Meniscal Tears Research Articles

Dual-energy CT applications in musculoskeletal disorders.

Dual-energy CT (DECT) is an exciting application in CT technology conferring many advantages over conventional single-energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow oedema detection, metal artefact reduction, monosodium urate analysis, and collagen analysis for ligamentous, meniscal, and disc injuries are made possible through its advanced DECT post-processing capabilities. These provide superior information on tissue composition, artefact reduction and image optimization. Newer DECT applications to evaluate fat fraction for sarcopenia, Rho/Z application for soft tissue calcification differentiation, 3D rendering, and AI integration are being assessed for future use. In this article, we will discuss the established and developing applications of DECT in the setting of MSK radiology as well as the basic principles of DECT which facilitate them.

Conservative Treatment Using Platelet-Rich Plasma for Acute Anterior Cruciate Ligament Injuries in Highly Active Patients: A Retrospective Survey.

Background The recommended treatment for anterior cruciate ligament (ACL) injuries in active, sports-oriented patients is reconstructive surgery in order to regain stability and prevent secondary meniscal injuries. However, ACL reconstruction requires a long recovery period and poses issues such as decreased muscle strength due to tendon harvesting and postoperative osteoarthritis (OA) progression, thereby raising significant expectations for the advancement of conservative treatments. Recent studies have shown that platelet-rich plasma (PRP) therapy, which utilizes the tissue repair-promoting property of platelets, is effective for ACL injuries. Methods We administered PRP therapy within six weeks after ACL injury in patients who expressed the desire for an early return to sports through conservative care. After the treatment, patients wore a simple brace that limited deep flexion but placed no restrictions on weight bearing. Four months was the standard goal established for returning to pre-injury condition, and, depending on the target level, timing, and knee condition, we adjusted the additional PRP treatments and rehabilitation approach, gradually authorizing the patients' return to sport. We assessed the ligament repair status by magnetic resonance imaging (MRI) just before the full return to sports.A retrospective survey was conducted to evaluate the status of ligament repair and the condition of return-to-sport in patients with ACLinjuries who underwent conservative treatment using PRP. Results The average patient age was 32.7 years and the average treatment was 2.8 PRP sessions. MRI evaluations confirmed that ligament continuity was regained in all cases. All the patients returned to their pre-injury level (Tegner Activity Scale 7.0) in an average of 139.5 days, but there was one instance of re-rupture following the return to sports. Conclusion All patients with ACL injury who underwent PRP therapy regained ligament continuity and returned to sport successfully with only one case of re-rupture.

The locked knee.

The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees.

Retrospective analysis and comparison of total internal disability preservation technique and standardized reconstruction technique

To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction. A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery. Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery. The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.

Progress on study of factors influencing the prognosis and complications of surgery for discoid meniscus injury in children

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and often occurs in the lateral discoid meniscus. Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance, while patients with symptoms and tears need to be treated surgically. Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach., and early to mid-term reports are good. The prognostic factors are the patient's age at surgery、follow-up time and type of surgery. Some patients experience complications such as prolonged postoperative knee pain, early osteoarthritis, retears and Osteochondritis dissecans. The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest. Retears of the lateral meniscus is the main reason for reoperation.

Physical therapy management for muscle tightness in a surfing athlete: a case report study

Background: Muscle tightness refers to the sensation of tension or stiffness in the muscles, often resulting from factors such as excessive physical activity, inadequate warm-up before exercise, muscle injury, or underlying medical conditions. This article describes a case of a surfer patient with muscle tightness who has had ACL reconstruction meniscectomy and physical therapy management.
 Case description: The patient was a 51-year-old male surfing athlete from New Zealand diagnosed with muscle tightness. The patient had a history of ACL and meniscus injuries, followed by ACL reconstruction and meniscectomy of the right knee. The patient was on vacation in Bali, and he was surfing every day. The patient underwent physical therapy twice a week. The intervention program included modalities (transcutaneous electrical nerve stimulation and ultrasound), manual therapy (massage and patellar mobilization), and exercise therapy (range of motion exercises, strength training, and stretching).
 Conclusion: The physical therapy intervention program designed for one week can yield positive results in reducing pain levels, improving the range of motion of the right knee, increasing the circumference of the right knee segment, and enhancing the functional activities of the right knee.

A High-Grade Lachman’s Exam Predicts a Ramp Tear of the Medial Meniscus in Patients with Anterior Cruciate Ligament Tear: A Prospective Clinical and Radiological Evaluation

Background: Medial meniscus ramp tears are present in 22.9–40.8% of anterior cruciate ligament tears. The diagnosis of ramp tears is difficult on MRI, with sensitivity reported around 48%, which has recently emphasized the importance of proper arthroscopic probing for ramp tears. Methods: A prospective evaluation was performed on patients undergoing a single bundle ACL reconstruction to assess patient demographics, posterior tibial slope, posterior cruciate ligament angle, Lachman’s exam, and rotational instability to determine secondary findings associated with medial meniscal ramp tears. Results: A total of 96 patients underwent ACL reconstruction, of these, 63 patients had an isolated ACL tear, and 33 patients had an ACL tear with a concomitant medial meniscus ramp tear. A high-grade Lachman’s exam and male sex were associated with medial meniscus ramp tears. There were no differences in posterior tibial slope, posterior cruciate ligament angle, or rotational instability between groups. Conclusions: This study found that a high-grade Lachman’s exam and male sex were significantly associated with patients with an ACL tear with a concomitant medial meniscus ramp tear. These findings suggest that an ACL tear with concomitant medial meniscus ramp tear may be better diagnosed based upon the clinical evaluation rather than other secondary radiological findings.

Remnant-Sparing Anterior Cruciate Ligament Reconstruction Results in Similar Clinical, Functional, and Quality-of-Life Outcomes to Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

To compare a large cohort of patients who underwent remnant-sparing anterior cruciate ligament reconstruction (rACLR) with a matched group of patients who underwent anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) with respect to clinical laxity, patient-reported outcomes, and functional testing. Patients who underwent rACLR between January 2010 and December 2015 were matched according to age, sex, body mass index, and graft type to patients who underwent ACLR. The primary outcome measure was the ACL Quality of Life (ACL-QOL) score at final follow-up of 24 months. Secondary outcomes included functional tests and clinical laxity measurements at 6, 12, and 24 months postoperatively. Concurrent intra-articular pathology at the time of surgery and postoperative complications were also recorded. Statistical analyses included the dependent t test and the Wilcoxon signed rank test. A total of 210 rACLR patients were successfully matched to a corresponding cohort of 210 ACLR patients. There were no statistically significant differences in ACL Quality of Life (ACL-QOL) or functional testing results between the groups; however, scores in both groups showed a steady and statistically significant improvement over time. A statistically significant difference was noted with respect to the Lachman test findings, favoring the rACLR cohort (Z= -2.79, P= .005); no between-group difference was seen for the pivot-shift test (Z= -0.36, P= .72). The rACLR group had a significantly lower rate of concurrent meniscal and chondral injury. There was no difference in complications between the groups (Z= -0.49, P= .63). There was no difference in patient-reported or functional testing outcomes in patients undergoing remnant-sparing compared with anatomic single-bundle ACLR. There was, however, a significantly lower rate of positive Lachman test findings after rACLR. Furthermore, the rate of concurrent meniscal and chondral pathology was lower in the rACLR group. Level III, retrospective cohort study.

Modified Mason-Allen vs Two Simple Stitch Fixation for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis

Background: Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a refixation technique for MMPRT instead of the conventional 2 simple stitches (TSS). This is in view of its superior biomechanical characteristics. Purpose: To perform a systematic review and meta-analysis to compare MMA and TSS configuration techniques for MMPRT repair and identify any differences between the 2 techniques in terms of clinical outcomes, medial meniscal extrusion (MME), and postoperative healing. Study Design: Meta-analysis; Level of evidence, 4. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase databases were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (“meniscus” OR “meniscal injuries”) AND (“Mason-Allen” OR “simple stitch” OR “suture techniques”). Data pertaining to all patient-reported outcome measures, postoperative complications, MME, postoperative healing, cartilage degeneration, and progression of knee osteoarthritis were extracted from each study. The pooled outcome data were analyzed using random- and fixed-effects models. Results: After abstract and full-text screening, 6 clinical studies were included. In total, there were 291 patients; 160 underwent MMA fixation, and 131 underwent the TSS technique. The majority of studies had similar surgical techniques regarding repair technique, suture material, tibial fixation, and number and position of tibial tunnels. There were no differences between the groups in terms of patient-reported outcome measures at 14.2 months. Both techniques were also similar in the degree of postoperative MME and meniscal healing. Conclusion: Both suture configurations were equivalent in terms of clinical outcomes, the extent of meniscal extrusion, and postoperative healing. The TSS technique may offer advantages in terms of faster learning curve and shorter operative time. However, randomized controlled trials with large sample sizes, longer follow-up and assessment of chondral degeneration, and presence of knee osteoarthritis are required to assess whether a true difference exists, as the majority of included studies were limited by their retrospective design.

OUTCOME OF TREATMENT FOLLOWING PRIMARY ARTHROSCOPIC REPAIR OF BUCKET HANDLE MENISCUS TEARS IN ADULTS

AimsWe studied the outcomes following arthroscopic primary repair of bucket handle meniscus tears to determine the incidence of re-tears and the functional outcomes of these patients.MethodologyProspective cohort study. Over a 4-year period (2016 to 2020), 35 adult patients presented with a bucket handle tear of the meniscus. Arthroscopic meniscal repair was performed using either the all inside technique or a combination of all-inside and inside-out techniques. 15 patients also underwent simultaneous arthroscopic anterior cruciate ligament reconstruction. Functional knee scores were assessed using IKDC and Lysholm scores.ResultsMean patient age at surgery was 27 years (range, 17 to 53years). Medial meniscus was torn in 20 and lateral in 15 cases. Zone of tear was white on white in 19, red on white in 9 and red on red in 7 cases. Average delay from injury to surgery was 4 months. At a mean follow-up of 4.5 years, the meniscus repair failed in 3 patients (8.5 %). Outcome following re-tear was meniscus excision. Average IKDC scores in patients with intact repair were 74.04 against 56.67 in patients with a failed repair (p< 0.0001). Similarly, Lyshlom scores were 88.96 and 67.333, respectively (p<0.0001).ConclusionThe survivorship of primary repair of bucket handle meniscus tears in our series was 91.5% at medium term follow-up. Functional outcomes were significantly poor in patients with a failed repair compared to those with an intact repair.

The use of platelet-rich plasma injections in the treatment of meniscal injuries - review of the literature

Introduction: In the knee joint are two menisci, which are fibrocartilaginous structures. The tears of the meniscus are one of the most common injuries within knee. Arthroscopy with suturing of torn or menisectomy are the most popular methods of treatment, however in long term observation menisectomy often results in osteoarthritis 10-20 years after surgery. For this reason, less invasive treatment methods are being sought, such as platelet-rich plasma injections. Platelet-rich plasma has many growth factors, which stimulates healing. Objective: The aim of this study is to review latest the literature on the use of platelet-rich plasma injections in the patients with meniscus tears. Material and methods: A literature review was conducted on databases such as PubMed and Google Scholar using the terms: ”meniscus”, “meniscus tear”, “platelet-rich plasma”, “platelet-rich plasma injections”, “meniscus injuries treatment’. Conclusions: The injuries of meniscus are very common, and often must be treated by arthroscopy. Platelet-rich plasma has a positive impact on tissue healing. Platelet-rich plasma injuries in the patients with meniscal tears repair lead to improve healing rates compare with patients without PRP injections, but there is no guidelines and further studies are necessary.

Factors associated with trajectories of bone marrow lesions over 4years: data from the Osteoarthritis Initiative.

To identify bone marrow lesion (BML) trajectories over 4years and their demographic and structural predictors in middle-aged and older adults with or at increased risk of knee osteoarthritis (OA). A total of 614 participants (mean age 61years, 62% female) from the Osteoarthritis Initiative cohort (OAI) were included. BMLs in 15 anatomical locations of the knee were measured annually from baseline to 4years using the Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS) method. BML trajectories were determined using latent class mixed models (LCMMs). Multinomial logistic regression was used to examine baseline characteristics that predicted BML trajectories. Three distinct BML trajectories were identified: "Mild-stable BMLs" (25.9%), "Moderate-stable BMLs" (66.4%), and "Rapid-rise BMLs" (7.7%). Compared to the "Mild-stable BMLs" trajectory, current smokers were more likely to be in the "Moderate-stable BMLs" (odds ratio [OR] 2.089, P < 0.001) and "Rapid-rise" (OR 2.462, P < 0.001) trajectories. Moreover, female sex and meniscal tears were associated with an increased risk of being in the "Rapid-rise BMLs" trajectory (OR 2.023 to 2.504, P < 0.05). Participants who had higher education levels and drank more alcohol were more likely to be in the "Rapid-rise BMLs" trajectory (OR 1.624 to 3.178, P < 0.05) and less likely to be in the "Moderate-stable BMLs" trajectory (OR 0.668 to 0.674, P < 0.05). During the 4-year follow-up, most participants had relatively stable BMLs, few had enlarged BMLs, and no trajectory of decreased BMLs was identified. Sociodemographic factors, lifestyle, and knee structural pathology play roles in predicting distinct BML trajectories.

Etiology and Nursing Care of Children's Knee Joint Sports Injury Diseases

The objective is to explore the etiology, diagnosis, treatment, and prevention of children's knee joint sports injury. The medical records of hospitalized children with sports injuries from 2019 to 2021 were retrospectively analyzed. The total number of hospitalized children with knee joint sports injury increased from 27 in 2019 to 46 in 2021. The main diseases are meniscus injury, dislocation of patella, avulsion fracture of tibial intercondylar crest, ligament injury, articular cartilage injury, and other diseases. Children's sports injuries occur in different ages groups, with the highest incidence in the age group of 7-14, and the incidence rate of boys is about 1.5 times that of girls. Moreover, the number of knee joint sports injury diseases in children is increasing, especially for school-age children. Low energy injury is the most common cause of injury, but high energy injury may lead to serious knee joint function damage, which should be paid great attention.

TTA-Rapid for treating the canine cruciate deficient stifle: Medium to long-term outcome and analysis of risk factors.

This study aimed to evaluate medium to long-term outcomes following treatment of lameness associated with cranial cruciate ligament insufficiency using the tibial tuberosity advancement (TTA)-Rapid technique and to investigate risk factors associated with outcome, including tibial plateau angle (TPA). Patient records for cases treated over an 80-month period were examined retrospectively. An owner postal questionnaire using a clinical metrology instrument (Liverpool Osteoarthritis in Dogs) evaluated the outcome at least 6 months after surgery. A total of 149 procedures were carried out in 120 dogs. Questionnaires were received for 64 dogs (53.3%), with a median follow-up time of 37.5 months. Outcome was judged to be satisfactory, based on frequency of lameness, in 63 (98.4%), while satisfactory outcomes were achieved in 61 (95.3%) based on severity of lameness and in 50 (78.1%) based on mobility score. Statistical analysis showed that age, bodyweight, TPA, meniscal injury and concurrent patellar surgery did not influence outcome, but time to follow-up positively correlated with mobility score. This study involved one surgeon in one centre with outcome data based on the completion of an owner questionnaire, although this used a validated clinical metrology instrument. TTA-Rapid offers a treatment option for cranial cruciate-deficient stifles with a good medium to long-term outcome, and no risk factors were identified to suggest any limitations to its use.

A REVIEW OF 2021 AND 2022 AAOS GUIDELINES FOR MENISCAL ARTHROSCOPIC PROCEDURES IN OSTEOARTHRITIS

For many decades, arthroscopy was considered the least invasive of all existing surgical methods of treating patients with gonarthrosis, however, carried out at the beginning of the XXI century randomized clinical trials (RCTs) demonstrated the futility of isolated lavage and debridement for this category of patients. The purpose of this work is to show trends in the indications for debridement and partial meniscectomy in patients with osteoarthritis in the 2021–2022 AAOS guidelines. Methods. AAOS 2021, 2022 recommendations for the treatment of osteoarthritis (without arthroplasty). The strength of recommendations depends on the number and quality of studies that may or may not recommend surgery. The results. In 2021, the third edition of the AAOS clinical guidelines for the treatment of osteoarthritis was released, which was supported by four studies. They suggest that arthroscopic partial meniscectomy be used for the treatment of meniscal tears in patients with concomitant mild or moderate osteoarthritis in whom physical therapy or other nonsurgical treatments have been ineffective. The 2022 AAOS guidelines reviewed 216 osteoarthritis situations and indications for arthroscopic procedures. The developed criteria are aimed at covering the most common clinical scenarios faced by qualified specialists treating osteoarthritis of the knee joint. The final decision on any particular criterion must take into account all the circumstances presented by the patient, as well as the needs and resources specific to the area or institution. Conclusions. The 2021 AAOS guidelines do not recommend arthroscopy with lavage and/or debridement in patients with a primary diagnosisof knee osteoarthritis. According to AAOS 2022 recommendations, arthroscopic interventions are suitable for young people with arthrosis of the knee joint in one or 2–3 departments. Arthroscopy as a method of choice for the treatment of terminal gonarthrosis has exhausted itself: most studies prove the ineffectiveness of lavage, debridement, microfracturing of the subchondral bone, and partial meniscectory.

A deep learning knowledge distillation framework using knee MRI and arthroscopy data for meniscus tear detection.

Purpose: To construct a deep learning knowledge distillation framework exploring the utilization of MRI alone or combing with distilled Arthroscopy information for meniscus tear detection. Methods: A database of 199 paired knee Arthroscopy-MRI exams was used to develop a multimodal teacher network and an MRI-based student network, which used residual neural networks architectures. A knowledge distillation framework comprising the multimodal teacher network T and the monomodal student network S was proposed. We optimized the loss functions of mean squared error (MSE) and cross-entropy (CE) to enable the student network S to learn arthroscopic information from the teacher network T through our deep learning knowledge distillation framework, ultimately resulting in a distilled student network S T. A coronal proton density (PD)-weighted fat-suppressed MRI sequence was used in this study. Fivefold cross-validation was employed, and the accuracy, sensitivity, specificity, F1-score, receiver operating characteristic (ROC) curves and area under the receiver operating characteristic curve (AUC) were used to evaluate the medial and lateral meniscal tears detection performance of the models, including the undistilled student model S, the distilled student model S T and the teacher model T. Results: The AUCs of the undistilled student model S, the distilled student model S T, the teacher model T for medial meniscus (MM) tear detection and lateral meniscus (LM) tear detection are 0.773/0.672, 0.792/0.751 and 0.834/0.746, respectively. The distilled student model S T had higher AUCs than the undistilled model S. After undergoing knowledge distillation processing, the distilled student model demonstrated promising results, with accuracy (0.764/0.734), sensitivity (0.838/0.661), and F1-score (0.680/0.754) for both medial and lateral tear detection better than the undistilled one with accuracy (0.734/0.648), sensitivity (0.733/0.607), and F1-score (0.620/0.673). Conclusion: Through the knowledge distillation framework, the student model S based on MRI benefited from the multimodal teacher model T and achieved an improved meniscus tear detection performance.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database

Background: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. Purpose: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. Results: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). Conclusion: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

Risk factors of knee reinjury after anterior cruciate ligament reconstruction.

This study aimed to investigate whether the return to level I sports, concomitant injuries, foot-related problems, and other factors would increase the risk of knee reinjury after anterior cruciate ligament reconstruction (ACLR). This study used a prospective cohort study design. Online enrolment from August 2018 to January 2019 in ACL Community Indonesia recruited 148 patients who had undergone ACLR less than one month prior to injury. Knee injury occurrence after ACLR was diagnosed through a physical examination and positive MRI or arthroscopic findings. During the study, 55 knee reinjuries occurred. The proportional hazards model analysis revealed that the risk of knee reinjury at 12 and 24 months for patients who returned to level I sports (hazards ratio (HR)=3.17 and HR=3.90, respectively) was significantly higher than that of the patients who did not return to sports and that the risk for those who returned to level II/III sports did not significantly increase at 12 or 24 months. Patients with concomitant meniscus injury had a significantly higher risk of knee reinjury at 12 and 24 months (HR=3.33 and HR=2.25, respectively) than those without, and the risk of knee reinjury for patients with concomitant posterior cruciate ligament injury was significantly higher at 12 months (HR=3.05) but not at 24 months. Fewer knee symptoms after ACLR were significantly associated with a lower risk of knee reinjury (HR=0.98) at 12 and 24 months. The return to level I sports, concomitant meniscus and posterior cruciate ligament injury, and knee symptoms after ACLR may increase the risk of knee reinjury for post-ACLR patients.

Dimorphic comparative histological and histometric study of the lateral and medial knee menisci in male and female human cadavers

The knee menisci are fibrocartilaginous discs present in between the femur and the tibia. They play a pivotal role in withstanding the weight-bearing forces and help to maintain the stability of the knee joint. Descriptive knowledge of the menisci is essential to understand the mechanism and design of the appropriate management of their pathological lesions. Several investigations have identified the anatomical and morphological differences between the medial (MMi) and lateral menisci (LMi) in humans. What remains unclear, however, is the comparative analysis of histological and histometric parameters of these menisci, especially between males and females. To evaluate and compare the different histological, histometric and biochemical parameters of different structural components (collagen, proteoglycans, cellularity, and vascularity) of MMi and LMi in male and female human cadavers, twenty-four knee joints, 12 males and 12 females, were dissected, and the menisci were excised and labeled. The middle region of each meniscus was cross-sectioned and subjected to different histological, histometric and biochemical studies. Histological examination of MMi and LMi in both males and females yielded several observations regarding different meniscal components; the orientation of collagen fibers was circumferential with intermingled radial fibers. Both fibroblasts and fibrochondrocytes were arranged singly or in rows alongside the direction of the collagen fibers. Also, the blood vessels were present toward the periphery, whereas the proteoglycans-rich areas were more evident in the inner region of each meniscus. Nevertheless, collagen fibers organization, safranin-O staining intensity, and cellular arrangement were all different between males and females. The analysis of these changes was further compared histometrically between MMI and LMi in males and females. The gained comparative histological, histometric and biochemical findings of this work are critical for providing detailed information on the microstructure and composition of both MMi and LMi in males and females. The present results also highlight the detrimental effects of histological structure on different meniscal injuries.

Utilization of cannulated screw fixation of Jail and TiRobot-assisted percutaneous indirect reduction technique for AO/OTA type 41B2 tibial plateau fracture treatment

PurposeThe present study was designed to investigate the precise procedure and effectiveness of percutaneous minimally invasive fixation assisted by TiRobot in managing AO/OTA type 41B2 tibial plateau fracture to provide an alternative solution for clinical application. MethodsIn total, 10 participants with AO/OTA type 41B2 tibial plateau fractures diagnosed by preoperative imaging examinations were enrolled in this study between May 2019 and May 2022. They were 5 males and 5 females, with an average age of 45.6 ± 11.3 years old (range 27–62 years old). All of them had closed fractures, including 6 cases with anterior cruciate ligament (ACL) tibial insertion avulsion fractures, 1 case with medial collateral ligament (MCL) tear, and 4 cases with a lateral meniscus tear. From injury through surgery, the entire time frame was 4.0 ± 1.5 days (range, 2–7 days). Following indirect percutaneous reduction assisted by TiRobot, the Jail method was used to treat all patients with minimally invasive internal fixation. Patients with ligament or meniscus injurieswere treated with arthroscopic surgery in one stage. The standardized functional exercise was performed postoperatively. The knee function was measured using the Hospital for Special Surgery (HSS) score, and the fracture reduction was assessed through the Rasmussen radiology score. ResultsAll patients were followed up for 12.7 ± 6.8 months (6–24 months).The fracture healing time was 11.8 ± 0.8 weeks (10–13 weeks), and the X-rays revealed satisfactory fracture reduction.The knee joint's Rasmussen score was 17.8 ± 0.4 (in the range of 17–18) a year after the procedure, with 8 patients receiving outstanding ratings and 2 cases receiving satisfactory scores. The HSS score was 93.8 ± 2.3 (range, 89 to 96), of which 10 cases were excellent. The motion range of the kneewas 138.7°±2.7° (range, −5° to 0° to 135°). No adverse effects or serious complications, such as internal fixation failure, postoperative infection, popliteal vascular injury, and common peroneal nerve injury, were observed during the last follow-up visit. ConclusionsThe intelligent assistance and accurate guidance of TiRobot can simplify and standardize procedures of percutaneous minimally invasive fixation in theSchatzker type Ⅲ tibial plateau fracture treatment. This technique increases the precision of indirect percutaneous reduction and screw fixation while minimizing bone grafting.