Treatment Of Meniscal Injuries Research Articles

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

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

Meniscal Lesions in Multi-Ligament Knee Injuries.

Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries. The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available. Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered. Seventy patients with MLKIs were included, with a mean age of 30.69years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89-26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%. The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns.It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs.

The Role of Ultrasound in the Diagnosis and Treatment of Meniscal Injuries.

This review evaluates the current understanding of the role of ultrasound in the diagnosis and treatment of meniscal disorders. Ultrasound (US) demonstrates similar sensitivity and specificity when compared to magnetic resonance imaging in the evaluation of meniscal injuries when compared to arthroscopy. Meniscal extrusion (ME) under US can be a reliable metric to evaluate for meniscal root tears in knees with and without osteoarthritis (OA). Sonographic ME is associated with development of OA in knees without OA. US following allograft meniscal transplant may be useful in predicting graft failure. US findings can be used to screen for discoid menisci and may demonstrate snapping of a type 3 discoid lateral meniscus. Shear wave elastography for meniscal injuries is in its infancy; however, increased meniscal stiffness may be seen with meniscal degeneration. Perimeniscal corticosteroid injections may provide short term relief from meniscal symptoms, and intrameniscal platelet-rich plasma injections appear to be safe and effective up to three years. Ultrasound-assisted meniscal surgery may increase the safety of all inside repairs near the lateral root and may assist in assessing meniscal reduction following root repair. Diagnostic US can demonstrate with high accuracy a variety of meniscal pathologies and can be considered a screening tool. Newer technologies such as shear wave elastography may allow us to evaluate characteristics of meniscal tissue that is not possible on conventional imaging. US-guided (USG) treatment of meniscal injuries is possible and may be preferable to surgery for the initial treatment of degenerative meniscal lesions. USG or US-assisted meniscal surgery is in its infancy.

Visual interpretable MRI fine grading of meniscus injury for intelligent assisted diagnosis and treatment

Meniscal injury represents a common type of knee injury, accounting for over 50% of all knee injuries. The clinical diagnosis and treatment of meniscal injury heavily rely on magnetic resonance imaging (MRI). However, accurately diagnosing the meniscus from a comprehensive knee MRI is challenging due to its limited and weak signal, significantly impeding the precise grading of meniscal injuries. In this study, a visual interpretable fine grading (VIFG) diagnosis model has been developed to facilitate intelligent and quantified grading of meniscal injuries. Leveraging a multilevel transfer learning framework, it extracts comprehensive features and incorporates an attributional attention module to precisely locate the injured positions. Moreover, the attention-enhancing feedback module effectively concentrates on and distinguishes regions with similar grades of injury. The proposed method underwent validation on FastMRI_Knee and Xijing_Knee dataset, achieving mean grading accuracies of 0.8631 and 0.8502, surpassing the state-of-the-art grading methods notably in error-prone Grade 1 and Grade 2 cases. Additionally, the visually interpretable heatmaps generated by VIFG provide accurate depictions of actual or potential meniscus injury areas beyond human visual capability. Building upon this, a novel fine grading criterion was introduced for subtypes of meniscal injury, further classifying Grade 2 into 2a, 2b, and 2c, aligning with the anatomical knowledge of meniscal blood supply. It can provide enhanced injury-specific details, facilitating the development of more precise surgical strategies. The efficacy of this subtype classification was evidenced in 20 arthroscopic cases, underscoring the potential enhancement brought by intelligent-assisted diagnosis and treatment for meniscal injuries.

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.

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

Background: Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. Hypothesis: Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. Results: An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type (P = .61) or meniscal procedure at the time of ACLR (P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type (P = .38) or meniscal procedure at the time of ACLR (P = .40). Conclusion: Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.

3D printing a universal knee meniscus using a custom collagen ink

Tears of the meniscus are among the most commonly diagnosed knee injuries. Because most of the meniscus lacks the ability to self-heal due to its low vascularity, surgical intervention is needed in more than 85% of cases. Tissue-engineered meniscal implants may provide a treatment strategy that better supports healing and long-term health and mobility benefits. We used three-dimensional printing to develop a “universal” human meniscal tissue repair device that can be trimmed to match the corresponding area of damage debrided during the patient's surgical repair. Computer aided design software was used to design an adult meniscus of average shape based on published physical dimensions. To reproduce the natural fiber arrangement found in the meniscus, the tool path for 3D bioprinting was structured to use alternating layers of circumferential and radial extrusions. We also developed extrudable, shear thinning bioinks based on meniscus biochemical components, including collagen I methacrylate, collagen II, and chondroitin sulfate methacrylate. The combination of this tissue-specific bioink and the deposition pattern to build the meniscus are novel. Ink formulations were evaluated with rheology to assess the viscosity and post-gelling stiffness. Inks retained shape fidelity when thermally gelled after printing into a support bath, and the fabricated menisci maintained stable dimensions for up to 4 weeks post printing. Bioprinted menisci containing human mesenchymal stem cells were also dimensionally stable, and viable cells were present up to 4 weeks post printing. Increased glycosaminoglycan deposition was noted in the bioprinted meniscus over 21 days, and decorin and collagen type I gene expression increased. Compression testing demonstrated that Young's modulus approaches 100 kPa when molded as a solid object and 45 kPa when extruded into the meniscus shape. This 3D printed, anisotropic meniscus emulates the natural architecture and biochemical composition of the natural human meniscus and has potential to be developed into a device for use in treatment of meniscal injuries.

Effectiveness of Rehabilitation for Knee Osteoarthritis Associated With Isolated Meniscus Injury: A Scoping Review.

Meniscus tear is the most common type of injury to the meniscus and occurs more frequently on the medial compartments than the lateral compartments. Further, it is often caused by trauma or degenerative processes and can occur anywhere on either the meniscus, anterior horn, posterior horn, or midbody. Treatment of meniscus injuries is likely to greatly impact the evolution of osteoarthritis (OA) as meniscus injuries can gradually progress to knee OA. Hence, treatment of these injuries is important for managing the progression of OA. While the types of meniscus injuries and symptoms have been reported previously, the effectiveness of rehabilitation according to the degree of meniscus injury (e.g., vertical, longitudinal, radial, and posterior horn tears) remains unknown. In this review, we aimed to investigate whether rehabilitation for knee OA associated with isolated meniscus injuries varies with the degree of injury and determine the effects of rehabilitation on outcomes. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Physiotherapy Evidence Database for studies published before September 2021. Studies on ≥40-year-old patients with knee OA and isolated meniscus injury were included for analysis. The types of meniscus injury were classified as longitudinal, radial, transverse, flap, combined, or avulsion of the anterior and posterior roots of the medial meniscus, and assigned knee arthropathy grades of 0-4 according to the Kellgren-Lawrence classification. The exclusion criteria were meniscus injury, combined meniscus and ligament injury, and knee OA associated with combined injury in patients <40 years of age. There were no restrictions on the region, race, or gender of participants, or language or research format of the studies. The outcome measures were the Knee Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index Score, Visual Analog Scale or Numeric Rating Scale, Western Ontario Meniscal Evaluation Tool, International Knee Documentation Committee Score, Lysholm Score, 36-Item Short-Form Health Survey, one-leg hop test, timed up and go test, and re-injury and muscle strength. A total of 16 reports met these criteria. In studies that did not classify or distinguish degrees of meniscus injury, the effects of rehabilitation were generally favorable in the medium-to-long term. In cases where the intervention was not sufficiently effective, patients were recommended either arthroscopic partial meniscectomy or total knee replacement. Studies on medial meniscus posterior root tear did not confirm the effectiveness of rehabilitation due to the short intervention period. Further, Knee Osteoarthritis Outcome Score cut-offs, clinically important differences in Western Ontario and McMaster Universities Osteoarthritis Index, and minimum important changes in patient-specific functional scales were reported. Of the 16 studies reported in this review, nine met the definition. This scoping review has a few limitations such as the effect of rehabilitation alone could not be examined, and the intervention effectiveness differed at short-term follow-up. In conclusion, there was a gap in evidence regarding the rehabilitation of knee OA after isolated meniscus injury due to differences in intervention duration and methods. In addition, on short-term follow-up, intervention effects varied across studies.

Efficacy and safety of arthroscopic surgery combined with hyaluronic acid for meniscal injuries: A systematic review and meta-analysis of randomized controlled studies.

The efficacy and safety of arthroscopic surgery combined with hyaluronic acid in the treatment of meniscal injuries were evaluated by Meta-analysis to provide an evidence-based basis for the selection of clinical treatment options. PubMed, Cochrane Library, EMBASE, Scopus, Web of Science English databases, and Chinese databases of China National Knowledge Infrastructure, WAN FANG, VIP, and China SinoMed had been searched up to June 2021. Quality evaluation was performed concerning the Cochrane Systematic Evaluation Tool. The obtained data were analyzed using the statistical software Review Manager 5.3. Eleven randomized controlled trials with a total of 955 patients were eventually included, 473 in the arthroscopic combined with hyaluronic acid group (combined treatment group) and 482 in the arthroscopy alone group (surgery group). The results of the study revealed that the excellent treatment [OR = 3.44, 95% CI (2.10, 5.65), p < .00,001], the VAS score [MD = -0.99, 95% CI (-1.50, -0.48), p = .0002], the Lysholm score [MD = 9.70, 95% CI (6.41, 12.99), p < .00,001] and the joint mobility [MD = 6.31, 95% CI (0.84, 11.78), p = .02] of the combined treatment group were significantly better than the surgery group, the difference was statistically significant. The complications rate was comparable in both groups [OR = 0.86, 95% CI (0.29, 2.53), p = .78], with no statistically significant difference. Arthroscopic surgery combined with hyaluronic acid for meniscal injury can improve the efficiency of treatment compared with arthroscopic surgery alone, as well as the efficacy in relieving joint pain and improving joint function and mobility, without increasing the incidence of complications. Arthroscopic surgery combined with hyaluronic acid administration has good effectiveness and safety profile. Therefore, hyaluronic acid supplementation is recommended after arthroscopic surgery when treating meniscal injuries.

In VivoStudies of Mesenchymal Stem Cells in the Treatment of Meniscus Injury

This review summarizes the literature of preclinical studies and clinical trials on the use of mesenchymal stem cells (MSCs) to treat meniscus injury and promote its repair and regeneration and provide guidance for future clinical research. Due to the special anatomical features of the meniscus, conservative or surgical treatment can hardly achieve complete physiological and histological repair. As a new method, stem cells promote meniscus regeneration in preclinical research and human preliminary research. We expect that, in the near future, in vivo injection of stem cells to promote meniscus repair can be used as a new treatment model in clinical treatment. The treatment of animal meniscus injury, and the clinical trial of human meniscus injury has begun preliminary exploration. As for the animal experiments, most models of meniscus injury are too simple, which can hardly simulate the complexity of actual meniscal tears, and since the follow‐up often lasts for only 4–12 weeks, long‐term results could not be observed. Lastly, animal models failed to simulate the actual stress environment faced by the meniscus, so it needs to be further studied if regenerated meniscus has similar anti‐stress or anti‐twist features. Despite these limitations, repair of the meniscus by MSCs has great potential in clinics. MSCs can differentiate into fibrous chondrocytes, which can possibly repair the meniscus and provide a new strategy for repairing meniscus injury.

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction.

Background:Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear.Purpose/Hypothesis:The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively.Results:A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined (P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups.Conclusion:Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.

The Impact of Meniscal Treatment on Functional Outcomes Six Months After Anterior Cruciate Ligament Reconstruction (107)

Objectives:The incidence of anterior cruciate ligament (ACL) injuries continues to rise, and meniscal injuries are commonly associated with these tears. Treatment of meniscal injuries can impart delayed weightbearing range-of-motion restrictions, which can affect the post-operative rehabilitation protocol. These limitations after a meniscal repair could change how patients are managed and progressed through rehab. The effect of the meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction (ACLR) is unclear and may affect return-to-play assessments. The purpose of this study was to compare strength, jumping performance and patient reported outcomes between isolated ACLR patients and those undergoing surgical intervention for meniscal pathology at the time of ACLR surgery at a scheduled functional testing assessment an average of 6 months after surgery. Our hypothesis is that those undergoing meniscal repair will have lower strength recovery due to post-operative restrictions.Methods:In this retrospective cohort study, ACLR patients and healthy controls completed patient-reported outcomes (IKDC and KOOS), underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups, as well as functional hop testing as part of a return-to-sport test battery at 5-7 months post-operatively. ACLR patients were stratified as isolated ACLR, ACLR+Meniscectomy (ACLR-MS), ACLR+Meniscal Repair (ACLR-MR) and compared to healthy controls. Patients treated with meniscus repair were restricted to partial weight bearing and to 90 degrees of knee flexion for the first 6 weeks post-surgery. Comparisons were performed between meniscal treatment groups with regard to demographics, patient reported outcomes scales, knee extensor and flexor strength, while stratifying by graft type.Results:305 participants, including 165 ACLR patients (50 isolated ACLR, 71 ACLR + Meniscal Repair, 44 ACLR + Meniscectomy) and 140 healthy controls were included with an average time post-operatively to functional testing of 5.96±0.47 months. Heathy controls demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than all meniscal subgroups (p<.001). There were no differences between the IKDC, KOOS subscales, or in unilateral or limb symmetry measures of peak knee extensor or flexor torque between ACLR, ACLR+MS, and ACLR+MR patients (all p-values>.05).Conclusions:Persistent weakness, asymmetry and reduced subjective outcome scores measured at approximately 6 months post index surgery were not influenced by meniscus treatment. Knee flexor and extensor strength, limb symmetry, and patient reported outcomes did not significantly differ across patients undergoing isolated ACLR, ACL + Meniscus Repair, and ACL + meniscectomy. These findings suggest that the weightbearing and range-of-motion restrictions associated with meniscus repair recovery do not result in loss of early strength or patient reported outcomes, and they can be progressed through therapy accordingly.

Meniscus Anatomy and Basic Science.

A basic understanding of meniscal anatomy and biomechanics is important for physicians evaluating knee injuries and surgeons treating meniscal injuries. This chapter provides a concise review of meniscal anatomy and biomechanics relevant for the evaluation and treatment of meniscus injuries. Anatomic landmarks relevant for meniscal root repair and transplant are discussed, along with the gross, microscopic, vascular, and neuroanatomy of the menisci.

Clinical efficacy of platelet-rich plasma as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury

ObjectiveThe clinical efficacy of platelet-rich plasma (PRP) as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury remains controversial. This meta-analysis was performed to evaluate the clinical efficacy of PRP in the treatment of meniscal injury and provide evidence for the selection of clinical treatment options.MethodsA computer-based search of the PubMed, Embase, and Cochrane Library databases was performed to retrieve articles using the search terms “platelet-rich plasma” and “menisci.” Quality evaluation and data extraction were performed. The combined effect was assessed using RevMan version 5.3 software.ResultsThree randomized controlled trials and three cohort studies involving 293 patients were included in the meta-analysis. There were no significant differences in the International Knee Documentation Committee score or Lysholm score between the experimental and control groups. The failure rate and visual analog scale score were significantly lower and the degree of active flexion was significantly higher in the experimental group than in the control group.ConclusionThe findings of this meta-analysis suggest that PRP injection can effectively enhance the efficacy of arthroscopic repair of meniscal injury, reduce the failure rate and severity of pain, and improve active flexion.

Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold

Background: Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. Purpose: To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. Study Design: Controlled laboratory study. Methods: The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. Results: Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. Conclusion: Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. Clinical Relevance: This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.

The Meniscus in Normal and Osteoarthritic Tissues: Facing the Structure Property Challenges and Current Treatment Trends.

The treatment of meniscus injuries has recently been facing a paradigm shift toward the field of tissue engineering, with the aim of regenerating damaged and diseased menisci as opposed to current treatment techniques. This review focuses on the structure and mechanics associated with the meniscus. The meniscus is defined in terms of its biological structure and composition. Biomechanics of the meniscus are discussed in detail, as an understanding of the mechanics is fundamental for the development of new meniscal treatment strategies. Key meniscal characteristics such as biological function, damage (tears), and disease are critically analyzed. The latest technologies behind meniscal repair and regeneration are assessed.

Hyaluronic acid promotes proliferation and migration of human meniscus cells via a CD44-dependent mechanism

ABSTRACTPurpose: Treatment of meniscal injury is important for osteoarthritis (OA) prevention. Meniscus cells are divided between inner and outer cells, which have different characteristics and vascularity. We evaluated the effects of hyaluronic acid (HA) on the proliferation and migration of human inner and outer meniscus cells, and investigated the underlying healing mechanisms.Materials and Methods: Lateral menisci from 18 patients who underwent total knee arthroplasty were used. Meniscus cells were harvested from the outer and inner menisci and evaluated using migration and proliferation assays after treatment with HA or chondroitin sulfate (CS). The effects of HA on prostaglandin E2 (PGE2)-induced apoptosis and gene expression were evaluated.Results: Cell migration and proliferation were increased by HA in a concentration-dependent manner, in both inner and outer meniscus cells. PGE2-induced apoptosis and caspase-3/7 activity were suppressed by HA in both inner and outer meniscus cells, and these effects were blocked by an anti-CD44 antibody. COL2A1 and ACAN mRNA levels were upregulated following HA treatment of inner meniscus cells. MMP13 mRNA was downregulated following CS stimulation of both inner and outer meniscus cells. These results suggest that CS treatment suppresses the inflammatory reaction rather than providing meniscal restoration. The phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways were activated by HA in both types of meniscus cells; these effects were blocked by treatment with an anti-CD44 antibody.Conclusions: HA promoted human meniscus regeneration by inhibiting apoptosis, promoting cell migration, and accelerating cell proliferation, potentially through the PI3K/MAPK pathway via the CD44 receptor.

Porous Poly(vinyl alcohol)-Based Hydrogel for Knee Meniscus Functional Repair.

The meniscus has a key role within the knee joint, conferring stability, absorbing and redistributing loads, and influencing the overall movement proprioception. Recent developments in the treatment of meniscal injury have progressively shifted the focus from general resection to functional repair, with the recognition that restoring the biomechanical meniscal function helps to prevent degenerative changes in the knee joint and the insurgence of osteoarthritis. To address this clinical need, we have developed a biomimetic implant based on a porous poly(vinyl alcohol) (PVA) hydrogel. Such hydrogels are stable, biocompatible, and suitable to surgical translation, and their mechanical properties can be tuned to reduce the mismatch in the case of partial meniscectomy. The PVA implant structure is porous and permeable, allowing fluid flows and facilitating anatomical integration in situ. Here, we present a chemo-physical characterization of PVA porous hydrogels, focusing on their tunable morphology and associated viscoelastic properties. Biocompatibility was evaluated using primary bovine meniscal fibrochondrocytes, and integration with native tissues was assessed in an ex vivo model. Overall, our results suggest that a synthetic meniscal implant based on a porous PVA hydrogel could restore the physiological function of the meniscus and represent a promising clinical alternative to current resection treatments.

Cell-based treatment of meniscal injuries in an early OA situation - what is the best cell source?

Cell-based treatment of meniscal injuries in an early OA situation - what is the best cell source?

Surgical treatment of meniscus injury

Surgical treatment of meniscus injury