Longitudinal Tear Research Articles

S1677 Topical Cannabidiol (CBD) for the Treatment of Anal Fissures: A Case Series

INTRODUCTION: An anal fissure is defined as a longitudinal tear in the anal canal distal to the dentate line. It is a common benign condition that may be primary, resulting from local trauma, or secondary, stemming from an underlying disorder such as a malignancy, sexually transmitted infection, or inflammatory bowel disease. The primary symptom is anal pain particularly during defecation but may last for several hours. While the pathophysiology remains unclear, a mechanism of internal anal sphincter spasm, reduced perfusion and local ischemia has been proposed. Current first-line therapy involves a combination of a topical vasodilator therapy (nitroglycerin or calcium channel blockers) along with supportive measures such as a high fiber diet, sitz baths, local anesthesia, and stool softeners. Topical vasodilators are effective in 50% of cases but are often limited by side effects. The vasoactive properties of Cannabidiol (CBD) has been described in both human and animal models. CBD induced vasodilation has been shown in renal, mesenteric, opthalmic and cerebral arteries. The vasorelaxant properties of CBD have yet to be exploited in the management of anal fissures. We report five patients with anal fissures that were successfully treated with topical CBD. CASE DESCRIPTION/METHODS: Five consecutive patients who presented or were referred to a single Gastroenterology practice for an anal fissure were prescribed topical cannabidiol (1.4–2 mg/g) twice daily and supplemental fiber. One patient was female. Mean age was 49 (Range 31–63). Duration of symptoms was greater than 6 weeks in all patients. Each patient was asked to complete a modified HEMO-FISS QoL questionnaire to measure symptom improvement after two weeks of therapy. All patients reported a significant improvement in symptoms at follow-up. No side effects were reported. One patient later had a recurrence of symptoms that required treatment with Botulinum toxin injection. DISCUSSION: Cannabidiol has been shown to induce endothelium dependent vasorelaxation in human mesenteric arteries through activation of CB1 receptors. It is likely that the vasoactive properties of CBD reduce local ischemia and promote healing of chronic anal fissures. As far as we are aware, this is the first report showing a potential role for CBD in the management of acute and chronic anal fissures. Given the limited options for topical therapy and significant side effects, CBD provides an attractive alternative to conventional first line treatment. Further studies are warranted.

Anal Fissure in Children.

Anal fissure is a common clinical problem in children and is defined as a longitudinal tear in the anal canal. The typical presentation is painful defecation and rectal bleeding. The etiology of anal fissure is unknown, but passage of hard stools and increased internal anal sphincter pressure are considered important factors. The treatment is oriented to relieve the spasm of the internal anal sphincter, which prevents healing of the fissure. Conservative management with stool softeners, topical analgesics, and sitz baths is recommended as first-choice therapy. Surgical treatment has been replaced by nonoperative management as definitive therapy, which is associated with a marginally higher success rate than placebo. Most recent studies have focused on nonoperative treatment with glyceryl trinitrate, calcium channel blockers, or botulinum toxin injection treatment. There are a few controlled studies to compare the different nonoperative treatment options in children. Success rates vary between the studies, and there is no clear evidence about which is the optimal nonoperative treatment. A significant recurrence rate has been reported after nonoperative management of anal fissure. It is important to treat constipation to avoid recurrent tears in the anal canal.

Safety and efficacy of the treatment of chronic anal fissure by lateral internal sphincterotomy: A retrospective cohort study

BackgroundAn anal fissure is one of the most common anorectal diseases resulting from a longitudinal tear in anoderm under the dentate line. It causes severe pain during defecation, and the resulting emotional stress leads to a reduction in the overall quality of life of a person. There are several medical and surgical treatment procedures that are employed to treat anal fissures. In the present retrospective study, we aimed to evaluate the safety and efficacy of lateral internal sphincterotomy (LIS) surgical procedure for the treatment of chronic anal fissure. Additionally, we also analyzed the complications arising after the surgery and the factors affecting the complications. MethodsThe present study is a retrospective study that included 691 patients treated for chronic anal fissure in a private sector setting, by a single Saudi female surgeon, starting from April 2004 to April 2020. ResultsOut of the 691 patients included in the study, all the patients were female, with an average age of 45.77 years (ranging from 17 to 82 years). Major complaints of the patients were as follows: pain, bleeding, constipation, pruritus, perianal discharge. Recurrence was reported in 2 patients (0.3%) while, 3 patients (0.4%) developed gas incontinence.The complaints of all patients with gas incontinence regressed over a period of time. ConclusionThis study reports that lateral internal sphincterotomy (LIS) is a safe surgical treatment for chronic anal fissure, leading to a reduction in recurrence, incontinence rate and substantially improves symptoms, especially pain.

Longitudinal tear detection of conveyor belt under uneven light based on Haar-AdaBoost and Cascade algorithm

As the light of the belt conveyor changes drastically and unevenly, it will cause the longitudinal tear detection rate of the traditional methods drop sharply. To improve the situation, a novel method, which replaces the traditional geometric features with the Haar features, is proposed. First, the Haar feature was employed to train weak classifiers. Then, the AdaBoost algorithm is utilized to upgrade the weak classifiers to strong classifiers. Finally, the Cascade algorithm is introduced to combine strong classifiers in series into a cascade classifier that can reduce the training and processing time. The experiment following the above proposed method has shown that the recall, accuracy, and precision of tear detection under uneven light almost approaches the level under the uniform light (less than 3% difference), which indicates that our method is more accurate and robust than the existing methods in real-time belt tear detection.

Prevalence and Seasonal Pattern of Anal Fissure in Rural Hospital of Nepal

Introduction: Anal Fissure (AF) is a longitudinal tear in the epithelium of the anoderm within the anal canal. It is associated with symptoms of severe anal pain and rectal bleeding. While searching for literatures on AF prevalence in Nepal, there were hardly any systematic published studies except a few studies that mostly focused in the treatment and outcome of the disease. The objective of the present study is to report on AF prevalence with its seasonal pattern among anorectal disorder patients from this rural part of Nepal.
 Methods: This was a retrospective cross-sectional study from June 2015 to March 2020 at the Karnali Academy of Health Sciences. The demographic characteristics features of anal fissure were recorded. Cases included all hemorrhoids, perianal abscess and fistula in Ano with a bleeding history. Previous fistulectomy, biopsy-proven tuberculosis and malignancy were excluded. Statistical analysis was performed using SPSS 16.
 Results: A total of 1768 patients with ano-rectal disorders visited surgical outpatient department OPD) during the study period. Of 1768 patients, 415 patients (23.47%) had anal fissures. The mean age of patients was 29.02±13.58 years. There were 176 male patients (42.4%) and 239 (57.6%) patients were female. The majority (n=148; 35.7%) of patients were in the group 20 to 29 years. Most of the patients with anal fissure visited during winter time (42.7%).
 Conclusion: Anal fissure is common anorectal problem, with slight female predominance. The majority was found to affect the adolescent group

Infrared spectrum analysis method for detection and early warning of longitudinal tear of mine conveyor belt

• Monitor longitudinal tear with infrared thermography. • Overcome the interference caused by the change of infrared image threshold. • Select the appropriate detection spectral passband. • Coefficient T can be used to quantitatively describe tear change characteristics. A novel approach based on infrared spectrum analysis for early-warning of longitudinal tearing of the conveyor belt was proposed in the paper. Unlike most existing methods, the proposed method monitors the change process of the infrared radiation field of the longitudinal tearing through the infrared thermal imaging technology, and judges whether there is the risk of the longitudinal tearing of the conveyor belt through the frequency-domain characteristic coefficient T of the infrared radiation field. Experimental results exhibit that the characteristic coefficient T can quantitatively describe the change characteristics of infrared radiation field during the tearing process of conveyor belt. When the conveyor belt is complete penetration, the T value fluctuates violently from 0.6 to 1.6. This characteristic can be used as the precursor information of the tearing process, which broadens the train of thought for identification and early warning of conveyor belt longitudinal tearing.

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

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

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

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

Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure

Background: The longitudinal tear or defect in the epithelial lining of the anal canal distal to the dentate line is called anal fissure. It is of two types: acute and chronic. The break in the cycle of pain, spasm and ischemia is essential for successful treatment of anal fissure. Among multiple non-surgical treatment approaches, the appropriate approach with good patient compliance might be the use of topical agents as chemical sphincterotomy. However, the effectiveness of these agents has not been evaluated widely.
 Objectives: To evaluate clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure.
 Methodology: The study was prospective comparative type including total 158 patients. Initially, they were given first line therapy followed by chemical sphincterotomy agents. The study drugs were given to 84 patients (three groups - 0.2% glyceryl trinitrate, 2% diltiazem and their combination) who were not healed after initial therapy. Patients were assessed for pain using visual analogue scale and other symptoms prior to and after two and six weeks of therapy.
 Results: Complete healing rate was higher with combination (92.86%) than individual agents. The reduction of visual analog scale score within each group and between the groups in the period between before and after treatment was found to be statistically significant. Headache and hypotension were the common side effects seen during study.
 Conclusion: Anal fissures can be successfully managed by chemical sphincterotomy. The topical nitrates and calcium channel blockers in combination are found to be effective choice rather than individual agents.

The Associated Meniscal Tears and Associated Risk Factors in Concomitant ACL Injuries of the Knee: A Retrospective Analysis

Introduction: The pattern of meniscus tear has significant impact onsubsequent rehabilitation and functional outcome as theyare usually associated with ACL injury.Knowledge about associated meniscus tear helps to identifypatients in the early post-traumatic phase. 
 Objectives: To study meniscus tear patterns and associationbetween different tear patterns of meniscus in ACLinjured subjects and to identify potential demographic andother associated risk factors.
 Methodology: Routine arthroscopic findings database of 54 patientsoperated for primary ACL reconstruction from January 2017to December 2018 was used to study associated tear of meniscus. Based on arthroscopic evaluation, cases weregrouped into meniscus having no tear, minor tear and majortear. Major tear included complete radial tears, root tearsand unstable longitudinal tears including bucket-handletears.
 Result: Totalarthroscopycasesinthestudydurationwere124.Ofthose,43% (n=54) underwent ACL reconstruction (ACLR) for tornACL. Among the patients who underwent ACLR, 58% had notear, 26%hadminortears, and16%hadmajortears ofthemeniscus. Therewere significant differencesbetweenthree groups for gender, age groupsandmechanism of injury. Risk factors formajortearsweremalegenderandage<30years.Minorandmajortears were associated with a contact injury.
 Conclusion: Male, age <30 years and history of contact injury havehigh risks for having an associated meniscus tear. Earlyreferral to magnetic resonance imaging and/or arthroscopyis recommended to allow meniscus repair in a timelymanner.

Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes.

The past 2 decades have been marked by substantial progress in our knowledge of meniscus anatomy, function, and biomechanics, and also by the shifting of the surgical treatment of meniscal lesions from traditional meniscectomy towards arthroscopic repair to get away from the early osteoarthritis associated with meniscectomy. Posterior horn injuries of the lateral meniscus (LM) have been less studied due to their lower incidence and also due to the historical technical complexity of performing a repair in the posterolateral compartment. A retrospective analysis of prospectively collected data was performed of all athletic patients who had a peripheral longitudinal tear of the lateral meniscal posterior horn and who underwent at least one repair procedure with a posterolateral approach between 2014 and 2018. The type of injury, extent of lateral meniscal tear, and characteristics of sutures placed were assessed. Clinical assessment included objective and subjective IKDC ratings. The Tegner activity level score was determined before the injury and at the last follow-up visit. Failure was defined as a need for revision surgery. All complications were documented. The study population comprised 24 athletes with a mean follow-up of 25.2 ± 10months. The Tegner activity level was exactly the same before the injury as after the surgery. The mean IKDC score significantly increased from 41.8 (12.2) before the surgery to 94.5 (9.1) after. There were four reoperations for failure (16.6%) that required a new suture repair. None of these revised repairs sustained a new failure as of the last follow-up. Despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the LM. The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.

Magnetic resonance imaging of normal anatomy and injury of the peroneal tendon

Objective: To explore the MR characteristics of normal anatomy and injured peroneal tendon and the diagnostic value of MR in the peroneal tendon injuries. Methods: From February 2018 to December 2018, a total of 20 healthy volunteers (40 ankle joints) were selected, 10 males and 10 females, with an age range of 20-30 (26±3) years. Retrospective analyzed 62 patients with ankle sprain and peroneal tendon injuries confirmed by operation, 34 males and 28 females, with an age range of 14-78(41±14) years. All volunteers and patients underwent MR examination. The MRI characteristics of the normal anatomy of peroneal tendon were analyzed. The patients were classified according to the MR diagnostic criteria of injury. Then the MRI features of different types of injured peroneus longus tendon and peroneus brevis tendon were analyzed. At last, imaging findings were compared with surgical results. Results: The peroneal tendon of 20 healthy volunteers showed oval and elliptical band-like structures on T(1)WI and PD-FS sequences, with natural alignment, clear boundary and uniform low signal. The whole length of the peroneal tendon can't be displayed completely on the same imaging plane. It needed multi-dimensional observation combined with axial, coronal and sagittal directions. There were 62 cases of peroneal tendon injury, including 46 cases of peroneal tendon tear (7 cases of partial-thickness tear, 11.3% of the total injuries, 39 cases of full-thickness tear, 62.9% of the total injuries), 16 cases of peroneal tendon dislocation (15 cases of intrathecal dislocation, 24.2% of the total injuries, 1 case of extrathecal dislocation, 1.6% of the total injuries). In 7 cases of partial-thickness tear (4 cases of peroneus brevis tendon tear, 3 cases of peroneus longus tendon tear), MR showed irregular tendon shape and local continuity interruption. In 39 cases of full-thickness tear (31 cases of peroneus brevis tendon tear, 8 cases of peroneus longus tendon tear), MR showed that the tear was penetrated through the whole layer of tendon from dorsolateral side to plantar side of foot, and the range of tear was different. The torn tendon could be accompanied by tendinitis or effusion of tendon sheath; 15 cases of intrathecal dislocation (3 cases of type A, 12 cases of type B), MR findings of type A dislocation showed that the peroneus longus tendon was located in the deep part of the peroneus brevis tendon, MR findings of type B dislocation showed that the peroneus longus tendon was displaced into the longitudinal tear of peroneus brevis tendon. In 1 case of extrathecal dislocation (type Ⅲ), MR showed that the SPR and the attached cortex of lateral malleolus were avulsed together, and the peroneal tendon was displaced under the avulsed fracture piece. Conclusion: MR can accurately demonstrate the fine anatomical structure of peroneal tendon and the imaging features of injuries. It has important clinical application value for the early diagnosis and accurate treatment of peroneal tendon injuries.

Mechanical alterations in the avascular region of the meniscus following partial meniscectomy: A cadaveric porcine longitudinal meniscal tear model

BackgroundAlthough partial meniscectomy is a common treatment for the tears in the avascular region of the meniscus, mechanical alterations following meniscectomy are known to initiate mechanically-induced osteoarthritis. We aimed to measure the articular cartilage contact pressure distributions in the knees with surgically repaired and partially resected menisci in the avascular region. MethodsA pneumatic loading device was developed to apply a 1000 N compressive load on the cadaveric porcine knee samples at the flexion angles of 20, 35, 50, and 65°. We simulated longitudinal meniscal tears in the avascular inner 1/3 portion and the well-vascularized middle 1/3 portion of the meniscus. Articular cartilage contact pressures for the knees with intact, torn, repaired, and resected menisci were compared. FindingsFor the tears in well-vascularized regions, meniscal repairs restored articular cartilage contact pressures to the levels in intact joints. However, partial meniscectomy significantly increases the maximum contact pressures and the average contact pressures in highly compressed areas. However, partial meniscectomy in the avascular region did not alter the maximum articular cartilage contact pressures and the average contact pressures in highly compressed areas. Stabilities in knee samples were not significantly altered following partial meniscectomy in both inner and middle regions. InterpretationAlthough repair surgeries are beneficial for the tears in well-vascularized areas because the articular cartilage contact mechanics are reconstructed, partial meniscectomy may be a viable alternative treatment for the tears in avascular regions without introducing significant mechanical alterations.

Impact of the T2-weighted axial oblique MRI sequence in the assessment of peroneal tendons

To define the role of the T2-weighted axial oblique sequence for the magnetic resonance imaging (MRI) assessment of peroneal tendon pathologies. Two radiologists interpreted 180 ankle MRI examinations using standard sequences alone and then in combination with an axial oblique sequence. The readers indicated how likely a peroneal pathology was present using a five-level confidence scale. Diagnostic confidence, interobserver agreement, and clinical correlation were compared. Changes in diagnosis were recorded. For both readers, the diagnostic confidence was significantly higher using the axial oblique sequence for tendinosis and inframalleolar tenosynovitis for both tendons and for peroneus brevis partial and longitudinal split tears (p<0.001). For reader 1, the diagnostic confidence was also higher using the axial oblique sequence for peroneus longus partial tears (p=0.007). Changes in diagnosis were seen for tendinosis and tenosynovitis of both tendons and for peroneus brevis partial and longitudinal split tears in 0.6-10.8% of cases. Inter-rater reliability was significantly higher with the axial oblique sequence for the diagnosis of tendinosis, inframalleolar tenosynovitis, and partial tear for both tendons, and for peroneus brevis longitudinal split tear. Amongst 105 examinations with clinical information, peroneal pathologies were most frequently diagnosed as present in cases with lateral symptoms (17% versus 14%) and absent in cases without lateral symptoms (92% versus 86%) on the axial oblique sequence. The axial oblique sequence for the assessment of peroneal tendons allows for higher diagnostic confidence, inter-rater reliability, and clinical correlation and can lead to changes in diagnosis.

Contact mechanics after mattress suture repair of medial meniscus vertical longitudinal tear: an in vitro study.

Most studies have concentrated on the changes in contact pressure and area on the tibiofemoral joint. This study compared the contact mechanics underneath the medial meniscus of a repaired vertical longitudinal tear with that of the intact or the torn ones. In this controlled laboratory study, a 1000 N compressive axial load was applied to eight fresh-frozen cadaveric knees at four flexion angles and four loading conditions using a custom testing apparatus attached to a material testing machine. Intact knees, knees with a medial meniscus vertical longitudinal tear, and knees after meniscal repair were tested. The peak contact pressure and area underneath the meniscus were measured using Fuji pressure-sensitive film. A medial meniscus vertical longitudinal tear significantly increased the contact pressure and decreased contact area underneath the meniscus compared with those at the intact meniscus under all tested biomechanical conditions, and repair of the tear can restore the contact pressure and area in most conditions. While the repaired group showed a significantly higher or similar contact pressure compared with the tear group at 90° neutral knee position and at 60°, 90° 5 N·m-external rotation and 134 N-anterior tibial translation, and 5 N·m-internal rotation at all flexion angles. The contact area corresponding to the aberrant result of the contact pressure in the repaired group was lower than in the intact meniscus group. The contact mechanics underneath the meniscus of the repaired medial meniscus vertical longitudinal tear were significantly improved compared with the corresponding tear conditions in most cases, while the contact pressure and area at some certain status after repair were not significantly different from those of the corresponding tear conditions.

Functional Outcomes of Arthroscopic Combined Anterior Cruciate Ligament Reconstruction and Meniscal Repair: A Retrospective Analysis

PurposeTo evaluate the outcomes of arthroscopic meniscal repair performed in combination with anterior cruciate ligament (ACL) repair.MethodsThis study presents a case series of 34 patients who underwent repair of meniscal tears along with ACL reconstruction from 2014 to 2016. Cases of discoid meniscal lesions and combined or ligament injuries other than ACL injuries were excluded. Patients were followed up periodically, at 3, 6, 9, 12, and 24 months. Preoperative and postoperative functional evaluations were performed using visual analog scale, International Knee Documentation Committee, and Lysholm knee scores.ResultsThe mean age of the patients was 29.1 years (range, 17-44 years). The mean follow-up period was 18 ± 7.8 months (range, 6-24 months). Among the 34 individual knees, 1 patient (3%) underwent both medial and lateral meniscal repairs. Medial meniscal repair was performed in 20 knees (59%), whereas the lateral meniscus was repaired in 13 knees (38%). A longitudinal tear was the most common type of tear pattern, followed by radial (6 patients) and complex (3 patients) tear patterns. The radial and complex tears were treated with an additional partial meniscectomy. The mean International Knee Documentation Committee score was 38.46 preoperatively and improved to 80.30 at final postoperative follow-up (statistically significant difference, P < .01). The mean Lysholm score was 50.30 preoperatively and improved to 91.40 at final postoperative follow-up (statistically significant difference, P < .01). According to the Lysholm knee score, 31 patients (89%) had excellent or good results. The mean visual analog scale score decreased from 7.3 preoperatively to 2 postoperatively. The clinical success rate of the repairs was 89%. Of 35 repairs, 4 (11%) had retears.ConclusionsArthroscopic meniscal repair along with ACL reconstruction provided predictable high rates of meniscal healing and yielded favorable functional and clinical results. Patient selection remains one of the most important prognostic factors.Level of EvidenceLevel IV, therapeutic case series.

Delayed or neglected meniscus tear repair and meniscectomy in addition to ACL reconstruction have similar clinical outcome.

To compare the clinical outcomes of meniscus repair and meniscus resection with concurrent anterior cruciate ligament (ACL) reconstruction in patients with ACL rupture and neglected or delayed medial meniscus tears. Thirty patients with ACL ruptures and unstable vertical longitudinal medial meniscus tears were included. Patients were divided into two groups. Group I included 15 patients who underwent meniscal repair and Group II included 15 patients who underwent meniscectomy. The knee range of motion, McMurray test, Lachman test, pivot shift test, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Questionnaire, Hospital for Special Surgery (HSS) Knee score, and Tegner activity (TA) scale were used to assess all patients. The median follow-up time was 3.6 (0.5-6.5) years. Median age was 28 (16-36) years. Fourteen patients (93.3%) in Group I and six patients (40%) in Group II returned to their preinjury sport activity level (P = .007). Median maximum knee flexion was 132° (121°-140°) in Group I and 134° (121°-139°) in Group II (n.s.). All patients had full knee extension and negative McMurray test results. Lachman and pivot shift test results were similar between groups. The median IKDC Questionnaire score was 99 (86-100) in Group I and 93 (70-100) in Group II (P = .016). The difference in Lysholm Knee Scoring Scale, HSS knee, and TA scale score between groups were not significant. Clinical outcomes of patients that underwent meniscus repair were better than those that underwent meniscus resection with concurrent ACL reconstruction. The technically complicated and costly meniscus repair may achieve better clinical outcomes than meniscectomy when treating a neglected or delayed meniscal tear with a concurrent ACL tear. III.

Comparison between two rabbit models of posttraumatic osteoarthritis: A longitudinal tear in the medial meniscus and anterior cruciate ligament transection

Animal osteoarthritis (OA) models have been developed to understand OA progression and evaluate new OA therapies. However, individual variations in joint lesions remain a critical problem in most current OA models. We established a novel rabbit model by creating a longitudinal tear in the medial meniscus body that was reproducible and similar to posttraumatic biomechanical disturbances in human OA. New Zealand rabbits underwent surgery and were assessed for 9 weeks. The rabbits were randomized into the sham control, medial meniscal tear (MMT), and anterior cruciate ligament transection (ACLT) groups. The animals were sacrificed at 4, 6, and 9 weeks posttreatment. The knee joints were harvested for histological and gene expression assessments. Both the MMT and ACLT procedures led to time-dependent degenerative changes in the femoral condyle cartilage. At each time point, the MMT group cartilage showed more severe degenerative changes than did the ACLT group cartilage. Consistently, inflammatory cytokine and catabolic gene expression were significantly higher, and anabolic gene expression was significantly lower in the MMT group than in the ACLT group. MMT treatment caused more severe structural damage to the cartilage and higher catabolic gene expression levels than the ACLT model at each time point. The MMT model may be highly beneficial in investigating posttraumatic OA (PTOA) development, especially PTOA from a meniscal injury. The MMT model replicated key features of human PTOA, including meniscal lesions, inflammatory responses, and the progression to osteoarthritic cartilage degeneration, thereby providing an exciting new avenue for translating promising treatments to clinical practice.

MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation

Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging.

Knee Arthroscopy: The “Crevice Sign,” a New Pathognomonic Sign for Unstable Posterior Medial Meniscal Tear in Anterior Cruciate Ligament–Deficient Knees

There has been increased emphasis on medial meniscus repair in the anterior cruciate ligament–reconstructed knee, as this improves stability. We describe an arthroscopic sign of an unstable medial meniscal tear that is diagnostic. The “crevice sign” is a longitudinal fissure located on the distal medial femoral condyle. In the anterior cruciate ligament–deficient knee, there is increased strain on the medial meniscus. A posterior longitudinal medial meniscal tear can occur at the time of the index injury or with subsequent instability events. During this injury, the knee pivots and the anterior edge of the unstable medial meniscus digs into the articular cartilage of the medial femoral condyle, resulting in a longitudinal split of the distal femoral condyle articular cartilage. If this sign is observed during arthroscopy, it is recommended that surgeons thoroughly probe the medial meniscus to ensure no pathology is missed.