Meniscal Pathology Research Articles

Use of Implant-Mediated Guided Growth With Tension Band Plate in Skeletally Immature Patients With Knee Pathology: A Retrospective Review.

Background: Skeletally immature patients with coronal plane angular deformity (CPAD) may be at increased risk for intra-articular pathology and patellofemoral instability (PFI). These patients may be candidates for implant-mediated guided growth (IMGG) procedures with tension band plates to address CPAD in addition to procedures for concomitant knee pathology. However, there are limited data on performing these procedures simultaneously. Questions/Purpose: We sought to demonstrate the feasibility of combined procedures to address both knee pathology and concomitant CPAD using IMGG in skeletally immature patients. Methods: We conducted a retrospective review of skeletally immature patients who underwent IMGG and concomitant surgery for anterior cruciate ligament reconstruction, osteochondritis dissecans repair, meniscus pathology, or PFI at a single institution by 2 surgeons between 2008 and 2019. Data on demographics, surgical details, follow-up, and complications were recorded. Deformity correction was assessed in a subset of eligible patients. Results: Of 29 patients meeting inclusion criteria, deformity correction was assessed in a subset of 17 patients (15 valgus, 2 varus). At final follow-up, 16 of 17 patients had mechanical tibiofemoral (mTFA) angles of <5° of varus or valgus. One patient developed "rebound" valgus >5° after plate removal. Conclusions: The IMGG performed in the setting of treating intra-articular knee pathology is feasible and should be considered for skeletally immature patients with CPAD undergoing surgery for concomitant knee pathology.

Quantitative magnetic resonance imaging of meniscal pathology ex vivo

ObjectiveTo determine the ability of conventional spin echo (SE) T2 and ultrashort echo time (UTE) T2* relaxation times to characterize pathology in cadaveric meniscus samples.Materials and methodsFrom 10 human donors, 54 triangular (radially cut) meniscus samples were harvested. Meniscal pathology was classified as normal (n = 17), intrasubstance degenerated (n = 33), or torn (n = 4) using a modified arthroscopic grading system. Using a 3-T MR system, SE T2 and UTE T2* values of the menisci were determined, followed by histopathology. Effect of meniscal pathology on relaxation times and histology scores were determined, along with correlation between relaxation times and histology scores.ResultsMean ± standard deviation UTE T2* values for normal, degenerated, and torn menisci were 3.6 ± 1.3 ms, 7.4 ± 2.5 ms, and 9.8 ± 5.7 ms, respectively, being significantly higher in degenerated (p < 0.0001) and torn (p = 0.0002) menisci compared to that in normal. In contrast, the respective mean SE T2 values were 27.7 ± 9.5 ms, 25.9 ± 7.0 ms, and 35.7 ± 10.4 ms, without significant differences between groups (all p > 0.14). In terms of histology, we found significant group-wise differences (each p < 0.05) in fiber organization and inner-tip surface integrity sub-scores, as well as the total score. Finally, we found a significant weak correlation between UTE T2* and histology total score (p = 0.007, Rs2 = 0.19), unlike the correlation between SE T2 and histology (p = 0.09, Rs2 = 0.05).ConclusionUTE T2* values were found to distinguish normal from both degenerated and torn menisci and correlated significantly with histopathology.

Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment

To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index, and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative International Knee Documentation Committee was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain, and 7 patients (10.2%) presented complications. Groups that improved (GPE > 0) and did not improve (GPE < 0) did not present differences regarding age, sex, follow-up time, chondral lesions, or body mass index. Patients without improvement had a greater incidence of smoking (P= .001), varus alignment (P= .008), and more advanced KL classification (P < .001). In the multivariate analysis based on the GPE score, KL classification (P= .038) and smoking (P= .003) were significant. Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment. Level IV (case series).

Subsequent meniscal tears following tibial tuberosity advancement and tibial plateau leveling osteotomy in dogs with cranial cruciate ligament deficiency: An in vivo experimental study.

To evaluate the short- and mid-term effects of tibial tuberosity advancement (TTA) and tibial plateau leveling osteotomy (TPLO) on subsequent meniscal tears. Experimental in vivo study. Purpose-bred beagle dogs (n=15). For each dog, the cranial cruciate ligaments were transected; one limb underwent TTA and the other limb underwent TPLO. Orthopedic and radiographic examinations were performed preoperatively and at 12 and 32 weeks postoperatively. Gross evaluation of the stifle joint was performed after euthanasia at 12 (n=10) and 32 (n=5) weeks. Lameness scores were not different between TTA and TPLO limbs at any time point. Radiographic osteoarthritis scores of TTA stifles (1.33 ± 0.49) were higher than TPLO stifles (0.67 ± 0.49) (p=.002) at 12 weeks postoperatively, but there was no difference between groups at 32 weeks postoperatively. Subsequent medial meniscal tears occurred in 6/10 TTA stifles, and 0/10 TPLO stifles at 12 weeks postoperatively and in 5/5 TTA stifles, and 1/5 TPLO stifles at 32 weeks postoperatively. Subsequent lateral meniscal tears occurred in 4/5 TTA stifles at 32 weeks postoperatively. Medial meniscal total gross pathology score was higher in TTA than TPLO stifles. TTA stifles had more articular cartilage damage when compared with TPLO stifles at 32 weeks postoperatively. In this within-dog experimental comparison, subsequent medial meniscal tears and cartilage injury was more prevalent following TTA when compared to TPLO. In an experimental model, TPLO protects the medial meniscus and articular cartilage better than TTA in stifles with complete cranial cruciate ligament deficiency.

Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI.

To assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal extrusion, grade of chondrosis, and extent of surrounding edema-like marrow signal intensity. Our retrospective study included 219 patients with knee pain and SIFK seen on MRI. SIFK lesions were categorized from grade 1 to 4 with a low grade (1 and 2) vs high grade (3 and 4) distinction. Associations between SIFK grade, location, lesion dimensions, edema-like marrow signal intensity, incidence of meniscal tears/type/location, and chondrosis (grade 0 to grade 4), as well as patients' age and weight, were assessed. Our analysis consisted of 115 males and 104 females with 17% of the patients showing grade 1 SIFK, 59% grade 2, 16% grade 3, and 8% grade 4. No chondrosis or low-grade chondrosis was mostly present in patients with low-grade SIFK (68.9%), whereas high-grade chondrosis was mostly present in patients with high-grade SIFK lesions (65.4%) (p < 0.01). Further sub-analysis demonstrated that high-grade SIFK was associated with high-grade chondrosis in the same compartment (p < 0.01) but not in the adjacent compartment. There was a significant difference in the extent of edema-like marrow signal intensity between the two groups, with high-grade SIFK more frequently demonstrating severe edema-like marrow signal intensity compared to low-grade SIFK (p < 0.01). High-grade SIFK lesions are associated with unicompartmental high-grade chondrosis.

The translated Danish version of the Western Ontario Meniscal Evaluation Tool (WOMET) is reliable and responsive.

The purpose of this study was to translate and cross-culturally adapt the Western Ontario Meniscal Evaluation Tool (WOMET) for use in Denmark and evaluate its test-retest reliability and comparative responsiveness. Sixty patients (mean age 50years (range 19-71years), females 57%) with meniscal injury scheduled for arthroscopic meniscal surgery at a small Danish hospital in the period from September 2017 to February 2018 were included in this study. The WOMET was translated into Danish using forward and backward translation. The WOMET was completed at baseline (pre-surgery), at 3 and 6months postoperatively. Additionally, reliability was assessed at 3months and 3months plus 1week, for patients with a stable symptom state (global response question) between test and retest. Comparative responsiveness was assessed between the WOMET and the Knee Injury and Osteoarthritis Outcome Score (KOOS4-aggregate score of 4 of the 5 KOOS subscales). The Danish version of WOMET showed excellent test-retest reliability, intraclass correlation coefficient of 0.88 (95% CI 0.84-0.92) for the total score. The standard error of measurement was 125 points and the minimal detectable change was 347 points (i.e. 8% and 22% of the total score, respectively). The WOMET was responsive with an effect size (ES) of 1.12 at 6months after surgery, which was comparable to the KOOS4 (ES 1.10). The Danish version of the WOMET is a reliable and responsive measure of health-related quality of life in patients with meniscal pathology. Level II.

Long-term National Trends of Arthroscopic Meniscal Repair and Debridement

Background: Optimal treatment of meniscal pathology continues to evolve in orthopaedic surgery, with a growing understanding of which patients benefit from which procedure and which patients might be best treated nonsurgically. In 2002, Moseley et al found no difference between arthroscopic procedures, including meniscal debridement and sham surgery, in patients with osteoarthritis of the knee. This called into question the role of routine arthroscopic debridement in these patients. Additionally, an increased interest in understanding and maintaining the function of the meniscus has more recently resulted in a greater focus on meniscal preservation procedures. Study Design: Descriptive epidemiology study. Purpose/Hypothesis: The purpose was to evaluate the trends of arthroscopic meniscal debridement and repair and the characteristics of the patients receiving these treatments, compare the differences in practice between newly trained orthopaedic sports medicine specialists and those of other specialties, and analyze if there are differences in practice by region. It was hypothesized that the American Board of Orthopaedic Surgery (ABOS) database would evaluate practice patterns of recent graduates as a surrogate for current treatment and training and, consequently, demonstrate a decreased rate of meniscal debridement. Methods: Data from ABOS Part II examinees from 2001 to 2017 were obtained from the ABOS Case List. Current Procedure Terminology (CPT) codes related to arthroscopic meniscal treatment were selected. The examination year, age of the patient, practice region, and examinee subspecialty were analyzed. Patient age was stratified into 4 groups: <30, 30 to 50, 51 to 65, and >65 years. Examinee subspecialty was stratified into sports medicine and non–sports medicine. Statistical regression analysis was performed. Results: Between 2001 and 2017, ABOS Part II examinees submitted 131,047 cases with CPT codes 29880 to 29883. Meniscal debridement volume decreased for all age groups during the study period, while repair increased. Sports medicine subspecialists were more likely than their counterparts to perform repair over debridement in patients aged younger than 30 years (P = .0004) and between 30 and 50 years (P = .0005). Conclusion: This study provides insights into arthroscopic meniscal debridement and repair practice trends among ABOS Part II examinees. Meniscal debridement is decreasing and meniscal repair is increasing. Younger patient age and treatment by a sports medicine subspecialty examinee are associated with a higher likelihood of repair over debridement.

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

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

Association between physical activity and KNEE osteoarthritis features on magnetic resonance imaging in individuals without knee osteoarthritis: a systematic review

Purpose: As there are concerns that a high degree of physical activity (PA) may increase the risk of knee osteoarthritis (OA) development, epidemiological studies have been undertaken to examine whether PA has effects on structural changes in the knee. Several studies used magnetic resonance imaging (MRI) to capture OA features (e.g. cartilage defects and meniscal pathologies) in early onset of disease as the development of OA features on radiography usually takes years. Therefore, the aim of this study was to systematically review all studies that evaluated the association between PA levels and knee OA features on MRI, among subjects without knee OA.

Ultrasound-Guided Perimeniscal Injections: Anatomical Description and Feasibility Study.

To anatomically describe the ultrasound (US)-guided perimeniscal injection technique, and evaluate its feasibility in the treatment of meniscal pain. This work was initially undertaken in four cadaveric specimens with US-guided medial and lateral perimeniscal injection of China ink, followed by cadaveric dissection to assess injectate distribution, and potential injury to intra-articular and peri-articular structures. Then, 35 consecutive patients who underwent US-guided perimeniscal corticosteroid injection under local anesthesia for the treatment of symptomatic medial (30/35) or lateral (5/35) degenerative meniscal tear were retrospectively evaluated. Clinical outcome was assessed using a 0-10 numerical verbal rating scale (VRS) to evaluate severity of pain before, during, and after procedure at 6 weeks follow-up. Seven of eight (87.5%) ex vivo injections were accurate. A single inaccurate medial perimeniscal injection infiltrated the tibial collateral ligament instead of the perimeniscal area. No anatomical specimen exhibited intrameniscal injection or injury to regional structures. All procedures (35/35) performed clinically were technically successful. Median VRS scores were: 7 (range, 3-9) before procedure, 5 (range, 0-10) during procedure, and 1.5 (range, 0-9) after procedure at 6 weeks follow-up (P <.0001). No complication was observed. US-guided perimeniscal injections can accurately and safely deliver injectates in the perimeniscal area. In addition, our data suggest that perimeniscal corticosteroid injection provides significant symptom relief at 6 weeks in patients with meniscal pain. Further studies with long-term follow-up will be required to evaluate the role of perimeniscal injections in the nonoperative management of meniscal pathology.

The Importance of a Thorough History and Exam: Commentary on an article by Evan M. Farina, MD, et al.: "Meniscal and Mechanical Symptoms Are Associated with Cartilage Damage, Not Meniscal Pathology".

The Importance of a Thorough History and Exam: Commentary on an article by Evan M. Farina, MD, et al.: "Meniscal and Mechanical Symptoms Are Associated with Cartilage Damage, Not Meniscal Pathology".

Is meniscal status in the anterior cruciate ligament injured knee associated with change in bone surface area? An exploratory analysis of the KANON trial

To study bone shape changes as a potential early feature of post-traumatic structural knee OA development, we estimated the association between meniscal status in the anterior cruciate ligament (ACL) injured knee and longitudinal condyle changes in bone surface area. We used data from the KANON trial, including 121 young ACL-injured adults. We obtained baseline and 2-year follow-up knee MRIs. Our outcome was change in the bone surface areas (mean mm2, log-transformed) in 4 locations (femur, tibia, patella, and trochlea femur) in the medial and lateral compartment from baseline to 2 years. Meniscal pathology was defined as both present at baseline and newly developed (i.e., incident or progressed) using ACLOAS. We used multilevel linear regression adjusted for baseline bone area, age, sex, body mass index, treatment arm (i.e., early or optional delayed ACL reconstruction), and location. We analyzed medial and lateral compartment separately. We present results as percentage (%) bone area change difference with 95% confidence intervals (CI). We analyzed 109 subjects (median 27 (18-36) years, 83% men) due to missing MRI information. The bone surface area increased on average by ∼2% over 2 years. The differences between knees with and without baseline meniscal pathology were 1.1% (95%CI 0.0-2.3%) and 1.4% (95%CI 0.6-2.2%) in the medial and lateral compartment, respectively, and 1.2% (95%CI 0.3-2.0%) and 1.3% (95%CI 0.6-2.0%) for medial and lateral newly developed pathology, respectively. Our finding of ∼1% increase bone area in compartment with meniscal pathology suggests a potentially important association between meniscal integrity and early bone surface area changes after ACL injury. Trial registration number ISRCTN 84752559.

Accuracy of magnetic resonance imaging of the knee for intra-articular pathology in children: A comparison of 3T versus 1.5T imaging

BackgroundMagnetic resonance imaging (MRI) is an essential tool in assessment of knee pathology in children. Published values demonstrate variable accuracy of MRI, lower accuracy in younger patients, and none compare 3T–1.5T. We aim to assess the accuracy of MRI for anterior cruciate ligament, meniscal, osteochondral and chondral abnormality; and to compare 3T–1.5T MRI. MethodsArthroscopy findings and pre-operative MRI reports were reviewed retrospectively. Agreement between MRI report and arthroscopic findings were assessed, using arthroscopy as the gold standard. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for all pathologies, and both magnet strengths. ResultsOf 439 patients there were 109 exclusions, 330 patients remained for review. Average time from MRI to arthroscopy was 120 days, with mean age 13.6. Sensitivity for medial meniscal pathology was 78.7%, lateral meniscal pathology 60.4%, ACL rupture 92.5%, OCD 94.2% and chondral change 23.1%. The only significant difference was sensitivity for ACL injury (1.5T: 96.7%, 3T 83.3%, p = 0.02), suggesting no disadvantage of 1.5T imaging. ConclusionMRI of the knee gives relatively lower sensitivity and accuracy for lateral meniscal tear compared to medial meniscal tear and has poor sensitivity for chondral pathology in children. There is no clear disadvantage of 1.5T imaging compared to 3T.

Rates of Concomitant Meniscal Tears in Pediatric Patients With Anterior Cruciate Ligament Injuries Increase With Age and Body Mass Index

Background:Anterior cruciate ligament (ACL) tears are frequently associated with meniscal injury. Risk factors for concomitant meniscal injuries have been studied in the adult population but less so in pediatric patients.Purpose:To evaluate the relationship between age and body mass index (BMI) and the presence of a concomitant meniscal tear at the time of ACL reconstruction (ACLR) in pediatric patients.Study Design:Case-control study; Level of evidence, 3.Methods:A single-institution retrospective review was performed of patients aged <19 years who underwent primary ACLR over a 3.5-year period. Revision ACLR and multiligament knee reconstructions were excluded. Logistic regression was used to identify risk factors associated with having a meniscal tear at the time of surgery. Subgroup analysis was performed for medial and lateral meniscal tears.Results:Included in this study were 453 patients (230 males, 223 females; median age, 15 years). Of these, 265 patients (58%) had a meniscal tear, including 150 isolated lateral meniscal tears, 53 isolated medial meniscal tears, and 62 patients with both lateral and medial meniscal tears. Median time from injury to surgery was 48 days. For every 1-year increase in age, there was a 16% increase in the adjusted odds of having any meniscal tear (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.05-1.27; P = .002), with a 20% increase in the odds of having a medial meniscal tear (OR, 1.20; 95% CI, 1.07-1.35; P = .002) and a 16% increase in the odds of having a lateral meniscal tear (OR, 1.16; 95% CI, 1.05-1.27; P = .003). For every 2-point increase in BMI, there was a 12% increase in the odds of having any meniscal tear (OR, 1.12; 95% CI, 1.02-1.22; P = .016) and a 10% increase in the odds of having a lateral meniscal tear (OR, 1.10; 95% CI, 1.01-1.19; P = .028).Conclusion:Pediatric patients undergoing ACLR had a 58% incidence of concomitant meniscal pathology. Increasing age and BMI were independent risk factors for these injuries, while no association was found between time to surgery and meniscal pathology.

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee.

Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.

Anterior cruciate ligament reconstruction with lateral extraarticular tenodesis better restores native knee kinematics in combined ACL and meniscal injury.

To determine if anterior cruciate ligament (ACL) reconstruction (ACLR) with lateral extraarticular tenodesis (LET) is beneficial for restoring knee kinematics with concomitant meniscal pathology causing rotatory knee instability. Twenty patients with an ACL tear were randomized to either isolated ACLR or ACLR with LET. Patients were divided into four groups based on the surgery performed and the presence of meniscal tear (MT): ACLR without MT, ACLR with MT, ACLR with LET without MT, and ACLR with LET with MT. Kinematic data normalized to the contralateral, healthy knee were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Anterior tibial translation (ATT) and tibial rotation (TR) as well as patient-reported outcome measures (PROMs) were analyzed at 6- and 12-months postoperatively. At 6months, ACLR with LET resulted in significantly decreased ATT at heel strike compared to ACLR (ACLR without MT: 0.3 ± 0.8mm and ACLR with MT: 1.4 ± 3.1mm vs. ACLR with LET without MT: -2.5 ± 3.4mm and ACLR with LET with MT: -1.5 ± 1.2mm ATT, p = 0.02). At 6months, at toe off ACLR with LET better restored ATT to that of the contralateral, healthy knee in patients with meniscal pathology, while in patients without meniscal pathology, ACLR with LET resulted in significantly decreased ATT (1.0 ± 2.6mm ATT vs. -2.6 ± 1.7mm ATT, p = 0.04). There were no significant differences in kinematics or PROMs between groups at 12months. For combined ACL and meniscus injury, ACLR with LET restores native knee kinematics at toe off but excessively decreases ATT at heel strike in the early post-operative period (6months) without altering knee kinematics in the long term. Future large-scale clinical studies are needed to better understand the function of LET and ultimately improve patient outcomes. III.

Evaluating Posterior Cruciate Ligament Integrity in Inflammatory Arthritis Patients Prescribed Biologic Agents: A Radiological Case-Control Study.

IntroductionPatients with inflammatory arthropathies present a significant challenge to the arthroplasty surgeon when they present with symptomatic degenerative changes of their knee joint. Debate is ongoing regarding the selection of implants for this cohort of patients. There is conflicting evidence for the use of posterior-stabilising (PS) over cruciate-retaining (CR) designs in this cohort. Biologics are licensed for use in moderate-to-severe disease that has not responded to conventional treatment. To our knowledge, there are no studies that have assessed the integrity of the posterior cruciate ligament (PCL) on magnetic resonance imaging (MRI) in these patients with more advanced disease prescribed biologic agents.AimThe aim of this study is to assess the integrity of the PCL on MRI in patients with inflammatory arthritis who are prescribed biologic agents.MethodsA case-control study was performed, with cases identified through chart review to confirm prescription of biologic agents for inflammatory arthropathies, who also had contemporaneous MRI knee scans performed. Knee MRIs for age- and sex-matched controls with osteoarthritis (OA) and meniscal pathology were identified from the National Joint Registry and the Hospital In-Patient Enquiry (HIPE), respectively.The MRIs were reviewed by two musculoskeletal radiologists who were blinded to the clinical details. They were asked to assess the MRIs to determine PCL integrity, synovial Inflammation, and any associated pathology.ResultsNo difference was noted in the rate of synovitis, PCL attenuation, or PCL tears between the OA and inflammatory arthropathy groups (p > 0.05).ConclusionsThe results of this study show no difference in the integrity and continuity of the PCL in those patients for age- and sex-matched controls on MRI. This finding lends support to the use of CR total knee arthroplasty in patients with inflammatory arthropathy on biologic agents.

Landing Asymmetry Is Associated with Psychological Factors after Anterior Cruciate Ligament Reconstruction.

The goals of this work were to 1) determine the relationship between psychological readiness for return to sport and side-to-side symmetry during jump-landing in patients recovering from anterior cruciate ligament reconstruction (ACLR) and 2) determine whether psychological readiness for return to sport, graft type, meniscal pathology, sex, and time since surgery could predict landing symmetry in ACLR patients. Thirty-eight patients recovering from primary unilateral ACLR (22 men/16 women; 19 patellar tendon autograft/19 hamstring autograft; age: 16.3 ± 1.9 yr; 25.7 ± 6.2 wk postoperative) completed the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) and 10 bilateral stop-jumps. Three-dimensional lower extremity kinematics and kinetics were collected at 240 and 1920 Hz, respectively. Peak knee extension moment limb symmetry index (LSI) was computed during the first landing of the stop-jump. The relationship between the ACL-RSI and peak knee extension moment LSI was determined using Pearson correlations. Multivariate regression was used to determine the ability of the ACL-RSI, graft type, meniscal pathology, sex, time since surgery, stop jump entry speed, and jump height to predict knee extension moment LSI. There was a significant relationship between the ACL-RSI and peak knee extension moment LSI (r = 0.325; P = 0.047). The backward regression model found that 36.9% of the variance in knee extension moment LSI could be explained by the ACL-RSI (P = 0.040), graft type (P = 0.006), and jump height (P = 0.027). There is a significant moderate association between psychological readiness for return to sport and asymmetric landing kinetics in patients after ACLR. Future work should investigate whether improving movement confidence results in improved kinetic landing symmetry.

Translation, cross-cultural adaptation and psychometric evaluation of the Greek version of the Western Ontario Meniscal Evaluation Tool (WOMET)

Background The Western Ontario Meniscal Evaluation Tool (WOMET) is a questionnaire designed to evaluate the health-related quality of life (HRQoL) of patients with meniscal pathology. The purpose of this study is to culturally adapt and validate the WOMET into Greek using the COSMIN checklist. Materials and Methods One-hundred three patients (40 females, 63 males; mean age: 42.9 ± 18.5) with meniscal pathology were recruited in this study. The test-retest reliability of the WOMET was assessed with the intraclass correlation coefficient (ICC) while the internal consistency was evaluated using Cronbach’s α. The concurrent validity was assessed by evaluating the correlation among the WOMET and the Knee injury and Osteoarthritis Outcome Score (KOOS) while construct validity was assessed with Exploratory Factor Analysis (EFA). Results The ICC for the overall WOMET score was 0.91 while the Cronbach’s α was 0.96. WOMET was moderately to strongly correlated with the domains of the KOOS with the strongest correlation being between WOMET and Quality of Life domain (r = 0.81). EFA provided support for a two factor solution explaining the 66.2% of the total variability. Conclusions The Greek version of WOMET is considered a valid tool for measuring the HRQoL of Greek speaking patients with meniscal pathology.

Meniscal and Mechanical Symptoms Are Associated with Cartilage Damage, Not Meniscal Pathology.

Traditionally defined "meniscal" and "mechanical" symptoms are thought to arise from meniscal tears. Yet meniscal tears and cartilage damage commonly coexist in symptomatic knees. To better characterize the primary driver of these symptoms, we investigated whether the presence of preoperative patient-reported knee symptoms (PRKS), including knee catching/locking, grinding/clicking/popping, and pain with pivoting, are associated with various intra-articular pathological conditions diagnosed at knee arthroscopy. We collected prospective data from 565 consecutive patients who underwent knee arthroscopy from 2012 to 2019 and had PRKS collected via the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The diagnosis of meniscal pathology and concomitant cartilage damage was confirmed and classified intraoperatively. We used multivariable regression models, adjusting for possible confounders, to examine the association of specific pathological conditions of the knee with the presence of preoperative PRKS. Tricompartmental cartilage damage was strongly associated with significantly worse PRKS, with an increase of 0.33 point (95% confidence interval [CI] = 0.08 to 0.58; p = 0.01) on a 0 to 4-point scale. We did not observe an association between meniscal pathology and preoperative PRKS. Contrary to current dogma, this study demonstrates that traditionally defined "meniscal" and "mechanical" knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.