Knee Dysfunction Research Articles

Establishing a framework for the design and fabrication of patient-specific scaffolds targeting partial meniscal defects

Meniscal injuries are a leading cause of knee dysfunction and are commonly treated with partial meniscectomy, which often leads to altered joint biomechanics and early-onset osteoarthritis. Current meniscal implants and scaffolds fail to address patient-specific anatomical variations, particularly for partial defects, limiting their clinical effectiveness. This pioneering study introduces the first methodology specifically designed to develop patient-specific scaffolds tailored to partial meniscal injuries, representing a groundbreaking advancement in the field. Using medical imaging and computer-aided design, precise 3D models of injured and intact menisci were created, leveraging the contralateral meniscus as a reference. Scaffolds were fabricated through extrusion-based 3D printing, enabling accurate replication of the defect geometry. Ex vivo analyses demonstrated the scaffolds’ adaptability to diverse defect types and their morphological fidelity to the native tissue. Quantitative assessments revealed minimal deviations, underscoring the precision of the proposed method. This innovative methodology provides a robust framework for developing anatomically precise scaffolds, paving the way for personalized regenerative strategies. Beyond its current application, it holds potential for creating cell-laden scaffolds, acellular implants, or permanent prosthetic devices, addressing critical challenges in meniscal repair and advancing patient-specific tissue engineering.

Progress of Research on Rehabilitation Treatments for Specific Symptoms of Knee Osteoarthritis

Knee osteoarthritis (KOA) is a common chronic degenerative bone and joint disease characterized by knee degeneration, pain, stiffness and knee dysfunction. The global prevalence of KOA has been gradually increasing with the aging of society and changes in lifestyle, rising by nearly 50% in the last 30 years, causing a heavy health and economic burden to patients, families and society. KOA cannot be completely cured at present, and all relevant guidelines recommend non-surgical and non-pharmacological treatments, mainly rehabilitation, as the preferred basic treatment for KOA. This paper adopts the literature search method to systematically analyse the relevant literature in the past 5 years, and review the rehabilitation methods for treating specific symptoms caused by KOA and the existing benefits and limitations of each therapy from various aspects, such as physiotherapy, occupational therapy, traditional Chinese medicine rehabilitation and emerging therapies, with a view to providing more valuable reference information for clinical rehabilitation and researchers, and to promote further development and application of rehabilitation methods for KOA.

Patellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings.

Patellar pathologies are a common cause of knee dysfunction, with Patellofemoral Pain Syndrome (PFPS) alone responsible for 25% of knee-related visits to sports medicine clinics. Non-traumatic conditions, while often overlooked, can also lead to significant discomfort and functional limitations, highlighting the importance of accurate and timely diagnosis for effective management and prevention of complications. This pictorial review examines the radiologic characteristics of various non-traumatic patellar disorders, focusing on imaging modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Key diagnostic markers, including patellar tilt, tibial tuberosity-trochlear groove distance (TT-TG), and congruence angle (CA), are discussed for their significance in non-traumatic pathology identification. Furthermore, this review highlights specific radiologic features for a range of non-traumatic patellar conditions, including patellar tendinopathy, chondromalacia patellae, and trochlear dysplasia, emphasizing how distinct radiologic findings facilitate precise diagnosis and clinical assessment. Ultimately, it provides a practical guide for clinicians in diagnosing non-traumatic patellar pathologies through a comprehensive review of key radiologic features while also discussing advancements in imaging technologies and management strategies to support accurate diagnosis and effective clinical decision-making.

Design and development of knee rehabilitation robot

This research presents a comprehensive design and analysis of a knee rehabilitation platform aimed at aiding individuals with knee dysfunction. Dysfunction in the knee joint can lead to an imbalance in gait and posture during activities of daily living (ADLs) such as standing, walking, and running. This study focuses on developing a 2-degree-of-freedom (2-DoF) knee rehabilitation device capable of mimicking linear and angular movements. A slider mechanism-based knee rehabilitation device is developed and simulated alongside various other mechanisms. The proposed mechanism achieves 32.5° of flexion for a linear movement of 0.45 m within 6 seconds, outperforming other mechanisms. To validate simulation results, a 3D-printed model is fabricated, and experimental studies are conducted under no-load conditions, showing close alignment with simulation outcomes with a deviation of ±5%. The device’s key features include portability, compliance, compactness, and enhanced stiffness. Future research will involve conducting pilot studies to further evaluate the practical efficacy and potential enhancements of the proposed knee rehabilitation platform.

Comparison of the effects between arthroscopic transtibial pullout technique and all-inside repair in the treatment of medial meniscus posterior root tears.

Medial meniscus posterior root tears (MMPRTs) significantly contribute to knee dysfunction, leading to abnormal biomechanics and accelerated cartilage degeneration. Arthroscopic transtibial pullout and all-inside repair are two commonly used techniques for treating MMPRTs, each with unique advantages and limitations. To compare the clinical and functional outcomes of the transtibial pullout and all-inside repair techniques in the treatment of MMPRTs, with a focus on postoperative recovery, knee function, and complications. 40 patients with MMPRTs were randomized to undergo either the transtibial pullout or all-inside repair technique. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and active range of motion (AROM) of knee flexion, both before and after surgery. Data on operative time, time to ambulation, hospital stay duration, and complications were also collected. Both surgical groups showed significant improvements in clinical outcomes postoperatively (p<0.001). The transtibial group exhibited greater functional recovery, with IKDC, Tegner, and Lysholm scores improving by approximately 60%, 110%, and 68%, respectively, compared to the all-inside group. However, complications were more frequent in the transtibial group, including three cases of wound healing issues and one infection, while the all-inside group had one case of deep vein thrombosis. No re-tears were observed in either group during follow-up. Both the transtibial pullout and all-inside repair techniques effectively restore knee function in patients with MMPRTs. While the transtibial pullout provides better functional outcomes, it is associated with a higher complication rate. The choice of surgical approach should consider patient-specific factors, including tear characteristics and overall health, to optimize results.

Associations between folate intake and knee pain, inflammation mediators and comorbid conditions in patients with symptomatic knee osteoarthritis

BackgroundTo investigate the associations between folate intake and changes in knee pain, inflammation mediators and comorbid conditions over 2 years in patients with symptomatic knee osteoarthritis (OA).MethodsA post-hoc analysis was performed based on data from the VIDEO study, a multicenter, randomized, double-blind, placebo-controlled clinical trial aimed at assessing the impact of vitamin D supplementation on patients with knee OA who were also vitamin D deficient. The original trial’s design and inclusion and exclusion criteria were integrated into this subsequent post-hoc analysis. The average daily folate intake was evaluated using the Dietary Questionnaire for Epidemiological Studies version 2 over two years. The progression of knee symptoms was monitored at the baseline and then at months 3, 6, 12, and 24, utilizing the Western Ontario and McMaster Universities Index alongside a 100-mm visual analog scale. Levels of serum inflammatory mediators were quantified using ELISA techniques. Assessments of knee joint structures, leg muscle strength, depressive symptoms, feet pain, and low back pain were treated at both baseline and follow-up intervals.ResultsFolate intake was correlated with reductions in overall knee pain, dysfunction, and stiffness, as well as decreased levels of Leptin and Apelin. Additionally, it was associated with enhanced leg muscle strength and diminished feet and low back pain. However, there is no association between folate intake and alterations in serum cytokine levels or knee joint structural changes. Within the subsets of overall knee pain, a significant relationship was identified between folate intake and the reduction of pain experienced when ascending or descending stairs and standing for two years.ConclusionsFolate intake was linked with reduced knee pain, lower levels of adipokines, and a decreased prevalence of comorbid conditions in individuals with knee OA, implying that folate consumption may be associated with an improvement in knee OA symptoms, but further research is needed to verify this association.

Prepatellar bursa mucosa: An unreported postoperative complication of patellar fracture.

Patellar fracture is a common injury caused by overstrain of the extensor mechanism or a direct trauma to the knee. The most common complications after patellar fracture are nonunion, infection, post-traumatic arthritis, joint fibrosis, symptomatic hardware, and extensor mechanism failure. These are attributed to the post-fracture flexion and extension movements, the primary damage to the articular cartilage, and the thin soft tissue coverage over the knee. To our knowledge, prepatellar bursa mucosa is an unreported postoperative complication of patellar fracture. We describe a case of a 58-year-old woman with a left patellar fracture from a fall. Complete healing was achieved after in 2 months postoperatively using the improved Kirschner wire tension band and a cable grip system; however, at 7 months postoperatively, a prepatellar skin mass appeared. The patient reported prepatellar discomfort with no pain and influence of movement of the knee and daily life. One year postoperatively, we surgically removed the implants and mass. The pathological result showed bursa mucosa. The literature review shows that pain, secondary knee dysfunction, fracture nonunion, and malunion are postoperative complications of patellar fractures. However, prepatellar bursa mucosa have not been previously reported as a postoperative complication. This case highlights the need for appropriate placement of the intraoperative implant in adults with patellar fractures.

Diagnostic Musculoskeletal Ultrasound for Medial Collateral Ligament Injuries: Applications in Rehabilitation.

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries.

Association between Elastic Modulus of Foot Soft Tissues and Gait Characteristics in Young Individuals with Flatfoot.

Flatfoot is a common foot deformity, causing foot pain, osteoarthritis of the midfoot, and even knee and hip dysfunction. The elastic modulus of foot soft tissues and its association with gait biomechanics still remain unclear. For this study, we recruited 20 young individuals with flatfoot and 22 age-matched individuals with normal foot arches. The elastic modulus of foot soft tissues (posterior tibial tendon, flexor digitorum brevis, plantar fascia, heel fat pad) was obtained via ultrasound elastography. Gait data were acquired using an optical motion capture system. The association between elastic modulus and gait data was analyzed via correlation analysis. The elastic modulus of the plantar fascia (PF) in individuals with flatfoot was higher than that in individuals with normal foot arches. There was no significant difference in the elastic modulus of the posterior tibial tendon (PTT), the flexor digitorum brevis (FDB), or the heel fat pad (HFD), or the thickness of the PF, PTT, FDB, and HFD. Individuals with flatfoot showed greater motion of the hip and pelvis in the coronal plane, longer double-support phase time, and greater maximum hip adduction moment during walking. The elastic modulus of the PF in individuals with flatfoot was positively correlated with the maximum hip extension angle (r = 0.352, p = 0.033) and the maximum hip adduction moment (r = 0.429, p = 0.039). The plantar fascia is an important plantar structure in flatfoot. The alteration of the plantar fascia's elastic modulus is likely a significant contributing factor to gait abnormalities in people with flatfoot. More attention should be given to the plantar fascia in the young population with flatfoot.

A New Paradigm in the Management of Knee Osteoarthritis and Arthroplasty with Dynamic Patient-source Outcome Measures: Comprehensive Clinical Review of the Knee Kinesiography Exam with the KneeKG® System

While knee disorders, and more specifically knee osteoarthritis, account for a significant portion of the orthopedic visits to health care providers, there are still clinical gaps that need to be addressed to achieve effective management of this disease. The absence of functional tools to objectively assess knee function in motion and weight-bearing conditions poses a challenge for clinicians to hindering their ability to design individualized conservative and surgical treatment plans aimed at achieving better patient outcomes. The Knee Kinesiography exam with the KneeKG® system provides accurate, reliable, three-dimensional, and real-time information about dynamic knee malalignment and joint dysfunction during weight-bearing activities through the assessment of kinematic biomechanical markers. This work presents a comprehensive clinical review of the materials related to this exam which have been published since its validation in 2012. The aim is to summarize literature evidence on how the Knee Kinesiography exam may enhance both non-surgical and surgical management of knee osteoarthritis and arthroplasty. The access to objective patient-source outcome measures from this exam, directly associated with both patient-reported outcomes and osteoarthritis onset and progression before and after total knee arthroplasty, can allow clinicians to identify mechanisms behind knee pain, dysfunction, and dissatisfaction. In the era of orthopedic value-based care, such patient-source data may help clinicians better understand the condition of the knee and thus assist them in their decision-making to establish the best personalized care plan possible throughout the continuum of care, from diagnosis to post-surgery management.

Development of a brief core set for knee dysfunction based on the International Classification of Functioning, Disability and Health: assessing construct validity and measurement potential

BackgroundThe comprehensive core set for knee dysfunction was developed to classify the functioning of people with any knee dysfunction. To be used as a clinical instrument to measure the functioning of people with knee dysfunction, the construct validity of the core set still needs to be assessed. The purpose of this study was to analyze the construct validity of the comprehensive core set for knee dysfunction as an instrument to measure functioning.MethodsA cross-sectional study with 200 participants with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Participants were assessed using the comprehensive core set for knee dysfunction with 25 categories, the subjective form from the International Knee Documentation Committee scale, and measures of self-perceived general health and functioning. The construct validity of the core set was assessed by Rasch analysis, and the external construct validity was assessed by correlation between the score of the brief core set for knee dysfunction with the subjective form from the International Knee Documentation Committee scale, and scores of self-perception of health and functioning.ResultsTwelve categories were consistent with a unidimensional construct, with no difference in the response pattern for age, sex, educational level, and time of complaint. These categories were included in the brief core set for knee dysfunction. The mean score of the brief core set was 37 ± 21 points, a value classified as moderate impairment regarding functioning. Correlations with the subjective form from the International Knee Documentation Committee scale and scores of self-perception were adequate (p < 0.01; r > 0.5).ConclusionThe brief core set for knee dysfunction, a set with 12 categories, can be used as a clinical instrument to measure and score the functioning of people with knee dysfunction, aged between 18 and 89 years, with adequate construct validity.

Clinical advantage staging and underlying mechanisms of Wangbi Tablets against knee osteoarthritis based on "disease-formula" interaction network

The clinical advantage staging and underlying mechanisms of Wangbi Tablets against knee osteoarthritis(KOA) were studied based on the &quot;disease-formula&quot; interaction network. Firstly, the clinical symptoms and related genes corresponding to Wangbi Tablets and KOA in the acute, remission, and recovery phases were collected from clinical guidelines/consensus and SoFDA database, and the putative targets of Wangbi Tablets were obtained from ETCM 2.0. Then, Jaccard similarity and cosine similarity were employed to assess the similarities of clinical symptoms, genes, and enriched pathways between Wangbi Tablets and KOA in different phases. The &quot;disease-formula&quot; interaction network of the drug targets and disease genes was constructed, and the key targets were screened by topological feature calculation. KEGG and Reactome database were used for the functional enrichment of the key targets, on the basis of which the functional characteristics of Wangbi Tablets against KOA in the acute, remission, and recovery phases were predicted. Finally, the SW1353 cells exposed to lipopolysaccharide were used to decipher the mechanism of Wangbi Tablets against KOA. The results showed that 92/3 921, 138/3 708, 139/3 800, and 196/3 946 clinical symptoms and the related genes corresponded to KOA in the acute, remission, and recovery phases and Wangbi Tablets were collected from SoFDA, and 260 putative targets of Wangbi Tablets were obtained from ETCM 2.0. Wangbi Tablets had highest similarity of clinical symptoms, genes, and enriched pathways with KOA in the remission phase and the secondary highest similarity with KOA in the recovery phase. The key targets of Wangbi Tablets mainly participated in the regulation of immunity-inflammation imbalance and exerted pain-relieving and bone-protecting effects to alleviate symptoms such as knee joint pain, joint swelling, soreness, fatigue, and dysfunction. Intriguingly, the key targets of Wangbi Tablets possessed antioxidant effects during KOA in the acute and remission phases, while they maintained material and energy metabolism homeostasis and protected vessels during KOA in the recovery phase. The cell experiment indicated that Wangbi Tablets down-regulated the expression of interleukin(IL)-6, IL-1β, tumor necrosis factor-α(TNF-α), and Bcl-2-associated X protein(Bax)/B-cell lymphoma 2(Bcl-2) via regulating the phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt) signaling pathway. The findings lay a theoretical foundation for further clarifying the clinical advantage stage and precise clinical application of Wangbi Tablets in treating KOA.

Tuina on knee pain and functional decline of lower limbs for patients with mild-to-moderate knee osteoarthritis in Shanghai: protocol for a multicentre, assessor-blinded, randomised controlled trial

IntroductionKnee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary...

“Varus knee dysfunction contributing to early medial knee arthritis: Novel pathomechanics, diagnosis and multi-modal conservative interventions”

ObjectiveEvaluate whether the three-planar spring test and pathomechanics-based interventions (manual therapy, strengthening, orthosis) increase the range of motion and explore potential changes in joint space of varus knee dysfunction, further investigating their potential association with the early development of medial knee arthritis (MKA). MethodsSingle group, pre-and post-test design. Adults (n = 54) exhibiting a positive spring test for varus knee dysfunction, characterised by extension lag with proximal tibia externally rotated and subluxed laterally, completed the study. Outcome measures include pain intensity, ROM, functional abilities and X-ray measures (joint space, tilt, and tibia position relative to the femur) following the interventions. ResultsAfter interventions, the spring test has become negative at the pre-assessment range. There is an increased ROM [internal rotation by 3.61° (95CI 3.22, 4.01) and extension by 3.92° (95CI −4.51, −3.33)], and X-ray measurements showed an increase in both medial and lateral joint space by 0.78 mm (95CI 0.63, 0.92) and 0.13 mm (95CI −0.03, 0.24) respectively. Additionally, total joint space expansion happened by 0.28 ± 0.23 mm. The proximal tibia medially shifted by 0.85 ± 0.96 mm, and the medial tilt was reduced by 1.79°±1.28°. A significant decrease in pain by five points (NPRS) and an increase in the overall functional abilities of participants by 36.9 points (95CI 34.72, 39.09). ConclusionThe study results indicate that diagnosis with a spring test and interventions have increased the medial joint space and ROM, possibly improved alignment and synovial fluid, contributing to decreasing the pain and improving the functional abilities, thereby supporting the study's objective.

Implementasi Load Cell sebagai komponen Alat Rehabilitasi Disfungsi Sendi Lutut

Knee joint fractures caused after surgery or other activities that cause knee dysfunction require a rehabilitation process. Knee dysfunction means the knee joint cannot be bent/moved at the desired angle. Because the function of the knee is so important in relation to human activities, it is necessary to immediately carry out rehabilitation measures for a perfect return. Rehabilitation in this case can be done with weight training. In this research, loading for rehabilitation will be designed using load cell-based electronic engineering for the desired load, because the equipment used so far works manually.The research began with inventorying component requirements, designing the circuit, compiling a process algorithm, functional testing, calibration and data collection. The research data is a function of weight on movement, in this case motorbikes. The output of the research is a control circuit prototype to regulate load-based motor movement.The equipment specifications are produced with a loading capacity limit of 5 kg with a change step of 250 grams.

Strengthening Quality Measurement to Predict Success for Total Knee Arthroplasty: Results from a Nationally Representative Total Knee Arthroplasty Cohort.

When performed well on appropriate patients, total knee arthroplasty (TKA) can dramatically improve quality of life. Patient-reported outcome measures (PROMs) are increasingly used to measure outcome following TKA. Accurate prediction of improvement in PROMs after TKA potentially plays an important role in judging the surgical quality of the health-care institutions as well as informing preoperative shared decision-making. Starting in 2027, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin mandating PROM reporting to assess the quality of TKAs. Using data from a national cohort of patients undergoing primary unilateral TKA, we developed an original model that closely followed a CMS-proposed measure to predict success, defined as achieving substantial clinical benefit, specifically at least a 20-point improvement on the Knee injury and Osteoarthritis Outcome Score, Joint Arthroplasty (KOOS, JR) at 1 year, and an enhanced model with just 1 additional predictor: the baseline KOOS, JR. We evaluated each model's performance using the area under the receiver operator characteristic curve (AUC) and the ratio of observed to expected (model-predicted) outcomes (O:E ratio). We studied 5,958 patients with a mean age of 67 years; 63% were women, 93% were White, and 87% were overweight or obese. Adding the baseline KOOS, JR improved the AUC from 0.58 to 0.73. Ninety-four percent of those in the top decile of predicted probability of success under the enhanced model achieved success, compared with 34% in its bottom decile. Analogous numbers for the original model were less discriminating: 77% compared with 57%. Only the enhanced model predicted success accurately across the spectrum of baseline scores. The findings were virtually identical when we replicated these analyses on only patients ≥65 years of age. Adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power, eliminating ceiling and floor effects and mispredictions for readily identifiable patient subgroups. The enhanced model neither favors nor discourages care for those with greater knee dysfunction and requires no new data collection. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

The Effect of Active Release Technique on Hamstring Extensibility: ACritically Appraised Topic.

Hamstring extensibility plays a significant role in maintaining postural alignment essential for a functional musculoskeletal system. When hamstring extensibility is lacking, individuals are placed at a higher risk for developing various lumbar spine, pelvis, knee, and foot dysfunctions. Limited hamstring extensibility is common, occurring in as much as 40% of college students and 86% of the adult population. Therefore, it is essential to maintain hamstring extensibility, which can be aided by understanding intervention effectiveness for improving flexibility. To critically appraise the literature on the effectiveness of Active Release Technique (ART) for the treatment of hamstring extensibility deficits. What is the effect of ART in a healthy population with or without hamstring extensibility deficits? Three studies were included for critical appraisal. Two studies concluded a single treatment session of ART that individuals possessing limited straight leg raise range ofmotion experienced improved active knee extension, popliteal angle, and sit-and-reach test measures. In the third study, a single session of ART was effective at improving hamstring extensibility in males without hamstring extensibility dysfunction. Based on the current level 1 and level 3 evidence, ART may be an effective treatment to produce acute increases in hamstring extensibility. Future research is still needed. Level B evidence exists to support the use of ART to improve hamstring extensibility in the healthy population.

Ligamentous Knee Joint Instability: Association with Chronic Conditions of the Knee and Treatment with Prolotherapy

Ligamentous knee joint instability and other conditions associated with knee dysfunction are common musculoskeletal complaints that affect a large percentage of the global population. A healthy knee has normal joint mechanics and can maintain its stability as it responds to the forces placed upon it. Once undue forces, whether from injury, wear and tear, or overuse, cause the soft tissue structures of the knee to stretch beyond their normal range of motion, they can become lax, elongated, damaged, or torn, especially the ligaments. This condition, known as ligamentous knee instability, causes destructive joint forces to occur, which results in the development of other pathophysiologic conditions related to knee dysfunction, including osteoarthritis, patellar pain syndromes, tendinopathies, meniscus tears, and osteochondral defects. Traditional treatments address the consequences of joint instability, such as synovitis and joint swelling, but do not address the underlying ligament and/or disease that led to the joint instability. Prolotherapy promotes the repair of injured or degenerated tissues, such as ligaments, tendons, and menisci, by stimulating the physiological healing process of the joint. This process corrects the underlying joint instability, reduces associated pain, improves knee function, and has the potential to slow the degenerative process.

Meniscal Repair Compared to Meniscectomy for Meniscal Injury: 3-year Outcomes from a Retrospective Cohort Study.

Meniscal injury is a common problem that can lead to knee pain and dysfunction. Meniscal repair and meniscectomy are two treatment approaches for meniscal injury, but the latter may increase the risk of osteoarthritis. We aimed to compare the 3-year outcomes of a new method of meniscal suturing with meniscectomy among patients with meniscal injury. This retrospective cohort study compared meniscal repair (treatment group) and meniscectomy (control group) in patients with meniscal injury. We evaluated the outcomes of 134 patients. under treatment with these approaches based on the Lysholm scale, which measures knee function and symptoms. The study used the chi-square test and the Mann-Whitney U test to compare the proportion of patients with different outcomes and the Lysholm scale scores between the treatment and control groups. The study also conducted subgroup analyses based on gender and age using the Mann-Whitney U test. The level of significance was set at P < 0.05 for all statistical tests. The treatment group had a higher proportion of patients with excellent results, although the difference was not statistically significant (17.2% in the treatment group vs. 10.0% in the control group, P = 0.223). However, a comparative analysis of the proportion of patients with good results revealed statistically significant differences, with 67.2% of patients in the treatment group achieving good outcomes compared to 45.7% in the control group (χ2 = 6,256, df = 1 P = 0.012, HR 1,470 95%CI 1,081-1,999). The average score on the Lysholm scale was significantly higher in the treatment group (87.48, 95% CI 85.1-89.7, SD = 9.2) compared to the control group (81.73, 95% CI 78.4-84.9, SD = 13.7) (U = 1609, Z = -2.813, P = 0.005). Subgroup analyses based on gender and age also showed significant differences in the Lysholm scale scores. The study demonstrates that meniscal repair is more effective than meniscectomy in improving patient outcomes, with a higher proportion of patients achieving excellent and good results and higher scores on the Lysholm scale. These findings support the use of meniscal repair as a preferred treatment approach for patients with meniscal injuries.

PATELLAR DISLOCATION AND PATELLAR INSTABILITY PANORAMIC REVIEW

Introduction: Primary patellar dislocation is usually the initial manifestation of patellofemoral instability. Among the long-term repercussions of this disorder are recurrent dislocation and indefinable knee dysfunction. At present, there is no agreement on the optimal treatment of patellar dislocation. Objective: to detail the current information related to patellar dislocation, epidemiology, mechanism of action, clinical evaluation, imaging evaluation, classification, differential diagnosis, treatment and complications of the disease. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 22 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: patella, knee anatomy, patellar dislocation, knee instability. Results: Approximately 5% of the time it is related to osteochondral fractures. To define whether a patella is high or low, a lateral radiograph should be taken with the knee in 30° of flexion to determine Blumensaats line. The increase in the Q angle facilitates patellar dislocation. Most patellar dislocations are related to congenital anomalies of the patella or trochlea, high patella, hypoplasia of the vastus medialis and hypertrophy of the lateral retinaculum. Conclusions: Patellar dislocation is usual in individuals with connective tissue disorders and hypermobility, the patella can be dislocated laterally, superiorly or intra-articularly, presenting different mechanisms of action for each case. It is important to have a good knowledge of the anatomy and to measure the Q angle because the increase of this angle facilitates patellar dislocation. It is essential to establish the etiology of the dislocation, especially in those with recurrent dislocations as this may alter the management plan. In addition to the clinical evaluation it is important to request anteroposterior, lateral knee and axial projections. When conservative treatment is chosen, reduction and immobilization with a cast or orthosis should be performed with the knee in extension, the long knee brace can be used, with or without arthrocentesis to relieve the symptomatology; surgical treatment is mostly used in recurrent dislocations. At the moment, no surgical technique is able to correct all the problems of patellar alignment. It should be kept in mind that the surgical procedure should take into account the individuals age, diagnosis, activity level and the situation of the patellofemoral joint. Patellofemoral instability should be treated with the goal of correcting all of the alignment issues. The usual complications are loss of knee mobility, recurrent dislocation and patellofemoral pain. KEY WORDS: dislocation, patella, knee, instability.