Meniscal Tears Research Articles

Knee malalignment and laterality influence 2-year meniscus tear repair outcomes: A pilot study.

To analyse biomechanical determinants for radiological and clinical outcomes of posterior horn longitudinal vertical meniscal tear (LVMT) repairs. Patients undergoing primary repair of vascular zone traumatic full-thickness posterior horn LVMT were enroled. We hypothesized four potential factors would influence mid-term outcomes: malalignment (varus/valgus ≥5° for medial/lateral tears), meniscal laterality (medial vs. lateral), concomitant anterior cruciate ligament reconstruction (ACLR) and cartilage damage (Outerbridge grade ≥ II). The primary outcome was posterior horn nonhealing rate 6 months postoperatively (T1), evaluated using computed tomography arthrography (CTA) and Henning's criteria. Secondary outcomes were patient-reported outcomes measures (PROMs) assessed at T1 and ≥24 months postoperatively (T2). Univariate and multivariate logistic regression models estimated the marginal relative risk (MRR) of nonhealing for each determinant, while fractional logit regression assessed determinants' impact on PROMs at T1 and T2. Seventy-eight patients (median age 29 years, interquartile range [IQR]: [21-37]); 76% male), were followed for ≥2 years (median 2.5 years, IQR: [2.1-3.6]). LVMTs extended to the middle horn in 81% and to the anterior horn in 52%. Posterior horn nonhealing rates (53%) were higher than in the middle (35%, p = 0.013) and anterior horn (7%, p < 0.001). Malalignment was present in 14%, medial meniscal involvement in 77%, ACLR in 55% and cartilage damage in 37%. Malalignment (MRR = 1.48, 95% confidence interval (CI): [0.84, 2.09]) and medial laterality (MRR = 1.7, 95% CI: [0.93, 3.6]) were independently identified as potential nonhealing risk factors. But it is the combination of varus malalignment and medial laterality that significantly increased the risk of nonhealing (MRR = 2.54, 95% CI: [1.09, 6.01], p = 0.033) and negatively impacted all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and International Knee Documentation Committee (IKDC) score at T1 and/or T2. Combined varus malalignment and medial meniscus involvement strongly predicted repair nonhealing and poorer outcomes after posterior horn LVMT repair. Prospective cohort pilot study. Level III.

Assessment of stifle effusion-synovitis as a predictor for canine cruciate disease

Objective: To objectively quantify stifle effusion-synovitis in dogs with confirmed cranial cruciate ligament (CrCL) disease, with or without meniscal pathology, through radiographic assessment by investigating an association between severity of effusion-synovitis and cruciate and meniscal disease, and to establish a standardised quantitative radiographic measurement screening tool to predict severity of cruciate and meniscal injury. Methods: A total of 100 diseased stifles met the inclusion criteria and were assigned to either partial CrCL tear (PT), complete CrCL tear (CT), partial CrCL tear with meniscal pathology (PTM) or complete CrCL tear with meniscal pathology (CTM) groups. Quantitative measurement assessment was then performed to evaluate the percentage of cranial effusion-synovitis (CrES), caudal effusion-synovitis (CdES) and cranial fat pad compression. Three surgeons conducted a blinded review of 15 mediolateral stifle radiographs and were instructed to subjectively and quantitatively predict the degree of cruciate and meniscal pathology. Results: A significant difference of CrES between CT and PT groups (P=0.0173) and CTM and PT (P=0.0169) groups was identified. A significant difference in CdES between PT and CT groups (P=0.0015), PT and CTM groups (P=0.0041) and CTM and CT (P=0.0005) groups was identified. Quantitative measurement demonstrated improved sensitivity, specificity and agreement when compared to subjective assessment. Clinical significance: The results of this study propose that a quantitative radiographic measuring tool for predicting the severity of cruciate and meniscal disease may improve diagnosis of stifle pathology in a clinical setting and aid in pre-operative clinician decision making compared to subjective classification schemes.

Public perceptions of meniscus tears: Evaluating knowledge gaps and the role of education.

Meniscus tears are common, occurring acutely during sports or as degenerative tears with aging. Limited information exists about the public's understanding of these injuries and their management. This study aimed to evaluate the public's baseline understanding of meniscus tear management and assess the effectiveness of an educational intervention to improve their understanding. Level III, Cross-Sectional Study. A 33-question survey on meniscus anatomy, injury risk, diagnosis, treatment, and surgical expectations was distributed online to adults aged 18+ over 5 months from the beginning of July. An educational video and handout were provided to improve baseline knowledge. Data analysis included descriptive statistics, ANOVA, McNemar's test, and a paired t-test to measure pre- and post-intervention changes. Baseline surveys from 245 participants showed 66.9% were women, 69.4% were aged 18-29, and 63.7% were white. 46.1% held a bachelor's degree, and 90.2% had limited knowledge of meniscus tears. 76% believed surgery was necessary, 84% thought degenerative tears were repairable, and 65% didn't understand the link to osteoarthritis. Most expected over 3 months for recovery. Higher scores were associated with male gender, healthcare experience, and prior knowledge (p<0.05). Post-intervention, correct responses rose from 45.3% to 75% (p<0.001) among 118 participants. Significant misconceptions about meniscus tears were identified. An educational intervention notably improved knowledge of meniscus anatomy, its link to osteoarthritis, and treatment options. This underscores the importance of education in aligning patient expectations with current medical practices to enhance care quality.

Structurally sophisticated 3D-printed PCL-fibrin hydrogel meniscal scaffold promotes in situ regeneration in the rabbit knee meniscus.

A meniscus injury is a common cartilage disease of the knee joint. Despite the availability of various methods for the treatment of meniscal injuries, the poor regenerative capacity of the meniscus often necessitates resection, leading to the accelerated progression of osteoarthritis. Advances in tissue engineering have introduced meniscal tissue engineering as a potential treatment option. In this study, we established the size of a standardized meniscal scaffold using knee Magnetic Resonance Imaging (MRI) data and created a precise Polycaprolactone (PCL) scaffold utilizing 3-Dimensional (3D) printing technology, which was then combined with Fibrin (Fib) hydrogel to form a PCL-Fib scaffold. The PCL scaffold offers superior biomechanical properties, while the Fib hydrogel creates a conducive microenvironment for cell growth, supporting chondrocyte proliferation and extracellular matrix (ECM) production. Physical and chemical characterization, biocompatibility testing, and in vivo animal experiments revealed the excellent biomechanical properties and biocompatibility of the scaffold, which enhanced in situ meniscal regeneration and reduced osteoarthritis progression. In conclusion, the integration of 3D printing technology and the Fib hydrogel provided a supportive microenvironment for chondrocyte proliferation and ECM secretion, facilitating the in situ regeneration and repair of the meniscal defect. This innovative approach presents a promising avenue for meniscal injury treatment and advances the clinical utilization of artificial meniscal grafts.

Comparison of clinical outcomes among patients treated with high tibial osteotomy and meniscal repair of degenerative medial meniscal tear with mild varus deformity.

The clinical benefits of high tibial osteotomy (HTO) in patients with mild varus deformity with degenerative medial meniscal tear (DMMT) remain unclear. This study aimed to compare clinical outcomes among middle-aged patients with mild varus deformity who underwent arthroscopic meniscal repair and HTO for DMMT. In this retrospective study, patients who underwent isolated arthroscopic meniscal repair via the inside-out technique and those who underwent medial opening-wedge HTO were assigned to group M and H, respectively. The inclusion criteria were: an age of 40-65 years; percentage of mechanical axis of 30-50% measured using full-length weight-bearing anteroposterior radiographs; Kellgren-Lawrence grade ≤ 2; minimum postoperative two-year follow-up; and HTO correction angle < 10°. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and minimal clinically important difference achievement rate for the KOOS subscales preoperatively and at the final follow-up. Group M and H included 21 and 41 patients, respectively. The median ages were 53 and 58 years in groups M and H, respectively. In group H, 24 cases underwent meniscal repair. No significant differences in all KOOS subscales were found preoperatively. However, the median KOOS symptoms subscale in group H (89.3) was significantly better than that in group M (80.4) at the final follow-up (p = 0.04). The main finding of the study indicated that KOOS symptoms after HTO were superior to those after isolated arthroscopic meniscal repair for DMMT. HTO might be a potentially useful treatment for DMMT in middle-aged patients with mild varus deformity, even with a small correction angle. Retrospective comparative study, Level III.

Bone marrow lesion and medial meniscus extrusion width changes following arthroscopic partial meniscectomy for medial meniscal flap tears

BackgroundThe current literature evaluating meniscectomy outcomes often mixes various tear patterns, failing to elucidate the impact of specific tear types on procedure results. Flap tears, which are prone to causing mechanical symptoms, require targeted research. This study aims to examine Lysholm scores following a meniscectomy for medial meniscus flap tears, to determine if extensive resections lead to poorer one-year outcomes, and to assess their impact on postoperative bone marrow lesion (BML) risk and medial meniscus extrusion (MME) width.MethodsPatients undergoing arthroscopic meniscectomy for medial meniscal flap tears were classified into three groups: minimum resection, single leaf resection, and subtotal resection. Lysholm scores and medial joint space (MJS) width on Rosenberg view radiographs were measured preoperatively and one year postoperatively. BMLs and MMEs were assessed via MRI preoperatively and at 1, 3, 6, and 12 months postoperatively.ResultsFifty patients (mean age 60 ± 13 years) underwent meniscectomy: minimum resection in 21 (42%), single leaf in 23 (46%), and subtotal in 6 (12%). The Lysholm scores improved significantly, from 65.5 ± 17.6 to 93.4 ± 16.5 (n = 50) at 12 months in patients overall (p < 0.001), while MJS width decreased from 3.9 ± 0.7 mm to 3.5 ± 0.8 mm (p < 0.001). There were no significant differences in Lysholm scores or MJS widths among the three resection patterns. The occurrence rate of BMLs in the medial femoral condyle and tibial plateau increased post-surgery, peaking at 1 month, but then improved to near-baseline by 12 months. The occurrence rate of BMLs was higher in the single leaf and subtotal meniscectomy groups post-surgery, but declined across all groups by 12 months. Among the three groups with different resection patterns, MME width at 12 months was 2.7 ± 1.8 mm in the subtotal resection group, which was significantly larger than in the other groups.ConclusionsArthroscopic partial meniscectomy for flap tears yielded favorable 12-month outcomes. Larger resections were associated with greater BML incidence and greater MME width.

Return to sport after anterior cruciate ligament reconstruction - prognostic factors and prognostic models: A systematic review.

A variety of criteria are used to make return to sport decisions after anterior cruciate ligament (ACL) reconstruction. This systematic review summarized and evaluated prognostic factors and clinical prognostic models for returning to sports after ACL reconstruction. Independent pairs of reviewers assessed eligibility, extracted data, and evaluated risk of bias and certainty of evidence. A systematic literature search was conducted in key electronic databases. studies published in English, longitudinal cohort or case-control design, reporting outcomes on return to sport or Tegner Activity Score (TAS), participants aged ≥16 years undergoing primary ACL reconstruction, and defined as athletes/sport players or having a pre-injury TAS ≥5. Only associations between predictors and outcomes that were analyzed in ≥3 studies and had consistent results in the same direction in ≥75 % of the studies were considered and reported. Risk of bias was evaluated using the QUIPS or PROBAST tools, and certainty of evidence was evaluated using the GRADE framework. 37 studies (5 low, 6 moderate, and 26 high risk of bias) on prognostic factors and 1 study on prognostic models (low risk of bias), representing 6278 participants, were included. Six prognostic factors were identified and rated as very low certainty evidence: fewer concomitant meniscal injuries, shorter time between injury and surgery, higher jump test scores, better physical functioning, higher muscle strength, and greater psychological readiness to return to sport. Two prognostic models with AUC 0.77-0.78 and 70 % accuracy for predicting return to sport were identified. There is a very low certainty of evidence that returning to sport is associated with both physical, psychological and demographic prognostic factors. More methodologically sound research on prognostic factors and prognostic models for return to sport in athletes after ACL reconstruction is needed.

Current status and factors influencing kinesiophobia in patients with meniscus injury: a cross-sectional study

ObjectivesThis study aimed to examine the relationships between kinesiophobia and injury severity, balance ability, knee pain intensity, self-efficacy, and functional status in patients with meniscus injuries and to identify key predictors of kinesiophobia.DesignA single-center, prospective cross-sectional study.MethodsA cross-sectional study involving 123 patients diagnosed with meniscus injuries at Fujian Provincial Hospital was conducted. The knee range of motion test was used to determine limitations in knee joint mobility, whereas magnetic resonance imaging (MRI) was used to assess the severity of meniscus damage. Several validated scales were administered: the Tampa Scale of Kinesiophobia (TSK-17) to measure kinesiophobia, the visual analog scale (VAS) to assess pain intensity, the general self-efficacy scale (GSES) to evaluate self-efficacy, and the Lysholm knee score (LKS) to assess knee functional status. Additionally, balance ability was assessed using the Huber 360 Neuromuscular Control Training and Assessment System (DJO, USA). Spearman’s correlation analysis was applied to explore factors associated with kinesiophobia, whereas simple linear regression analysis was used to identify its predictors.ResultsAmong the 123 participants included in the study, 60.16% were identified as experiencing kinesiophobia. Among these participants, 69.10% had grade III meniscus injuries, and 33.3% exhibited limited joint movement. The key clinical characteristics were as follows: the median VAS score was 4 (IQR 2–6), the GSES score was 22 (IQR 20–29), and the LKS score was 45 (IQR 38–55). Kinesiophobia was significantly correlated with injury severity, limited joint movement, pain intensity, self-efficacy, and other functional parameters (P < 0.05). However, no significant correlation was detected between kinesiophobia and limits of stability. Simple linear regression analysis (R²=0.917) revealed several significant predictors of kinesiophobia, including injury severity (β = 2.08), pain intensity (β = 0.882), Romberg quotient (RQ) (β = 3.239), and limited joint movement (β = 0.868). In contrast, self-efficacy (β =-0.455) was negatively associated with kinesiophobia. Furthermore, Grade III injuries and RQ were found to be associated with markedly higher levels of kinesiophobia.ConclusionKinesiophobia is strongly associated with knee injury severity, limited joint movement, RQ, pain intensity, and self-efficacy, which are key predictors. Clinical interventions should focus on these factors to enhance rehabilitation outcomes.

Can Baseline MRI Findings Identify Who Responds Better to Early Surgery Versus Exercise and Education in Young Patients With Meniscal Tears? A Subgroup Analysis From the DREAM Trial

Can Baseline MRI Findings Identify Who Responds Better to Early Surgery Versus Exercise and Education in Young Patients With Meniscal Tears? A Subgroup Analysis From the DREAM Trial

High failure rate in meniscal repair when preceding anterior cruciate ligament reconstruction: An analysis of two-stage surgery for concomitant ACL injury and traumatic meniscus tear.

To investigate the failure rate, predictive factors associated with failure and clinical outcomes after a two-stage surgery; meniscus repair followed by subsequent anterior cruciate ligament (ACL) reconstruction (ACLR). Patients with a concomitant traumatic meniscus tear and ACL injury who underwent a two-stage surgery between January 2015 and January 2021 were identified. The primary outcome was meniscal repair failure, defined as a reoperation (re-repair or resection). A Cox-regression analysis was used in order to analyse factors associated with meniscal repair failure within 3 years after the primary surgery for a meniscal repair. Secondary outcomes were range of motion (ROM), anterior knee laxity and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1- and 2-year follow-up. The thresholds of patient acceptable symptom state (PASS), treatment failure (TF) and minimum important change (MIC) were applied to KOOS4 (mean score of the KOOS Pain, Symptoms, Sports/Rec and QoL subscales). A total of 150 patients were included. The meniscal repair failure rate after 3 years was 36.7%. Failure of meniscal repair was significantly associated with a time interval >1 year between the meniscal repair to the ACLR (hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.2-5.5; p < 0.01), medial meniscus repair (HR = 2.3; 95% CI = 1.6-3.4; P < 0.01), and female sex (HR = 1.42; 95% CI = 1.0-1.9; p = 0.01). The age of the patient was not associated with meniscal repair failure. At the 6-month follow-up, most patients (72.5%) showed less than 2 mm of knee laxity; four patients (6.7%) experienced loss of extension and four patients (1.7%) experienced loss of flexion. On the KOOS4, at the 2-year follow-up, PASS was achieved in 53.4%, TF occurred in 1.7%, and MIC was reached in 36.4% of patients. The meniscus repair failure rate after the staged procedure was 36.7% at 3 years. A longer time interval from meniscal repair to ACLR, medial meniscus repair, and female sex were associated with an increased risk of meniscal repair failure. Age was not associated with meniscal repair failure. Level IV case series retrospective study.

Surgical Management of Meniscus Tears: Update on Indications and Techniques for Repair.

Because of the crucial role of the menisci in maintaining cartilage and joint health, meniscal tears affect the long-term health of the knee. Although partial meniscectomy has a role in the treatment of complex degenerative tears and tears with low healing capacity, advances in the concepts and understanding of meniscal repair, along with improvements in repair techniques and instrumentation, have expanded the indications for meniscal repair. With appropriate patient selection and preoperative planning, repair of meniscal tears can lower the rate of degenerative changes when compared with meniscectomy. The purpose of this review is to provide a concise overview of current repair indications, techniques, instrumentation, and outcomes for a variety of commonly encountered meniscal tears (radial, vertical, horizontal, oblique, ramp, root) in the knee.

Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study.

Anterior cruciate ligament (ACL) injuries are common in pediatric and adolescent patients. Understanding this population's injury characteristics and treatment strategies is vital for managing this high-risk group. To report the descriptive epidemiology and treatment strategies of a large cohort of skeletally immature patients with complete ACL tears. Cross-sectional study; Level of evidence, 2. Consecutive skeletally immature patients diagnosed with complete ACL tears were enrolled at 10 institutions across the United States. Treatment was provided by 1 of 23 participating orthopaedic surgeons. Patient characteristics (chronological and skeletal age, sex, race, and ethnicity) as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected. A total of 749 skeletally immature participants were included in the final cohort; the mean chronological age was 12.9 years, and 62% were male. The mean skeletal age (13.2 years) was a mean of 0.34 years (4 months) higher than the mean chronological age (P < .001). Tanner staging revealed that 18% of participants were Tanner stage 1, 20% were Tanner stage 2, 28% were Tanner stage 3, 30% were Tanner stage 4, and 4% were Tanner stage 5. Five percent of participants reported a previous ipsilateral knee injury, and 30% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89%), with noncontact injuries the most common (64%). The most common sport resulting in an ACL tear among boys was American football (41%) and among girls was soccer (44%). Overall, 99.9% of skeletally immature patients were treated surgically by 1 of 4 reconstruction techniques: transphyseal (53%), partial transphyseal (7%), physeal-sparing all-epiphyseal (13%), and physeal-sparing iliotibial band (ITB) (27%). The most common surgical techniques for patients with a skeletal age <13 years were physeal sparing with ITB (56%) and all-epiphyseal (22%), while in patients with a skeletal age ≥13 years, transphyseal (71%) and physeal sparing with ITB (12%) were the most common. Overall, 57% of patients who underwent ACL reconstruction had arthroscopically documented meniscal tears, with high rates of meniscal repair (90% medial tears and 66% lateral tears). Almost all skeletally immature patients with ACL tears were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal ages.

Association Between Patient Characteristics and the Depth of Microvascular Penetration Into the Adult Human Meniscus.

Current knowledge on the microvascular anatomy of adult human menisci is based on cadaveric studies. However, considerable interindividual variation in meniscal microvascularization has been reported in recent studies with small sample sizes. To assess the association between patient characteristics and the depth of microvascularization of the meniscus. Descriptive laboratory study. Menisci from 174 patients who received total knee replacement between March 2021 and December 2023 were collected. A total of 174 lateral and 102 medial menisci were included. Three sections were made from each meniscus: the anterior horn, midbody, and posterior horn. Immunohistochemical staining (CD-31) was used to visualize the microvasculature. The 4 primary outcome measures were the correlation between the depth of microvascular penetration into the lateral meniscus (0%-100%) and (1) age, (2) smoking, (3) degree of osteoarthritis, and (4) history of cardiovascular disease. To account for repeated measurements within each patient, a linear mixed-effects model was estimated to study the association between microvascularization and the patient's characteristics previously introduced. The depth of vascular penetration ranged from 0% to 78% into the lateral menisci and from 0% to 67% into the medial menisci. No significant correlations were found between age, smoking, degree of osteoarthritis, or history of cardiovascular disease and the degree of vascular penetration into the lateral meniscus. The linear mixed-effects model analysis, adjusted for location within the meniscus (anterior horn, midbody, or posterior horn) and meniscal side (lateral or medial), showed no significant associations between the same patient characteristics and meniscal microvascularization. The degree of microvascular penetration into the meniscus has a wide range among adults >50 years. However, the depth of microvascularization was not associated with age, smoking, degree of osteoarthritis, or history of cardiovascular disease. Because no associations were found between depth of microvascular penetration into the meniscus and patient characteristics, the latter cannot be used to estimate the vascular status of a meniscal tear in clinical practice.

Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management

Prediction of risk for isolated incomplete lateral meniscal injury using a dynamic nomogram based on MRI-derived anatomic radiomics and physical activity: a proof-of-concept study in 3PM-guided management

Combined use of cleft and truncated triangle signs helps improve the preoperative MRI diagnosis of lateral meniscus posterior root tears in patients with ACL injuries.

This study aimed to investigate whether combining the analysis of different magnetic resonance imaging (MRI) signs enhances the diagnostic accuracy of lateral meniscus posterior root tears (LMPRTs) in patients with anterior cruciate ligament (ACL) injuries. We hypothesised that analysing the cleft, ghost and truncated triangle signs and lateral meniscus extrusion (LME) measurement together would improve the preoperative MRI-based diagnosis of LMPRTs. This retrospective study used prospectively collected registry data from two academic centres, including patients undergoing primary or revision ACL reconstruction (ACLR) and LMPRT repair. The control group included age- and sex-matched (1:1) patients undergoing ACLR without any lateral meniscus tears. LME (mm) and the presence of cleft, ghost and/or truncated triangle signs were evaluated using preoperative MRI. In total, 252 patients (126 per group) were included. Individually, the cleft and truncated triangle signs achieved the highest sensitivity (60% and 62%, respectively) and accuracy (>89%). The presence of either sign increased sensitivity to 79% and enabled the correct classification of 93% of ACL injuries as having or not having an LMPRT, with high specificity (95%) and good positive predictive value (74%). This combination was considered the most efficient in reducing false positives and false negatives. The LME (cutoff value: 2.2 mm) and ghost sign had lower sensitivities (50% and 14%, respectively) and accuracies (83% and 87%) and were not part of the optimal combination. The cleft and/or truncated triangle signs on preoperative MRI reliably detected 79% of LMPRTs in this cohort, with high specificity (95%) and good positive predictive value (74%). This combination provides an effective method for achieving reasonable sensitivity while minimising false positives, aiding surgeons in preoperative diagnosis and planning for LMPRT repair. Level III.

Knowledge translation and exercise for degenerative meniscal pathology and early osteoarthritis (KNEE-DEeP): Protocol for a single arm feasibility study

Background The Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Knee Osteoarthritis (KNEE-DEeP) intervention was designed to promote greater uptake of evidence-based non-surgical treatments for knee pain attributed to degenerative meniscal pathology and early knee osteoarthritis (OA) in primary care, by tackling barriers at a service, clinician and patient level. Evidence indicates that patients frequently do not access first-line treatments, namely exercise and patient education, prior to specialist referral. The KNEE-DEeP intervention supports general practitioners (GPs) and physiotherapists to enhance their skills and confidence in managing patients with this type of knee pain through professional development workshops. In turn, patients will receive an ‘enhanced consultation’ from their GP and be referred to an early ‘best practice’ physiotherapy session. Physiotherapists will work with patients to develop a collaborative action plan focussing on self-management and exercise. Methods This protocol outlines a single arm non-randomised feasibility study with a mixed method process evaluation. The study intends to recruit 15 GPs, five physiotherapists and 36 patients from general practices in the South-West of Ireland. Eligible patients, will be aged between 35 years and 69 years inclusive, and attend their GP with an episode of non-traumatic knee pain attributed to a degenerative meniscal tear (DMT) or early OA. Physiotherapists and GPs will be trained in intervention delivery. Within two weeks of receiving an ’enhanced consultation‘ from their participating GP, patients will attend the one-hour ‘best practice’ physiotherapy session. Patient data will be collected via online questionnaires at baseline, 12 weeks and 6 months. Qualitative interviews to assess the feasibility and acceptability of the intervention will be conducted with a purposive sample of GPs, physiotherapists and their enrolled patients. Ethics and Dissemination Approved by Clinical Research Ethics Committee of the Cork Teaching Hospitals. Results will be presented in peer-reviewed journals and at international conferences. Registration clinicaltrials.gov (NCT06576557)

Patients With a Quadriceps Tendon Autograft Demonstrate Greater Asymmetry in Landing Kinetics Than Patients With a Bone-Patellar Tendon-Bone Autograft 6 Months After Anterior Cruciate Ligament Reconstruction.

Asymmetric landing kinetics 6 months after anterior cruciate ligament reconstruction (ACLR) are associated with higher risk of second anterior cruciate ligament injury. Little is known about landing kinetics after ACLR with an all-soft tissue quadriceps tendon (QT) autograft despite its increasingly common use in young, active patients. The purpose of this study was to compare landing kinetics during a bilateral drop vertical jump (DVJ) 6 months after ACLR in participants who had undergone primary ACLR with a QT or bone-patellar tendon-bone (BTB) autograft. The hypothesis was that patients with a QT autograft will experience more asymmetry during a bilateral DVJ than patients with a BTB autograft 6 months after ACLR. In addition, greater impact force asymmetry will be associated with worse patient-reported outcome measures. Controlled laboratory study. Participants who underwent primary unilateral ACLR with a QT or BTB autograft between May 2022 and December 2023 were prospectively recruited to undergo DVJ assessment and patient-reported outcome measures 6 months after ACLR. DVJ assessment was completed using force-sensing insoles. Peak impact force, average loading rate, and impulse data were collected at 100 Hz. Forty-four participants (22 BTB, 22 QT) completed DVJ assessment and International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) surveys at 6 ± 1 months after ACLR. Graft source groups did not differ by age (P = .884), sex (P = .531), mass (P = .872), height (P = .572), months since surgery (P = .683), or lateral (P = .637) or medial (P = .416) meniscal tear treatment rate. On average, participants with a QT autograft demonstrated 26.2% greater contralateral limb peak impact force (P = .004), 18.4% lower peak impact force limb symmetry index (P = .009), 18.5% lower involved limb impulse (P < .001), and 15.1% lower impulse limb symmetry index (P < .001) when compared with participants with a BTB autograft. Graft source groups did not differ in IKDC score (P = .333) or ACL-RSI score (P = .070). Neither IKDC nor ACL-RSI score was strongly associated with any kinetic variables. Participants with a QT autograft exhibit greater asymmetry in landing kinetics when compared with participants with a BTB autograft 6 months after ACLR, and landing kinetics were not associated with IKDC or ACL-RSI score.

Prevalence and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.

Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients undergoing ACLR. The purpose of this study was to perform a systematic review and meta-analysis to determine the pooled prevalence of and risk factors for MMRLs in pediatric patients with ACL injuries. PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried in December 2023 for studies reporting on MMRLs in pediatric patients (≤21y old) undergoing ACLR. Articles were only included if they reported on the prevalence and/or risk factors for arthroscopically diagnosed MMRLs. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MMRLs by generating effect estimates in the form of odds ratios (OR) with 95% CI. Seven studies were identified, which included 1362 pediatric patients (mean±SD age, 15.3±1.4y old) that underwent ACLR. The pooled MMRL prevalence was 16.4% (range, 13.2% to 28%) calculated across 6 studies. Of the 7 studies identified, 5 qualified for the risk factor analysis, which included a total of 536 ACLR patients. Twenty risk factors were identified, of which 8 were amenable to being explored quantitatively. Anterolateral ligament (ALL) injuries on magnetic resonance imaging (MRI) [odds ratio (OR), 4.16; 95% CI, 1.40-12.34; P=0.01], MMRLs on preoperative MRI (OR, 4.09; 95% CI, 2.52-6.64; P<0.00010), posteromedial tibial plateau bone marrow edema (OR, 2.11; 95% CI, 1.16-3.83; P=0.01), and concomitant lateral meniscus tears (OR, 1.70; 95% CI, 1.04-2.76; P=0.03) were important risk factors for pediatric MMRLs. Skeletal maturity (physes open or closed), male sex, or collateral ligament injury was not associated with the presence of pediatric MMRLs. The overall pooled prevalence of MMRLs was 16.4% in pediatric patients undergoing ACLR. Significant risk factors for pediatric MMRLs included the presence of concomitant ALL injuries on MRI, identification of MMRLs on MRI, posteromedial tibia plateau bone marrow edema, and concomitant lateral meniscus tears at the time of surgery. Skeletal maturity, male sex, or collateral ligament injury were not associated with MMRLs in pediatric ACL tears. Systematic review and meta-analysis; level of evidence: IV.

Return to On-Snow Performance in Ski Racing After Anterior Cruciate Ligament Reconstruction.

The individual variation in on-snow performance outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) in elite alpine ski racers has not been reported and may be influenced by specific injury characteristics. To report the performance statistics of elite ski racers before and after ACLR and to identify surgical and athlete-specific factors that may be associated with performance recovery. Descriptive epidemiological study. International Ski and Snowboard Federation (FIS) points, FIS ranking, average placing, and average percentage behind the winning time in each race were calculated for 30 national and provincial team ski racers at 1 year before and 3 years after ACLR. Injury characteristics were obtained from operative reports and clinical notes. The mean age at the time of primary ACLR was 21.6 ± 3.5 years. Overall, 27 of 30 (90%) ski racers returned to the same preinjury competition level. Yet, only 16 of 30 (53%) improved in FIS points, and 13 of 30 (43%) improved in FIS ranking, in one of the speed or technical disciplines by 3 years after surgery. Of the skiers who improved in FIS points, 36% sustained multiligamentous injuries, 45% sustained meniscal tears, and 45% sustained chondral lesions. Of those who failed to improve in FIS points, 50% sustained multiligamentous injuries, 50% sustained meniscal tears, and 60% sustained chondral lesions. Meniscal tears and chondral lesions occurred mostly on the lateral side. The medial collateral ligament was involved in 8 of 9 multiligamentous injuries. These findings suggest significant individual variation in the recovery of on-snow performance of ski racers after ACLR, despite returning to the same competition circuit. The pattern of secondary injuries alongside primary ACL ruptures showed little association with improved performance.

Anterior Cruciate Ligament Reconstruction: Analysis of Grafts, Associated Injuries, And Anesthetic Strategies

Objective: This study analyzed the clinical and surgical outcomes of patients undergoing anterior cruciate ligament (ACL) reconstruction, evaluating associated injuries, graft types, anesthetic strategies, and tourniquet time. Methods: Sixteen patients with ACL injuries were included, and their medical records were reviewed to collect data on the variables. Associated injuries were categorized, the types of grafts used were recorded, and anesthetic practices and tourniquet times were analyzed. Results: Associated injuries were identified in 60% of patients, with meniscal injuries being the most common (40% with sutures). The patellar tendon was the most used graft (80%), while anesthetic methods such as spinal anesthesia combined with continuous additional block (BCA) were applied in 40% of cases. The average tourniquet time was 68 minutes, remaining within safe limits according to the literature. Conclusion: ACL reconstruction requires meticulous surgical planning, considering clinical and technical variables. Graft selection and anesthetic strategies, combined with the preservation of joint structures, are essential for favorable functional outcomes and the prevention of complications.