Meniscal Tears Research Articles

Comparison of Subsequent Surgery After Repair in Bucket-Handle Meniscal Tears and Meniscectomy Analysis of a Large, Contained Cohort Study.

Bucket-handle meniscal tears are large longitudinal vertical meniscal tears that have an attached fragment flipped into the intercondylar notch. Meniscal repair attempts to restore the function of the meniscus and aims to preserve joint mechanics. Alternatively, meniscectomy results in quicker recovery but may lead to future degeneration. To evaluate the long-term risk of subsequent ipsilateral knee surgery in patients who underwent a bucket-handle meniscal repair (BHMR) versus meniscectomy/bucket-handle meniscal debridement (BHMD) and assess risk factors associated with subsequent knee surgical intervention. Cohort study; Level of evidence, 3. An electronic health records search for all patients who underwent arthroscopic knee meniscal surgery (repair and meniscectomy) between 2011 and 2018 was performed. Natural language processing was used to search for terms of interest in the long operative notes to determine whether these surgeries were performed for bucket-handle meniscal tears. These patients comprised our initial cohort. Study patients were followed for at least 1 year and for up to 5 years (until December 31, 2019), with censoring at death or membership disenrollment. Baseline patient characteristics and outcomes were evaluated via a database review. The primary outcome was subsequent ipsilateral knee surgeries and secondary outcomes included contralateral knee surgeries, deep surgical site infections, and venous thrombotic events. Multivariable logistic regression analyses were used to model for subsequent surgical treatment of the ipsilateral knee. A subset analysis for patients aged 30 to 50 years was then performed. The median follow-up time was 52.4 months (interquartile range [IQR], 33.5-60 months). A total of 1359 patients underwent BHMR and 1537 patients underwent BHMD. The median age was 24 years (IQR, 17-34 years) for the BHMR versus 38 years (IQR, 27-47 years) for the BHMD group (P < .001). Body mass index (BMI) was significantly lower in the BHMR group compared with the BHMD group (P < .001). BHMR was significantly more likely to be performed during a concomitant ipsilateral anterior cruciate ligament reconstruction (ACLR) than a BHMD (44.2% vs 30.1%, P < .001). During the follow-up period, a total of 656 subsequent ipsilateral procedures were performed in 393 (13.6%) patients. Patients who underwent initial BHMR were at a significantly higher risk of undergoing subsequent meniscal repair (4.3% vs 1%, P < .001), meniscectomy (12.1% vs 3.3%, P < .001), and ACLR (7.4% vs 2.9%, P < .001) compared with those who underwent BHMD. Multivariable analysis showed that BHMR, younger age, and lower BMI were risk factors for subsequent ipsilateral surgery. After adjusting for patient demographic and clinical characteristics, subset analysis showed that for patients aged 30 to 50 years, undergoing a BHMR versus a BHMD led to a 2.3-fold higher risk of subsequent surgery, a 5.3-fold higher risk of subsequent meniscal repair and a 3.2-fold higher risk of subsequent meniscectomy. BHMR was more often performed in younger patients with a lower BMI, especially during a concomitant ACLR. Patients treated with BHMR were more likely to undergo subsequent surgeries, with the likelihood decreasing with increasing age. Subset analyses showed increasing risk for subsequent surgeries with BHMR versus BHMD in the cohort consisting of patients aged 30 to 50 years.

Arthroscopic Partial Meniscectomy for a Degenerative Meniscus Tear Is Not Cost Effective Compared With Placebo Surgery: An Economic Evaluation Based on the FIDELITY Trial Data.

In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial meniscectomy (APM) over conservative treatment or placebo surgery. Yet, advocates of APM still argue that APM is cost effective. Giving advocates of APM their due, we note that there is evidence from the treatment of other musculoskeletal complaints to suggest that a treatment may prove cost effective even in the absence of improvements in efficacy outcomes, as it may lead to other benefits, such as diminished productivity loss and reduced costs, and so the question of cost effectiveness needs to be answered for APM. (1) Does APM result in lower postoperative costs compared with placebo surgery? (2) Is APM cost-effective compared with placebo surgery? One hundred forty-six adults aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis according to the American College of Rheumatology clinical criteria were randomized to APM (n = 70) or placebo surgery (n = 76). In the APM and placebo surgery groups, mean age was 52 ± 7 years and 52 ± 7 years, and 60% (42 of 70) and 62% (47 of 76) of participants were men, respectively. There were no between-group differences in baseline characteristics. In both groups, a standard diagnostic arthroscopy was first performed. Thereafter, in the APM group, the torn meniscus was trimmed to solid meniscus tissue, whereas in the placebo surgery group, APM was carefully mimicked but no resection of meniscal tissue was performed; as such, surgical costs were the same in both arms and were not included in the analyses. All patients received identical postoperative care including a graduated home-based exercise program. At the 2-year follow-up, two patients were lost to follow-up, both in the placebo surgery group. Cost effectiveness over the 2-year trial period was computed as incremental net monetary benefit (INMB) for improvements in quality-adjusted life years (QALY), using both the societal (primary) and healthcare system (secondary) perspectives. To be able to consider APM cost effective, the CEA analysis should yield a positive INMB value. Nonparametric bootstrapping was used to assess uncertainty. Several one-way sensitivity analyses were also performed. APM did not deliver lower postoperative costs, nor did it convincingly improve quality of life scores when compared with placebo surgery. From a societal perspective, APM was associated with € 971 (95% CI -2013 to 4017) higher costs and 0.015 (95% CI -0.011 to 0.041) improved QALYs over 2-year follow-up compared with placebo surgery. Both differences were statistically inconclusive (a wide 95% CI that crossed the line of no difference). Using the conventional willingness to pay (WTP) threshold of € 35,000 per QALY, APM resulted in a negative INMB of € -460 (95% CI -3757 to 2698). In our analysis, APM would result in a positive INMB only when the WTP threshold rises to about € 65,000 per QALY. The wide 95% CIs suggests uncertain cost effectiveness irrespective of chosen WTP threshold. The results of this study lend further support to clinical practice guidelines recommending against the use of APM in patients with a degenerative meniscus tear. Given the robustness of existing evidence demonstrating no benefit or cost effectiveness of APM over nonsurgical treatment or placebo surgery, future research is unlikely to alter this conclusion.Level of Evidence Level III, economic analysis.

Meniscus Injuries in Soccer.

Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players.

Efficacy and adverse reactions of arthroscopic medial collateral ligament release for medial meniscus injury: A meta-analysis

The posterior root tear of the medial meniscus has received increasing attention from scholars in recent years, with its incidence rate accounting for 10.1%–27.8% of all meniscal tears. A comprehensive search of eight databases was conducted to identify studies on the efficacy and negative consequences of arthroscopic medial collateral ligament release for medial meniscus damage. Data analysis was performed using RevMan 5.3 software, following a thorough assessment of the literature quality. A total of seven studies were included in this meta-analysis. Based on the data from these studies, there was no statistically significant difference between the test group and the control group in terms of Lysholm scores [standardized mean difference (SMD): 3.23; 95% confidence interval (CI): −1.61, 8.06; P = 0.191], IKDC scores (SMD: 0.42; 95% CI: −3.54, 4.37; P = 0.837), VAS scores (SMD: −0.48; 95% CI: −1.36, 0.40; P = 0.283), and operation time (SMD: −24.87; 95% CI: −41.68, −8.05; P &amp;lt; 0.01). According to Lysholm scores, IKDC scores, VAS scores, operation time, and adverse reactions, the findings of this research imply that arthroscopic medial collateral ligament release may be favorable to people who have medial meniscus injury. Nevertheless, current outcomes require confirmation by additional studies of excellent quality.

Long-Term Results of Meniscus Allograft Transplantation With Bone Fixation Show Improved Outcomes but Progression of Joint Space Narrowing, Osteoarthritis, and Cartilage Degeneration

PurposeTo investigate the clinical and objective outcomes of meniscal allograft transplantation (MAT) using bone fixation in patients after a minimum follow-up duration of 15 years, and to compare the demographic factors and allograft status between patients who experienced progression of osteoarthritis and those who did not. MethodsThe consecutive patients who underwent primary MAT between December 1996 and January 2008 were retrospectively reviewed. The inclusion criteria was primary MAT with a minimum follow-up duration of 15 years. Clinical outcomes were evaluated using the modified Lysholm score, along with an evaluation of clinical failure. In objective outcomes, the progression of joint space narrowing, osteoarthritis, and the status of the associated cartilages and allografts were evaluated with follow-up radiographs and MRI. ResultsAmong the 79 cases, 54 knees in 52 patients were included in the study and evaluated for clinical outcomes. The mean Lysholm score improved from 73.9 ± 17.5 preoperatively to 86.4 ± 15.6 over a mean follow-up period of 17.5 ± 3.8 years (P<0.001). Regarding the Minimal clinically important differences (MCID), 38 cases (70.4%) showed an improvement in the Lysholm score. The cumulative clinical survival rate was 87.0%. Objective evaluations evaluated in 32 cases with a minimum of 15 years of radiographic data revealed significant progression of joint space narrowing, osteoarthritis, and cartilage degeneration at the final follow-up, with 11 (34.4%) out of 32 cases exhibiting allograft tears involving ˃50% of the allograft. Patients with osteoarthritis progression exhibited more meniscal allograft tears and extrusion on the last follow-up MRI scan than those without progression. ConclusionNotable progression in joint space narrowing, osteoarthritis, and cartilage degeneration were observed in objective assessment. The progression of osteoarthritis might be associated with allograft tears and extrusion. In clinical evaluations, favorable long-term clinical outcomes were consistently demonstrated after MAT using the bone fixation technique. Level of EvidenceLevel Ⅳ, therapeutic case series.

Reoperation Rates of Meniscal Repair Are Associated With a Higher Reoperation Rate Than Meniscectomy in Patients Aged 40 and Older

To compare the long-term reoperation rates of meniscectomy and meniscal repair and to determine patient and surgical factors associated with earlier reoperation among patients ≥40 years. A retrospective study was conducted using the IBM MarketScan Commercial Claims and Encounters Database from January 1, 2006, through December 31, 2020. Patients 40 and older who received a meniscectomy or a meniscal repair with a minimum 1-year follow-up were included. The primary outcome was ipsilateral knee reoperation during the study period. Kaplan-Meier survival curves were used to determine differences in reoperation rates for meniscal repair and meniscectomy over time. Multivariable Cox regression analysis was performed to identify factors associated with earlier time to reoperation. A total of 3,026 patients (2,367 meniscectomy, 659 meniscal repair) were included. Mean follow-up was 14.5 ± 0.29 years (range, 1.0-14.91 years). There were no significant differences in baseline demographic characteristics of follow-up between the 2 groups. The survival curves of the 2 procedures significantly differed (P= .02), and the overall reoperation rate was higher after meniscal repair than meniscectomy (13.5% vs 10.1%, P= .01). However, the incidence of subsequent ipsilateral meniscectomy, meniscal repair, and knee arthroplasty procedures did not significantly differ. Multivariable Cox regression analysis identified meniscal repair, obesity, concomitant anterior cruciate ligament reconstruction, and increasing age as being significant risks for earlier reoperation, and male sex was protective. In a population of patients aged ≥40 with surgically treated meniscal tears and 14.5-year average follow-up, meniscal repair was associated with higher overall reoperation with shorter survival times compared to meniscectomy. However, the indications for the 2 procedures likely differed. Additionally, obesity, older age, female sex, and concomitant anterior cruciate ligament reconstruction were risk factors for earlier reoperation. Level III, retrospective comparative case series.

Effect of arthroscopic partial meniscectomy on structural degeneration of the knee – A 5-year MRI-based follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

ObjectiveTo assess the 5-year effects of arthroscopic partial meniscectomy (APM) vs. placebo-surgery on the development of the structural changes of the knee by MRI. DesignThis multicentre, randomized, participant- and outcome-assessor-blinded, placebo-surgery-controlled trial was carried out in Finland. We randomized 146 adults, mean age 52 years (range 35 to 65) to undergo either APM or placebo surgery. The subjects had symptoms of degenerative medial meniscus tear, a tear verified in MRI and arthroscopy, and no advanced osteoarthritis at baseline. We compared the baseline and 5-year follow-up MRIs using MRI Osteoarthritis Knee Score (MOAKS) scoring to derive subregional data on cartilage damage, osteophytes and bone marrow lesions (BMLs). Progression of structural cartilage changes analysed per subregion was the main outcome, that of osteophytes and BMLs secondary outcomes. We analysed the progression with multilevel logistic regression model on subregion level data, adjusted for randomization stratification factors, and using robust standard errors. ResultsSixty-three (90%) subjects in the APM and 73 (96%) in the placebo-surgery group had MRI at both time points. The adjusted odds ratio (APM vs. placebo-surgery) was 1.31 (95% confidence interval 0.81, 1.94) for progression of cartilage damage, 2.86 (1.16, 6.21) for osteophytes, and 1.43 (0.84, 2.43) for BMLs. ConclusionsWe found a slightly greater risk for progression of osteophytes in the APM group compared to the placebo-surgery group at 5 years after surgery. Trial registrationClinicalTrials.gov (NCT01052233 and NCT00549172).

Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction.

The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%. To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction. Case-control study; Level of evidence: 3. Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: "pass" if the LSI at 6 months postoperatively was ≥85% and "fail" if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength. A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R 2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration (P = .879). Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.

Differences in Graft Tear Configurations in Medial and Lateral Meniscal Allograft Transplantation: Objective Evaluations Using Magnetic Resonance Imaging

Background: Few studies have compared the characteristics of meniscal allograft tears between medial and lateral meniscal allograft transplantation (MAT) using bone fixation. Purpose: To investigate the prevalence, location, and patterns of allograft tears after MAT with the bone fixation technique and compare tear patterns between medial and lateral compartments according to the time elapsed after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The charts of consecutive patients who underwent primary medial or lateral MAT between December 1996 and June 2019 were retrospectively reviewed. The location, pattern, and postoperative periods during which allograft tears occurred were evaluated by reviewing all series of follow-up magnetic resonance imaging (MRI) scans, which were performed at 6 weeks, 3 months, 6 months, and 1 year postoperatively and every 2 years thereafter with the patient's agreement. Postoperative periods for allograft tears were defined as the time between surgery and the follow-up MRI scan in which the meniscal tear was first confirmed. Allograft tears were compared between the medial and lateral MAT groups. Results: A total of 327 consecutive patients who underwent MAT (55 medial, 272 lateral) with a minimum 2-year follow-up were retrospectively reviewed. The incidences of allograft tears after medial and lateral MATs were 32.7% and 30.9%, respectively. The mean times for tears were 80.1 ± 81.1 months and 48.9 ± 46.3 months in the medial and lateral MAT groups, respectively (P = .130). In both the medial and lateral MAT groups, allograft tears were observed mainly in the posterior horn, with complex tears being the most commonly identified tear type. In medial MATs, root tears were the second most common at 27.8%, with a significantly higher proportion than the lateral MATs (P = .014). On the other hand, in lateral MATs, meniscocapsular separation and radial tears were the second most common at 15.5% each, albeit not significantly more common than in medial MATs (P = .123 and P = .454, respectively). All root tears in medial MATs and meniscocapsular separations in lateral MATs were observed within 1 year postoperatively. Conclusion: Significant differences in allograft tear patterns were identified between the medial and lateral MAT groups. The proportion of root tears in medial MATs was higher than that in lateral MATs; conversely, the proportion of meniscocapsular separation was more common in lateral MATs. Such tear patterns, which may require surgical repair or graft resection, were observed only within 1 year of surgery. Therefore, close observation and regular follow-up in the earlier postoperative period are necessary after medial or lateral MATs.

Meniscus Tears in Climbing - a Triviality or Serious Concern?

Introduction In the past few years, the popularity of climbing and the number of its new recreational enthusiasts increased. It became clear that there are more types of trauma than finger injuries that should be commonly associated with the sport. This overview focuses on meniscus tears as a prevalent underestimated complaint of climbers. Aim of the studyWe aim to bring attention to meniscus lesions and deal with mechanisms of knee injury in climbing while considering the current views on the structure, function, types of lesions, treatment methods, and results in light of topical literature. Materials and methodsThe methodology for the literature search involved using the keywords: ''meniscus tears'', ''climbing injury'', ''bouldering'', ''arthroscopy'', and ''meniscus repair''. The phrases were searched in the PubMed and Google Scholar databases. ConclusionsWe concluded that climbers should recognise acute and chronic meniscus lesions as a concern requiring training breaks, possibly further diagnosis, and adequate treatments. Moreover, awareness of the risk of this type of injury in climbing should be raised, and preventive action should be taken to limit the number of new cases.

Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases

ObjectiveWhile meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure. MethodsA retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score. ResultsFifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p ​= ​0.4). ConclusionsFC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure. Level of evidenceLevel IV, case series.

Deep Learning-Enhanced Accelerated 2D TSE and 3D Superresolution Dixon TSE for Rapid Comprehensive Knee Joint Assessment.

The aim of this study was to evaluate the use of a multicontrast deep learning (DL)-reconstructed 4-fold accelerated 2-dimensional (2D) turbo spin echo (TSE) protocol and the feasibility of 3-dimensional (3D) superresolution reconstruction (SRR) of DL-enhanced 6-fold accelerated 2D Dixon TSE magnetic resonance imaging (MRI) for comprehensive knee joint assessment, by comparing image quality and diagnostic performance with a conventional 2-fold accelerated 2D TSE knee MRI protocol. This prospective, ethics-approved study included 19 symptomatic adult subjects who underwent knee MRI on a clinical 3 T scanner. Every subject was scanned with 3 DL-enhanced acquisition protocols in a single session: a clinical standard 2-fold in-plane parallel imaging (PI) accelerated 2D TSE-based protocol (5 sequences, 11 minutes 23 seconds) that served as a reference, a DL-reconstructed 4-fold accelerated 2D TSE protocol combining 2-fold PI and 2-fold simultaneous multislice acceleration (5 sequences, 6 minutes 24 seconds), and a 3D SRR protocol based on DL-enhanced 6-fold accelerated (ie, 3-fold PI and 2-fold simultaneous multislice) 2D Dixon TSE MRI (6 anisotropic 2D Dixon TSE acquisitions rotated around the phase-encoding axis, 6 minutes 24 seconds). This resulted in a total of 228 knee MRI scans comprising 21,204 images. Three readers evaluated all pseudonymized and randomized images in terms of image quality using a 5-point Likert scale. Two of the readers (musculoskeletal radiologists) additionally evaluated anatomical visibility and diagnostic confidence to assess normal and pathological knee structures with a 5-point Likert scale. They recorded the presence and location of internal knee derangements, including cartilage defects, meniscal tears, tears of ligaments, tendons and muscles, and bone injuries. The statistical analysis included nonparametric Friedman tests, and interreader and intrareader agreement assessment using the weighted Fleiss-Cohen kappa (κ) statistic. P values of less than 0.05 were considered statistically significant. The evaluated DL-enhanced 4-fold accelerated 2D TSE protocol provided very similar image quality and anatomical visibility to the standard 2D TSE protocol, whereas the 3D SRR Dixon TSE protocol scored less in terms of overall image quality due to reduced edge sharpness and the presence of artifacts (P < 0.001). Subjective signal-to-noise ratio, contrast resolution, fluid brightness, and fat suppression were good to excellent for all protocols. For 1 reader, the Dixon method of the 3D SRR protocol provided significantly better fat suppression than the spectral fat saturation applied in the standard 2D TSE protocol (P < 0.05). The visualization of knee structures with 3D SRR Dixon TSE was very similar to the standard protocol, except for cartilage, tendons, and bone, which were affected by the presence of reconstruction and aliasing artifacts (P < 0.001). The diagnostic confidence of both readers was high for all protocols and all knee structures, except for cartilage and tendons. The standard 2D TSE protocol showed a significantly higher diagnostic confidence for assessing tendons than 3D SRR Dixon TSE MRI (P < 0.01). The interreader and intrareader agreement for the assessment of internal knee derangements using any of the 3 protocols was substantial to almost perfect (κ = 0.67-1.00). For cartilage, the interreader agreement was substantial for DL-enhanced accelerated 2D TSE (κ = 0.79) and almost perfect for standard 2D TSE (κ = 0.98) and 3D SRR Dixon TSE (κ = 0.87). For menisci, the interreader agreement was substantial for 3D SRR Dixon TSE (κ = 0.70-0.80) and substantial to almost perfect for standard 2D TSE (κ = 0.80-0.99) and DL-enhanced 2D TSE (κ = 0.87-1.00). Moreover, the total acquisition time was reduced by 44% when using the DL-enhanced accelerated 2D TSE or 3D SRR Dixon TSE protocol instead of the conventional 2D TSE protocol. The presented DL-enhanced 4-fold accelerated 2D TSE protocol provides image quality and diagnostic performance similar to the standard 2D protocol. Moreover, the 3D SRR of DL-enhanced 6-fold accelerated 2D Dixon TSE MRI is feasible for multicontrast 3D knee MRI as its diagnostic performance is comparable to standard 2-fold accelerated 2D knee MRI. However, reconstruction and aliasing artifacts need to be further addressed to guarantee a more reliable visualization and assessment of cartilage, tendons, and bone. Both the 2D and 3D SRR DL-enhanced protocols enable a 44% faster examination compared with conventional 2-fold accelerated routine 2D TSE knee MRI and thus open new paths for more efficient clinical 2D and 3D knee MRI.

After 40 days intra-articular injury, risk profile increases linearly with time to surgery in adolescent patients undergoing primary anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) injuries are becoming more common in youth athletes. Time-to-surgery has been shown to significantly affect the rates of concurrent injuries at the time of ACL reconstruction (ACLR). The purpose of this study was to evaluate if time-to-surgery in ACLR impacts observances of intra-articular injuries and to categorize injury profile in relation to time. An Institutional Review Board-approved retrospective cohort study was conducted. Included subjects were aged 21 and below and underwent primary ACLR within 6 months of injury between January 2012 and April 2020. Skeletal maturity was determined via imaging. Laterality, location and severity/pattern of meniscal and chondral injuries were recorded. Multivariate logistic regression was utilized to identify risk factors for intra-articular pathology. Cut-off analyses were added to regression models to identify trends of concurrent injuries. Eight hundred and fifty patients met the inclusion criteria. Patients with observed articular cartilage injuries had a significantly longer time-to-surgery of 66 days (p = 0.01). Risk factors for chondral injury were time-to-surgery (p = 0.01) and skeletal maturity (p = 0.01), while medial meniscal tears were prognosticated by time-to-surgery (p = 0.03), skeletal maturity (p = 0.01) and body mass index (p = 0.00). Cut-off analysis showed that after 40 days the proportion of patients with observed chondral injury increased with time to surgery and that there were significantly different observances of chondral (p = 0.00) and medial meniscal (p = 0.03) injuries in the 6-week model, as compared to the continuous time model. Longer time-to-surgery in ACLR is associated with higher rates of concomitant intra-articular pathology, especially chondral injuries. After 40 days, the observed rates of intra-articular injury increase proportionately with time from injury. A 6-week categorical model best stratifies intra-articular injury risk profile. Risk factor analysis identified skeletally mature patients with delayed surgery of >12 weeks to be at the highest risk for both chondral and medial meniscal injuries after an ACLR. Level III.

Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments.

The anterior cruciate ligament (ACL) is a vital but frequently injured structure. An ACL injury can result in dysfunction, meniscal injuries, and the early onset of osteoarthritis. This article aims to discuss favourable reconstruction techniques through a literature review with consideration for novel methods in order to identify superior methods that provide a patient's return to function. Current surgical options include reconstruction using different types of autografts and allografts.

Combining a digital health application with standard care significantly enhances rehabilitation outcomes for ACL surgery patients.

Anterior cruciate ligament (ACL) rupture is one of the most common sports injuries. Regardless of the surgical treatment, patients require intensive education about the pathology, therapeutic optionsand physical therapy. However, it is often not possible for the patient to start physical therapy directly and schedule adequate consultations. Digital health applications are medical devices that can help bridge the gap between physiotherapy sessions and provide qualified, convenientand effective education and treatment. This study is needed to explore alternative methods to ensure continuous and effective rehabilitation for ACL patients who face delays in accessing traditional physiotherapy.The study aimed to compare app-assisted therapy plus standard of care (conventional orthopaedic and physiotherapeutic measures) versus isolated standard of care for patients with planned ACL surgery. A monocentric, two-arm, 1:1 randomized controlled study examined 80 patients after a cruciate ligament rupture with or without meniscal injury. Patients over 18 years with a confirmed diagnosis of ACL rupture and planned surgical reconstruction using autologous grafts were included. The study criteria additionally included willingness to use the Orthopy app and sufficient German language proficiency. The study excluded patients with severe concomitant injuries, prior knee surgeries, chronic pain conditionsand those not compatible with app usage. Patients were randomized and their baseline data (t0) was collected. Subsequently, they received their treatment according to their treatment group. The study included a presurgery period (2-6 weeks) and a postsurgery period (14 weeks). Interim assessments were done via online questionnaires at t1 (if more than 3 weeks before surgery) and t3, t4and t5 (postsurgery). Additional clinical assessments were conducted at t2 (presurgery) and t6 (14 weeks postsurgery). Primary outcome measures included the knee injury and osteoarthritis outcome score (KOOS), with subjective pain and function levels (numeric rating scale [NRS]) as secondary endpoints. The clinical trial was able to show positive outcomes on the KOOS Pain and Symptoms subscale of the primary endpoint KOOS in the interventional group compared to the standard of care group. A statistically significant pain reduction could be seen at t1 (p = 0.0005), t2 (p = 0.0068)and t4 (approximately 6 weeks after surgery; p = 0.01). A significant reduction of symptoms at t1 (p = 0.0001), t2 (p = 0.0036)and t6 (p = 0.0377) were recognized. These findings are further supported by the significant benefit of the pain NRS at t4 and positive tendencies at t3, t5and t6. The KOOS subscales quality of life (p = 0.0066), activities of daily living (p = 0.0009)and Sport (p = 0.0484) showed significant effects before surgery. The Orthopy app is a medical device that is both safe and effective for use. Combining the Orthopy app and standard of care can significantly improve prehabilitation and rehabilitation in surgical treatment with ACL reconstruction compared with the isolated standard of care. Level I.

Evaluating the Effectiveness of Physical Therapy in Patients Post-Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears.

ABSTRACT Background: Meniscal tears are among the most common knee injuries, often resulting from sports-related activities or trauma. The menisci are vital for maintaining knee health and function, and a tear can lead to pain, swelling, and impaired mobility. Arthroscopic partial meniscectomy (APM) is a common surgical intervention aimed at alleviating symptoms by removing the damaged portion of the meniscus. Despite the benefits, postoperative challenges such as pain, reduced knee function, and prolonged recovery times are common, making rehabilitation a critical component of recovery. Objective: This study aims to evaluate the effectiveness of physical therapy in patients who have undergone APM for traumatic meniscal tears. The objective is to determine the impact of structured rehabilitation on pain levels, knee function, and overall quality of life compared to standard postoperative care without intensive physical therapy. Methods: A retrospective cross-sectional study was conducted with a sample size of under 50 participants from various private and public orthopedic clinics in Karachi. The study involved patients who had undergone APM and were assessed using the Visual Analog Scale (VAS) and Lysholm scoring scale. The exclusion criteria included patients with meniscal tears less than 10mm, non-traumatic meniscal tears, other knee surgeries, and pre-existing conditions that might interfere with physical therapy outcomes. Results: The average age of participants was approximately 36 years, with a mean body weight of 69 kg. Sports-related trauma was the leading cause of meniscal tears (41.9%), followed by accidents (34.9%) and age-related degeneration (23.3%). Physical therapy led to significant improvements in knee function, with 76.7% of participants reporting good functionality and 93% noting reduced pain and swelling. However, challenges such as difficulty with stair climbing (51.2%) and muscle soreness (27.9%) were also reported. Conclusion: Physical therapy plays a crucial role in the postoperative rehabilitation of patients following APM. The findings indicate that structured rehabilitation significantly improves functional outcomes, reduces pain, and enhances the quality of life. However, variability in patient outcomes suggests the need for further research to optimize rehabilitation protocols, considering individual factors such as the extent of the injury, pre-existing conditions, and patient adherence.

Kinematic gait analysis for patients with meniscus injury

To investigate application of the Codamotion 2CX1 three-dimensional dynamic joint motion capture system to analyze the kinematic characteristics of patients with different degrees of meniscus injury. From December 2020 to June 2022, 135 patients with meniscus injury and recruited normal people were collected, including 82 males and 53 females, aged 14 to 29 years old, with disease duration of 1 to 3 months. Combined with clinical symptoms and MRI examination, the diagnosis of meniscus injury was confirmed, and the patients were divided into stages, including 37 cases of grade 0(normal), 30 cases of gradeⅠ, 33 cases of gradeⅡ, 35 cases of grade Ⅲ according to Stoller grading standard. Subjects in each group were tested walking by using Codamotion 2CX1 three-dimensional dynamic joint motion capture system. Quantitative indexes of walking and kinematics were collected, including knee flexion and extension, internal and external rotation and internal and external turning, and their kinematics were analyzed. In the distribution of knee flexion/extension, there were significant differences in maximum knee flexion, minimum knee extension and knee flexion and extension range among 4 groups(P<0.05). In the distribution of internal/external rotation of knee joint, there were significant differences in the range of internal rotation and rotation of knee joint among 4 groups(P<0.05). In the distribution of internal/external turning of knee joint, there were significant differences in the range of internal and external turning of knee joint among 4 groups(P<0.05). The clinical stage progression was positively correlated with the range of motion of knee extension, external rotation, internal and external turning and turning range(P<0.05). It was negatively correlated with knee flexion, internal rotation, flexion extension and rotation range(P<0.05). The internal and external rotation angles of knee joint could be used as independent factors influencing the clinical stage of meniscus injury (P=0.006, 0.019<0.05). The knee movement of patients with meniscus injury has obvious changes, and the changes are different under different clinical stages. Gait analysis provides a reliable basis for the kinematic analysis of meniscus injury, helps to better understand the kinematic indexes of joints, and provides a reliable auxiliary diagnosis and treatment plan, which provides a new direction for the follow-up medical research.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'. Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.

Transphyseal arthroscopic anterior cruciate ligament reconstruction in children under 12 years.

The incidence of anterior cruciate ligament (ACL) injuries in children is on the rise. Despite this trend, the optimal management of these injuries remains a matter of ongoing debate. In this light, our study seeks to assess the clinical, radiological, and functional outcomes of transphyseal ACL reconstruction in preadolescent patients in the medium-term. This prospective study included preadolescent patients aged up to 12 years who underwent ACL transphyseal reconstruction between 2010 and 2020 and had a minimum follow-up of 2 years. Clinical assessments encompassed joint stability and range of motion. Furthermore, leg length discrepancy (LLD) and femorotibial alignment were evaluated both clinically and radiologically using full-length lower limb standing radiographs. Pre- and postoperative functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scales, and the return to normal sports activity was evaluated using the ACL-Return to Sport after Injury (ACL-RSI) scale. Complications and relevant follow-up data were also recorded. Statistical analyses were conducted to evaluate these outcomes. A total of 35 preadolescent patients, consisting of 24 males and 11 females, with a mean age at surgery of 11.2 ± 0.7 years (8.7-12), were included in the study. The mean follow-up was 52.3 ± 20.7 months (24.1-95.9). No significant growth disturbances or clinically relevant LLD were evidenced. All patients demonstrated clinically stable knees with full range of motion at the 2-year follow-up. There were statistically significant improvements in pre- and postoperative IKDC (39.3 ± 13.5 vs. 99.7 ± 0.8, p < 0.005) and Lysholm scores (48.2 ± 15.1 vs. 99.6 ± 1.4, p < 0.005). All but two patients were able to return to their pre-injury level of sports activity, with a mean ACL-RSI score of 93.5 ± 1.3. The analysis revealed an 8.6% rerupture rate and an11.4% rate of contralateral ACL injuries, with 5-year survival rates of 92.3% and 88.8%, respectively. Subgroup analyses based on age, gender, surgical delay, or associated meniscal lesions did not reveal any significant differences in functional outcomes. Additionally, there was no discernible relationship between age or timing of ACL reconstruction and the risk of meniscal injuries. Our study reinforces the value of ACL reconstruction in skeletally immature preadolescent patients, with transphyseal technique proven to be a safe, effective, and technically simpler option, even for children under the age of 12. The findings indicate excellent functional outcomes, a high rate of successful return to sporting activities, and minimal to no incidence of growth-related complications in the medium-term. Level II, prospective comparative cohort study, before and after intervention.

Cell-free decellularized skin matrix scaffolds: A promising approach for meniscus regeneration in a rabbit meniscectomy model

Tissue engineering presents a promising approach for the treatment of meniscal injuries, yet the development of meniscal scaffolds that exhibit both superior biomechanical properties and biocompatibility remains a considerable challenge. In this study, decellularized skin matrix (DSM) scaffolds were first prepared using porcine skin through decellularization and freeze-drying techniques. The DSM scaffold has favorable porosity, hydrophilicity, and biocompatibility. Importantly, the collagen content and tensile modulus of the scaffold are comparable to those of native meniscus (44.13 ± 2.396 mg/g vs. 42.41 ± 2.40 mg/g and 103.30 ± 2.98 MPa vs. 128.80 ± 9.115 MPa). Subsequently, the peptide PFSSTKT (PFS) with mesenchymal stem cells (MSCs) recruitment capability was used to modify DSM to construct DSM-PFS scaffolds. Compared to the DSM scaffold, the optimized DSM-PFS scaffold enhanced in vitro collagen and glycosaminoglycan (GAG) production and upregulated the expression of cartilage-specific genes. Furthermore, the DSM-PFS scaffold was more effective in recruiting MSCs in vitro. In vivo studies in rabbit models showed that the DSM-PFS scaffold successfully promoted meniscus tissue regeneration. Three months post-implantation, meniscus tissue formation can be observable, and after six months, the neo-meniscus exhibited tissue structure and tensile properties similar to the native meniscus. Notably, the DSM-PFS scaffold exhibited significant chondroprotective effects, slowing osteoarthritis (OA) progression. In conclusion, the DSM-PFS scaffold may represent a promising candidate for future applications in meniscus tissue engineering. Statement of significanceWe developed a decellularized skin matrix (DSM) meniscus scaffold using whole-layer porcine skin, demonstrating superior biomechanical strength and biocompatibility. Following modification with the stem cell-recruiting peptide PFS, the optimized DSM-PFS scaffold outperformed the DSM scaffold in cell attraction, collagen and glycosaminoglycan production, and cartilage-specific gene expression. Implanted into rabbit knee joints, the cell-free DSM-PFS scaffold induced meniscal tissue formation within three months, achieving the histological structure and tensile strength of the native meniscus by six months. Moreover, it significantly protected the cartilage. Our findings provide new insights into the fabrication of scaffolds for meniscal tissue engineering, with the DSM-PFS scaffold emerging as an ideal candidate for future applications.