Lateral Meniscal Lesions Research Articles

Prevalence of Articular Surface Injuries in Patients Undergoing Meniscal Surgery: A Retrospective Analysis of 758 Cases.

Background and aim Meniscal tears are often associated with articular surface damage, which could be an important factor in the clinical outcome. However, these concomitant lesions are usually reported as binary variables. Reports of the severity/extent of the concomitant lesions and stratification by meniscal tear are scarce in the literature; in addition, sample sizes of previous reports are limited. This study aimed to characterize meniscal lesions, determine the prevalence of articular surface lesions and their severity, and correlate these lesions with meniscal injury characteristics. Methods A cross-sectional study of patients undergoing meniscal surgery between 2017 and 2023 was conducted. Patient characteristics and arthroscopic findings on the location and type of meniscal injury as well as the degree of chondral lesion (sICRS score) were recorded by the surgeon. Statistical analysis included frequency reporting for patient characteristics and study variables, including the median and interquartile range of the sICRS classification of articular surface lesions. Meniscal tear types were categorized as degenerative or non-degenerative to explore associations with chondral injury. Chi-squaretestand univariate and multivariate logistic regression models were employed to analyze relationships between variables. Results A total of 758 surgeries were analyzed, with a mean age of 39.56 years (SD: 12.71) and 67.90% male participants. Medial meniscus injuries accounted for 57.52%, lateral meniscus 36.02%, and both menisci 6.64%. Significant differences were found in vascular area, topography, and lesion type between isolated medial and lateral meniscus lesions (p<0.01). Chondral lesions were present in 35.22% of cases, with significant differences among meniscal injury types (p<0.01). Degenerative tears showed higher rates of chondral damage compared to non-degenerative tears, particularly in lateral meniscus injuries (p<0.01). Regression analysis identified age, gender, meniscal injury characteristics, and meniscectomy percentage as risk factors for articular surface injuries. Conclusion Articular surface injuries frequently accompany meniscal lesions, with associations between affected menisci and articular damage extent. Femoral condyles show greater involvement corresponding to compartment-specific meniscal lesions, unlike tibial plateaus. Meniscal degeneration is present in about half of articular cartilage injury cases. Some meniscal tear types may relate to more severe articular lesions, but larger studies are needed to confirm these findings and explore other tear patterns.

Meniscal Lesions in Multi-Ligament Knee Injuries.

Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries. The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available. Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered. Seventy patients with MLKIs were included, with a mean age of 30.69years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89-26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%. The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns.It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs.

The Impact of Bone Marrow Venting Augmentation on Knee Functions in the Repair of Vertical/Longitudinal Meniscus Tears: A Triple Comparison.

Preserving and restoring meniscus function is crucial for maintaining knee biomechanics and overall functionality. To enhance the healing process after meniscus repair, various biological techniques have been introduced. In this study, three treatment approaches examined were bone marrow venting with stem cells (BMVP), anterior cruciate ligament reconstruction (ACLR) with meniscus repair, and isolated meniscus repair. From 2015 to 2019, we retrospectively analyzed data from 83 patients who presented with complaints of knee pain or pain in addition to instability, were diagnosed with vertical/longitudinal meniscus tears, and underwent arthroscopic repair (30 with isolated repair, 28 with ACLR repair, and 25 with BMVP) at our University Hospital. Among the 28 patients with anterior cruciate ligament rupture, pain and instability were the predominant complaints, whereas 55 patients with meniscus tear primarily complained pain. Clinical and functional conditions were assessed using Lysholm, WOMAC, IKDC, and VAS scores before and 18months after surgery. Surgical success was evaluated based on Barrett's criteria. Causes of failure were analyzed considering demographic data, smoking status, injury time, tear location, shape, zone, and suture type and number. Of the participants, 58 were male, 25 were female, 61 had medial meniscus lesions, and 22 had lateral meniscus lesions. The tear types included 51 simple longitudinal tears, 18 bucket handle tears, and 14 complex tears. A significant improvement was observed in the postoperative 18month Lysholm, WOMAC, and IKDC values in all three groups (p: 0.001). At the 18month mark, clinical and functional outcomes were comparable between BMVP and ACLR repair groups (Lysholm p: 0.951, WOMAC p: 0.241, IKDC p: 0.984). Both of these procedures yielded better results compared to isolated meniscus repair (Lysholm p: 0.001, WOMAC p: 0.027, IKDC p: 0.001). The superior clinical and functional outcomes observed after meniscus repair with BMVP and ACLR, compared to isolated meniscus repair, indicate positive effects of bone marrow stem cells, blood components, and tissue healing factors on meniscus repair and knee function.

Females show worse functional outcome and quality of life compared to males 2 years after meniscus surgery:Data analysis from the German Arthroscopy Registry.

The purpose of this study was to investigate the impact of sex on knee function, activity and quality of life following meniscus surgery using data from the German Arthroscopy Registry. This is a retrospective cohort study with data collected between 2017 and 2022. Patient-reported outcome measures (PROMs), namely Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol Visual Analogue Scale (EQ Scale), and Marx Activity Rating Scale (MARS), were collected preoperatively and at 6, 12and 24 months postoperatively. Data were analysed to examine differences between male and female patients regarding PROMs, pre-existing conditions, meniscus lesion typesand surgical treatments. A total of 1106 female (36.6%) and 1945 male patients (63.7%) were included. Males were significantly younger than females and had a higher body mass index. Overall, there were four times more medial meniscus lesions (MMLs) (77.5%) than lateral meniscus lesions (LMLs) (27.9%). Degenerative LMLs were more frequent in females, while traumatic LMLs were more common in males. Frequencies of traumatic and degenerative MMLs were similar among males and females. Males had higher absolute KOOS irrespective of treatment or meniscus lesion type. Meniscus repair resulted in similar improvements in ΔKOOS for both sexes, while meniscus resection exhibited higher absolute KOOS for males at each time point. Males generally had higher EQ Scale and MARS than females. Greater improvements in knee function, activity and quality of life were observed in males. While MMLs appear to be comparable among sexes, the nature of LML differed significantly. These results may help surgeons to refine patient selection for specific treatments to improve overall clinical outcomes. Level III.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database

Background: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. Purpose: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. Results: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). Conclusion: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

Medial meniscal lesions increase antero-posterior laxity in knees with anterior cruciate ligament injury.

The aim of this study was to quantify the impact of concomitant meniscal lesions on knee laxity using a triaxial accelerometer in a large population of patients affected by anterior cruciate ligament (ACL) injury. A total of 326 consecutive patients (261 men and 65 women, mean age 31.3 ± 11.3) undergoing primary ACL reconstruction, were preoperatively evaluated through Lachman and pivot shift tests using a triaxial accelerometer to quantify knee laxity. An analysis based on the presence of meniscal tears assessed during surgery was performed to evaluate the impact of meniscal lesions on knee laxity. The anterior tibial translation (Lachman test) presented significantly higher values in patients with medial meniscal lesions (7.3 ± 1.7 mm, p = 0.049) and both medial and lateral meniscal lesions (7.7 ± 1.6 mm, p = 0.001) compared to patients without concomitant meniscal lesions (6.7 ± 1.3 mm). Moreover, patients with both medial and lateral meniscal lesions presented significantly higher values of anterior tibial translation compared to patients with lateral meniscal lesions (p = 0.049). No statistically significant differences were found between the groups in terms of tibial acceleration (pivot shift test). This study demonstrated that the contribution of concomitant meniscal lesions to knee laxity can be objectively quantified using a triaxial accelerometer in ACL-injured knees. In particular, medial meniscus lesions, alone or in association with lateral meniscus lesions, determine a significant increase of the anterior tibial translation compared to knees without meniscus tears. Level IV.

Lateral meniscus with tears or with histologic calcification does not increase the risk of lateral osteoarthritis after medial unicompartmental arthroplasty.

Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown. We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment. CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The tenyear cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions. On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary.

All-Inside Repair of Complex Posterior Horn Meniscus Tears

Background: Due to difficult-to-access location and complex tear patterns, the management of meniscus injuries in isolation and in conjunction with anterior cruciate ligament injury may be challenging. The aim of this video is to present techniques and tips that may help surgeons perform arthroscopic all-inside repair of complex meniscus tears. Indications: Indications for the presented repair techniques are young patients with high activity demands, symptomatic lateral and medial meniscus lesions, ligamentous knee instability, chondral changes grade 2 or less, neutral joint alignment, and body mass index below 35 kg/m2. Technique Description: High anterolateral, low anteromedial, and accessory anterolateral portals are used for the arthroscopic assessment of meniscus tear quality and pattern, and to ensure adequate access to the lesion. Horizontal mattress, vertical mattress, and cerclage sutures are passed using a range of all-inside devices to approximate tear edges with the aim of restoring native hoop stresses along the circumferential meniscus collagen fibers. Tear edges are abraded to enhance healing potential. Two separate cases and complex tear configurations are presented to illustrate these all-inside meniscus repair techniques. Results: Meniscus repair yields superior long-term outcomes compared with partial meniscectomy. Improvements in subjective knee function and lower rates of progression to long-term knee osteoarthritis are reported in patients treated with meniscus repair versus resection. Advantages of all-inside meniscus repair include the reduced risk of iatrogenic neurovascular lesions, decreased operative time, restoration of native contact surfaces, and repair without fixation of the menisci to the surrounding soft tissue. Discussion/Conclusion: Arthroscopic all-inside meniscus repair enables the safe and efficient management of complex meniscus tears in active patients with symptomatic meniscus pathology, and can be performed concurrent with knee ligament surgery. Consequently, all-inside meniscus repair techniques are a versatile addition to the toolkit of complex knee surgeons. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Lateral meniscal body extrusion is associated with MRI-defined knee structural damage progression over 4 years: Data from the osteoarthritis initiative

PurposeTo investigate the association of lateral meniscal body extrusion (LMBE) with OA-related knee structural damage progression over 4 years and to obtain thresholds of LMBE in predicting knee structural damage progression. MethodWe studied 196 subjects (67 male) with a mean age of 59.5 ± 7.9 (SD) years (range45-78 years) that were randomly selected from the Osteoarthritis Initiative. Radiological assessment was performed using the Osteoarthritis Research Society International grading system. Baseline LMBE was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3.0 T scanner. Knee structural damages were measured using the whole-organ MRI score. Linear regression analysis and binary logistic regression analysis was used to assess the correlation between LMBE and knee structural damage. ROC analysis and Youden index were used for calculating thresholds. ResultsCross-sectionally, increased LMBE was significantly associated with more severe lateral meniscal damage, patellofemoral and lateral compartment cartilage damage, and posterior cruciate ligament damage. Longitudinally, LMBE was statistically associated with progression of lateral meniscal damage, lateral compartment cartilage damage and bone marrow edema patterns, posterior cruciate ligament lesions and popliteal cysts. The thresholds of LMBE in suggesting progression of lateral meniscal lesions and lateral compartment cartilage lesions were 1.4 mm and 1.3 mm, respectively. ConclusionBaseline LMBE was associated with structural damage progression over 4 years in knees with or at risks for OA. Thresholds of 1.4 mm and 1.3 mm could be used in predicting progression over 4 years of lateral meniscal damage and lateral compartment cartilage damage, respectively.

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine.

The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. Consensus statement. This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.

Complication rate and isokinetic test performance of combined ACL repair and ALL reconstruction vs. ACL and ALL reconstruction: A matched-pair analysis at 6 months follow-up

There has been renewed interest in anterior cruciate ligament (ACL) repair procedures in the past decade. The aim of this study was to evaluate complication rate and isokinetic test performance in a matched pair analysis between patients who underwent ACL reconstruction and patients who underwent ACL repair + augmentation. A retrospective analysis of prospectively collected data was performed. Patients undergoing ACL repair + augmentation with anterolateral ligament reconstruction were propensity matched in a 1:1 ratio to patients who underwent ACL + ALL reconstruction. At 6 months follow-up, patients were clinically evaluated and underwent isokinetic test. The overall complication rate and the Limb Symmetry Index (LSI) were evaluated. The hamstring concentric and eccentric deficit was evaluated in relation to the non-operated limb. The study population comprised 98 patients (49 matched pairs). The repair group presented 8 (16%) patients with complications and the reconstruction group presented 4 (8%) patients with complications ( p = 0.22). Regarding the repair group, the complications were: 3 re-ruptures, 2 lateral meniscus lesions, 1 medial meniscus lesion and 2 cyclops syndromes. In the reconstruction group, the complications were: 2 cyclops syndromes, 1 lateral meniscus lesion and 1 medial meniscus lesion. Regarding the LSI, the repair group had 12 (24%) patients presenting a concentric hamstring test deficit, and 12 (24%) patients with eccentric hamstring test deficit. The reconstruction group had 18 (37%) patients with concentric hamstring test deficit and 16 patients (33%) with eccentric hamstring test deficit. The overall complication rate between patients who underwent ACL reconstruction and patients who underwent ACL repair + augmentation was not statistically different. Patients who underwent ACL repair + augmentation presented less hamstring deficit at the isokinetic test at 6 months follow-up.

The aspiration test reveals an instability of the posterior horn of the lateral meniscus in almost one-third of ACL-injured patients

PurposeAnterior cruciate ligament (ACL) injuries often lead to associated injuries of the posterior horn of the lateral meniscus (PHLM). Arthroscopic, assessment of PHLM instability may be difficult in the absence of a visible meniscus damage. The main objective of this prospective multi-center study was to compare the ability of the probing and aspiration tests to identify PHLM instability in a population of patients undergoing ACL reconstruction (ACLR) and a control group of patients with an intact ACL undergoing knee arthroscopy.MethodsA prospective case–control analysis was performed in three sports medicine centers. One-hundred and three consecutive patients operated for a primary isolated ACLR without structural lateral meniscus damage other than a root tear were included. They were compared to a control group of 29 consecutive patients who had a knee arthroscopy with an intact ACL and no structural lateral meniscus lesion. The probing and aspiration tests were consecutively executed according to previously published methods.ResultsIn the control group, no lateral meniscus lesions were visualized during arthroscopy, and both probing and aspiration tests were negative in all patients. In the group of ACL-injured patients, a Forkel type I–III posterolateral meniscus root tear (PLMRT) was found in 12 patients (12%). In this subgroup, the probing test was positive in 4/12 patients (33%) and the aspiration test in 5 additional patients (75%). In 15 patients (15%), an elongation of the posterior root of the lateral meniscus (defined as type IV PLMRT as an addendum to the Forkel classification) could be observed during arthroscopy. In this subgroup, only 1 patient displayed a PHLM instability with the probing test (7%), whereas the aspiration test was positive in 13/15 patients (87%). In the remaining 76 patients (74%), no structural lesion of the PHLM could be identified. Nevertheless, an instability of the PHLM could be identified in 8 of them (11%) with the probing test, and the aspiration test was positive in 2 additional knees (13%) of this apparently normal subgroup. Altogether, in the entire ACL injury cohort, a positive probing test was observed in 13/103 patients (13%) and a positive aspiration test in 32/103 knees (31%) (p < 0.01).ConclusionCareful observation and examination of the PHLM with the aspiration test revealed a substantial amount of previously undiagnosed lateral meniscus instabilities in ACL-injured knees. The prevalence of PHLM instability as evaluated by the aspiration test was high (31%). The aspiration test was superior to the probing test in detecting an instability of the PHLM in a population of ACL-injured patients.Level of evidenceII.

Effect of Concomitant Meniscal Lesions and Meniscal Surgery in ACL Reconstruction With 5-Year Follow-Up: A Nationwide Prospective Cohort Study From Norway and Sweden of 8408 Patients.

Background:Increased knowledge of the factors predicting outcome after anterior cruciate ligament reconstruction (ACLR) is needed.Purpose:To determine the effect of concomitant meniscal lesions, and the surgical management thereof, on patient-reported outcomes 5 years after ACLR.Study Design:Prospective cohort study; Level of evidence, 2.Methods:A total of 15,706 patients who underwent primary unilateral ACLR between 2005 and 2008 were enrolled prospectively and evaluated longitudinally. All patients were part of the Norwegian and Swedish national knee ligament registries. Outcomes at 5-year follow-up were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariable linear regression model was used to assess possible effects on prognosis, as measured by KOOS, of a concomitant meniscal lesion and its associated surgical treatment.Results:At a mean follow-up of 5.1 ± 0.2 years, KOOS data were available from 8408 patients: 4774 (57%) patients with no and 3634 (43%) patients with concomitant meniscal lesions (mean patient age, 33.8 ± 10.7 years). Patients with concomitant meniscal lesions reported equal crude mean scores compared with patients without meniscal lesions in all KOOS subscales 5 years after ACLR. The mean improvement in scores from preoperative to the 5-year follow-up was greater for patients with a concomitant meniscal lesion for the KOOS Pain, Activities of Daily Living (ADL), and Sport and Recreation subscales. In the adjusted regression analyses, using patients without concomitant meniscal lesions as the reference, neither no treatment nor resection or repair of medial meniscal lesions were significantly associated with KOOS scores 5 years after ACLR. Except for the ADL subscale, in which a repaired lateral meniscal lesion was associated with better outcome, no significant associations between any of the lateral meniscal lesion treatment categories and KOOS outcome at 5-year follow-up were identified.Conclusion:Concomitant meniscal lesions at the time of ACLR conferred no negative effects on patient-reported outcomes 5 years after ACLR. The improvement in selected KOOS subscales from preoperative to the 5-year follow-up was significantly greater for patients with concomitant meniscal lesions than for patients without such lesions.

Significant Increase in the Rate of Meniscal and Chondral Injuries Between Primary and Revision Anterior Cruciate Ligament Reconstruction. (188)

Objectives:Anterior cruciate ligament (ACL) injuries are often associated with meniscal and chondral lesions. Meniscal lesions are present in up to 50% of ACL injured knees, and chondral lesions occur with an incidence of 20% to 40% in acute ACL-injured knees. The major importance of this lies in the fact that menisectomy and severe chondral damage are important predictors of poor outcomes including the subsequent development of knee osteoarthritis. Furthermore, patient reported outcomes following revision ACL reconstruction remain inferior to primary ACL reconstruction and this may, at least in part, be due to an increased incidence and severity of meniscal and chondral injuries. Although multiple studies have demonstrated that meniscal and chondral lesions are generally present at a higher rate at the time of revision ACL reconstruction when compared to primary ACL reconstruction, large studies following individual patients through primary and revision ACL reconstruction and tracking the change in the occurence of these injuries are scarce. The primary objective of this study was to determine the proportion of patients with meniscal and chondral injuries at the time of primary ACL reconstruction and determine how this rate changed by the time they underwent revision ACL reconstruction. The hypothesis was that the proportion of patients with meniscal and/or chondral lesions would be significantly greater at revision ACL reconstruction when compared to the primary procedures.Methods:Consecutive patients who underwent primary and then revision ACL reconstruction between March 1999 and February 2018 were identified using a single center registry. Patient characteristics, and intraoperative data from each procedure were collected and analyzed. This specifically included the occurrence and type of meniscal and chondral pathology. Descriptive statistics were used to evaluate the study sample using medians, descriptive data analysis was conducted depending on the nature of the criteria. Comparison between variables were assessed with student’s t test for quantitative variables and Mcnemar test for categorical variables. Statistical significance was set a t p<0.05.Results:213 consecutive patients underwent both primary ACL reconstruction and then revision surgery during the study period. The average time from primary ACLR to Revision was 46.8 ± 36.6 months (range 5-181).The mean age of patients at primary ACLR was 22.21±7.21 years. The mean age of patients at revision ACLR 26.1 ± 8.3 years. The mean IKDC for the entire population was 85.53 ± 11.59, The mean ACL-RSI score was 71.89 ± 23.95. The mean Lysholm score was 91.77±10.24. The proportion of patients with chondral lesions significantly increased from 7% at primary ACL to 15.5% at revision ACL (p < 0.05). Meniscal lesions also significantly increased from 44.6 % at primary ACLR to 70% at revision ACLR (p < 0.05). There was no significant difference in the rate of lateral meniscal lesions (11.7 vs 13.1, p > 0.05). However, the proportion of patients with a medial meniscus lesion (25.4 vs 36.2, p < 0.05) and bimeniscal lesions (7.5 vs 20.7, p < 0.05) increased significantly at revision ACL reconstruction.Conclusions:The proportion of patients with meniscal and//or chondral injuries at the time of revision ACL reconstruction is significantly higher than at the time of primary ACL reconstruction. Specifically, the rate of medial meniscus and bimeniscal injuries is significantly higher in patients undergoing revision ACL reconstruction

Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment

IntroductionIn patients aged over-50 years, although data are sparse, results of anterior cruciate ligament (ACL) surgery are good if selection is correctly performed. However, non-operative treatment is usually proposed for this age group, as patients generally prefer just to scale down their sports activities. Non-operative results are acceptable, but with a high risk of residual instability, secondary lesions and lifestyle alteration. The main aim of the present study was to compare results between surgical versus non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised assessing prognostic factors for poor functional outcome, and comparing the 2 groups epidemiologically to identify clinical decision-making factors. The study hypothesis was that results are comparable between operative and non-operative treatment of ACL tear. Material and methodThree hundred twenty patients were followed up prospectively: 92 non-surgical (NS group) and 288 surgical (S group). Classical epidemiological data were collected. Clinical laxity, differential laximetry, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic assessment were collected pre- and postoperatively, as were intraoperative data. Early and late complications were collected. ResultsAll patients were followed up. Patients were principally female, and were older, less athletic, with more stable knee and less severe functional impact in the NS group. Functional scores improved in both groups, and especially in group S, where sports scores were also better. In the NS group, laximetry at follow-up correlated with preoperative marked pivot-shift (p=0.024). Severe differential laxity was predictive of poor IKDC score (p=0.06). In the S group, laximetry at follow-up correlated with preoperative explosive pivot-shift (p<0.001), lateral meniscal lesion (p=0.007), use of hamstring tendon (p=0.007), and non-operated early complications (p=0.004). Factors for poor global KOOS score in group S comprised female gender (p<0.001), high BMI (p<0.001) and skiing (p=0.038). Factors for poor Tegner scores comprised skiing or team sport (p<0.05), isolated moderate medial osteoarthritis (p=0.01), and non-operated early complications (p=0.022). Factors for poor IKDC score comprised female gender (p=0.064), and non-operated early complications (p=0.019). Complications did not differ between groups. Discussion/ConclusionResults were satisfactory in both groups, with significant improvement in functional scores, but were better in group S. For NS patients, pivot sport was barely feasible and sports activity scores decreased. In case of severe laxity at diagnosis, surgical treatment should be proposed. Level of evidenceIII; non-randomized prospective comparative series.

The association of meniscal body height with knee structural changes in middle-aged and elderly patients with symptomatic knee osteoarthritis.

To investigate whether and how meniscal height is associated with osteoarthritis (OA)-related knee structural changes in symptomatic knee OA. We studied 106 patients (61 female, aged 40-73 years) with symptomatic knee OA. X-ray was used for Kellgren-Lawrence score. Meniscal body heights and extrusion were measured on coronal sections of intermediate-weighted MRI sequence. Knee structural changes were assessed using the modified whole-organ magnetic resonance imaging score (WORMS). Associations between meniscal body height and knee structural changes were assessed using linear regression analysis. Higher medial meniscal body height was significantly associated with severe medial meniscal lesions (p = 0.001-0.023), medial compartmental cartilage lesions (p = 0.045), patellofemoral compartmental and medial compartmental bone marrow edema patterns (p = 0.001-0.037), anterior cruciate ligament and patellar ligament abnormalities (p = 0.020-0.023), and loose bodies (p = 0.017). However, lateral meniscal body height was negatively correlated with WORMS scores for lateral meniscal lesions (p ≤ 0.018), lateral compartmental cartilage lesions (p ≤ 0.011), and lateral compartmental bone marrow edema patterns (p = 0.038). Higher medial meniscal body height was associated with more severe medial compartment structural abnormalities and patellofemoral bone marrow edema patterns, while lateral meniscal body height was inversely correlated with the severity of lateral compartment structural abnormalities. Our study revealed that meniscal body height was associated with multiple OA-related knee structural changes, which would be beneficial in identifying patients with or at risks for knee OA.

Ramp lesion of the medial meniscus.

Ramp lesion of the medial meniscus used to be completely disregarded in the past.Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention.It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc.Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended.Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon.Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

Midterm Results of Medial Unicompartmental Knee Arthroplasty Performed in Patients With Lateral Meniscus Abnormalities on Preoperative MRI Without Symptoms Related to Lateral Meniscus

BackgroundThe purpose of the present study was to compare the functional outcomes of medial unicompartmental knee arthroplasty (UKA) between patients with lateral meniscal abnormalities (LM [+] group) on the preoperative magnetic resonance imaging and those without lateral meniscal pathology (LM [–] group) and to evaluate the effect of a lateral meniscus lesion on functional outcomes after minimal 5 year follow-ups of medial UKA. MethodsThe outcomes of 66 knees (LM (+) group) were compared with the outcomes of 59 knees (LM (−) group) with a mean follow-up period of 75 months (range 60-93 months). The clinical outcomes were examined including the KS object/function score, Knee Injury and Osteoarthritis Outcome score, lateral side pain, and squatting ability at the last follow-up. The radiological parameters (mechanical axis and component position) were compared at the final follow-up visit. ResultNo significant intergroup difference was found in terms of the KS object/function score, Knee Injury and Osteoarthritis Outcome score, presence of lateral side pain, and squatting ability. On the radiographic evaluation, there was no statistical difference in the position of the implant and mechanical axis between the two groups. After the surgery, the LM (+) group showed a tendency of slight varus alignment in the postoperative radiography. ConclusionThe results of UKA for medial unicompartmental knee osteoarthritis were excellent regardless of preoperative lateral meniscal pathology in the magnetic resonance imaging, if the patients had no symptoms related to the lateral meniscus lesion.

Steep posterior lateral tibial slope, bone contusion on lateral compartments and combined medial collateral ligament injury are associated with the increased risk of lateral meniscal tear.

To determine the risk factors for lateral meniscus and root tears in patients with acute anterior cruciate ligament (ACL) injuries. A total of 226 patients undergoing acute ACL reconstruction were included in the study sample. Exclusion criteria were revisions, fractures, chronic cases, and multiple ligament injuries, with the exception of medial collateral ligament (MCL) injuries. The patients were divided into groups based on the presence of lateral meniscus and root tears by arthroscopy. Binary logistic regression was used to analyze risk factors including age, sex, body mass index (BMI), injury mechanism (contact/non-contact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial and meniscal slope, mechanical axis angle, and grade of pivot shift. Overall lateral meniscus (LM) tears were identified in 97 patients (42.9%), and LM root tears were found in 22 patients (9.7%). The risk of an LM tear in ACL-injured knees increased with bone contusion on LTP (odds ratio [OR], 3.5; 95% confidence interval [CI] 1.419-8.634; P = 0.007), steeper lateral tibial slope (OR, 1.133; 95% CI 1.003-1.28; P = 0.045), MCL injury (OR, 2.618; 95% CI 1.444-4.746; P = 0.002), and non-contact injury mechanism (OR, 3.132; 95% CI 1.446-6.785; P = 0.004) in logistic regression analysis. The risk of LM root tear in ACL-injured knees increased with high-grade pivot shift (OR, 9.127; 95% CI 2.821-29.525; P = 0.000) and steeper lateral tibial slope (OR, 1.293; 95% CI 1.061-1.576; P = 0.011). The increased risk of LM lesions in acute ACL-injured knees should be considered if significant risk factors including bone contusion on lateral compartments, MCL injury, and a steeper lateral tibial slope are present. Moreover, high-grade rotational injury with steeper lateral tibial slope are also significant risk factors for LM root tears, and therefore care should be taken by clinicians not to miss such lesions. III.

Predictors of Pediatric Anterior Cruciate Ligament Injury: The Influence of Steep Lateral Posterior Tibial Slope and Its Relationship to the Lateral Meniscus

To examine the relationship between posterior tibial slope and lateral meniscal bone angle (LMBA) on anterior cruciate ligament (ACL) tear risk in a pediatric population. In this case-control study, non-contact ACL-injured pediatric patients with no significant lateral meniscal lesions were matched by age and sex in a 1:1 ratio to a group of radiologically normal controls. Knee magnetic resonance imaging (MRI) studies were analyzed by 3 independent, blinded observers measuring the medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), and LMBA. Sagittal slope asymmetry was calculated as the absolute difference in degrees between slopes, and the relationship between LMBA and LTS was calculated as a ratio. Binary logistic regressions identified independent predictors of ACL injury. Receiver operator characteristics were performed to determine predictive accuracy. 20 study patients were compared with 20 sex- and age-matched controls (age 14.8 ± 2.42, mean ± standard deviation). LTS was significantly higher in the ACL-injured group (11.30° ± 3.52° versus 7.00° ± 2.63°, P= .0001), as were the absolute slope difference (7.10 ± 2.92° versus 3.14 ± 3.25°, P= .0002) and LTS:LMBA ratio (0.46 ± 0.17 versus 0.26 ± 0.12, P= .0001). No significant differences were observed for MTS or LMBA. Independent predictors were LTS (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.18 to 2.13, P= .002), LTS:LMBA ratio (OR 3.13, 95% CI 1.48 to 6.62, P= .003), and absolute slope difference (OR 1.65, 95% CI 1.17 to 2.32, P= .005). LTS:LMBA ratio was the strongest predictor variable (area under the curve 0.86). This study suggests that LTS, absolute slope difference, and LTS:LMBA ratio are significant pediatric ACL-injury risk factors. All 3 demonstrate good predictive accuracy; however, the relationship between steep LTS and shallow LMBA was the strongest predictor. III, case-control study.