Lateral Meniscectomy Research Articles

Acute meniscal injury following successful unicompartmental knee arthroplasty

The case of an active 53-year-old man with a well-functioning unicompartmental knee arthroplasty who suffered an acute athletic injury to the knee is described. A mechanical problem was diagnosed and he was successfully treated by arthroscopic partial lateral meniscectomy for a displaced meniscal tear. This case points to an important difference noted by history and physical examination between an acute injury to the unreplaced compartment of a knee with a unicompartmental knee arthroplasty and progression of the arthritic process.

Topographic variation in biglycan and decorin synthesis by articular cartilage in the early stages of osteoarthritis: An experimental study in sheep

Articular cartilage contains large molecular weight proteoglycans that aggregate with hyaluronic acid (aggrecan) and small species, particularly biglycan (dermatan sulphate proteoglycan-1) and decorin (dermatan sulphate proteoglycan-2), that do not. Mechanical stresses have been shown to profoundly influence the metabolism of aggrecan by articular chondrocytes; however, there are limited corresponding data on the metabolism of dermatan sulphate proteoglycans 1 and 2. The objective of this study was to examine the metabolism of aggrecan, biglycan, and decorin in articular cartilage from different weight-bearing areas of normal ovine stifle joints and in joints 6 months after menisectomy, a procedure that has been shown to induce early osteorthritic changes. [35S]proteoglycans synthesised by cartilage explants from eight different weight-bearing regions of unoperated and meniscectomised ovine stifle joints during 48 hours of culture were separated by size-exclusion chromatography, hydrophobic chromatography, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis and were quantitated by phosphor-screen autoradiography. The synthesis and degradation of the proteoglycans were expressed relative to the DNA content of the explants. In control joints, the cartilage exposed to high contact stress synthesised significantly less proteoglycan overall and more decorin than joint regions bearing less stress. Explants from high stress regions also released significantly greater amounts of resident proteoglycans (dimethylmethylene blue positive) into media during culture. After lateral meniscectomy, the lateral tibial and femoral cartilages showed elevated biosynthesis of both 35S-dermatan sulphate proteoglycans 1 and 2. This chondrocyte biosynthetic response was accompanied by increased catabolism of aggrecan and the release of its degradation products into culture media. These experiments revealed, in normal joints, a topographic variation in proteoglycan synthesis by articular cartilage that was related to the mechanical stress to which the tissues were subjected in vivo. This biosynthetic pattern changed when the load distribution of the joint was altered by unilateral meniscectomy. These data suggest that an altered chondrocyte phenotypic expression of proteoglycans in response to abnormal mechanical loading is an early event in osteoarthritis.

Popliteal artery injury complicating arthroscopic meniscectomy

We describe two patients who sustained serious vascular complications following arthroscopic lateral meniscectomy. Such injuries are rarely encountered or reported in the literature and, as such, the potential catastrophic sequelae of this particular complication of arthroscopy may be underestimated. Investigation of suspected popliteal artery injuries is outlined and the need for a high index of suspicion and early referral to a vascular surgeon is stressed.

Acceleration of experimental lapine osteoarthritis by calcium pyrophosphate microcrystalline synovitis.

To investigate the effects of chronic calcium pyrophosphate dihydrate (CPPD) synovitis on the development of osteoarthritic (OA) lesions in an animal model. OA was induced in the right knees of 30 male New Zealand white rabbits by partial lateral meniscectomy and section of the fibular collateral and sesamoid ligaments (PLM/LS), followed by 8 weekly intraarticular (IA) injections of 1 mg (low-dose) or 10 mg (high-dose) of CPPD crystals in 3 sets of experiments (10 rabbits each). The contralateral left knees served as controls: experiment 1 PLM/LS alone, experiment 2 8 weekly IA injections of CPPD crystals alone, and experiment 3 sham surgery plus 8 weekly IA injections of CPPD crystals. At 8 weeks, repeated IA injections of low-dose and high-dose CPPD crystals into meniscectomized right knees resulted in more severe OA than in meniscectomized but noninjected left knees (experiment 1) (P = 0.003 and P = 0.001, respectively). One-fourth of the meniscectomized knees (11 of 40), both CPPD-injected and noninjected, showed embedded synovial cartilage shards. The data demonstrate a worsening effect of chronic CPPD crystal-induced synovitis on experimental OA produced in the rabbit knees by PLM/LS, and support a possible role for CPPD microcrystalline inflammation in the progression of OA lesions in clinical CPPD crystal deposition disease.

The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results

A retrospective review of patients who underwent arthroscopic partial lateral meniscectomy for lateral meniscus tears in otherwise normal knees was conducted to review the long-term functional, clinical, and radiographic results. Twenty-six patients (27 knees) were evaluated by questionnaire; 20 patients (21 knees) also underwent physical examination and radiographic analysis. Minimum follow-up was 5 years and mean follow-up was 8 years. Patient data were obtained from detailed questionnaires, knee examinations, and radiographs. Excellent or good results decreased from 92% at the time of maximal improvement to 62% at the most recent follow-up: 85% of patients were initially able to return to their preinjury activity level; however, only 48% were able to maintain this level of activity at the most recent follow-up. Seventy-two percent of patients had either one or no Fairbank changes and there was no statistical difference when comparing radiographic criteria in the operated and nonoperated knee. Early results for partial lateral meniscectomy can be quite good; however, significant deterioration of functional results and decreased activity level can occur. Radiographic changes did not correlate with subjective sumptoms and functional outcome in our patient population. Our findings suggest that the functional outcome for patietns undergoing partial lateral meniscectomy may deteriorate with time and it may be helpful to counsel patients concerning long-term expectations.

Partial lateral meniscectomy in athletes

Arthroscopic partial lateral meniscectomies performed for isolated meniscal tears, without associated ligamentous injury, in 41 athletes between August 1, 1988 and June 1, 1991 were reviewed for clinical and functional outcome. The study population was composed of 27 males and 14 females, with an average age of 26 years (range 17-40). Thirty-seven patients (90%) reported previous trauma to the knee. At an average follow-up of 3 years (range 2-5), 85% of the patients had excellent/good results, and 98% of the athletes returned to full sports activities after an average of 55 days. Patients' prognoses depended on (a) type of meniscal tear and (b) presence/absence of an articular cartilaginous lesion. Athletes who had isolated, longitudinal type tears of the lateral meniscus had the best outcome: 100% achieved excellent/good results and averaged 41 days to return to full sports activities. Athletes with complex meniscal tears and tears associated with articular cartilaginous lesions had the poorest results, achieving 79% and 64% excellent/good results, respectively, and averaging 64 and 78 days, respectively, for return to full sports activities.

Long-term effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: A retrospective review of functional, clinical, and radiographic results

Long-term effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: A retrospective review of functional, clinical, and radiographic results

Arthroscopic partial meniscectomy: 5-year follow-up.

The purpose of this study was to determine the influence of preexisting chondromalacia at time of surgery on the results at a minimum of 5 years follow-up of arthroscopic partial meniscectomy. The patients were divided into two groups: group I (87 patients, average age 29.8 years) with no intraoperative findings of chondromalacia at the time of surgery, and group II (234 patients, average age 39.2 years) with chondromalacia at the time of surgery. The follow-up period was 70-86 months, with the criterion of a minimum of 5 years in each patient. Postoperative changes were evaluated according to Fairbank's classification and preoperative X-rays were compared to follow-up X-rays. For statistical analysis the Mann-Whitney test was used. In both groups arthroscopic partial lateral meniscectomy led to worse results in respect of the development of osteoarthritis. Following partial medial meniscectomy preexisting chondromalacia had a negative influence on the radiological outcome. An increase of osteoarthritis was also proven in our patient population which was statistically significantly related to age and female sex (P = 0.002).

Arthroscopic view of an irreducible knee dislocation

Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. His neurovascular status was intact. Attempts under sedation and anesthesia and even arthroscopy failed to reduce the dislocation. Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.

変形性膝関節症に対する高分子量ヒアルロン酸ナトリウム（ＳＰＨ）の使用経験 特に関節鏡所見について

The result of intraarticular injection of high molecular weight sodium hyaluronate in the knee joint were reviewed. Twelve knees in 12 patients were divided into two groups: Group A consisted of 10 patients with osteoarthritis in the medial compartment of the knee and arthroscopic medial partial meniscectomy had been performed. Group B consisted of 2 patients who had osteoarthritis in the medial compartment of the knee and lateral partial meniscectomy had been performed. After meniscectomy all patients received intraarticular injection of high molecular weight sodium hyaluronate into the knee joint for at least 5 months. After this therapy all knees were arthroscoped again. Improvement was obserbed in both groups.These results suggest that high molecular weight sodium hyaluronate is effective for improvement of degenerative joint cartilage.

Follow-up Study of Total Lateral Meniscectomy in the Children's Knee

Follow-up Study of Total Lateral Meniscectomy in the Children's Knee

Arthroscopic lateral meniscectomy

Surgical Principle Partial or total arthroscopic lateral meniscectomy by triangulation. A special arthroscope is not necessary. Additional instruments are inserted through separate portals. The technique used was originally described by Gillquist [1–4] and modified based on information given by Glinz [5], Holder [6], and Klein and Schulitz [8].

Lateral meniscal variant with absence of the posterior coronary ligament.

We reviewed the cases of 3468 patients who had had arthroscopy of the knee between January 1976 and December 1988. Twenty-six patients (0.8 per cent) had a partial or a complete discoid lateral meniscus, and seven (0.2 per cent) had the Wrisberg-variant-type lateral meniscus. Of the seven patients, six had operative stabilization of the meniscus and one had a partial lateral meniscectomy because of an irreparable complex tear. Subjective, objective, and radiographic evaluations were performed on the patients who had had stabilization of the meniscus. According to the scale of Tegner and Lysholm, the result was excellent in four patients, good in one, and fair in one. None of the six patients had a tear of the sutured meniscus after an average follow-up of thirty-two months (range, twenty-four to forty months). Two patients had progressive symptoms attributable to osteoarthrosis, but the changes in the articular cartilage had been present at the time of the index procedure. None of the seven Wrisberg-variant-type menisci demonstrated a true discoid shape of the meniscus. We therefore classified this lesion as a lateral meniscal variant with absence of the posterior coronary ligament.

Meniscectomy in Children and Adolescents A Long-Term Follow-Up Study

Thirty-nine patients treated with total meniscectomy younger than 16 years of age were studied. The average follow-up period was 21 years; 71% of the patients reported pain; 68%, stiffness; 54%, swelling; and 41%, giving way. Approximately half the patients described progression of symptoms, but only 27% were asymptomatic. Only 10% noted limitations at work, but 62% had limitations in sports. Twelve percent have had further knee surgery. Forty-nine percent received unsatisfactory subjective/functional ratings. On physical examination, 25% of patients had range of motion loss of greater than 5 degrees, 22% had thigh atrophy of greater than 1 cm, and 20% developed substantial instability. Overall, 27% received unsatisfactory objective ratings. Ninety percent of patients had abnormal roentgenograms. Changes occurred predominantly in the meniscectomized compartment. Forty-four percent of patients had unsatisfactory roentgenographic ratings. Overall ratings indicated that 63% of patients' results rated unsatisfactory. More unsatisfactory results occurred in patients with a follow-up period of longer than 26 years, in those with substantial instability, and in males. Few differences existed between medial and lateral meniscectomies or with increasing durations of symptoms preoperatively.

Congenital discoid lateral meniscus in children. A follow-up study and evolution of management

Fifty-two children with 62 discoid lateral menisci were reviewed at an average follow-up of 5.5 years. Their average age at operation was 10.5 years and the mean delay in diagnosis was 24 months. Most of the children had vague and intermittent symptoms and the classical clunk was demonstrable in only 39% of the knees. An associated osteochondritis dissecans of the lateral femoral condyle was seen in seven knees. Forty-eight knees with symptomatic torn discoid menisci underwent open total lateral meniscectomy, six had arthroscopic partial meniscectomy and eight knees with intact discoid menisci, were left alone. Based on Ikeuchi's grading (Ikeuchi 1982), 37% of the knees had an excellent result, 47% had a good result and 16% had a fair result: none was poor. Arthroscopic partial meniscectomy is recommended only when the posterior attachment of the discoid meniscus is stable. A total meniscectomy is indicated for the Wrisberg-ligament type of discoid meniscus with posterior instability.

Ｕｌｉｎａｓｔａｔｉｎの実験的変形性関節症ウサギに対する作用

A multipotent enzyme inhibitor, ulinastatin, was tested for the effect on osteoarthritis (OA) induced by a partial lateral meniscectomy combined with section of the fibular collateral and sesamoid ligaments in knee joints of rabbits. In the control group, treatd with human serum albumin, histopathological oganges quite similar to those in human OA were observed both in the tibial and the femoral cartilage. In addition, biochemical changes such as decrease in keratan sulfate content and increase in collagenase activity were observed in the meniscus and the synovial fluid, respectively. These changes were markedly suppressed by intraarticular injection of ulinastatin at 30 or 300 units/site, given semiweekly for seven weeksf starting from one week after the surgical induction o, OA. These results suggest that ulinastatin is expected to be useful treatment of OA.

A Long-Term Follow-Up Study of Total Meniscectomy in Children

The long-term effects of single meniscectomy in 89 children have been analyzed at an average of 16.8 years after surgery. Seventy-four percent were pleased with the outcome, but only 52% or 58% had objectively satisfactory results according to the two scoring systems used. Significantly poorer results were achieved with lateral meniscectomies. The range of movement was significantly decreased after lateral meniscectomy. Minor instabilities were recorded in 45% of the patients and major instabilities in 15%. Anteroposterior and rotatory instabilities were objectively measured, and a significant increase was noted in knees that had lateral meniscectomy. Grade I gonarthrosis was recorded in 39% of the surgically treated knees and Grades II and III gonarthroses in 9%. The joint space was significantly reduced in all knees irrespective of the injured compartment.

膝外側半月板，滑膜ヒダ切除後に発症したＲｅｆｌｅｘ Ｓｙｍｐａｔｈｅｔｉｃ Ｄｙｓｔｒｏｐｈｙの一症例

A 20-year old woman visited our hospital in October 1987. She complained of intermittent pain, flexion contracture, and locking of the rigth knee. Physical examination rivealed tenderness, a pathological plica, and a positive McMurray's test, but radiograph demonstrated no abnormalities. The lateral meniscectomy and resection of the plica were performed at arthrotomy in December 1987.Postoperatively the knee pain and contracture persisted despite early ambulation, physical therapy, and non-steroidal antiinflammatory drugs. Radiograph 3 months after surgery demonstrated patchy osteoporosis of the distal femur, patella, and proxymal tibia. Physical examination revealed diffuse tenderness, swollen, warm, contracture, and skin atrophy of the affected knee. Results of laboratory investigation were normal or negative. The patient was diagnosed reflex sympathetic dystrophy of the knee following meniscectomy and resection of the plica, treated by kindly physical examination and steroidal drugs. The sympyoms were relieved gradually after the treatment. To date 22 weeks following surgery, the patient returned to a Bialy life without disability. Reflex sympathetic dystrophy must be an unusual complication following meniscectomy.

Upper tibial osteotomy for secondary osteoarthritis of the knee.

Of 34 consecutive proximal tibial osteotomies for secondary degenerative arthritis in patients under 40 years of age, 33 were evaluated at least three years (mean 7.5 years) after operation. In all 73% were satisfactory, with four failures in 21 procedures in men and five failures in 12 procedures in women. The primary abnormalities were medial meniscectomy (11), medial and lateral meniscectomy (4), osteochondritis dissecans (3), osteochondritis dissecans with medial meniscectomy (4) and fracture (11). All four knees with both medial and lateral meniscectomy had unsatisfactory results despite obtaining anatomical alignment. Eight patients needed subsequent surgery; five of them had total knee replacement, four within four years of the osteotomy. Proximal tibial osteotomy in younger patients with secondary arthritis gives similar results to those for older patients with primary osteoarthritis. If it fails, this is generally within the first four years after the operation.

Arthroscopic treatment of the discoid lateral meniscus: Results of long-term follow-up

Twenty-two patients (25 knees) were evaluated at an average follow-up of 54 months for clinical results of arthroscopic treatment of the discoid lateral meniscus syndrome. Discoid lateral menisci were classified arthroscopically as incomplete (92%) or complete (8%); no Wrisberg-type lesions were noted. Three patients (14%) had bilateral lesions. Symptomatic torn discoid menisci (20 knees) and torn discoid menisci with other significant symptomatic lesions (3 knees) underwent arthroscopic partial lateral meniscectomy utilizing the saucerization technique. Asymptomatic intact discoid menisci (2 knees) were left unresected. Using the knee scale of Ikeuchi, 55% of the symptomatic torn lesions were rated as excellent or good, 30% were rated as fair, and 15% were rated as poor at follow-up. Two of the 3 asymptomatic torn lesions were rated as excellent or good, as were both of the intact discoid lesions. Factors associated with an unsatisfactory rating at follow-up included preexistent degenerative changes, age, and sex. Duration of symptoms, type of discoid tear, and length of follow-up were not necessarily related to outcome results. Seven knees (28%) required arthroscopic reevaluation at a postoperative average of 23 months, documenting apparent physiologic function of the saucerized rim in 4 patients and failure of saucerization in 3 patients (12%). Overall, 14 of the 22 patients in this study (64%) resumed a normal activity level postoperatively, including 61% of those with symptomatic torn discoid lateral menisci.