Medial Meniscal Tears Research Articles

Usefulness of ultrasonography for dynamic evaluation of medial meniscus hoop function in early knee osteoarthritis

This study aimed to evaluate the dynamics of the medial meniscus during knee flexion–extension by ultrasonography and compare them with MRI findings to confirm the usefulness of ultrasonography for evaluating early knee osteoarthritis (KOA). In total, 100 patients were diagnosed with early KOA using clinical and radiographical findings. Dynamic ultrasonographic evaluation and MRI were performed in all patients. Medial meniscal extrusion (MME) and medial meniscal tears were evaluated via ultrasonography and MRI. Abnormal MME was defined as MME > 2 mm on ultrasonography during knee extension. Patients with abnormal MME were divided into two groups: a decrease group (group D) and a non-decrease group (group N). Age, sex, absence or type of meniscus tear, and MME were compared between the two groups. Of the 100 patients, 75 demonstrated MME > 2 mm at knee extension. MME at all assessment positions using ultrasonography and MRI were significantly greater in group N (n = 34) than that in group D (n = 41). Medial meniscus posterior root tears or radial tears were observed in most cases in group N. A lack of decrease in MME from 0° to 90° of flexion on ultrasonography was a characteristic finding in patients with a loss of meniscal hoop function.

A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign

BackgroundDiagnosing partial tears of the medial meniscus (MM) posterior root is difficult. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs.MethodsEighteen patients who had arthroscopically confirmed partial MMPRTs were included. As a control, 18 patients who underwent partial meniscectomy for other types of MM tears were evaluated. Isolated partial MMPRTs were classified into the following three types: type A, accurate partial stable tear (cleavage < 1/2 of root width); type B, bridged unstable root tear (cleavage ≥ 1/2 of root width); type C, complex horn tear expanded to the root. Conventional MRI-based findings of MMPRTs were evaluated between two groups (n = 23). Posterior root irregularity, bone marrow spot, and ocarina-like appearance showing several condensed circles in triangular meniscal horn (ocarina sign) were also evaluated.ResultsPosterior root irregularity and bone marrow spot were frequently observed in the partial MMPRTs (47.8%), compared with the other MM tears (P = 0.007 and 0.023, respectively). The ocarina sign was detected in 69.6% of patients with partial MMPRTs. A significant difference between two groups was observed in a positive ratio of ocarina sign (P < 0.001). Types A, B, and C of the partial tear/damage were observed in three, eight, and seven patients, respectively. The ocarina sign was the most common MRI finding in each type of partial MMPRT.ConclusionsThis study demonstrated that a characteristic MRI finding, “ocarina sign,” was frequently observed in patients with partial tear/damage of the MM posterior root. The ocarina sign was the most common MRI finding in several types of partial MMPRTs. Our results suggest that the ocarina sign may be useful to diagnose unnoticed partial MMPRTs.Level of evidence: IV, retrospective comparative study.

The posterior oblique ligament in MRI of acute knee trauma

To identify the posterior oblique ligament and assess incidence and patterns of injury to the ligament on MRI of acute knee trauma. One hundred twenty-three MRI studies met the study criteria. For each case, the posterior oblique ligament was identified and scored as injured or normal. Incidence of proximal and distal posterior oblique ligament tears was calculated. Fisher's tests were employed to determine significance of association between tears of the posterior oblique ligament and components of the posteromedial corner and other capsuloligamentous structures of the knee. The posterior oblique ligament was reliably identified as a distinct structure in 123 MRI scans that met the criteria and was consistently labeled as intact or torn. Posterior oblique ligament tear was seen in 61.7% of knee trauma with proximal injury in 56.5% and distal injury in 97.3% of positive cases. Posterior oblique ligament disruption was a part of multiligamentous injury in 94.7% of positive cases. Posterior oblique ligament injuries (n = 76) had an extremely significant relationship with oblique popliteal ligament tears (n = 27) (p = 0.0001), semimembranosus tendon insertion tears (n = 15) (p = 0.0005), and medial collateral ligament tears (n = 15) (p = 0.0005) and a highly significant association with medial meniscus tears (n = 68) (p = 0.0049) and posterior cruciate ligament tears (n = 12) (p = 0.0033). The association with anterior cruciate ligament tears (n = 53) was not significant. The posterior oblique ligament is a distinct radiological entity consistently identified in acute trauma MRI. Disruptions of the distal posterior oblique ligament are frequent in complex knee injury, notably in association with oblique popliteal ligament, medial collateral ligament, and semimembranosus tendon tears.

Medial Meniscus Repair in Major League Soccer Players Results in Decreased Performance Metrics for One Year and Shortened Career Longevity.

BackgroundThe rate of medial meniscus tear (MMT) in professional soccer players is high. There are no studies on objective performance metrics following medial meniscus repair in these athletes.PurposeExamine the impact of MMT treated with surgical repair on performance metrics and career longevity in Major League Soccer (MLS) players.MethodsMLS players who sustained an MMT between 1993 and 2019 were identified via publicly available databases. These players were each matched to 2 uninjured controls by debut date, experience, position, race, ethnicity, height, weight, and body mass index (BMI). Demographic data and performance metrics were then collected for both groups. Matches, minutes, goals, assists, shots, shots on target, duels, and duel percentage won are collectively referred to as performance metrics. Statistical analysis compared demographic distributions and performance metrics between the MMT and control groups.ResultsThirty-three MLS players who had undergone medial meniscus repair were identified and matched to 66 controls. All performance metrics decreased in the MMT group when compared to their controls in the first year after injury. This difference remained significant even when the performance metrics were normalized with respect to time, indicating that the injured players both played less and were not as productive. At 2 years after injury, performance metrics returned to pre-injury levels and were equivalent to those of the healthy controls. Career length was found to be significantly different between the two groups at 8.81 ± 3.9 years for the MMT group and 12.63 ± 3.51 years for the control group (P < 0.001).ConclusionMLS players undergoing medial meniscus repair had decreased performance metrics in the first year after injury but returned to baseline levels of play at the second year after injury. Their careers were also shorter than those of their uninjured controls.

ACL reconstruction, medial meniscus repair and high tibial osteotomy done as a single stage procedure in a case of neglected ACL and partial medial meniscus tear with a subsequent varus knee: A case report

A long standing anterior cruciate ligament (ACL) tear causes progressive degenerative changes in the knee. This leads to secondary meniscal lesions, cartilage degenerative changes and subsequent varus angulation.A 27 year old male footballer presented to us with a traumatic right knee pain and swelling with recurrent instability, since 8 years. On examination there was knee laxity with an obvious varus deformity of the right leg. Radiographs showed medical compartment osteoarthritis and MRI was suggestive of a chronic ACL and medial meniscus tear. A single step salvage procedure of ACL reconstruction, medial meniscus repair and valgus producing high tibial osteotomy (HTO) was done for this patient. Post operatively there was no knee laxity and instability. At one year follow up, the patient had a satisfactory outcome with a painless and complete knee range of motion and had full weight bearing.In this case report we have shown how a single step salvage procedures with biological reconstructions can be done for patients with chronic ACL and medial meniscus tear patients with varus angulation, with a good outcome. Hence, simultaneous reconstructions of the ACL and medial meniscus with HTO can be used as a novel management technique to delay arthroplasty in young patients with unstable arthritic knees.

Articular Cartilage and Meniscus Risk Factors of Patient-Reported Outcomes 10 Years after ACL Reconstruction: A Multicenter Cohort Study (160)

Objectives:Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 10-year follow-up after ACLR.Methods:Between 2002 and 2008, 3273 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the risk factors of IKDC, KOOS, and Marx at 10 years.Results:We completed a minimum follow-up on 77% (2530/3273) of our cohort at 10 years. The cohort was 56% male with a median age of 23 years at the time of enrollment. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-22%, lateral femoral condyle [LFC]-15%, medial tibial plateau [MTP]-4%, lateral tibial plateau [LTP]-11%, patella-18%, trochlear-8%) and meniscal (medial-37%, lateral-46%). Variables that were predictive of 10-year outcomes included articular cartilage damage in the patellofemoral and medial compartments and previous medial meniscus surgery (6% of knees) (Table). Medial and lateral meniscus tears and treatment at the time of ACLR were not associated with 10-year outcomes. Other variables that significantly influenced 10-year outcomes included sex, race, BMI, type of reconstruction (primary vs. revision), baseline outcome scores, and MCL pathology (5.5% of knees).Conclusions:Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscus surgery prior to ACLR are associated with 10-year ACLR outcomes. However, meniscal tears/treatment at the time of ACLR did not predict 10-year outcomes.

Application of pie-crusting technique of deep medial collateral ligament under arthroscopy in repairing posterior horn of medial meniscus tears

To explore effectiveness and safety of an inside-out, arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint. From January 2016 to December 2017, 61 patients (61 knees) were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint, who were divided into valgus group and pie-crusting group according to exposure of PHMM region . There were 28 patients in valgus group, including 12 males and 16 females aged from 27 to 60 years old with an average age of (35.75±7.57) years old;who were performed conventional valgused knee to exporsure PHMM region. There were 33 patients in pie-crusting group, including 15 males and 18 females aged from 26 to 58 years old with an average age of (36.06±7.93) years old;who were treated with inside-out, arthroscopic deep MCL pie crusting release technique with MM-Ⅱ meniscus suture package (Smith & Nephew). Operation time, preoperative and postopertaive Lysholm score of knee joint, injury of MCL between two groups were recorded and compared. All patients were followed up from 12 to 18 months with an average of (15.19±2.22) months. The incisions were healed at stageⅠ. There were no statistical difference in anatomical classification of PHMM between two groups(P>0.05). There was difference in opertaion time between valgus group (83.32±5.01) min and pie-crusting group (50.06±3.67) min (P<0.05). Postopertaive Lysholm score of knee joint at 3 months in two groups were higher than that of before operation (P<0.05), and Lysholm total score of knee joint in pie-crusting group was higher than that of valgus group (P<0.05). Acocording to Lysholm score of knee joint, 7 patients got excellent results, 12 good, 7 moderate and 2 poor in valgus group;19 patients got excellent results, 10 good, 4 moderate in pie-crusting group;and had difference between two groups (P<0.05). MCL injury of valgus group (15 patients with degree 0, 10 patients with degreeⅠ, 3 patients with degreeⅡ, 0 patient with degree Ⅲ) was higher than pie-crusting group(28 patients with degree 0, 5 patients with degreeⅠ, 0 patient with degreeⅡ, 0 patient with degreeⅢ)(P<0.05), while there was no differnce between two groups in MCL injury at 1 month after opertaion (P>0.05) . The inside-out, arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace, shorten operation time, reduce injury to MCL and obtain good clinical efficacy.

The Natural History of Medial Meniscal Root Tears: A Biomechanical and Clinical Case Perspective.

Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of degenerative disease. These injuries lead to an increase in average contact pressure in the medial compartment, along with increases in peak contact pressure and a decrease in contact area relative to the intact state. Loss of the root attachment impairs the function of the entire meniscus and leads to meniscal extrusion, thus impairing the force-dissipating role of the meniscus. Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repairs have been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA. In this study, the authors will describe the biomechanical basis of the natural history of medial meniscal root tears and will support the biomechanical studies with a case series including patients that either underwent non-operative treatment (5 patients) or non-anatomic repair of their medial meniscal root tears (6 patients). Using measurements derived from axial MRI, the authors will detail the distance from native root attachment center of the non-anatomic tunnels and discuss the ongoing symptoms of those patients. Imaging and OA progression among patients who were treated nonoperatively before presentation to the authors will be discussed as well. The case series thus presented will illustrate the natural history of meniscal root tears, the consequences of non-anatomic repair, and the findings of symptomatic meniscal extrusion associated with a non-anatomic repair position of the meniscus.

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing

PurposeTo retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair. MethodsFrom May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant. ResultsSeven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both). ConclusionThe failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

Both medial and lateral bucket-handle meniscus tears associated with chronic ACL injury: A rare presentation of triple-PCL sign

BackgroundSeveral types of meniscal tear could be presented in both acute and chronic anterior cruciate ligament injury. The incidence of bucket-handle meniscus tears can be up to 30% of the overall meniscus tears cases. The case of both compartment (medial and lateral) bucket-handle meniscus is rarely occurred.CaseA case of both medial and lateral bucket-handle meniscus tears was reported in a male of 21 years old. The patient also had a chronic anterior cruciate ligament injury. The magnetic resonance imaging also showed a rare presentation of the triple-PCL sign with the sagittal view. Arthroscopic surgery with a meniscus repair and anterior cruciate ligament reconstruction was performed on the patient.ConclusionsSeveral specific imaging signs including triple-PCL sign could be presented in a rare case of both medial and lateral bucket-handle meniscus tears. Recognition of this sign is important to have accurate preoperative diagnosis and proper treatment plan.

Magnetic resonance imaging does not reliably detect Kaplan fiber injury in the setting of anterior cruciate ligament tear.

There has been a continued effort to better understand the role Kaplan fiber injury plays in persistent instability following ACL tears. However, the prevalence of these injuries remains poorly understood. Therefore, the purpose of this study was to define the prevalence of Kaplan fiber injury in the setting of complete anterior cruciate ligament tear using a commonly used grading system for assessing ligament injuries. The inter-rater reliability of this commonly used grading system and the relationship between Kaplan fiber injury and injury to other structures commonly found in conjunction with ACL tears was also evaluated. All isolated, complete anterior cruciate ligament tears confirmed on magnetic resonance imaging within 90days of injury between 2014 and 2020 at a single institution were included for analysis. Each scan was read by two, fellowship-trained musculoskeletal radiologists. Kaplan fiber injury was evaluated using a previously described grading scheme. Kappa, [Formula: see text], of inter-rater agreement was determined for all magnetic resonance image scans. Kruskal Wallis test was performed to assess for associations between Kaplan fiber injury and magnet strength (1.5T vs. 3.0T), patient gender, the presence of medial and/or lateral meniscal tears, and/or posterolateral tibial bone bruise. Between 2014 and 2020, 131 patients (94 males, 37 females) with a complete anterior cruciate ligament tear were included in the final analysis. The mean age of the cohort was 27.8 ± 6.8years. Kaplan fiber injuries were identified in 51 of 131 (38.9%, CI 31.0-47.5%) scans with complete anterior cruciate ligament injuries (Grade 1: 28, Grade 2: 18, and Grade 3: 5). Inter-rater agreement for Kaplan fiber injury was fair ([Formula: see text] with 43 (32.8%) scans requiring third reviewer adjudication. There were no significant associations between Kaplan fiber injury and gender, magnet strength, meniscal tears, or posterolateral tibial bone bruise. The prevalence of Kaplan fiber injuries was comparable to previously described rates; however, the classification system used to report Kaplan fiber injury was associated with low inter-rater reliability. The presence of Kaplan fiber injury was not associated with other injuries commonly observed in conjunction with ACL tear. The previously proposed Kaplan fiber injury classification system is not reproducible nor is it likely to aid surgeons in distinguishing higher grades of rotatory knee instability. Level IV.

Evidence-based rationale for treatment of meniscal lesions in athletes

Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid not only to the pathology, but also to a player's contract status, time in the season, specific demands of his/her sport and position on the field, and future consequences. Successful treatment requires the clinician to understand the player's goals and needs, communicate effectively between all stakeholders, and a have knowledge of the challenges posed by the different types of meniscal tear seen in this population. Paramount is the distinction between injuries to the medial and lateral meniscus. Deficiency of the lateral meniscus, as a result of a tear or a meniscectomy, leads to frequent early problems and inexorably to chondral degeneration thereby affecting an athlete's ability to perform. Therefore, it is strongly recommended to repair the majority of lateral meniscal tears. Medial meniscal tears pose a more challenging treatment dilemma, as the success of partial meniscectomy in achieving reproducible, early return to play must be balanced against the long-term degenerative consequences. Many meniscal tears are correctly treated non-operatively.Level of evidence V.

Utility of High-Resolution Sonography for Evaluation of Knee Joint Pathologies as a Screening Tool

Objective: Magnetic resonance imaging (MRI) has been established as the gold standard imaging technique for assessing knee joint pathologies. However, high-resolution sonography (HRS) is affordable, easily available, cost-effective, and can be used for knee joint assessment. This study was conducted to assess the diagnostic yield of HRS in the evaluation of knee joint pathologies compared with MRI. Materials and Methods: In the study, 103 patients, with symptomatic knee pain, were included. HRS was performed followed by MRI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Kappa values were calculated to assess the performance of HRS compared with MRI. Results: The most frequent pathologies observed on HRS were knee joint effusion (84%) followed by medial meniscal (43%) and lateral meniscal (26%) tear. Conclusion: HRS demonstrated good diagnostic accuracy in diagnosis of knee joint pathologies as compared with MRI. Therefore, HRS could be utilized as a screening tool for detection of knee joint pathologies.

Pediatric and Adolescent ACL Reconstruction: Is Delaying Surgery Doing More Harm Than Good?: Commentary on an article by David A. Kolin, BA, MSc, et al.: "ACL Reconstruction Delay in Pediatric and Adolescent Patients Is Associated with an Increased Risk of Medial Meniscal Tears".

Pediatric and Adolescent ACL Reconstruction: Is Delaying Surgery Doing More Harm Than Good?: Commentary on an article by David A. Kolin, BA, MSc, et al.: "ACL Reconstruction Delay in Pediatric and Adolescent Patients Is Associated with an Increased Risk of Medial Meniscal Tears".

Is It Water On The Knee?! Operation!

HISTORY: A 53-year-old male with history of knee osteoarthritis presented with worsening right knee pain 2.5 months following MVA. He also noted a mobile mass over the superior lateral knee. There was no relief with NSAIDs or rest. PHYSICAL EXAMINATION: Antalgic gait with crutches. Right knee with moderate effusion, limited range of motion to 100 degrees flexion and 10 degrees extension with crepitus, tenderness to palpation over the lateral joint line with a palpable mass superior to the lateral femoral condyle. Positive McMurray’s test. DIFFERENTIAL DIAGNOSIS: 1. Osteoarthritis flare2. Meniscal tear3. Avulsion fracture of the femur4. Crystalline arthropathy5. Synovial osteochondromatosis TEST AND RESULTS: Right Knee X-Ray: Linear bony density along the medial femoral condyle, suspicious for an acute to subacute avulsion fracture. Stable findings of synovial osteochondromatosis. Synovial Fluid Analysis: No organisms or crystals identified. Right Knee MRI without contrast: Tricompartmental osteoarthritis with secondary synovial osteochondromatosis with large calcified intra-articular body within the suprapatellar recess measuring 4.7 cm. Moderate joint effusion. Moderate synovitis. Medial and lateral complex meniscal tears. Pellegrini-Stieda lesion, compatible with sequela of prior MCL injury without periligamentous edema. FINAL WORKING DIAGNOSIS: Synovial osteochondromatosis with a large loose body with underlying osteoarthritis and medial and lateral complex meniscal tears. TREATMENT AND OUTCOMES: Aspiration was performed for 47 cc serous synovial fluid followed by intra-articular corticosteroid injection. At 3 week follow-up visit, the patient noted 50% improvement in pain, but recurrent effusion and increased buckling. Case was discussed with an orthopedic surgeon and recommendation was made for loose body excision and possible total knee arthroplasty. After discussion, the patient preferred to avoid surgery and continue conservative care with bracing and physical therapy.

Menisco-ligamentous injuries of knee joint: Can ultrasonography serve as an effective screening modality?

The aim is to calculate sensitivity, specificity and diagnostic accuracy of Ultrasonography (USG) as a screening modality in evaluation of Menisco- Ligamentous injuries of knee joint with Magnetic Resonance Imaging (MRI)as gold standard for comparison.Patients with clinically suspected Menisco-Ligamentous injurieswere evaluated by USG initially followed by MRI on the same day. A total of 60 patients (50 males, 10 females) underwent USG and MRI. USG was done using high frequency probe (9-14 Hz) and all the injuries noted. USG of the normal knee was done for comparison. MRI with trauma protocol sequences was done on the same day. The accuracy of USG and MRI in diagnosis of menisco-ligamentous injuries was compared. Majority of the patients (50%) belonged to age group of 21-40 years. Most common injuries seen were medial meniscal tear followed by medial collateral ligament injury. The strength of agreement between USG and MRI was good with Diagnostic accuracy of USG ranging from 83.3% to 95% for different meniscal/ligamentous injuries.USG is an effective imaging modality with high accuracy in diagnosing menisco-ligamentous injuries. USG can act as an effective screening modality in closed knee trauma for evaluation of menisco- ligamentous injuries especially in resource constrained regions owing to its easy availability, portability and lower cost. MRI can be reserved for patients with suspicious USG and clinical findings.

Are structural abnormalities on knee MRI associated with osteophyte development? Data from the Osteoarthritis Initiative

To assess which structural abnormalities on knee MRI are associated with development of osteophytes in middle-aged subjects without radiographic knee osteoarthritis. We included subjects from the Osteoarthritis Initiative, aged 40-55 years, Kellgren & Lawrence grade 0 in both knees, and knee MRIs from both knees available at baseline, 24, 48 and 72 months. Structural exposures on MRI assessed using MOAKS included cartilage damage, bone marrow lesions, meniscal tear, meniscal extrusion, and Hoffa/effusion synovitis. We assessed whether each structural exposure was associated with the development of osteophytes on MRI in the medial and lateral tibiofemoral, and patellofemoral compartment. We estimated hazard ratios (HR) including 95% confidence intervals (CI) for osteophyte development using a mixed complementary log-log regression model adjusted for age, sex, and body mass index. We included 680 knees from 340 subjects with a mean (SD) age of 50 years (3.0), and 51% men. In the medial tibiofemoral compartment, the absolute risk of osteophyte development in the first 24-month period was 4% in knees without, and 15% in knees with medial meniscal tear. Corresponding adjusted HR was 6.6 (95%CI=3.4-12.9). In the lateral tibiofemoral compartment, the adjusted HR for developing osteophytes having a lateral meniscal tear was 3.3 (95%CI=1.3-8.4). In the patellofemoral compartment, patellofemoral cartilage damage was most clearly associated with developing osteophytes (HR=2.6, 95%CI=1.8-3.7). Meniscal tear seem to be the strongest structural risk factor for the development of tibiofemoral osteophytes, and patellofemoral cartilage damage for the development of patellofemoral osteophytes, respectively. Local biomechanical factors are important in early osteophyte development.

Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis

BackgroundMedial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs.MethodsThe MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates.ResultsSeven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95–11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19–0.46).ConclusionConcurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.

Nationwide Ethnic/Racial Differences in Surgical Treatment of Discoid Meniscus in Children: A PHIS Database Study.

Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No US population-based studies have examined the discoid meniscus ethnic/racial distribution. In pediatric patients undergoing meniscus surgery, it is hypothesized that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with medial meniscus tears. The Pediatric Health Information System was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using International Classification of Diseases, 10th Revision, Clinical Modification codes. A cohort of patients treated surgically for discoid meniscus was compared with a cohort of patients treated surgically for medial meniscal tear. These 2 populations were compared based on age, sex, ethnicity/race, Current Procedural Terminology code, insurance, urban versus rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations. A discoid meniscus cohort of 399 children (median age, 13.0 y) was compared with a medial meniscus tear cohort of 3157 children (median age, 16.0 y) (P<0.001). Hispanic/Latino children accounted for 36.8% of the discoid lateral meniscus and 22.7% of the medial meniscus populations (P<0.001). Among pediatric patients that had surgery for discoid lateral meniscus or medial meniscus, Hispanic/Latino children had 2.36 times the odds of surgery for discoid meniscus compared with White patients after adjusting for age and insurance (P<0.001). Asian children also had 2.41 times the odds of surgery for discoid meniscus compared with White patients (P=0.017). This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients undergoing surgery for discoid meniscus, Hispanic/Latino and Asian patients were a significantly larger percentage of the population than White patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a torn discoid meniscus versus a torn medial mensicus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. Level IV.

Meniscal tears associated with complete vs partial anterior cruciate ligament injury

Purpose: To investigate the incidence and location of meniscal tears in relation to complete vs partial anterior cruciate ligament (ACL) injury.Subjects and Methods: We collected MRI of 114 patients (114 knees) diagnosed with combined ACL and meniscal injury at a follow up 3 months to 2 years of knee injury at our center in last 3 years. The subjects comprised 68 males and 46 females ranging in age from 20 to 55 years. The patients were divided into two groups: Meniscal tears with Partial ACL injury and Complete ACL injury and the results were compared between this two groups.Results: The incidence of complete ACL injury diagnosed with MRI was 52.63% (60 of 114 knees) and partial ACL injury was 47.36% (54 of 114 knees). Regarding the locations of meniscal tears, in complete ACL injury (60 knees), medial meniscal tear was found in 60% (36 of 60 knees), lateral meniscal tear in 31.66 % (19 of 60 knees), and bilateral meniscal tears in 8.33 % (5 of 60 knees). In Partial ACL injury (54 knees), medial meniscal tear was found in 46.29 % (25 of 54 knees) and lateral meniscal tear in 42.59 % (23 of 54 knees) and bilateral (including medial and lateral) meniscal tears in 11.11 % (6 of 54 knees). Bucket handle tear was observed in 11 knees (medial: 8 knees, lateral: 3 knees) in complete ACL injury, and 4 knees (medial: 3 knees, lateral: 1 knee) in partial ACL injury.Conclusion: Incidence of medial meniscus tear was more than 50% in complete ACL injury. Lateral meniscus tear was more associated with partial ACL injury compared to complete ACL injury.