Medial Meniscal Tears Research Articles

Medial meniscus tears are most prevalent in type I ACL tears, while type I ACL tears only account for 8% of all ACL tears.

This study aimed to assess the distribution of different anterior cruciate ligament (ACL) tear locations in different magnetic resonance imaging (MRI) planes, and to explore the relationships of ACL tear types with both meniscus injuries and bone bruising. A retrospective study was performed in patients under 60years old who underwent MRI scans in the sagittal and coronal oblique planes of the knee for ACL tears between 2014 and 2020. Patients with reports of chronic tears, partial tears, or prior surgeries were excluded. Tear locations were classified into five types, and the meniscus tear measurement variables included the presence of ramp, root, bucket-handle, and other types of tears. All injuries were confirmed by arthroscopy. Meanwhile, the presence and location of bone bruising were analysed and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruising subscale. A total of 291 patients were included. The prevalence rates of type I and type III injuries were 23/291 (7.9%) and 145/291 (49.8%) in the sagittal plane and 22/291 (7.6%) and 179/291 (61.5%) in the oblique coronal plane, respectively. The prevalence of medial meniscus tears with ACL tears was 126/291 (43.3%), while that of lateral meniscus tears with ACL tears was 77/291 (26.5%). The highest prevalence of medial meniscus injury with ACL tears was 15/22 (68.2%) for type I injuries. Bone bruises were located on the lateral femoral center in 125 patients (46%) and on the lateral tibia posterior in 132 patients (48%); the common areas of bone bruising were slightly correlated with type III ACL tears but not correlated with type I ACL tears. The plane in which an MRI scan is performed affects the classification of ACL tears. The tear type is associated with the prevalence of medial meniscus injuries, and medial meniscus tears are most prevalent in type I ACL tears. IV.

Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear

BackgroundIn this study, we investigated newly developed ultrasound (US)-guided medial collateral ligament (MCL) bursa injection as a conservative therapy for symptomatic degenerative medial meniscal (MM) tears. We aimed to describe the anatomical target and precise technique of this injection, confirm its accuracy using fresh cadaveric knees, and then evaluate preliminary clinical outcomes. MethodsAnatomical studies were performed on three fresh cadavers. For the clinical study, 50 patients with medial knee joint pain without knee osteoarthritis were treated with US-guided MCL bursa injection. Severity of pain was assessed pre-injection, and 1 week and 4 weeks post-injection using a 0–10 numerical rating scale (NRS). Clinical success was defined as a full return to daily activities. All patients underwent magnetic resonance imaging (MRI) within 1 week of the first injection. Patients who underwent surgery within 12 months of the first injection were investigated as clinically unsuccessful cases, and MRI and arthroscopic findings were examined. ResultsCompared with pre-injection (6.8 ± 1.2), the average NRS score was significantly lower at 1 week (1.8 ± 2.0) and at 4 weeks (1.5 ± 1.7) post-injection (both P < 0.01). The primary clinical success rate was 76.0%, and injection-related adverse events were not observed. Nine patients underwent surgery (arthroscopic surgery for degenerative flap tear (n = 7) and high tibial osteotomy for medial meniscus posterior root tear and proximal tibial malalignment (n = 2)). ConclusionsUS-guided MCL bursa injection is safe, reproducible, and effective for symptomatic MM degenerative tears. However, US-guided injections of the MCL bursa may be ineffective for flap tears and posterior root tears.

Pulsed Electromagnetic Field Enhances Healing of a Meniscal Tear and Mitigates Posttraumatic Osteoarthritis in a Rat Model

Background: Meniscal tears in the avascular region are thought to rarely heal and are a considerable challenge to treat. Although the therapeutic effects of a pulsed electromagnetic field (PEMF) have been extensively studied in a variety of orthopaedic disorders, the effect of a PEMF on meniscal healing has not been reported. Hypothesis: PEMF treatment would promote meniscal healing and prevent osteoarthritis progression. Study Design: Controlled laboratory study. Methods: A total of 72 twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control (Gcon), treatment with a classic signal PEMF (Gclassic), and treatment with a high–slew rate signal PEMF (GHSR). Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progression of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to evaluate the intra-articular inflammation. Meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their scoring systems. Results: Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in Gcon at 8 weeks. However, the menisci in the 2 treatment groups were restored to normal morphology, with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of the PEMF treatment groups were significantly higher than those in Gcon at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than did the classic signal at week 8 (P < .01). Additionally, the HSR signal significantly downregulated the secretion levels of interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the meniscus and synovium as compared with the control group. When compared with the 2 treatment groups, Gcon had significantly higher degeneration scores (Gcon vs Gclassic, P < .0001; Gcon vs GHSR, P < .0001). The HSR signal also exhibited significantly lower synovitis scores compared with the other two groups (Gcon vs Gclassic, P < .0001; Gclassic vs GHSR, P = .0002). Conclusion: A PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. As compared with the classic signal, the HSR signal showed increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment, therefore protecting the knee joint from posttraumatic osteoarthritis development. Clinical Relevance: Adjuvant PEMF therapy may offer a new approach for the treatment of meniscal tears attributed to the enhanced meniscal repair and ameliorated osteoarthritis progression.

Arthroscopic Anterior Cruciate Ligament Reconstruction in Ghana: A 2-Year Outcome Assessment

Objective: The goal of this study was to evaluate the treatment outcomes of arthroscopic anterior cruciate ligament reconstruction among patients at the Komfo Anokye Teaching Hospital, (KATH) in Ghana.Methods: A prospective cohort study. We enrolled consenting patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the KATH over a 3-year period, from January 1, 2015 to December 31, 2018 and followed up each study participant for 2 years. Post-operative assessments were performed at 2, 6, 12, 24 weeks, 1year and at 2 years, to record outcome variables such as range of motion, pain, swelling and laxity of the affected knee as well as excessive discharge from the surgical site, suggestive ofinfection. Tegner Lysholm knee scores were obtained for each patient at 2-years following surgery. The follow-up was concluded in 2020.Results: Over the 3-year period, 40 primary arthroscopic ACL reconstructions were performed in 40 patients. Most of the patients were young adult males who sustained a tear of the anterior cruciate ligament following a fall from a standing height. Out of this number, 31 had isolated ACL tear, 4 had ACL tear associated with LCL tear and 3 had ACL tear with associated meniscal tear. Two of the participants had ACL, PCL and LCL tear and a complex medial meniscal tear, with associated posterolateral corner rotatory instability. ACL reconstructions that were performed within 12 months following injury had higher mean Tegner Lysholm score of 7 (range of 5-9), than those carried out later than 12 months after injury. Overall, 37 of the patients (93%) had good to excellent outcome at 2 years post-operatively. Three of the patients who were competitive athletes before injury had returned to competitive sport within 1 year of surgery. There was one case of surgical site infection giving an infection rate of 2.5% and one case of graft rupture that requiredrevision ACL reconstruction.Conclusion: Arthroscopic ACL reconstruction is feasible at the study site with low complication rate and provides good to excellent outcome in 93% of patients. The procedure is generally safe and effective in restoring knee function following an ACL tear. Patientreported outcomes are superior when reconstruction is performed within 12 months of injury compared to later reconstructions.

Anterolateral Ligament Reconstruction in a Collegiate Lacrosse Athlete

A 21-year-old female lacrosse athlete with a prior left knee anterior cruciate ligament reconstruction sustained an acute, noncontact injury to the same knee during practice. Clinical examination showed adequate sagittal plane joint stability, with reduced rotational support. Radiologist’s findings following magnetic resonance imaging suggested an increased signal at the anterior cruciate ligament, presence of a subacute medial meniscus tear, and Grade II strain of the semimembranosus tendon. Surgical intervention included anterolateral ligament reconstruction and debridement. The clinical team used patient-reported outcome measures and symmetry of strength and balance to progress therapy. Although cleared for exercise, her National Collegiate Athletic Association (NCAA) eligibility expired and she never returned to sport.

Transtibial single-tunnel all-inside technique for repair of a complete radial meniscal tear

IntroductionRadial meniscus tears significantly compromise knee biomechanics due to loss of the circumferential fiber connections and have been shown to be biomechanically equivalent to a total meniscectomy. There is a paucity of data regarding the biomechanical performance of radial meniscal repairs and numerous technical challenges associated with surgical repair. Further, current repair methods have been shown to lead to high rates of incomplete, nonanatomical healing of the meniscus and can potentially cause progressive joint degeneration and osteoarthritis. This is particularly true for the avascular portions of the meniscus. As a result, such injuries have been historically treated with a partial meniscectomy. There has been a growing interest in transtibial repair mechanisms as a potential solution to this challenging pathology. ObjectivesThe purpose of this technical note is to detail a method for repairing a complete radial tear of the medial meniscus using a single-tunnel transtibial technique. MethodsAfter a thorough history and clinical examination, and imaging, the patient was diagnosed with a complex medial meniscal tear with a primary radial tear component. A single tunnel transtibial meniscal repair was indicated and performed. ResultsAn anatomic repair was achieved with tension across the defect. The patient successfully returned to activities. ConclusionsSingle-tunnel transtibial repairs of radial tears in the meniscus may provide increased stability by anchoring the meniscal leaflets to the tibia as well as a potential biological benefit by releasing growth factors and progenitor cells from the bone marrow.

Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees.

This study aimed to evaluate the different clinical results and factors associated with cartilage defects in military draftees who underwent different treatments after anterior cruciate ligament (ACL) rupture. Overall, 105 patients who had sustained ACL rupture were military draftees who underwent a conscription examination for physical status assessment from January 2012 to December 2020. Patients were divided into three groups: conservative treatment after ACL rupture, status post-anterior cruciate ligament reconstruction (ACLR), but graft rupture, and status post-ACLR with graft intact. Inter-group comparisons and statistical analyses were performed for age, body mass index (BMI), thigh circumference difference, side-to-side difference in anterior knee translation by KT-2000, meniscus tear, and cartilage defect. Multivariate logistic regression analysis was used to determine the factors associated with cartilage defects. The multivariable regression model showed that BMI (odds ratio OR: 1.303; 95% CI: 1.016–1.672; p = 0.037), thigh circumference difference (OR: 1.403; 95% CI: 1.003–1.084; p = 0.034), tear of lateral meniscus (LM) and medial meniscus (MM) (OR: 13.773; 95% CI: 1.354–140.09; p = 0.027), and graft rupture group (OR: 5.191; 95% CI: 1.388–19.419; p = 0.014) increased the risk of cartilage defects. There was no correlation between cartilage defects and age, KT-2000 difference, tear of LM or MM, or graft intact group. Progression of osteoarthritis was concerned after ACL rupture, and this study identified several factors of post-ACLR graft rupture, greater thigh circumference difference, BMI, and meniscus tear of both LM and MM affecting cartilage defects, which represent early degenerative osteoarthritis changes of the knee. The results of this study should be customized for rehabilitation and military training, especially in military draftees with ACL injuries.

Comparison of incidence of medial meniscal injury in small dogs (≤15 kg) and medium-to-large dogs (>15 kg) with naturally occurring cranial cruciate ligament disease undergoing tibial plateau levelling osteotomy: 580 stifles (2015 - 2019).

To investigate whether a difference exists in incidence of medial meniscal tears between small (≤15 kg) and medium-to-large (>15 kg) dogs with naturally occurring cranial cruciate ligament disease. Records were retrospectively reviewed to identify the incidence of medial meniscal tears in dogs undergoing tibial plateau levelling osteotomy. Degree of cruciate insufficiency, method of identification (arthroscopy or arthrotomy), tibial plateau angle, weight and signalment were recorded. A two-proportion z-test with clustering adjustment was used to compare the meniscal tear rate between the two groups. Logistic regression analysis was used to investigate the effects of variables on medial meniscal tears. Seventy-six stifles in 67 small dogs and 504 stifles in 384 medium-to-large dogs were included. The rate of meniscal injury at index surgery was 38.2% in small dogs and 36.7% in medium-to-large dogs. The subsequent meniscal tear rate was 1.3% in small dogs and 8% in medium-to-large dogs. The difference in meniscal tear rate was not statistically significant at either index surgery or subsequently. Degree of cruciate ligament insufficiency and use of arthroscopy were significantly associated with medial meniscal tears at index surgery. No variables were significantly associated with subsequent medial meniscal tears. No significant difference exists in medial meniscal tear rate between small and medium-to-large dogs either at index surgery or subsequently. The index of suspicion of concurrent medial meniscal tears should be higher in dogs with complete tear of the cranial cruciate ligament but a partial tear does not preclude meniscal pathology.

IS ABNORMAL PATELLA HEIGHT A PREDISPOSING FACTOR FOR ISOLATED MENISCAL TEARS?

Objective: The relationship between patellar height and knee pathologies has been assessed in the literature. However, the relationship with isolated meniscal tears has not been evaluated. This study aims to evaluate whether or not patellar height is a predisposing factor for isolated medial or lateral meniscal tear. Material and Methods: The consecutive 411 patients who had magnetic resonance imaging between 2018-2020 were evaluated retrospectively. The patients between 18 and 50 years of age with isolated medial or lateral meniscal tear were included. The patients without any meniscal tear or ligament injury formed the control group. The 160 patients included in the study were divided into three groups: 65 medial meniscus, 30 lateral meniscus, and 65 control group. Patellar height was measured with the Insall-Salvati method by two orthopedic surgeons twice, with an interval of one month. Results: All of the groups were similar in terms of age and gender (p&gt;0,05). Patellar length (0.252), patellar tendon length (0.059), and Insall-Salvati ratios (0.810) of all groups did not show any significant difference. The abnormal patellar height rates were similar in the medial meniscus and control groups (12.4%- 13.9%), while abnormal patella height (33.4%), especially patella baja, was observed more frequently in the lateral meniscus group. However, no statistically significant difference was found. A significant strong correlation was observed between and within the observers’ measurements (p:0.000). Conclusion: Abnormal patella height, especially patella baja, was observed more frequently in the isolated lateral meniscus group. Abnormal patellar height could be a predisposing factor for isolated lateral meniscal tear.

Association of Meniscus Injuries in Patients With Anterior Cruciate Ligament Injuries.

Introduction: In today's orthopaedic practice, meniscus and anterior cruciate ligament (ACL) injuries are prevalent. It is more common in sports injuries and automobile accidents. In patients with ACL tears, meniscus problems are also common. Several studies have linked meniscus injuries to the development of osteoarthritis in early stages. Early onset of osteoarthritis has been observed in ACL-repaired patients with meniscus tears. As a result, meniscus tears should be detected and corrected as soon as possible to avoid degenerative changes in the knee joint. The goal of the study was to see if there was a link between meniscus injuries and ACL injuries in our rural community.Methods: This retrospective study was conducted on 48 patients at the R.L. Jalappa Hospital & Research Centre from January 2012 to December 2019. Patients between the ages of 18-65 diagnosed with ACL tear with/without meniscus damage in their knees were included in the study. Patients with posterior cruciate ligament (PCL) tear, medial collateral ligament (MCL) or lateral collateral ligament (LCL) injury, previously operated index knees, and patients with more than grade 3 knee osteoarthritis (Kellgren and Lawrence classification) were excluded. Clinical assessment of patients with knee injuries, MRI and diagnostic arthroscopy of the knee joint details were collected. After obtaining the data, we estimated the incidence of meniscus injuries associated with chronic ACL injuries. We also calculated the percentage of side/laterality injury (medial meniscus or lateral meniscus) and part of meniscus injury (anterior horn, body, and posterior horn) in chronic ACL-deficient knees. Patient characteristics such as age and gender were correlated with functional knee assessment using a modified Lysholm score. P-value and chi-square tests were used to assess the data. P-value of less than 0.5 was considered significant.Results: Average age of the participants was 32.31 years. There were 42 men and six women in the group. Isolated medial meniscus, lateral meniscus, and combined medial and lateral meniscus had average ages of 31.83, 31.16, and 40.28 years, respectively. ACL injuries on the right side were seen in 23 patients the left side was seen in 25 patients. In comparison to the right side, the isolated medial meniscus injury on the left side was more severe. In case of a combination of medial and lateral meniscus tears, the right side suffered more damage than the left. Eleven patients had an isolated ACL tear without a meniscus injury, while the other 37 had a meniscus injury and an ACL tear. Excellent scores were observed in 11 cases, satisfactory scores in 26, and unsatisfactory in 11 cases. Age group was categorized into three groups, less than 30, 30-45, and more than 45 years. Excellent, satisfactory, and unsatisfactory scores were observed in seven, eleven, and seven patients on the left side and excellent, satisfactory, and unsatisfactory scores in four, fifteen, and four patients on the right side, respectively. P-value was not statistically significant when comparing outcomes by age, gender, or side.Conclusion: Meniscus injuries occurred 77% of the time when there was a persistent ACL injury. In comparison to a lateral meniscus injury, the incidence of medial meniscus injury associated with chronic ACL tear was higher. In comparison to the anterior horn and body of the medial meniscus, the majority of medial meniscus tears were found in the posterior horn.

Attachment Type, Thickness, and Volume of the Posterior Meniscofemoral Ligament and Meniscal Pathology.

Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We investigated the correlation between meniscal pathology and anatomic features of pMFL such as attachment type, thickness, and volume. We retrospectively evaluated 191 patients who underwent knee MRI. MR images were reviewed to assess the attachment type of the pMFL on the medial femoral condyle (high vs. low), the thickness of the pMFL, and the presence of a meniscal tear or a discoid meniscus. The pMFL volume was quantified by using three-dimensional (3D) segmentation software. The relationship between the frequency of medial or lateral meniscal tear and anatomic features of pMFL were analyzed using Chi-square, Fisher's exact, or Mann-Whitney U test. High type pMFLs had significantly greater thickness and volume than low type pMFLs (p < 0.001). Patients with degenerative lateral meniscal tear had significantly higher thickness and volume of the pMFL than patients with intact lateral meniscus (p < 0.05). The pMFL thickness and volume were not significantly related to traumatic lateral meniscal tear, medial meniscal tear, and discoid meniscus. High type pMFLs tended to be thicker and larger than low type pMFLs and higher thickness and volume of the pMFL was significantly related to the degenerative lateral meniscal tear. However, the attachment type of the pMFL itself was not significantly related to the lateral meniscal tear as well as the medial meniscal tear.

Development of convolutional neural network model for diagnosing meniscus tear using magnetic resonance image

BackgroundDeep learning (DL) is an advanced machine learning approach used in diverse areas, such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is advantageous for image recognition and classification. In this study, we aimed to develop a CNN to detect meniscal tears and classify tear types using coronal and sagittal magnetic resonance (MR) images of each patient.MethodsWe retrospectively collected 599 cases (medial meniscus tear = 384, lateral meniscus tear = 167, and medial and lateral meniscus tear = 48) of knee MR images from patients with meniscal tears and 449 cases of knee MR images from patients without meniscal tears. To develop the DL model for evaluating the presence of meniscal tears, all the collected knee MR images of 1048 cases were used. To develop the DL model for evaluating the type of meniscal tear, 538 cases with meniscal tears (horizontal tear = 268, complex tear = 147, radial tear = 48, and longitudinal tear = 75) and 449 cases without meniscal tears were used. Additionally, a CNN algorithm was used. To measure the model’s performance, 70% of the included data were randomly assigned to the training set, and the remaining 30% were assigned to the test set.ResultsThe area under the curves (AUCs) of our model were 0.889, 0.817, and 0.924 for medial meniscal tears, lateral meniscal tears, and medial and lateral meniscal tears, respectively. The AUCs of the horizontal, complex, radial, and longitudinal tears were 0.761, 0.850, 0.601, and 0.858, respectively.ConclusionOur study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears.

Modified iliotibial band tenodesis versus lateral extracapsular tenodesis, to augment anterior cruciate ligament reconstruction: a 2-year randomized controlled trial.

Residual instability following anterior cruciate ligament (ACL) reconstruction is associated with disruption of the anterolateral complex (ALC). Our goal was to conduct a randomized controlled trial comparing the effectiveness of modified Iliotibial tenodesis (MITBT) versus lateral extracapsular tenodesis (LET) to correct this residual instability. Group 1 underwent MITBT, Group 2 LET, added to the ACL reconstruction. Outcomes of interest were Tegner activity Scores (TAS), international knee documentation committee score (IKDC), knee osteoarthritis outcome score (KOOS), ACL related quality of life (ACL QoL), recurrent ACL rupture and meniscal tears. Follow-up was 2 years. Statistical analysis used chi-squared tests, frequency statistics and generalized linear models. We have followed the guidelines outlined in the CONSORT statement. A total of 164 patients were randomized, 84 to Group 1, 80 to Group 2. Group 1 had higher TAS than Group 2, at 2 years (median 8, range 7-10 vs. median 7, range 5-9, P<0.001). Group 1 had higher ACL QoL scores at 1 and 2 years post-surgery (82.1, SD2.7 vs. 67.9, SD 4.0, P< 0.001 and 82.5, SD 2.6 vs. 68.8, SD 3.8, P<0.001, respectively), and higher KOOS Sport/recreation subscale at both 1 and 2 years (91.5, SD4.3 vs. 78.3, SD7.9, P<0.001 and 91.8, SD4.8 vs. 80.4, SD 9.5, P<0.001). Risk of recurrent ACL rupture (0% vs. 5%, P=0.040-0.05) and medial meniscal tear (2.4% vs. 14%, P=0.007-0.02) were lower in Group 1. Augmentation of ACL reconstruction with the MITBT, rather than the LET, was associated with improved outcomes, and lower risks of recurrent ACL rupture and medial meniscal tears.

Comparison of Two Stifle Exploratory Methods Using Mini-Arthrotomy for Diagnosis of Canine Medial Meniscal Pathology: An Ex Vivo Study.

The main aim of this study was to compare the accuracy of stifle exploratory using either a stifle distractor (SD method) or a combination of Hohmann and Senn retractors (HS method) for diagnosing canine medial meniscal tears in cranial cruciate ligament-deficient stifles. Fifteen pairs of canine cadaveric pelvic limbs were used and cranial cruciate ligament were transected in all stifles. Paired limbs were then randomly assigned to one of five groups based on the tears created in the caudal pole of the medial meniscus: no tear, peripheral detachment, or a variation in three vertical longitudinal tears. A craniomedial mini-arthrotomy was performed by two observers and diagnosis of the medial meniscal status was made utilizing the HS and SD methods. Correct diagnosis of the meniscal tear was compared for both methods and observers. Correct diagnoses were made using the HS and SD methods in 24/30 and 24/30 cases for observer 1 respectively; and in 17/30 and 19/30 cases for observer 2 respectively. There was no significant difference in the correct diagnosis of meniscal tears within each observer between the two methods. Both HS and SD methods have equal accuracy for the diagnosis of canine medial meniscal pathology for a board-certified surgeon. Unassisted surgeons using the SD method for the evaluation of the medial meniscus are at no diagnostic disadvantage compared with assisted surgeons utilizing the HS method.

Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture.

To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). Prospective clinical trial. Twenty-six client-owned dogs. Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P=.0017), and procedure time was shorter (P=.073) with NA when compared to SA. The lameness scores did not differ before and after NA (P=.25). Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.

Objective laxity and subjective outcomes are more influenced by meniscal treatment than anterior cruciate ligament reconstruction technique at minimum2 years of follow-up

ObjectiveThe purposes of this study were: (1) to compare three different surgical techniques for anterior cruciate ligament (ACL) reconstruction at a minimum 2 years of follow-up in terms of objective laxity and patient-reported outcomes; (2) to inspect the role of meniscal tears and treatment alongside with ACL reconstruction. Methods59 patients were randomly assigned to one of the three reconstruction groups according to the ACL reconstruction technique: Double Bundle, Single Bundle, Single Bundle with Lateral Plasty. Autologous hamstring tendons were used in all the ACL reconstruction techniques. Objective laxity tests and KOOS were collected before surgery as a baseline and at a minimum of 2 years of follow-up and compared through a Repeated measure ANOVA. Secondary analysis to evaluate the effect of meniscal treatment on laxity reduction and scores improvement was also conducted using ANOVA. Three laxity evaluations were performed: anterior/posterior displacement at 30° of knee flexion (AP 30), anterior/posterior displacement at 90° of knee flexion (AP 90), and pivot-shift test. ResultsObjective laxity and KOOS showed statistically significant improvement at follow-up in all three groups (p < 0.0001) without differences among the techniques. A higher AP 30 (mean difference 2.4 mm, p = 0.0333, ES = 0.66) was found at baseline for the patients with irreparable medial meniscal tear compared to the patients with isolated ACL tear; a statistically significant difference in pain score at two-year follow-up was found between patients who underwent lateral meniscectomy and patients with either meniscal repair (mean difference 6.9 ± 12.5) or isolated ACL tear (mean difference 6.8 ± 16.1); patients with reparable meniscal tear had a statistically significant pain score improvement compared to the patients who underwent medial and lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2 respectively). ConclusionComparable objective laxity and subjective outcomes were found among the three ACL reconstruction techniques at a minimum of 2 years of follow-up. The presence of irreparable medial meniscal tear increased pre-operative laxity (AP 30, mean difference 2.4 ± 3.6 mm). Patients with meniscal repair presented higher pain relief between baseline and follow-up compared with patients undergoing medial or lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2, respectively).

Negative Predictive Value of Mri-Detected Medial Meniscus Tears is Reduced in Young Athletes with Chronic ACL Injury

Background:A delay in anterior cruciate ligament reconstruction (ACLR) is associated with an increase in the prevalence in medial meniscus tears identified at the time of surgery. However, the specific effect of time on the predictive value of magnetic resonance imaging (MRI) for detecting meniscus injury in the young athletic population with ACL tears is unclear.Purpose:To investigate the effect of time from MRI to ACLR on the predictive value of MRI to detect meniscus tears in adolescent and young adult athletes.Methods:A retrospective review was performed of patients aged 13-25 years who underwent primary ACLR at an academic institution from January 2017 to June 2020. Multi-ligament injuries were excluded. Primary data recorded included time from MRI to surgery and descriptions of medial and lateral meniscus tears on both MRI and operative reports. Time from MRI to surgery was divided into four intervals: 0 to 6 weeks, 6 weeks to 3 months, 3 months to 6 months, and beyond 6 months. Multivariable analysis was used to determine the positive (PPV) and negative predictive value (NPV) of MRI in detecting meniscus tears as compared to arthroscopic findings at each of the 4 time intervals.Results:432 patients (54% female) were included with a mean age of 18 ± 3.4 years. The mean time from injury to MRI was 78 ± 187 days; the mean time from MRI to surgery was 71 ± 98 days. 252 patients had pre-operative MRIs without meniscus tears; 33 (13.1%) of those had a medial meniscus tear identified at the time of surgery (Table 1). New medial meniscus tears (100% vertical tears) were identified in 7/18 (38.9%) patients with surgery 6 months from MRI. There was a statistically significant decrease in the NPV of MRI to identify medial meniscus tears in patients who underwent ACLR greater than 6 months after imaging (odds ratio 0.16 [0.05–0.53], P < 0.005). Age, gender, body mass index, mechanism of injury, primary sport, and ethnicity did not affect the predictive value of MRI. Sensitivity and specificity of MRI to predict a medial meniscus tear in the entire cohort was 79% and 80%, respectively.Conclusion:Surgeons should counsel patients preoperatively about increased possibility of undiagnosed medial meniscus tears being found at the time of ACLR if greater than 6 months have passed from MRI to surgery.Table 1.Breakdown of Medial Meniscus Tears by Time from MRI until Surgery

Older Age and Surgical Delay May Affect Medial Meniscus Repairability During Anterior Cruciate Ligament Reconstruction in Adolescents and Young Adults

Background:In the setting of meniscus pathology, earlier treatment of meniscus tears may increase the likelihood of repair in young patients. Moreover, delayed anterior cruciate ligament reconstruction (ACLR) has been associated with an increased risk of meniscus injury. There is, however, limited data on the relationship between surgical delay and meniscus repairability in the setting of an ACLR in young patients.Purpose:The purpose of this study was to examine meniscus tear patterns and the likelihood of repair at the time of ACLR in young athletes, and specifically, to determine whether age and time from injury to surgery are correlated with tear patterns or meniscus repairability.Methods:Records were retrospectively reviewed on patients aged 13-25 years who underwent primary ACLR from January 2017 through December 2017. Patients with multi-ligament knee injuries were excluded. Demographic data were collected including age, sex, BMI, race/ethnicity, insurance status, primary sport, mechanism of injury, and time from injury to surgery. Operative reports were reviewed to document meniscus tear type/pattern and all concomitant pathology/procedures. Univariate and logistic regression analyses were used to determine factors associated with meniscus repair.Results:89 eligible patients underwent ACLR during the study period. 59 (51% females) with mean age 19.3 ± 3.4 years had concomitant meniscus pathology and were included for analysis. The mean time to surgery was 5.2 ± 7.4 months. Combined medial and lateral meniscus tears accounted for 37% of tears, followed by lateral (32%) and medial (31%) tears. For tear type, medial and lateral tears were most commonly vertical (57.5%) and complex (34%), respectively. Surgical repair was performed in 67.5% of medial tears but only 34% of lateral tears. Univariate analyses demonstrated a statistically significant correlation between medial meniscus repair and time to surgery (p=0.01) and age (p=0.01), with repair less likely with a surgical delay >3 months and age >18 years. However, time to surgery was not significant after adjusting for age. There was a statistically significant difference in age between those with a surgical delay > 3 months (20.6 ± 3.4 vs.18.3 ± 3.0; p=0.01). Age and time to surgery did not affect the location or type of meniscus tear. There was no correlation between other demographic or surgical variables and time to surgery.Conclusion:In the setting of concomitant ACL and medial meniscus injury, age >18 years and surgical delay >3 months may decrease the likelihood of medial meniscus repair in young athletes.

Factors Associated with Stiffness Following Pediatric and Adolescent ACL Reconstruction: Early Results from Score: A Multi-Center Quality Improvement Registry

Background:Anterior Cruciate Ligament reconstruction (ACLr) is commonly performed in pediatric and adolescent patients. The most common early complication associated with ACLr is stiffness, including motion loss and arthrofibrosis. There is minimal literature regarding risk factors for stiffness following ACLr in this age group.Hypothesis/Purpose:To evaluate the incidence and risk factors associated with stiffness following ACLr using a multi-center quality improvement registry.Methods:A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of ACLr was reviewed. Audit processes using CPT codes were designed to insure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Stiffness was defined as motion loss that prompted any deviation from the normal post-operative course (Clavien Dindo grade II or greater), including additional clinical or physical therapy (PT) visits, serial/dynamic splinting, or secondary surgery for stiffness (Clavien Dindo grade III). Each case of stiffness and associated complication form was secondarily reviewed to insure consistency of identification and grading. Demographic and peri-operative data were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons.Results:2,839 ACLr cases (mean age 15.1, 6-19; female 46.9%) were identified, with stiffness reported in 4.2% of patients (including isolated flexion or extension and combined stiffness) and secondary surgery for stiffness (manipulation under anesthesia and/or lysis of adhesions) performed in 1.1% of patients. Loss of extension occurred in 3.8% of patients (59.3% females), while loss of flexion occurred in 3.1% of patients (49.4% females). Overall stiffness occurred with longer tourniquet times (93.0 min vs. 78.8 min, p<0.001) when used. Anterior displacement of medial or lateral meniscus tear were associated with nearly twice the incidence of extension loss (7.1%) and three times the incidence of surgery for stiffness (3.7%).Conclusion:Post-operative stiffness following ACLr is rare but may be associated with certain demographic and perioperative factors, such as female sex, prolonged tourniquet time, and certain concomitant injuries such as anteriorly displaced meniscus tears. The degree to which altered practices and/or additional monitoring/vigilance in the setting of such factors warrants additional study.

Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach.

Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.