Meniscal Lesions Research Articles

Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study.

The aim of this study was to analyze the relationship between medial posterior tibial slope (MPTS) and medial meniscus slope (MMS) with the location of meniscal lesions. We hypothesize that meniscuses with greater MPTS and MMS are more likely to have lesions in posterior horn.A total of 292 patients underwent arthroscopic surgery between January 2014 to September 2019 due to knee osteoarthritis (OA) and meniscal lesions were reviewed. Based upon the location of meniscal tears, patients were categorized as group B (tears in posterior horn) and group A (other sites). MPTS and MMS were measured from magnetic resonance imaging (MRI) slices. Osteoarthritis grade was evaluated in anteroposterior radiographs by the criteria defined by Kellgeren and Lawrence. Demographic data, OA grade, MPTS, and MMS for the 2 groups were compared and analyzed.The group A had 29 (39%) male and 45 (61%) female subjects with a mean age of 57.07 ± 6.79 years. Group B consists of 74 (34%) male and 144 (66%) female subjects with a mean age of 58.90 ± 7.594 years. (P = .067 and P = .458 for age and sex, respectively). In group A, 31 knees (42%) were determined to be Kellgren–Lawrence grade one, 32 knees (43%) grade two, and 11 knees (15%) grade three. In group B, 86 knees (39%) were categorized in grade one, 85 knees (39%) in grade two, and 47 knees (26%) in grade three (P = .085). The mean MPTS was 5.06 ± 2.11 degree for group A and 6.15 ± 2.37 degree for group B (P = .001). The mean MMS for group A was lower than group B (1.38 ± 2.12 degree vs 3.14 ± 2.92 degree; P < .000)This study demonstrated that increased MPTS and MMS may be considered as the risk factors for medial meniscal posterior horn tears.

Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions.

The purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)-injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns. Data from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center-based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi-square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury's relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal-Wallis test. Significance was set at p < 0.05. Two hundred and thirty-nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non-contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non-contact injuries (10% vs 4%, p < 0.05). Two-thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL-associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction. III.

Comparison of Outcomes of Anterior Cruciate Ligament Reconstructions Using Patellar Tendon or Hamstring Tendon Autografts with Femoral Cross-pin Fixation

Aim: In this study, we aimed to compare outcomes of anterior cruciate ligament (ACL) reconstructions using bone–patellar tendon–bone graft (BPTG) or hamstring tendon graft (HTG) with cross-pin fixation at the femoral side. Materials and Methods: The retrospective observational study included records of 100 patients who underwent ACL reconstruction with femoral cross-pin fixation between May 2008 and August 2012. The patients were divided into two groups according to the graft type used: the BPTG group and the HTG group. The preoperative and postoperative 6th-month Tegner Lysholm Knee Scoring Scale (TLKS) scores, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) scores, and Lachman test results were compared. The effects of meniscus lesion presence on the outcomes were also investigated. Results: Of the 100 patients, 93 were male and 7 female. The HTG and BPTG groups consisted of 62 and 38 patients, respectively. The mean age was 24.1±4.9 (18–38) years for the HTG group and 32.1±6.8 (21–54) years for the BPTG group. The mean pre- and postoperative TLKS scores were respectively 50.5 and 94.3 in the BPTG group, and 49.9 and 95.2 in the HTG group. The mean pre- and postoperative IKDC-SKF scores were 51.3 and 95.6 in the BPTG group, and 51.8 and 95.6 in the HTG group. The postoperative score improvement was statistically significant in all patients (p&amp;lt;0.05), but there was no significant difference between the two groups. The postoperative improvement in knee stability was statistically significant in all patients (p&amp;lt;0.05). The postoperative score improvement was less in patients with meniscal injury (p&amp;lt;0.05). Discussion and Conclusion: We found no significant difference between the two groups in terms of functional knee scores. However, the presence of meniscus lesions negatively affects the postoperative outcomes.

Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50years.

Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50years. The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. A total of 228 patients aged 54.8 ± 4.3years at index ACLR were assessed at a follow-up of 14.3 ± 3.8months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median - 4, range - 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). In primary ACLR for patients aged over 50years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. III.

Characterization of Synovial Cytokine Patterns in Bucket-Handle and Posterior Horn Meniscal Tears.

The specific etiology of meniscal tears, including the mechanism of lesion, location, and orientation, is considered for its contribution to subsequent joint cytokine responsiveness, healing outcomes, and by extension, appropriate lesion-specific surgical remediation. Meniscal repair is desirable to reduce the probability of development of posttraumatic osteoarthritis (PTOA) which is strongly influenced by the coordinate generation of pro- and anti-inflammatory cytokines by the injured cartilage. We now present biochemical data on variation in cytokine levels arising from two particular meniscal tears: bucket-handle (BH) and posterior horn (PH) isolated meniscal tears. We selected these two groups due to the different clinical presentations. We measured the concentrations of TNF-α, IL-1β, IL-6, IL-8, and IL-10 in knee synovial fluid of 45 patients with isolated meniscal lesions (BH tear, n = 12; PH tear, n = 33). TNF-α levels were significantly (p < 0.05) greater in the BH group compared with the PH group, whereas IL-1β levels were significantly greater (p < 0.05) in the PH group compared with the BH group. Both BH and PH groups were consistent in presenting a positive correlation between concentrations of IL-6 and IL-1β. A fundamental difference in IL-10 responsiveness between the two groups was noted; specifically, levels of IL-10 were positively correlated with IL-6 in the BH group, whereas in the PH group, levels of IL-10 were positively correlated with IL-1β. Collectively, our data suggest a possible influence of the meniscal tear pattern to the articular cytokine responsiveness. This differential expression of inflammatory cytokines may influence the risk of developing PTOA in the long term.

The menisci and articular cartilage: a life-long fascination.

The menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other.Traumatic meniscus tears should be repaired, when possible, to protect the articular cartilage.Traumatic articular cartilage lesions can be treated with success using biological treatment options such as microfracture or microdrilling, autologous chondrocyte transplantation (ACT), or osteochondral transplantation (OCT) depending on the depth and area of the lesion.Degenerative cartilage and meniscus lesions often occur together, and osteoarthritis is already present or impending. Most degenerative meniscus lesions should be treated first conservatively and, after failed conservative treatment, should undergo arthroscopic partial meniscus resection. Degenerative cartilage lesions should also be treated conservatively initially and then surgically; thereby treating the cartilage defect itself and also maintaining the axis of the leg if necessary.Tears of the meniscus roots are devastating injuries to the knee and should be repaired e.g. by transtibial re-fixation.The clinical role of ‘ramp’ lesions of the meniscus is still under investigation.Cite this article: EFORT Open Rev 2020;5:652-662. DOI: 10.1302/2058-5241.5.200016

Evaluation of biomarkers of joint damage in patients subjected to arthroscopy.

Recently, the determination of biochemical markers has been intensely explored to better understand the mechanisms underlying knee OA. In this study, we aimed to explore the expression pattern of five biochemical markers in patients with knee OA. After IRB approval and signed informed consent, 26 patients were enrolled. Serum and synovial samples were collected prior to knee arthroscopy. Pre-operative assessment included diagnosis, Lysholm, Tegner Activity Scale, IKDC score, and radiographic Kellgren and Lawrence classification. ELISA of CTX-I, CTX-II, NTX-I, MMP3, and MMP13 were measured in serum and synovial fluid samples. Twenty-six patients were included, with a mean age of 42 ± 15years old. Mean results and standard deviation of the biomarkers in serum were as follows: CTX-I 5.8 ± 5.5ng/mL, CTX-II 3.8 ± 1.7ng/mL, NTX-I 52 ± 71 (nMBCE), MMP3 1.18 ± 0.6ng/mL, and MMP13 1243.6 ± 1422pg/mL; synovial fluid results were as follows: CTX-I 0.74 ± 0.5ng/mL, CTX-II 5.1 ± 2.5ng/mL, NTX-I 254 ± 85 (nMBCE), MMP3 0.4 ± 0.4ng/mL, and MMP13 797 ± 1391pg/mL. We observed a differential pattern of expression in serum NTX-I in patients with chronic meniscus injuries when compared with ACL injuries or cartilage lesions. In conclusion, the clinical criteria of early OA are useful to categorize patients with knee conditions. The biochemical markers explored did not yield a differential pattern that can be associated with this classification. Serum NTX-I could be a useful marker of chronic meniscal lesion in future longitudinal studies, after adjusting for age and sex.

Ruptura isolada de menisco lateral em cão –relato de caso

Menisci are important intra-articular structures whose main function is attributed to load transmission and impact absorption, reducing biomechanical stress and providing greater osteoarticular stability. In dogs, knee-related disorders are described as the main causes of claudication. This report aims to describe a case of lateral meniscal lesion in a canine without signs of femorotibiopatellar instability, whose main change was claudication. The diagnosis was confirmed through orthopedic evaluation and magnetic resonance imaging, in which an anechogenic line of dissolution of meniscal continuity and intact ligament structures was visualized. As a treatment, the technique of total meniscectomy was chosen, which allowed the recovery of limb function and absence of clinical manifestations. &nbsp

The combination of an inflammatory peripheral blood gene expression and imaging biomarkers enhance prediction of radiographic progression in knee osteoarthritis

ObjectivePredictive biomarkers of progression in knee osteoarthritis are sought to enable clinical trials of structure-modifying drugs. A peripheral blood leukocyte (PBL) inflammatory gene signature, MRI-based bone marrow lesions (BML) and meniscus extrusion scores, meniscal lesions, and osteophytes on X-ray each have been shown separately to predict radiographic joint space narrowing (JSN) in subjects with symptomatic knee osteoarthritis (SKOA). In these studies, we determined whether the combination of the PBL inflammatory gene expression and these imaging findings at baseline enhanced the prognostic value of either alone.MethodsPBL inflammatory gene expression (increased mRNA for IL-1β, TNFα, and COX-2), routine radiographs, and 3T knee MRI were assessed in two independent populations with SKOA: an NYU cohort and the Osteoarthritis Initiative (OAI). At baseline and 24 months, subjects underwent standardized fixed-flexion knee radiographs and knee MRI. Medial JSN (mJSN) was determined as the change in medial JSW. Progressors were defined by an mJSN cut-point (≥ 0.5 mm/24 months). Models were evaluated by odds ratios (OR) and area under the receiver operating characteristic curve (AUC).ResultsWe validated our prior finding in these two independent (NYU and OAI) cohorts, individually and combined, that an inflammatory PBL inflammatory gene expression predicted radiographic progression of SKOA after adjustment for age, sex, and BMI. Similarly, the presence of baseline BML and meniscal lesions by MRI or semiquantitative osteophyte score on X-ray each predicted radiographic medial JSN at 24 months. The combination of the PBL inflammatory gene expression and medial BML increased the AUC from 0.66 (p = 0.004) to 0.75 (p < 0.0001) and the odds ratio from 6.31 to 19.10 (p < 0.0001) in the combined cohort of 473 subjects. The addition of osteophyte score to BML and PBL inflammatory gene expression further increased the predictive value of any single biomarker. A causal analysis demonstrated that the PBL inflammatory gene expression and BML independently influenced mJSN.ConclusionThe use of the PBL inflammatory gene expression together with imaging biomarkers as combinatorial predictive biomarkers, markedly enhances the identification of radiographic progressors. The identification of the SKOA population at risk for progression will help in the future design of disease-modifying OA drug trials and personalized medicine strategies.

Meniscal ramp lesions: frequency, natural history, and the effect on knee cartilage over 2 years in subjects with anterior cruciate ligament tears.

(i) To investigate the frequency and natural evolution of meniscal ramp lesions (MRLs) on MRI in subjects with acute ACL tear and (ii) to compare knee cartilage compositional degeneration between subjects with MRLs and subjects without meniscal pathology over 2 years. Fifty-seven subjects with ACL tears (32 females; age 32.6 ± 8.3 years; BMI 24.5 ± 3.5 kg/m2) from a prospective study were screened for the presence of MRLs. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MRI was performed prior to and 2 years after ACL reconstruction. Follow-up MR images were assessed for changes in the signal intensity of the MRLs and the presence of meniscal tears. Differences of compositional parameters were compared between subjects with MRLs and without meniscal lesions using independent samples t tests. MRLs were found in 16% (9/56) of the subjects with ACL tears at baseline. Only one subject with MRLs developed a posterior horn meniscal tear over 2 years. In 12 knees, no meniscal tears were found, which were defined as controls. Most interestingly, cartilage ∆T1ρ of the medial femur and medial tibia increased significantly more in subjects with MRLs compared with controls (mean difference, MF = 6.0 ± 0.8 vs. 2.3 ± 0.6, p = 0.004, and MT = 4.4 ± 1.4 vs. 0.4 ± 0.6, p = 0.027) and medial femur ∆T2 over 2 years increased significantly more in MRL than in control knees (5.1 ± 2.5 ms vs. 2.2 ± 1.9 ms, p = 0.012). Subjects with ACL tear presented MRLs in 16% of cases. Compared with controls without meniscal lesions, knees with MRLs demonstrated accelerated degeneration of cartilage composition in the medial knee compartment over 2 years.

Central Transpatellar Tendon Portal Is Safe When Used for Anterior Cruciate Ligament Reconstruction.

Central transpatellar tendon portal (CTP) was suggested first for complex meniscal lesion and subsequently for a better femoral footprint view during reconstruction of anterior cruciate ligament (ACL). A comprehensive evaluation of possible consequences of using the CTP performing an ACL reconstruction does not exist. Our hypothesis was that the use of CTP for ACL reconstruction does not lead to a higher rate of complications or clinically evident radiological abnormalities. In total, 141 patients were prospectively evaluated, 69 underwent ACL reconstruction using a standard high medial portal as view portal, and 72 where a CTP was used. Clinical evaluation, Kujala's score, patellar height, and magnetic resonance (MR) abnormalities were evaluated up to 1-year follow-up. Clinical complications were reported in 16 cases with no statistically significant differences between the two groups. The group 2 had significantly more MR abnormalities (p = 0.048), but the differences in MR alterations do not have any clinical repercussion even in a sports-active population. No differences were found between the groups in Kujala's score, time to return to work, and sport or patellar height. The overall mean preoperative Caton-Deschamps Index decreased significantly (p = 0.034) postoperatively. Postoperative patellar height seems to slightly decrease after ACL reconstruction regardless of the kind of the portals used intraoperatively and the initial patellar height. Nevertheless, this change in patellar height does not influence the postoperative outcome. CTP used for ACL reconstruction does not lead to significative major clinical complications.

A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures

BackgroundPosterolateral tibial plateau fractures (PTPF) remain a challenge for orthopedics surgeons because the special anatomical structures of the posterolateral corner of knee joint including the fibular head, the lateral collateral ligament, and the peroneal nerve, which impedes the exposure of the fracture fragments and need irregular implants to get a stable fixation. The purpose of present study was to introduce a new articular fracture fragments restoration technique for three patterns of PTPF and investigate the relationship between associated soft injuries and fracture patterns.MethodsFrom May 2016 to April 2018, 31 patients with PTPF who had undertaken arthroscopically assisted reduction and fixation (AARF) were enrolled in present study. Demographic data, pre-operation, and post-operation X plan films, three-dimensional computed tomography (CT) scans and magnetic resonance imaging (MRI) were reviewed. Present samples were divided into three patterns with lateral inclination (LI), posterior inclination (PI), and parallel compression (PC) according to the orientation of the articular fragment inclination. Rasmussen anatomical score was used to assess the radiological results. Rasmussen functional score, Hospital for Special Surgery knee-rating Score (HSS), and range of motion (ROM) of the knee joint at the final follow-up were measured to evaluate the clinical outcomes.ResultsIn this series, the post-operation tibial plateau angle (TPA) was 9.7° ± 3.5°(range 4.0°–15.8°) and the Rasmussen anatomical score was 17.7 ± 0.7(range 16–18); clinical outcomes showed that the HSS score was 92.7 ± 21.8 (range 90–96) and the Rasmussen functional score was 27.9 ± 1.0 (range 26–30). Of all the patients, the anterior cruciate ligament (ACL) injuries including the ACL tibial attachment ruptures occurred in 16 patients (51.6%), meniscus lesions happened in 19 patients (61.3%), medial collateral ligament (MCL) injuries were founded in 13 patients (41.9%). The number of ACL injuries including the ACL tibial attachment ruptures in the PI fracture pattern (12 cases) is significantly higher than LI (2 cases) and PC (2 cases) fracture pattern (p < 0.05).ConclusionProfound understanding the different patterns of PTPF and using our reduction technique will facilitate to restore the main articular fracture fragments. The PI fracture patterns have a significant high incidence of the ACL ruptures.Level of evidenceTherapeutic study, Level IV.

Outcome of anterior cruciate ligament reconstruction in children and adolescents: A retrospective study

BackgroundIndications and outcomes of anterior cruciate ligament (ACL) reconstruction in children and adolescents is still controversial. It was the aim of this study to analyze outcomes of anterior cruciate ligament reconstruction in this special age group. MethodsRetrospectively, we analyzed 62 consecutive cases of ACL reconstruction using a physis crossing technique in six to 16-year-old patients with a mean follow-up of 69 months. ResultsCases operated later than six weeks after trauma had significantly more meniscal lesions than patients operated within six weeks of trauma. At last follow-up, we found good or very good subjective and objective results in 71% of the patients. ConclusionIn active and healthy children with anterior knee instability after ACL tear, ligament reconstruction is a safe and successful procedure and should be considered within six weeks of trauma because instability seems to promote secondary meniscal lesions.

Meniscal ramp lesions should be considered in anterior cruciate ligament-injured knees, especially with larger instability or longer delay before surgery.

To determine the incidence of meniscal ramp lesions in an anterior cruciate ligament (ACL) injured knees and to clarify whether ramp lesions are related to chronic ACL deficiency and increased knee instability. Consecutive ACL injured patients were evaluated arthroscopically for a ramp lesion via a trans-notch view and evidence of menisco-capsular injury was recorded. Other concomitant injuries to the knee were also noted. Incidence of meniscal ramp lesions, delay before surgery, and anterior-posterior stability was analyzed. All patients underwent bilateral KT-2000 evaluation. One hundred and three consecutive ACL injured patients with a mean age of 24years were included in this study. In total, a ramp lesion was found in 10 knees (9.7%) via a trans-notch view. None of these lesions could be identified by the standard view from the anterolateral portal. Other medial meniscal lesions were found in 26 knees (25.2%) by standard arthroscopic viewing. The ramp lesion group had significantly longer delay before surgery with a median of 191days (p < 0.01) as well as a larger side-to-side difference of KT-2000 measurement (7.3 ± 1.8mm; p < 0.01), compared with the intact medial meniscus group (53days and 5.5 ± 1.5mm, respectively). Ramp lesions that were identified using a trans-notch view were not visualized with standard arthroscopic views. Increased anterior tibial translation and longer delay before surgery were seen in knees with ramp lesions. Careful inspection of the posteromedial menisco-capsular region is required as hidden menisco-capsular lesions may occur which may result in residual knee instability. Level II.

Lateral tibial plateau fractures-functional outcomes and complications after open reduction and internal fixation.

Tibial plateau fractures are severe intra-articular injuries; their treatment is accompanied by numerous complications and requires extensive surgical experience. In this manuscript, we compared our experiences with data from the literature. Retrospectively, we analyzed 41 patients with closed lateral tibial plateau fracture (Schatzker's I-III). All fractures were treated surgically with open reduction and internal plate fixation. Post-operative complications and final outcomes were monitored according to the Tegner Lysholm Knee Scoring System. The average follow-up was 5.7 years (2-10). We analyzed 41 patients (Schatzker I-III), average age 46.7 ± 13.0 years. Traumatic lesion of the lateral meniscus was present in 15 (36.58%) patients. Post-traumatic knee osteoarthritis was present in all (100%) patients after lateral meniscectomy and in 20% of patients it occurred after meniscus repair (p = 0.007). Post-traumatic knee osteoarthritis was present in 12 (29.68%) patients. Infection occurred in five (12.19%) patients, DVT in three (7.3%) patients, and we had one (2.43%) case of non-lethal PE. Final functional outcomes were excellent in 13 (31.7%), good in 21 (51.21%), moderate in five (12.19%), and poor in two (4.87%) patients. Lateral tibial plateau fractures are severe intra-articular injuries which can leave lasting consequences, regardless of the restoring of the articular surface and stable internal fixation. Local skin condition and associated soft tissue injuries, comminution, degree of dislocation, and depression can significantly affect the development of post-traumatic osteoarthritis and poor outcomes.

Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study.

Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient’s Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red–white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red–white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.

MRI Criteria for Meniscal Ramp Lesions of the Knee in Children With Anterior Cruciate Ligament Tears.

OBJECTIVE. The purpose of this study was to investigate the performance of MRI criteria for identifying meniscal ramp lesions in children with concomitant anterior cruciate ligament (ACL) tear, with arthroscopy used as the reference standard. MATERIALS AND METHODS. This retrospective study included 85 children who underwent a preoperative MRI examination and arthroscopically guided primary ACL reconstruction between June 1, 2017, and December 31, 2019. Blinded to arthroscopic findings, two radiologists reviewed all MRI examinations and reached consensus on the presence or absence of an effusion and various findings within the medial and lateral tibiofemoral joints. Chi-square, Fisher exact, independent t, and Mann-Whitney U tests were used to compare MRI findings between patients with and without arthroscopically confirmed meniscal ramp lesions. RESULTS. At arthroscopy, 35 children (23 boys and 12 girls; mean [± SD] age, 15.7 ± 2.0 years) had ramp lesions and 50 children (22 boys and 28 girls; mean age, 15.1 ± 2.4 years) had intact meniscocapsular junctions. Knees in which a ramp lesion was observed were significantly more likely to have MRI findings of a medial meniscus tear (p = .005), peripheral meniscal irregularity (p = .001), junctional T2-weighted signal (p < .001), and a meniscocapsular ligament tear (p < .001). No significant difference was found between children with and without ramp lesions with regard to the presence of an effusion (p = .65) or a lateral meniscus tear (p = .08) or the extent of medial and lateral tibial plateau marrow edema (p = .67 and p = .83, respectively). CONCLUSION. MRI findings associated with an arthroscopic diagnosis of meniscal ramp lesion include medial meniscus tear, peripheral meniscal irregularity, junctional fluidlike signal, and capsular ligament tear.

Study regarding the importance of preoperative physical therapy in functional recoveryafter meniscectomy

The aim of this study is to highlight the role that physical therapy plays in the preoperative period in terms of functional recovery of patients with meniscus injuries that require surgery, this being related to regaining muscle strength and regaining joint mobility, an important aspect being reflected in the functional re-education and gait re-education. The study was conducted on a group of 20 subjects, consisting of 10 men and 10 women, divided in 2 groups, each group consisted in 5 men and 5 women, aged between 32 and 46 years. They suffered a knee injury that resulted in meniscal lesions, receiving the recommendation of surgery, as well as the recommendation to follow both preoperatively and postoperatively recovery program. Only 10 patients of 20 (1st group-5 men and 5 women) followed a preoperative kinetic program. The results highlight the benefits of practicing preoperative physical therapy in patients with meniscectomy.

Is quadruple semitendinosus tendon strands autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3years.

The purpose of this study was to compare the clinical outcomes of ST4 with those of STGs with a minimum follow-up of 3years. The hypothesis was that functional outcomes of the ST4 technique are at least as good as those of the STG technique. Cohort study. Level of evidence, 3 METHODS: Eighty-seven consecutive patients underwent isolated ACL reconstruction, 50 with the ST4 and 37 with STG. At the femoral side for both groups, the system of the fixation of the graft used a cortical fixation support and at the tibial side the group STG used an interference screw and the ST4 group used a tape locked system fixed by an interference screw. Clinical results were compared: IKDC score, KT-1000 arthrometry, radiologic evaluation of the differential laxity, as well as the Tegner score and the KOOS score. Two patients had a rerupture (STG), one in the ST4 group. The analysis of the subjective clinical results showed no statistically significant difference between the 2 groups. Differential laximetry was 0.7mm ± 0.4 (0 to 2mm) for the ST4 group and 1.6 ± 0.5mm (0 to 3mm) for the STG group with a statistically significant difference in favor of the ST4 group (p < 0.05). Age, sex, and presence of meniscal lesions were the factors influencing the KOOS score. This study comparing the clinical and laximetric results at the minimum 3-year follow-up of 2 ACL reconstruction techniques (ST4 vs STG) confirms the working hypothesis with an overall better score for the ST4 group.

Is bone marrow edema syndrome a precursor of hip or knee osteonecrosis? Results of 49 patients and review of the literature.

Diagnosis of bone marrow edema syndrome (BMES) can be challenging. There is sometimes uncertainty about the correct diagnosis of BMES on morphologic magnetic resonance imaging (MRI), since subchondral findings like lines and spots can be misinterpreted as "beginning" or "possible" avascular osteonecrosis (AVN). The aim of our study was to systematically assess the temporal course of BMES from first diagnosis on MRI until the end of clinical symptoms and the full disappearance of bone marrow edema (BME) to determine whether subchondral lines and spots detected in these patients can develop into osteonecrosis. In a combined retrospective and prospective study, we retrieved serial MRI scans of hips and knees with BME from the hospital database. According to clinical and imaging data, all patients with degenerative, infectious/inflammatory, rheumatic, neoplastic conditions and those showing typical osteonecrosis were excluded. We collected all available MRI examinations from first detection of BME until its disappearance. In case edema had not fully resolved in the last available MRI scan, we performed an MRI with an additional dynamic contrast-enhanced (DCE-MRI) sequence. For each MRI scan, we recorded the severity of edema, the presence of subchondral hypointense lines and the presence of subchondral focal hypointense zones on T1-weighted images by two independent readers. The DCE-MRI scans were used to calculate parameter maps to assess the perfusion characteristics. The study comprised 49 patients aged 22-71 years. In total, 171 morphologic and 5 DCE-MRI scans were evaluated. In 44 patients (89.8%), the BMES completely healed without remnants. In 18 of 49 patients (36.7%), a subchondral line was present in the first MRI exam. Nine patients (18.4%) developed a subchondral line within 1-5 months after the first MRI. In total, 27 out of 49 patients (55.1%) had subchondral lines (12 knees, 15 hips) during the timeframe of the study. All subchondral lines disappeared in the timeframe of the study. Subchondral focal hypointense zones were present in 14 out of 49 patients (28.6%): in 9 cases, subchondral focal hypointense zones disappeared after a median of 5.5 months (range, 1-85 months), while in 5 cases, subchondral focal lesions persisted until the end of the study (up to more than 85 months) without edema in the surrounding bone. All persisting subchondral focal lesions were hyperperfused. These 5 patients had associated meniscal lesions. Our study shows that subchondral lines and spots found in patients with BMES do not develop into AVN. Subchondral lines, which resemble subchondral insufficiency fractures, are associated with BMES. Subchondral focal T1-hypointense zones do not represent AVN; most probably these areas represent reparative processes within the subchondral bone, where tensile and shear force overload is present due to altered biomechanics.