Degenerative Meniscal Lesions Research Articles

Arthroscopic Belt Capsulodesis Using a Knotless Soft Suture Anchor for Extruded Medial Meniscus

In recent years, degenerative meniscal lesions have received increasing attention as an etiologic factor of knee osteoarthritis. Among various relevant factors, medial meniscal extrusion has been shown to be an independent predictor of the onset and progression of knee osteoarthritis. Therefore, surgical reduction of the extruded medial meniscus to restore meniscal function is key to preventing osteoarthritis of the knee. The arthroscopic centralization technique using knotless anchors has been developed and refined to reduce meniscal extrusion in the posteromedial region of the knee. Although a short-term study has reported favorable outcomes, the technique presents some pitfalls and can be technically challenging. This article describes the rationale and procedure for arthroscopic belt capsulodesis using 2 knotless anchors for reduction of medial meniscal extrusion. The reported procedure is technically simple and efficiently reduces meniscal extrusion by repairing the meniscotibial capsule, and it may be useful in the prevention of osteoarthritic progression.

Long-term clinical and radiological outcomes after arthroscopic partial meniscectomy on stable knees are better for traumatic tears when compared to degenerative lesions: A systematic review.

An arthroscopic partial meniscectomy (APM) for degenerative meniscus lesions and traumatic meniscus tears are two distinct entities and their long-term outcomes are rarely reported. The aim of this review was to compare the long-term (clinical and radiological) results of APM performed on stable knees for traumatic tears (TT) or degenerative lesions (DL). Pubmed, Scopus and Embase databases were searched to identify relevant studies published between 2010 and 2023 using the keywords 'meniscectomy' OR 'meniscectomies' OR 'meniscal resection'. English-language, Levels I-IV evidence studies reporting either radiographic or clinical outcome measures with a minimum of 6 years' follow-up after APM were included. Studies including discoid meniscus, open meniscectomy, unstable knee and combination with other procedures were excluded. To rate the quality of evidence, the methodological index for non-randomized studies was used. Thirty-two studies were included, with follow-up periods ranging from 6 to 22 years. Eleven studies dealt with TT with a mean age of 31.5 ± 6.6 years and a mean follow-up of 11.6 ± 6.9 years. At the last follow-up, radiographic osteoarthritis (OA) ranged from 36% to 76%, with an average rate of 48 ± 19%; functional scores ranged from 71 to 97, with a mean of 90 ± 4 for the Lysholm score, 86 ± 10 for the International Knee Documentation Committee (IKDC) and 94 ± 16 for the knee injury and osteoarthritis outcome (KOOS). Twenty-one studies dealt with DL with a mean age of 49.9 ± 7.2 years and a mean follow-up of 14.9 ± 6.3 years. At the last follow-up, radiographic OA ranged from 23% to 97%, with an average rate of 77 ± 28%; functional scores ranged from 40 to 87, with a mean of 79 ± 10 for the Lysholm score and 71 ± 16 for the IKDC. Ten-year clinical outcomes of APM are better for TTs when compared to DLs. Rates of OA are difficult to compare but lower for TTs. Level IV.

The Role of Ultrasound in the Diagnosis and Treatment of Meniscal Injuries.

This review evaluates the current understanding of the role of ultrasound in the diagnosis and treatment of meniscal disorders. Ultrasound (US) demonstrates similar sensitivity and specificity when compared to magnetic resonance imaging in the evaluation of meniscal injuries when compared to arthroscopy. Meniscal extrusion (ME) under US can be a reliable metric to evaluate for meniscal root tears in knees with and without osteoarthritis (OA). Sonographic ME is associated with development of OA in knees without OA. US following allograft meniscal transplant may be useful in predicting graft failure. US findings can be used to screen for discoid menisci and may demonstrate snapping of a type 3 discoid lateral meniscus. Shear wave elastography for meniscal injuries is in its infancy; however, increased meniscal stiffness may be seen with meniscal degeneration. Perimeniscal corticosteroid injections may provide short term relief from meniscal symptoms, and intrameniscal platelet-rich plasma injections appear to be safe and effective up to three years. Ultrasound-assisted meniscal surgery may increase the safety of all inside repairs near the lateral root and may assist in assessing meniscal reduction following root repair. Diagnostic US can demonstrate with high accuracy a variety of meniscal pathologies and can be considered a screening tool. Newer technologies such as shear wave elastography may allow us to evaluate characteristics of meniscal tissue that is not possible on conventional imaging. US-guided (USG) treatment of meniscal injuries is possible and may be preferable to surgery for the initial treatment of degenerative meniscal lesions. USG or US-assisted meniscal surgery is in its infancy.

Clinical Outcomes of Exercise Rehabilitation for Degenerative Tibial Meniscal Tears: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This study aims to comprehensively evaluate the effectiveness of exercise rehabilitation therapy for patients with Degenerative Meniscal Lesions of the Tibia (DMLT), providing more effective and safer treatment options for DMLT patients and offering more reliable evidence-based medical recommendations. Adhering to the PRISMA guidelines, this research conducted a literature search through databases such as PubMed, Web of Science, EMBASE, EBSCOhost, and Cochrane, with the search cut-off date being January 2024. Following the PICOS principles, a comprehensive search was conducted. Two researchers independently screened the literature and extracted data. Using R software, effect size analyses were conducted on indicators such as pain, knee joint function, lower limb muscle strength, and physical function in DMLT patients, with the significance level set at P<0.05, aiming to comprehensively assess the impact of exercise therapy on the rehabilitation outcomes for DMLT patients. The study included 12 randomized controlled trials, encompassing 1336 DMLT patients. Based on the quality assessment using the modified Jadad scale, the overall quality of the included studies was determined to be moderate.The meta-analysis showed that exercise therapy significantly reduced pain (WMD=-5.50, P<0.05), improved lower limb muscle strength (SMD=0.05, P<0.05), and enhanced physical function (SMD=0.65, P<0.05). Subgroup analyses revealed that, compared to surgery alone, exercise therapy combined with surgery had a significant effect on improving muscle strength and physical function. Functional training and home-based exercises showed more pronounced effects on specific indicators. The study results indicate that exercise therapy alone has limited effectiveness in improving knee joint function, and combining exercise with surgery does not show a significant advantage (P > 0.05). Additionally, subgroup analysis revealed no significant impact of intervention duration, exercise type, or patient age on functional improvement. Exercise therapy has shown potential in alleviating pain, enhancing lower limb muscle strength, and improving mobility in patients with degenerative meniscal lesions of the tibia (DMLT). Functional training and varied rehabilitation exercises may provide effective pathways for long-term recovery in these patients. This study has been registered in a prospective registry platform with the registration number: CRD42024518643.

A human meniscus explant model for studying early events in osteoarthritis development by proteomics.

Degenerative meniscus lesions have been associated with both osteoarthritis etiology and its progression. We, therefore, sought to establish a human meniscus ex vivo model to study the meniscal response to cytokine treatment using a proteomics approach. Lateral menisci were obtained from five knee-healthy donors. The meniscal body was cut into vertical slicesand further divided into an inner (avascular) and outer region. Explants were either left untreated (controls) or stimulated with cytokines. Medium changes were conducted every 3 days up to Day 21 and liquid chromatography-mass spectrometry was performed at all the time points for the identification and quantification of proteins. Mixed-effect linear regression models were used for statistical analysis to estimate the effect of treatments versus control on protein abundance. Treatment by IL1ß increased release of cytokines such as interleukins, chemokines, and matrix metalloproteinases but a limited catabolic effect in healthy human menisci explants. Further, we observed an increased release of matrix proteins (collagens, integrins, prolargin, tenascin) in response to oncostatin M (OSM) + tumor necrosis factor (TNF) and TNF+interleukin-6 (IL6) + sIL6R treatments, and analysis of semitryptic peptides provided additional evidence of increased catabolic effects in response to these treatments. The induced activation of catabolic processes may play a role in osteoarthritis development.

Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment.

Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.

A HUMAN MENISCAL CATABOLIC IN VITRO MODEL STUDIED BY PROTEOMICS

Purpose: Degenerative meniscus lesions have been associated with both OA etiology and its progression. Thus, the aim was to establish a human meniscus in vitro model to explore the meniscal response to cytokine treatment to mimic early stages of meniscus degradation using a proteomics approach.

Large medial meniscus extrusion and varus are poor prognostic factors of arthroscopic partial meniscectomy for degenerative medial meniscus lesions

BackgroundThe indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this study was to identify predictors of unfavorable clinical and radiologic outcomes after APM for DMMLs and to choose appropriate indications and improve treatment efficacy.MethodsA total of 86 patients with DMMLs undergoing APM were retrospectively reviewed. The mean follow-up time was 32.1 months. Clinical outcomes (including Lysholm score) and radiographic results (including Kellgren-Lawrence grade (K–L grade: 0/1/2/3/4) were evaluated at preoperative and final follow-up. Preoperative prognostic factors, including gender, age, Body Mass Index (BMI), Hip–Knee–Ankle (HKA), Medial Posterior Tibial Slope (MPTS), Medial Meniscus Extrusion (MME), K–L grade, occupational kneeling, and cartilaginous condition (Outerbridge grade ≤ 2, VS ≥ 3), for relatively unfavorable (fair or poor grade) Lysholm and progression of K–L grade, were investigated by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify a cutoff point for the extent of medial meniscal extrusion that was associated with the final Lysholm score.ResultsA significantly improved postoperative Lysholm score (84.5 ± 9.7) compared with the preoperative score (63.8 ± 9.3) (P < 0.001), but a progression of K–L grade (20/36/30/0/0–15/27/25/19/0) (P < 0.001). The adverse prognostic factor of Lysholm score was the advancing age (OR 1.109, P = 0.05) and HKA (OR 0.255, P < 0.001). The adverse prognostic factor of K–L grade progression was MME (OR 10.327, P < 0.001). The cutoff point for the relative value of preoperative medial meniscal extrusion associated with relatively unfavorable Lysholm scores was 2.05 mm (Area = 0.8668, P value < 0.0001, Sensitivity = 62.16%, Specificity = 93.88%).ConclusionsClinically, varus alignment, large MME, and older age were found to predict a poor prognosis after APM for DMMLs. The preoperative extent of MME can be used as a predictive factor for osteoarthritis in APM. Patients with varus and MME should avoid APM. High tibial osteotomy may be an effective treatment strategy.

Degenerative meniscal lesions: Conservative versus surgical management.

Introduction:Degenerative meniscal lesion (DML) typically occur in middle-aged patients without any history of significant acute trauma. Its prevalence increases with age and are associated with knee osteoarthritis (OA). The most frequent orthopedic treatment is arthroscopic partial meniscectomy (APM) to relieve pain and functional deficit associated with DML. The aim of the present narrative review is to focus on the guidelines of DML treatment in middle aged patients.Methods:A review was conducted of PubMed articles from January 1, 2000 to December 31, 2020 using a combination of the following keywords: knee, osteoarthritis, degenerative meniscal lesion, degenerative meniscal tear, and arthroscopic partial meniscectomy.Results:A total of 12 papers were included in the present narrative review. Of these, 3 papers assessed the clinical outcome of patients with DML treated conservatively and 9 papers compared the clinical outcome of patients with DML, with or without mechanical symptoms, treated with APM versus conservative therapy or APM versus sham surgery.Discussion:International guidelines recommend that DML in the presence of knee OA should be managed by conservative therapy rather than APM. Recent studies have demonstrated that even in the absence of radiographic signs of knee OA, with or without mechanical symtoms, there was no advantage of APM over conservative therapy of patients with DML. Moreover, APM offer no further advantage for knee symptoms or function compared with sham surgery. Numerous predictive factors of poor results after APM for DML have been identified in the current literature including age at surgery, female sex, obesity, meniscal extrusion, duration of the clinical symptoms, bone marrow edema, a low pre-operative score, complex meniscal lesions, larger meniscectomy, lateral meniscectomy advanced cartilage injuries and misalignment.Conclusion:Many randomized controlled clinical trials recommend against APM as the first-line treatment for managing knee pain in patients affected by DML and no radiographic knee OA that should be reserved for cases of failure after 3 month conservative therapy or earlier in patients with major knee mechanical symptoms. Nevertheless, surgeons should inform patients that APM in the presence of negative prognostic factors is associated with poor clinical outcome. (www.actabiomedica.it)

Biomechanics of the medial meniscus in the osteoarthritic knee joint.

BackgroundIncreased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus.MethodsThe finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone.ResultsThe maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model.ConclusionsHigher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.

Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study.

Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Prospective case series. Level 4. A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale (P = 0.03) and WOMAC (P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months (P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. This research supports the use of autologous PRP injections for symptomatic DMLs.

Gene expression profiling of primary fibrochondrocyte cultures in traumatic and degenerative meniscus lesions.

This study aimed to investigate how fibroblastic and chondrocytic properties of human meniscal fibrochondrocytes are affected in culture conditions according to the type of meniscal pathology and localization, and to provide basic information for tissue-engineering studies. Primary fibrochondrocyte cultures were prepared from meniscus samples of patients who had either traumatic tear or degeneration due to osteoarthritis. Cultures were compared in terms of mRNA expression levels of COL1A1, COL2A1, COMP1, HIF1A, HIF2A, and SOX9 and secreted total collagen and sulfated sGAG levels according to the type of meniscal pathology, anatomical localization, and the number of subcultures. mRNA expression levels of COL1A1, COMP1, HIF1A, HIF2A, and SOX9 were found to be increased in subsequent subcultures in all specimens. COL1A1 mRNA expression levels of both lateral and medial menisci of patients with traumatic tear were significantly higher than in patients with degenerative pathology, indicating a more fibroblastic character. P1 subculture of lateral and P3 or further subculture of medial meniscus showed more fibroblastic characteristics in patients with degenerative pathology. Furthermore, in patients with degenerative pathology, the subcultures of the lateral meniscus (especially on the inner part) presented more chondrocytic characteristics than did those of medial meniscus. The mRNA expression levels of the cultures showed significant differences according to the anatomical localization and pathology of the meniscus, indicating distinct chondrocytic and fibroblastic features. This fundamental knowledge would help researchers to choose more efficient cell sources for cell-seeding of a meniscus scaffold, and to generate a construct resembling the original meniscus tissue.

Relationship between degenerative medial meniscus lesions and the medial fat tissue thickness of the knee

Relationship between degenerative medial meniscus lesions and the medial fat tissue thickness of the knee

The menisci and articular cartilage: a life-long fascination.

The menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other.Traumatic meniscus tears should be repaired, when possible, to protect the articular cartilage.Traumatic articular cartilage lesions can be treated with success using biological treatment options such as microfracture or microdrilling, autologous chondrocyte transplantation (ACT), or osteochondral transplantation (OCT) depending on the depth and area of the lesion.Degenerative cartilage and meniscus lesions often occur together, and osteoarthritis is already present or impending. Most degenerative meniscus lesions should be treated first conservatively and, after failed conservative treatment, should undergo arthroscopic partial meniscus resection. Degenerative cartilage lesions should also be treated conservatively initially and then surgically; thereby treating the cartilage defect itself and also maintaining the axis of the leg if necessary.Tears of the meniscus roots are devastating injuries to the knee and should be repaired e.g. by transtibial re-fixation.The clinical role of ‘ramp’ lesions of the meniscus is still under investigation.Cite this article: EFORT Open Rev 2020;5:652-662. DOI: 10.1302/2058-5241.5.200016

Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study.

Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient’s Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red–white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red–white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.

Femoral Physeal-Sparing Anterior Cruciate Ligament Reconstruction Using the Iliotibial Band: Over-The-Top Technique

Anterior cruciate ligament injuries are increasingly frequent in skeletally immature patients. However, treatment within this subpopulation remains controversial. Conventional transphyseal reconstruction techniques have been questioned because of potential physeal injuries. Conservative treatment, on the other hand, may lead to degenerative meniscal and chondral lesions. This Technical Note describes the femoral physeal-sparing over-the-top technique using an iliotibial band. It is a safe and effective method for anterior cruciate ligament reconstruction in skeletally immature patients.

Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

IntroductionArthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no...

Chondral lesions at the medial femoral condyle, meniscal degeneration, anterior cruciate ligament insufficiency, and lateral meniscal tears impair the middle-term results after arthroscopic partial meniscectomy.

The aim of the present study was to analyse which clinical, radiological and arthroscopic findings are able to predict the postoperative outcome after arthroscopic partial meniscectomy. Furthermore, the present study aimed to investigate the postoperative outcome after partial meniscectomy in patients with degenerative meniscal lesions. A total of 91 patients with a follow-up period of 34.7 ± 11.4months after arthroscopic partial meniscectomy were included in this retrospective study. Clinical, radiological, and arthroscopic data were analysed at the time of follow-up. The multivariable linear regression analysis for postoperative outcome, based on the Western Ontario Meniscal Evaluation Tool (WOMET), included age, gender, body mass index, physical activity, presence of cartilage lesions, leg alignment, grade of radiographic osteoarthritis, location of meniscal lesions, meniscal extrusion, meniscal degeneration, presence of an anterior cruciate ligament tears as well as bone marrow lesions. WOMET and WOMAC scores showed a significant improvement of 45.0 ± 48.1 points (CI 34.9-55.1; p ≤ 0.0001) and 75.1 ± 69.3 points (CI 60.6-89.6; p = 0.001) within the follow-up period. Multivariable linear regression analysis showed that poor preoperative WOMET scores (p = 0.001), presence of cartilage lesions at the medial femoral condylus (p = 0.001), meniscal degeneration (p = 0.008), the presence of an anterior cruciate ligament lesion (p = 0.005), and lateral meniscal tears (p = 0.039) were associated with worse postoperative outcomes. Patients with femoral bone marrow lesions had better outcome (p = 0.038). Poor preoperative WOMET scores, presence of cartilage lesions at the medial femoral condylus, meniscal degeneration, concomitant anterior cruciate ligament lesions as well as lateral meniscal tears are correlated with worse postoperative outcomes after arthroscopic partial meniscectomy. Patients with femoral bone marrow lesions femoral are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. Despite justified recent restrictions in indication, arthroscopic partial meniscectomy seems to effectively reduce pain and alleviate symptoms in carefully selected patients with degenerative meniscal tears. III.

Identification of Pivotal Genes and Pathways in Osteoarthritic Degenerative Meniscal Lesions via Bioinformatics Analysis of the GSE52042 Dataset.

BackgroundTo better understand the process of osteoarthritic degenerative meniscal lesions (DMLs) formation, this study analyzed the dataset GSE52042 using bioinformatics methods to identify the pivotal genes and pathways related to osteoarthritic DMLs.Material/MethodsThe GSE52042 dataset, comprising diseased meniscus samples and healthier meniscus samples, was downloaded and the differentially-expressed genes (DEGs) were extracted. The reactome pathways assessment and functional analysis were performed using the “ClusterProfiler” package and “ReactomePA” package of Bioconductor. The protein–protein interaction network was constructed, followed by the extraction of hub genes and modules.ResultsA set of 154 common DEGs, including 64 upregulated DEGs and 90 downregulated DEGs, were obtained. GO analysis suggested that the DEGs primarily participated in positive regulation of the mitotic cell cycle and extracellular matrix organization. Reactome pathway analysis showed that the DEGs were predominantly enriched in TP53, which regulates transcription of genes involved in G2 cell cycle arrest and extracellular matrix organization. The top 10 hub genes were TYMS, AURKA, CENPN, NUSAP1, CENPM, TPX2, CDK1, UBE2C, BIRC5, and CCNB1. The genes in the 2 modules were primarily associated with M Phase and keratan sulfate degradation.ConclusionsA series of pivotal genes and reactome pathways were identified elucidate the molecular mechanisms involved in the formation of osteoarthritic DMLs and to discover potential therapeutic targets.

Impact of a national guideline on use of knee arthroscopy: An interrupted time-series analysis.

ObjectiveTo assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DesignInterrupted time series analysis.SettingPublic health care in Skåne region.ParticipantsPatients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015.Intervention(s)National guideline’s recommendation against the use of knee arthroscopy in patients with knee OA.Main Outcome Measure(s)1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years.ResultsA total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period.ConclusionThe national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.