates of concomitant injuries.

A short term functional outcome of bucket handle medial meniscus tears treated with arthroscopic repair: All-inside technique in a rural tertiary care hospital

Bucket-handle meniscal tears are defined as vertical longitudinal tears of the meniscus with displacement of the torn inner fragment toward the intercondylar notch region. It is most commonly encountered in medial meniscus. Management of bucket handle tears is important to preserve knee function & preserving the meniscus will limit future osteoarthrosis. A series of 20 cases of bucket handle medial meniscus tears were treated by Arthroscopic repair: All-inside technique and were followed up regularly till 6months and evaluated using Lysholm Knee Scoring Scale. Most patients had Excellent score at 6th month follow-up. Our study suggests Arthroscopic repair: All-inside technique is an effective management of medial meniscus bucket handle tears.

Functional outcome of arthroscopic repair of bucket handle and longitudinal medial meniscal tears in a military population by inside out and outside in technique: A prospective observational study.

ObjectiveTo assess if young military personnel who had sustained medial meniscal bucket handle/longitudinal tears could return to full, unrestricted active duty after meniscal repair by outside in/inside out technique. Methods32 medial meniscal longitudinal/bucket handle tears were repaired by inside-out and outside in technique between Jul 01, 2017 and June 30, 2018 and followed up for at least 18 months. ResultsThere were 03 failures of repair. The first 05 patients developed para-meniscal cyst due to irritation of soft tissue by PROLENE® suture hence the suture material was changed to ULTRABRAID® in next 27 patients and there was no occurrence of this complication. The mean IKDC, Lysholm and Tegner scores showed significant improvement till 12 months post op and thereafter there was marginal improvement in these scores. Most patients who had successful outcome at one year were able to carry out preinjury level of activities and join unrestricted active duty. ConclusionWith more than 90% able to re-join active duty, we could demonstrate that inside out/outside in technique is an excellent method of reliably and economically repairing a torn meniscus even for very high demand military personnel.

The Rising Moon sign is specific and sensitive in the diagnosis of bucket handle tears of the medial meniscus.

Bucket handle tears of the meniscus are common and can lead to locking, extension deficit and functional impairment. The diagnosis is determined by a combination of physical examination and imaging, but in some cases the diagnosis may be challenging since specific clinical tests are lacking. The aim of the present study was to assess the value of a new clinical test, the elective pain at the anterior aspect of the joint line (defined as the "Rising Moon sign") in the diagnosis of bucket handle tears of the medial meniscus. Forty patients treated for a bucket handle of the medial meniscus were enrolled as the study group and were compared to a matched group of 40 patients with a posterior horn tear of the medial meniscus and 50 healthy subjects. The following aspects were investigated in the groups: body mass index, extension deficit, pain at the posterior aspect of the joint line (PPJL), at the middle joint line (PMJL), at the anterior join line (PAJL) and at combined hyperflexion of the knee and external rotation of the foot (PHE). Pain at the anterior joint line (PAJL) was defined as the Rising Moon sign. In the bucket handle group the average flexion contracture was 12° (0-30°). The average PPJL was one (0-2), the average PMJL was 1.6 (0-3), PAJL was 2.5 (1-3) and PHE was 1.6 (1-2). In the posterior horn tear group the average flexion contracture was 0.9° (-10 to 5°). The average PPJL was 2.2 (1-3), the average PMJL was 1.4 (0-3), PAJL was 0.6 (0-2) and PHE was 2.5 (1-3). The rising moon showed 95% sensitivity and 98% specificity in the diagnosis of bucket handle tears. In addition it showed a positive predictive value of 97.4% and negative predictive value of 96%. Finally it also demonstrated high inter-observer reliability (0.905). The "Rising Moon" sign has shown to be highly predictive for bucket handle tears of the medial meniscus with very high specificity and sensitivity. In addition it is easy to perform with very high inter-observer reliability. Level IV.

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

Comparison of Accuracy in Expert Clinical Examination versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear

Background Many clinical tests and diagnostic studies have been developed to increase the clinician's ability to accurately diagnose disorders of the knee. Torn menisci or ligamentous structures within the knee cause significant pain and disability and thus require expeditious management. This study was conducted to evaluate the accuracy of clinical examination in comparison with MRI examination and with the help of arthroscopic examination as the gold standard in the diagnosis of meniscal tears. Method All of the arthroscopic surgery candidates, presenting symptoms of meniscal or cruciate ligament lesions, referring to Namazi and Chamran hospitals, Shiraz, Iran, were included in this study. Clinical examination (including McMurray test, Apley test, and 20 Thessaly test) was performed before the arthroscopy, and the results were recorded in special forms. Magnetic resonance imaging (MRI) results were also added. Then, arthroscopy was performed, declaring the definite diagnosis, and the results were compared to the results obtained from both tests and MRI. Statistical analysis was performed using SPSS software. Results 86 patients with a mean age of 27 years old, including 63 (73%) male and 23 (27%) female, were studied. 57 (66%), 19 (22%), and 10 (12%) injuries were caused by sports, twisting, or trauma, respectively. Arthroscopic results showed 32 meniscal tears, of which 28 (87%) and 4 (13%) were in medial and lateral menisci, respectively, including 10 bucket handle, 17 longitudinal, and 5 of other types (transverse, oblique, radial) of injuries. Comparing MRI results to arthroscopic results, we had 2 false-positive and 2 false-negative cases. 62 cases of McMurray test results were accurate; 15 and 9 cases were reported false positive and false negative, respectively. 60 cases of Apley test results were accurate; 16 and 10 cases were reported false positive and false negative, respectively. 78 cases of Thessaly test results were accurate; 5 and 3 cases were reported false positive and false negative, respectively. Comparing Thessaly test results to McMurray and Apley showed statistical significance (P < 0.05). Comparing Thessaly test results to MRI showed no statistical significance (P = 0.151), while comparing McMurray and Apley test results to MRI showed statistical significance (P < 0.01). Conclusion Clinical examination, performed by an experienced examiner, can have equal or even more diagnostic accuracy compared to MRI to evaluate meniscal lesions. In this study, the Thessaly test has been approved as a reliable clinical test in the diagnosis of meniscal tears.

Evaluation of functional outcome of bucket handle medial meniscus repair along with anterior cruciate ligament reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Bucket-handle meniscus tears (BHMT) are often displaced and unstable and comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. The aim of present prospective longitudinal cohort study was to evaluate the functional outcomes of bucket handle medial meniscus repair along with anterior cruciate ligament (ACL) reconstruction at 2 years follow up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between January 2017 to December 2018, 30 patients who underwent ACL reconstruction along with bucket handle medial meniscus repair were included in the study. Meniscus repair was done using the all inside, outside in, inside out or hybrid techniques. All patients were evaluated clinically at pre op and at 2 year follow up using knee injury and osteoarthritis outcome score and compared. Meniscal healing was assessed clinically using Barrett’s criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study comprised 30 patients with a mean age of 27.47 years (range from 13 to 49 years) with 66.67% males. According to clinical examination and Barrett criteria’s the clinical failure rate was 6.67% (2 out of 30 patients) who underwent partial menisectomy later. We also compared functional outcomes of sedentary and active peoplesand also between meniscal repair of less than 3 cm and more than 3 cm’s. There was no statistically significant difference in the functional outcomes in both the groups; however range of motion was significantly higher in tear length 3 cm or less compared to more than 3 cm.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Meniscal repair should be aggressively considered in young pa­tients to enhance functional recovery and durability of the knee joint, if the meniscus is reparable.&lt;/p&gt;

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions

ObjectivesTo examine the ability of surgeons to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy (APM) and exercise therapy in middle-aged patients.Design and settingElectronic survey. Orthopaedic...

Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0\xa0T MRI

ObjectiveTo identify abnormalities in asymptomatic sedentary individuals using 3.0 Tesla high-resolution MRI.Materials and methodsThe cohort comprised of 230 knees of 115 uninjured sedentary adults (51 males, 64 females; median age: 44 years). All participants had bilateral knee 3.0 T MRIs. Two senior musculoskeletal radiologists graded all intraarticular knee structures using validated scoring systems. Participants completed Knee Injury and Osteoarthritis Outcome Score questionnaires at the time of the MRI scan.ResultsMRI showed abnormalities in the majority (97%) of knees. Thirty percent knees had meniscal tears: horizontal (23%), complex (3%), vertical (2%), radial (2%) and bucket handle (1%). Cartilage and bone marrow abnormalities were prevalent at the patellofemoral joint (57% knees and 48% knees, respectively). Moderate and severe cartilage lesions were common, in 19% and 31% knees, respectively, while moderate and severe bone marrow oedema in 19% and 31% knees, respectively. Moderate-intensity lesion in tendons was found in 21% knees and high-grade tendonitis in 6% knees—the patellar (11% and 2%, respectively) and quadriceps (7% and 2%, respectively) tendons being most affected. Three percent partial ligamentous ruptures were found, especially of the anterior cruciate ligament (2%).ConclusionNearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings. Bucket handle and complex meniscal tears were reported for the first time in asymptomatic knees.

CT diagnosis of bucket handle meniscus tear

Bucket handle meniscus tears are difficult to diagnosis and are one of the most frequently missed tear patterns on magnetic resonance imaging (MR). However, this meniscal injury often requires arthroscopic intervention and preoperative characterization of the tear is important to orthopedic surgeons for treatment planning. MR is currently the best imaging modality for evaluating meniscal tears, but trauma patients in the emergency room more often undergo radiographs and further evaluation with computed tomography (CT) exams. To date, there is one study from 1988 that reported the value of CT in diagnosing bucket handle meniscus tears. We present an informative case of bucket handle meniscus tear after acute traumatic knee injury that was diagnosed on CT and later confirmed on arthroscopy.

Establishing signs for acute and healing phases of distal tibial classic metaphyseal lesions.

Stages of healing for classic metaphyseal lesions (CMLs) are not well established. Follow-up skeletal surveys provide an opportunity to evaluate signs of healing CMLs. To evaluate the sequence of CML healing phases by comparing initial and follow-up skeletal surveys in children with distal tibial CMLs on the initial survey. Findings could assist in child abuse investigations. We identified all distal tibia CMLs with initial and follow-up skeletal surveys performed January 2009 through December 2018 at our institution. Two pediatric radiologists reviewed the surveys using Likert score from 1 (no CML) to 5 (definite CML). Only cases with score of 4 or 5 by both radiologists were selected for the study. The initial and 2-week follow-up skeletal surveys were reviewed in consensus for presence of the following signs: corner fracture, thin bucket handle fracture, thick bucket handle fracture, bucket handle fracture with endochondral bone filling the gap, subphyseal lucency, deformed corner, and subperiosteal new bone formation. We used the Kruskal-Wallis test to evaluate for significant difference in thickness among thin bucket handle fracture, thick bucket handle fracture, and bucket handle fracture with endochondral bone filling the gap. We included 26 children (12 girls) with age range 1-9.9months who had a combined 34 distal tibia CMLs. Thin bucket handle fracture (n=13, 38.2%) was only seen on initial survey. On follow-up, six children had thick bucket handle fracture and four had bucket handle fracture with endochondral bone filling the gap. Fourteen thick bucket handle fractures (n=9) or bucket handle fractures with endochondral bone filling the gap (n=5) were noted on initial surveys; on follow-up, three (21.4%) had deformed corner, one (7.1%) had corner fracture, one (7.1%) had subphyseal lucency, and five (35.7%) were normal. None demonstrated thin bucket handle fracture on follow-up. Two of the nine (22.2%) thick bucket handle fractures became thicker, and 3/9 (33.3%) became bucket handle fractures with endochondral bone filling the gap. The metaphysis normalized in 8/34 (23.5%) CMLs on follow-up surveys. The thickness of thin bucket handle fracture was less than 1mm (mean±standard deviation [SD] = 0.6±0.2mm), which was significantly thinner (P<0.0001) compared with thick bucket handle fracture (1.7±0.5mm) and bucket handle fracture with endochondral bone filling the gap (1.9±0.6mm). The lack of thin bucket handle fractures on any follow-up skeletal surveys suggests this sign represents an acute phase of injury. The next phases of healing appear to be thick bucket handle fracture followed by bucket handle fracture with endochondral bone filling the gap. It is important to note that normalization of the metaphysis at 2-week follow-up does not exclude CML because this was seen in about one-fifth of cases.

Widening is a predictive factor of bucket handle tear in tibial plateau fractures.

It is well known that tibial plateau fractures have an association with soft tissue injuries. However, as far as the authors are aware, there has been no literature specifically on the incidence of bucket handle meniscal tears in patients with tibial plateau fractures. Bucket handle tears are often symptomatic and amenable to repair if detected early. Our objective was therefore to determine the incidence of bucket handle tears specifically in tibial plateau fractures and identify radiographic features which are suggestive of bucket handle tears. Data for 88 consecutive patients with tibial plateau fractures in a major trauma centre over a two-year period were analysed. Clinical records were reviewed to identify injuries with an associated bucket handle tear. Pre-operative computerised tomography was reviewed. Monovariant and multivariant analyses were conducted to identify radiographic predictive features. The results showed a 20% incidence of soft tissue injuries in concurrence with the existing literature. In addition, there was found to be a 10% incidence of meniscal bucket handle tears. Articular widening of > 8mm was found to be a unique significant predictor of bucket handle tears. It is essential to bear in mind the association with soft tissue injuries in tibial plateau fractures and the incidence of bucket handle tears in particular. The radiographic feature of articular widening should alert the clinician to the possibility of this injury. This will enable appropriate investigations and surgical planning to be carried out in order to improve patient management and outcomes.

Added value of thin axial MR cuts in the diagnosis of several meniscal tears: how far are they reliable?

BackgroundThe purpose of the study is to assess the added value of thin-cut (1 mm) axial magnetic resonance (MR) fat-saturated proton density (FS PD) weighted images (WIs) in the diagnosis of different types of meniscal tears. The study was conducted between January 2016 and August 2017 at a major private center group. This study included 28 patients with clinical suspicion of meniscal tear of age between 30 and 48 years including 19 males and 9 females. Axial 1-mm FS PD WIs were performed in addition to the conventional MR sequences. The type and classification of the meniscal tear were then diagnosed by a group of highly experienced musculoskeletal radiologists. The group assessed the morphology and classification of tears. The diagnosis was then confirmed by arthroscopy as a gold-standard reference.ResultsMeniscal tears were found in 23 out of 28 patients. Twenty-seven meniscal tears were found in the 23 patients: 2 root attachment radial tears (6.9%), 8 radial tears (27.6%), 7 longitudinal [vertical] tears (24%), 3 horizontal tears (10%), 5 displaced bucket handle tears (17%), 1 case of flab tear (3.4%), 1 case of meniscal fraying (3.4%), and 2 lesions which were diagnosed as artifacts and confirmed negative for tears by arthroscopy (6.8%). Diagnostic performance was as follows: sensitivity 96.3%, positive predictive value 100%, accuracy 96.6%, prevalence 93%, specificity 100%, and negative predictive value 66.67%.ConclusionThe study declared high diagnostic performance of thin-cut fat-saturated PD WIs in the diagnosis of different types of meniscal tears regarding their classifications and morphology which is crucial for further management.

Classic Metaphyseal Lesions and Abuse

Research Article| September 01 2019 Classic Metaphyseal Lesions and Abuse AAP Grand Rounds (2019) 42 (3): 28. https://doi.org/10.1542/gr.42-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Classic Metaphyseal Lesions and Abuse. AAP Grand Rounds September 2019; 42 (3): 28. https://doi.org/10.1542/gr.42-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: abuse, physical, fractures, perpetrator of child and adult abuse, torsion, traction, shoulder region, musculoskeletal torsion, function Source: Adamsbaum C, De Boissieu P, Teglas JP, et al. Classic metaphyseal lesions among victims of abuse. J Pediatr. 2019; 209: 154.e2– 159.e2; doi: https://doi.org/10.1016/j.jpeds.2019.02.013Google Scholar Investigators from multiple institutions in France conducted a retrospective review to better understand the circumstances of injuries in physically abused infants with classic metaphyseal lesion (CML), which is a fracture through immature metaphyseal bone near the growth plate. CML is thought to be caused by torsion or traction and is considered to be highly suggestive of abuse.1 Children included in the study were identified through review of cases of suspected abuse referred by the court system in France for expert medical evaluation. Only children with CML were included; all study participants who were living were examined by one of the authors. Data from medical records, abuse evaluation, police investigations, and court records were abstracted for study participants. Logistic regression was used to assess the association between anatomical location of CML and the presence of subdural hematoma (SDH). The mechanism of injury causing CML was described among a subset of study participants in whom the perpetrator admitted abusing the child. A total of 67 children with CML from physical abuse were identified. The mean age of victims was 3.4 months with no sex predominance; 8 children were born prematurely (gestational age <37 weeks). In addition to CML, all children had other signs of abuse. Concurrent injuries included unusual bruising (30 children) and burns (4 children). CML was identified on routine skeletal surveys in 43 patients (64%). Overall, 44 children had multiple CMLs. CML was more common in lower than upper extremities. There were 27 children with CML in whom the perpetrator admitted abusing the child. Among these were 19 male perpetrators (18 fathers and 1 stepfather) and 8 female perpetrators (3 mothers and 5 nannies). These perpetrators admitted using excessive force on joints by means of torsion, traction, violent compression, and other forced movements. Among male perpetrators, violent handling was described during diapering in 44% of cases, and among all perpetrators the use of excessive force during dressing or undressing the infant occurred in 30% of cases. Perpetrators of both sexes cited crying or feeding as trigger events. There were 24 children with SDH. Compared to CML at other anatomic sites, CML of the shoulder was associated with an increased risk of concurrent SDH (OR, 4.85; 95% CI, 1.16–20.18). The authors conclude that CMLs are caused by violent acts inflicted during routine care of infants. Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Caffey first described the radiological pattern of metaphyseal injury in abused infants.2 Although no specific fracture type is pathognomonic for physical abuse,3 CML, also known as “corner” or “bucket handle” fracture, is considered a strong indicator of inflicted injury in infants.4 However, iatrogenic causes of CMLs have been documented, including... You do not currently have access to this content.

The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI.

The ring-shaped meniscus (RSM) is a rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns of the meniscus, thus forming a complete ring. The lateral meniscus is more commonly involved than the medial meniscus. Distinguishing an RSM from a bucket handle tear (BHT) with a displaced fragment in the intercondylar notch is challenging and there are reports of negative arthroscopies for suspected BHTs. There are many reports of symptomatic and asymptomatic lateral RSMs diagnosed on MRI in the literature. We report a series of RSMs in six patients, which includes MRI descriptions of two cases of medial RSM and a case of bilateral lateral RSM, which were diagnosed on MRI and have never previously been reported. This study will also describe the various imaging features of a RSM that distinguish it from a displaced BHT. We will also discuss associated rare malformations encountered in our study, such as hypoplastic anterior cruciate ligament and the anomalous insertion of the popliteus tendon onto the posterior horn of a lateral RSM.

Meniscal click in cranial cruciate deficient stifles as a predictor of specific meniscal pathology.

To determine the predictive value of meniscal click for specific meniscal tear morphology. Prospective cohort. Client-owned dogs (104) with cranial cruciate ligament (CCL) deficiency treated with stifle arthroscopy (111). All stifles underwent a standardized examination for meniscal click before anesthesia (EBA) and during anesthesia (EDA). Presence or absence of a medial meniscal tear and diagnosis of tear morphology were confirmed with arthroscopic examination. Complete CCL tears were noted in 93 dogs, and incompetent partial tears were noted in 18 dogs. Medial meniscal tears were noted in 40.5% (55/111) of dogs, including bucket handle tears (BHT) in 65.6% (36/55) of tears. Frays of the lateral meniscus were noted in 6.3% of dogs (7/111). Examination for meniscal click before anesthesia was 38% sensitive and 94.5% specific, and EDA was 38% sensitive and 98.2% specific for all meniscal tear morphologies. Positive meniscal click at EBA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .3515, respectively). Positive meniscal click at EDA was associated with a meniscal BHT but not with a meniscal non-BHT (P < .0001 and P = .1909, respectively). A meniscal click is more commonly associated with a meniscal BHT than with a non-BHT. Meniscal tear morphology influences the presence or absence of meniscal click. Because of the high incidence of meniscal disease, this study provides evidence to support joint exploration in the treatment of CCL disease.

Cost effective method of arthroscopic inside out meniscus repair

The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. It is the orthopaedic surgeon’s responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. We present you series of 10 cases of repair of bucket handle tear of meniscus with indigenous inside out technique using Urology needle instead of conventional meniscus repair set and prolene 2-0.

Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. One of the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which is a frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the menisci from human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was to compare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscus of dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods &amp; Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. The ultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. In the joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively three and four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the two techniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscal tears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absence of meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicity and echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated by ultrasound were the presence of effusion and synovial membrane thickening.Discussion: The complete and almost complete CrCLR are diagnosed by clinical examination through the evaluation of instability of the stifle joint, which is not possible in partial CrCLR in stable joints. In this study of the five evaluated stable joints, the ultrasound correctly identified the partial CrCLR in three joints and the ligament integrity in one of the joints when compared to arthrotomy. In animals with stifle joint instability the meniscus assessment is fundamental as it is one of the main causes of persistent lameness in dogs subjected to conservative or surgical treatment. Ultrasonography cannot differentiate the types of meniscal tears but identified approximately 1.8 times more medial meniscus tears compared to arthrotomy. Despite the bucket handle being the most common tear of medial meniscus in dogs with CrCLR, four of the six meniscal tears identified by arthrotomy were folded caudal horn. This lesion causes cranial displacement of the caudal horn which may have facilitated its identification by minimally invasive arthrotomy, being the probable reason for its high incidence in this study. Echogenicity and echotexture changes without affecting the meniscus morphology were related with intrasubstance degeneration described in human medicine. Ultrasonography is not the better technique to assess the CrCL but can assist in identifying partial ruptures. Because it has results similar to magnetic resonance imaging, ultrasonography is an important tool in the diagnosis of meniscus tears.

Outcomes of Meniscus Repair in Children and Adolescents.

The purpose of this study was to review the clinical and functional outcomes of meniscus repair in children and adolescents. The sequel of meniscal tears and the outcome of meniscus repair have been well studied in adults. However, these topics have received less attention in the pediatric population despite the high prevalence and potentially critical effect on long-term knee function in children. Meniscus repair has a healing rate ranging from 33 to 100% with less than 40% reoperation rate. Several factors have been suggested to play a role in healing, such as concomitant ACL reconstruction and complexity of the tear. There is a lack of standardization among the utilization of functional outcome and activity level questionnaires across studies; however, most report improved function postoperatively. Other important considerations include bucket handle tears, the discoid meniscus, rehabilitation and return to sports, and alternatives after failed meniscus repair. Based on the favorable outcomes reported, meniscus repair should be attempted in most meniscus tears in children.