Treatment Of Meniscal Lesions Research Articles

Outside-In Single–Lasso Loop Technique for Meniscal Repair: Fast, Economic, and Reproducible

The current understanding of the biomechanical role of the meniscus, in conjunction with the increasing efforts to achieve its preservation within the orthopaedic community during treatment of meniscal lesions, has prompted the development of different meniscal repair techniques. The outside-in technique is recommended for anterior horn and middle-segment meniscal tears and has been recognized as a low-cost procedure with a low incidence of complications. Diverse modifications of this technique have been published over the past decade. On the basis of these previous outside-in technique modifications and aiming to simplify and reduce the number of surgical steps, as well as simplify suture and/or instrument manipulation, during this technique, we describe the single–lasso loop outside-in technique for meniscal repair. We believe this modified technique represents a simplified, economic, and highly reproducible procedure option whenever an outside-in technique for meniscal repair is considered.

3D Porous Gelatin/PVA Hydrogel as Meniscus Substitute Using Alginate Micro-Particles as Porogens.

One of the current major challenges in orthopedic surgery is the treatment of meniscal lesions. Some of the main issues include mechanical consistency of meniscal implants, besides their fixation methods and integration with the host tissues. To tackle these aspects we realized a micro-porous, gelatin/polyvinyl alcohol (PVA)-based hydrogel to approach the high percentage of water present in the native meniscal tissue, recapitulating its biomechanical features, and, at the same time, realizing a porous implant, permissive to cell infiltration and tissue integration. In particular, we adopted aerodynamically-assisted jetting technology to realize sodium alginate micro-particles with controlled dimensions to be used as porogens. The porous hydrogels were realized through freezing-thawing cycles, followed by alginate particles leaching. Composite hydrogels showed a high porosity (74%) and an open porous structure, while preserving the elasticity behavior (E = 0.25 MPa) and high water content, typical of PVA-based hydrogels. The ex vivo animal model validation proved that the addition of gelatin, combined with the micro-porosity of the hydrogel, enhanced implant integration with the host tissue, allowing penetration of host cells within the construct boundaries. Altogether, these results show that the combined use of a water-insoluble micro-porogen and gelatin, as a bioactive agent, allowed the realization of a porous composite PVA-based hydrogel to be envisaged as a potential meniscal substitute.

Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament

IntroductionRecently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair. The procedure is less invasive than ACL reconstruction, yet studies assessing early postoperative course are lacking. Goal therefore was to assess postoperative range of motion (ROM), complications and operative times following primary repair and compare this to the gold standard of reconstruction. MethodsA retrospective study was performed for which 52 repair and 90 reconstruction patients could be included. Patients were examined at one week and one, three and six months. Rehabilitation protocol consisted of early ROM and was equal for both groups. Outcomes were compared using independent t-tests and chi-square tests, and reported in mean±standard deviation. ResultsRepair had more ROM than reconstruction patients at one week (89°±18 vs. 61°±21, p<0.01) and one month (125°±14 vs. 116°±18, p < 0.01) postoperatively. Fewer repair patients had 90° ROM at one week (23% vs. 84%, p<0.01), and more repair patients had full ROM at one month (57% vs. 30%, p<0.01). Treatment of meniscal lesions, but not chondral lesions, influenced ROM. Trends towards fewer complications (2% vs. 9%, p=0.19) and infections (0% vs. 6%, p=0.20) were noted following primary repair, and the procedure was significantly shorter. Conclusions: Following primary repair, patients had better ROM, and trends towards fewer complications than reconstruction. Primary repair is a safe, brief procedure with early ROM and low complication rates.

Contribution of isokinetic in the treatment of meniscal lesions: Report of 26 cases

Meniscal injuries are an extremely common condition that also occurs well in young adults at a sporting injury, than in most elderly where it is often the degenerative changes in the knee illustration. The application of isokinetic knee is widespread, either in assessment or rehabilitation. The objective of the study is to determine the contribution of the isokinetic for meniscal pathology. This is a retrospective study of 6 months, including patients followed in physical medicine and rehabilitation for meniscal lesions confirmed by imaging and in whom supported classical rehabilitative and/or isokinetic was indicated. Twenty-six patients were followed in our service to support meniscal lesion. The average age was 32.18 years [18–60 years], there was a male predominance (67%). Five patients underwent partial meniscectomy, meniscal suturing 3 patients and 17 patients had no surgical indication. All patients had an isokinetic evaluation that objectified muscle weakness of the quadriceps and hamstrings of the injured knee, with an imbalance in the ratio IJ/Q, which has allowed us to adapt the rehabilitative care that was classic in 8 patients and 18 patients isokinetic. Improvement was objectified our patients at the end of rehabilitation. The concept of meniscus savings dominates the therapeutic management of meniscal lesions. A well-adapted rehabilitation is a pillar of support. The isokinetic allows an objective assessment of patients and an orientation of the rehabilitation treatment.

Implant méniscal en polyuréthane pour méniscetomie douleureuse chronique. Résultats à 5 ans

Treatment of meniscal lesions is the most common surgical intervention performed by orthopaedic surgeons today. Favorable results have been reported in the short term after partial meniscectomy. However, the risk of osteoarthritis and irreversible damage occurring in the long term remains. Therefore, a novel, biodegradable, polyurethane scaffold was developed to fulfill an unmet clinical need in the treatment of patients with presenting with painful irreparable partial meniscal defects. Fourty-three patients were consecutively treated for their partial meniscus defects with the scaffold technique (Actifit). These patients were prospectively clinically evaluated with a follow-up of 60 months. Magnetic resonance imaging (MRI) was used for morphologic analysis of the meniscal regeneration at 12, 24 and 60 months of follow-up. The patients included in this study showed a significant gradual clinical improvement after implantation of the scaffold. No effect of the scaffold on the opposing cartilage was observed on MRI. In thirteen patients, the treatment had failed (30.2%). Six patients were lost to follow-up (13.9%). At five years post-implantation, clinical outcome data from this study support the use of the polyurethane scaffold for the treatment of irreparable, painful, partial meniscus defects. However, well-designed, large-scale, randomized controlled trials are mandatory to confirm the initial results and the reliability of this procedure.

Paper 235: Effect of the Addition of Mesenchimal Stem Cells in the Healing of Acute and Chronic Meniscal Lesions in the Avascular Zone: An Experimental Study in Rabbits

the treatment of meniscal lesions is a challenge because, although lesions in the vascular region often heal with traditional techniques, lesions in the avascular area rarely heal. Different experimental studies have explored the effect of a variety of substances in the healing of lesions in the avascular area, but poor results are the norm. Adult Mesenchimal Stem Cells (MSC) obtained from fat have shown an ability to regenerate cutaneous and osseous defects. The objective of this study is to determine if the addition of MSC to a sutured meniscal lesion in the avascular zone of rabbit menisci improves the outcome of acute and delayed repairs. twenty four New Zealand rabbits were used in the study. MSC were obtained from fat extracted from the rabbits inguinal zone that was processed and cultured sequentially (two to three times) so as to obtain an adequate number of MSC; in the last culture the cells were incubated in a solution containing deoxibromouridine (DBU) so as to mark their DNA. The medial meniscus of both knees was approached, and a 0,5 cm longitudinal tear in the avascular area of the anterior horn was performed. In twelve rabbits the lesions were repaired immediately and in another twelve rabbits the lesions were repaired three weeks later. All the tears were sutured with one simple vertical stitch of nonabsorbable suture. A Matrigel® solution with 100,000-1,000,000 MSC was placed prior to suture tightening inside the sutured area of one of the knees; in the contralateral knee the Matrigel® solution was placed without cells to be used as controls. The rabbits were sacrificed after 12 weeks, menisci were evaluated macro-microscopically and an inmunohistochemical analysis with antibodies for DBU was performed to evaluate the presence of siblings of the stem cells. In the group repaired acutely three total and three partial healings were observed in the MSC group and none in the control group. In the group repaired after three weeks one total and one partial healing were observed in the MSC group and none in the control group The inmunohistochemical evaluation showed positive results in menisci with partial or complete healing. MSC have a strong positive effect in the healing of meniscal lesions in the avascular zone in rabbits repaired acutely. This effect is lees marked if at all present when the lesion is repaired in a delayed fashion.

Lésions méniscales isolées chez le sportif. À propos de 120 cas

Meniscal lesion is a frequent affection in sport practice and which can affect – in mid and long terms – the fonctionnal prognosis of the knee and thus the sport career of the patient. Hence the importance of precocious diagnosis and adequate take-in-charge. We report a series of 120 cases of isolate meniscal lesions (76% internal meniscal lesions and 24% external meniscal lesions) in a sports population treated under arthroscopy and rechecked after a mean relapse of four years. Our results were good to excellent in 82.5% of the cases with retake of sport activity in 90% of our patients of which 60% in the preoperative level. 54% of the cases underwent standard radio control in their last visit. This control was normal in 46% of them, showed a pinching in the internal compartment in 22% of the cases and external in 32% of the cases. As for its reliability, its simplicity and relative innocuteness, the treatment of meniscal lesions under arthroscopy fulfills the requirements imposed by sport population's tasks.

Lésions traumatiques des ménisques du genou

Preserving the meniscal body after an injury to the meniscus is very important. Meniscal function is an integral part of the knee function and it is related to the integrity of ligaments and cartilage. The anatomy and physiology of the meniscus are reviewed, as well as the pathogenesis, symptomatology and current meniscal imaging. The authors focus on the treatment of meniscal lesions, addressing the conservative approach and the operative management, including proper meniscal resection and meniscal suture, and describe the current operative techniques. It would be interesting to know how meniscal lesions in a stable knee or associated with a ligamentous injury are treated. A discussion of potential complications related to the operative management of these lesions concludes this chapter.

Histological and magnetic resonance imaging alterations after irradiation of meniscus using Holmium:YAG laser.

The authors performed an experimental and a prospective clinical study to evaluate the histological and magnetic resonance imaging (MRI) alterations after irradiation of meniscus using holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and InfraTome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). Recently, some authors reported a few cases with articular cartilage damage or paraarticular osteonecrosis following arthroscopic knee surgery in which the laser was used to assist in the treatment of meniscal pathology. Meniscus specimens in saline immersion were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 microm and pulse duration was 250 microsec. Power settings were 1-1.5 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 2, 3.5, and 6 K joules. Eight patients with meniscal problems underwent arthroscopic partial meniscectomy using Ho:YAG laser. Total laser energy used for these surgeries was 1.5-2.5 K joules. MRI was performed preoperatively and at 6 months postoperatively. At higher energy levels (more than 3 K joules), separation of the gap between the collagen fibers, and a three-dimensional dispersion in the striation were observed on electron microscopic evaluation of meniscus specimens. No patient had abnormal signals in MRI (a sign of articular cartilage damage or osteonecrosis) following arthroscopic laser surgery. When higher energy level is required, conventional instruments should be preferred in the treatment of meniscal lesions. Laser should be reserved for the posteriorly located and smaller meniscal lesions.

Rehabilitation Following Arthroscopic Meniscectomy

Meniscal injuries are reported to be the most common injury sustained by athletes, with sports injuries being responsible for over 30% of the total number of lesions. Treatment of meniscal lesions has evolved considerably over the past 20 years and partial meniscectomies, or menisci repairs, are now the treatment of choice for the majority of lesions. Following arthroscopic meniscectomy, patients are routinely able to walk without support within 1 to 3 days, return to work after 1 to 2 weeks, resume athletic training by 2 to 4 weeks and return to competition in 3 to 4 weeks. Physiotherapy has been widely prescribed following arthroscopic meniscectomy and exercise protocols have been described in the literature. However, few studies have actually ascertained whether or not physiotherapy accelerates recovery. From these studies, there is little doubt that some form of rehabilitation, e.g. pain control or exercises, may be effective in accelerating the recovery of muscle strength to preoperative values. Therefore, whether or not physiotherapy is required following arthroscopic meniscectomy may depend on the presence or absence of preoperative strength deficits, and thus, on whether it is the dominant or nondominant leg that is injured. In patients with no preoperative deficits, and a normal post-surgery evolution, full recovery may be expected within 6 weeks if pain and swelling are brought under control. Physiotherapy intervention may not, perhaps, be justified for these patients, except in professional athletes where a faster return to preoperative values may be desired.

False meniscal tears in magnetic resonance imaging of the knee (Comparison with arthroscopic findings)

Magnetic resonance imaging (MRI) of the knee followed by an arthroscopic procedure was performed in 80 patients between March 1992-November 1993. There were 57 male and 23 female patients and the mean age was 33 (16-64). Based on arthroscopic findings the sensitivity, specificity and accuracy of MRI was 97.1%, 60%, 76.3% for medial meniscal tears and 60%, 88%, and 81.3% for Iateral meniscal tears respectively. False positive results were more common on the medial side {18), than the Iateral side (7). False positive medial tears were all reported to be in the posterior horn while false positive Iateral tears were reported to be in the anterior or posterior horns. Of all the cases with a false positive report, only two patients had a completely normal arthroscopic examination while the rest had other intra-articular pathologies {mostly chondrallesions) to account for their symptoms. There were 8 false negative results on the Iateral side and one false negative result onthe medial side. Two of these Iateral false negative tears involved the posterior horn, three were transverse tears near the Dopliteal hiatus, one was an incomplete peripheral tear, one was a complete peripheral seperation and one was a torn discoid meniscus. The false negative medial tear involved the posterior horn. It was concluded that, a meticulous clinical examination followed by an arthroscopic procedure is the gold standard in the diagnosis and treatment of meniscallesions. Given the high cost and relatively high false results, MRI should be reserved for cases with tumoral conditions, high Ievel injured athletes in ''immediate need to know'' situations and patients with chronic symptoms that present with a difficulty in diagnosis.

Clinical results after arthroscopic meniscectomy in sportsmen

The treatment of meniscallesions has always been problem of crucial importance in the knee surgery. Now a main principle in the knee surgery; is perserving of the peripheral rim of the meniscus, included in stabilising soft tissue structures of the knee. The meniscectomy. which preserves as much functional meniscus tissue as possible is a method of choice. Within a period of four (1-4) years arthroscopic meniscectomy were performed. The functional activity scale used aspects of the knee scoring scale described by Lysholm was applied for analysing the postoperative status. The results obtained were 75% excellent, 12% good. 9% fair and 4% poor.