Article

Arthroscopic partial lateral meniscectomy in an otherwise normal knee: Clinical, functional, and radiographic results of a long-term follow-up study

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  • Perth Orthopaedics &Sportsmed centre
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Abstract

To determine the clinical, functional, and radiographic long-term results of patients who underwent arthroscopic partial lateral meniscectomy in an otherwise normal knee. Type of Study: This was a retrospective case-control study. Between 1982 and 1991, 107 arthroscopic partial lateral meniscectomies were performed; 75 of these patients had an isolated lateral meniscal tear and their data were evaluated using the Lysholm score and a questionnaire recording patients' subjective satisfaction. Radiographic analysis was performed according to the Jäger-Wirth classification and Fairbank changes. All 75 patients were examined by questionnaire, 55 underwent physical examination, and 58 had radiographic analysis. The follow-up period ranged from 5 to 15 years. Excellent and good Lysholm score results decreased from 77% at maximal improvement to 66% at follow-up; 43% of patients maintained their level of maximal improvement, 78% showed one or more Fairbank changes at follow-up, and using the Jäger-Wirth score, 84% showed radiographic deterioration. Although deterioration of functional and especially radiographic results occurred after arthroscopic partial lateral meniscectomy, the number of good results, even with mean follow-up of 12.3 years, is remarkable. There was a high percentage of radiographic changes in our study, but there is no significant correlation between them and subjective symptoms or between them and functional outcome. We believe that careful meniscectomy provides good results for a long period of time but, the longer the follow-up, the more radiographic changes have to be expected; when meniscal refixation is possible, it should be performed.

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... The age of participants at the time of surgery (19 studies) ranged from 8 to 85 years (mean 37.1 years). Twenty studies assessed surgically treated participants only, [11][12][13]23,[25][26][27][28][29][31][32][33]36,37,[39][40][41][42][43][44] whereas 2 studies assessed both surgically and nonsurgically treated participants. 24,30 Evidence of radiographic TF OA in the surgical knee was compared with the uninjured contralateral knee in 10 studies, 11,13,27,29,31,33,36,[40][41][42] and to an uninjured control group in 2 studies. ...
... Twenty studies assessed surgically treated participants only, [11][12][13]23,[25][26][27][28][29][31][32][33]36,37,[39][40][41][42][43][44] whereas 2 studies assessed both surgically and nonsurgically treated participants. 24,30 Evidence of radiographic TF OA in the surgical knee was compared with the uninjured contralateral knee in 10 studies, 11,13,27,29,31,33,36,[40][41][42] and to an uninjured control group in 2 studies. 24,30 Follow-up ranged from 5 to 22 years (mean 9.7 years) and included 2,306 knees. ...
... 24,30 Follow-up ranged from 5 to 22 years (mean 9.7 years) and included 2,306 knees. Thirteen studies had a mean follow-up between 5 and <10 years, [11][12][13]23,[25][26][27]31,32,36,37,42,43 whereas 7 studies 24,28,29,33,39-41 had a mean follow-up between 10 and <15 years, and 2 studies 30,44 had a mean follow-up *Age is reported as mean AE standard deviation and/or range across all study subjects who received arthroscopic partial meniscectomy unless otherwise indicated. There was some variability across studies in the radiologic classification system used to assess the development of TF OA, as well as in the specific radiographic views taken. ...
Article
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Purpose To assess the prevalence of tibiofemoral (TF) osteoarthritis (OA) following arthroscopic partial meniscectomy (APM) with a minimum follow-up of 5 years, to explore the prevalence of symptomatic TF OA, and to identify potential risk factors for the development of TF OA following APM. Methods An electronic search was conducted using PubMed, CINAHL, Pedro, AMED, Embase, the Cochrane Library, and clinicaltrials.gov. Prospective/retrospective studies including participants with a mean age ≥18 years old, undergoing isolated APM, reported radiographic assessment of knee OA as an outcome, had at least 5-year follow-up, and were written in English were included. Two authors extracted relevant data. Four authors assessed methodologic quality using the Center of Reviews and Dissemination and the Downs and Black checklist. The prevalence of TF OA after APM was reported for each study, with the range provided across studies for each time period (5 years to <10 years, 10 years to <15 years, ≥15 years). Results Twenty-two studies were included. Radiologic TF OA prevalence following APM ranged from 35% to 90%, 23% to 100%, and 52% to 57.7% at an average follow-up of 5 years to <10 years, 10 years to <15 years, and ≥15 years, respectively. Prevalence of symptomatic TF OA ranged from 24.1% to 67% according to individual operational definitions, with 2 studies reporting correlations between function and radiological findings. Conclusions APM results in a prevalence of radiographic TF OA ranging from 23% to 100% across follow-up periods of 5 or more years with the lowest prevalence reported between 5 and <10 years and the highest prevalence reported between 10 and <15 years follow-up. Considerably less data was available to assess symptomatic TF OA or risk factors associated with TF OA. Level of Evidence Level III, systematic review of Level II and III studies.
... ACL ruptures are often associated with meniscal [8,30,39] and cartilage lesions [5,12,30]. Partial or subtotal meniscal resection increases the pressure on the adjacent articular cartilage [3,5,9,17,27,30,33,36] that will result in osteoarthritis in the long run [2,9,16,24,27,36]. Sufficient surgical meniscus repair by suture protects affected knee joints from degeneration [3-5, 34, 36, 39]. ...
... ACL ruptures are often associated with meniscal [8,30,39] and cartilage lesions [5,12,30]. Partial or subtotal meniscal resection increases the pressure on the adjacent articular cartilage [3,5,9,17,27,30,33,36] that will result in osteoarthritis in the long run [2,9,16,24,27,36]. Sufficient surgical meniscus repair by suture protects affected knee joints from degeneration [3-5, 34, 36, 39]. ...
... ACL repair after more than 12 months is considered rather late for restoring ACL stability, but even more for repairing meniscal lesions [16,41]. Because of the prognostic importance of repairing meniscal lesions [36], we used a cut-off level of 6 months after ACL trauma in our study. To our knowledge, only one other study used a cut-off of 6 months between the time of ACL trauma and ACL reconstruction [1]. ...
Article
Full-text available
Purpose Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6 months after injury to that of surgery conducted 7–12 months after injury with regard to the incidence of meniscal and cartilage lesions. Methods This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1 year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options. Results Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3 % of surgical interventions were conducted within 6 months and 13.7 % after 6 months of trauma. Severe cartilage lesions grade III–IV did not significantly differ between the different time points of ACL repair (<6 months 39.9 %; >6 months 31.3 %; p = n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6 months 77.2 %, >6 months 46.7; p = 0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5–0 %; p = 0.002), however, not for men (73.3–53.8 %; p = n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p = n.s.) nor the sex (p = n.s.). Conclusions Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6 months after trauma was made to preserve the meniscus and reduce the risk of developing OA. Level of evidence Prospective cross-sectional cohort study, Level II.
... Meniscectomy and meniscal repair are two surgical options to treat meniscal lesions. Meniscectomy is known to incur a long-term risk of osteoarthritis [1][2][3][4][5][6][7][8][9][10], while meniscal repair has a more difficult immediate postoperative course [11][12][13][14][15], with higher rates of surgical revision and complications [16][17][18][19][20]. ...
... There are numerous reports of results in meniscectomy [2][3][4][5][6][7][8]10,[22][23][24] and meniscal repair [25][26][27][28][29], comparisons between the two [20,30,31] and meta-analyses [32][33][34]. Interpretation, however, is hindered by numerous biases: meniscal surgery was either isolated or associated to anterior cruciate ligament surgery; patient ages and clinical and radiological assessment scoring systems differed; follow-up was short or variable; and initial meniscal lesion type, repair technique, meniscectomy extent and initial chondral status were not always specified. ...
Article
Full-text available
Introduction: Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy. Patients and method: A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10-13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45±12.3 years (range, 9-47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. Results: Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98±4.69 versus 77.38±21.97 for symptoms (P=0.0043), 96.89±7.20 versus 78.57±18.9 for pain (P=0.0052), 99.89±0.33 versus 80.88±19.6 for daily life activities (P=0.0002), 96.11±9.83 versus 54.05±32.85 for sport and leisure (P=0.0005), but 91±16.87 versus 68.15±37.7 for quality of life (P=0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22±0.44) in-group R and 2 (mean, 2.19±0.98) in group M (P<0.0001). Discussion: At more than 10year's follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. Level of evidence: IV; retrospective study.
... Meniscectomy and meniscal repair are two surgical options to treat meniscal lesions. Meniscectomy is known to incur a long-term risk of osteoarthritis [1][2][3][4][5][6][7][8][9][10], while meniscal repair has a more difficult immediate postoperative course [11][12][13][14][15], with higher rates of surgical revision and complications [16][17][18][19][20]. ...
... There are numerous reports of results in meniscectomy [2][3][4][5][6][7][8]10,[22][23][24] and meniscal repair [25][26][27][28][29], comparisons between the two [20,30,31] and meta-analyses [32][33][34]. Interpretation, however, is hindered by numerous biases: meniscal surgery was either isolated or associated to anterior cruciate ligament surgery; patient ages and clinical and radiological assessment scoring systems differed; follow-up was short or variable; and initial meniscal lesion type, repair technique, meniscectomy extent and initial chondral status were not always specified. ...
... Meniscectomy and meniscal repair are two surgical options to treat meniscal lesions. Meniscectomy is known to incur a long-term risk of osteoarthritis [1][2][3][4][5][6][7][8][9][10], while meniscal repair has a more difficult immediate postoperative course [11][12][13][14][15], with higher rates of surgical revision and complications [16][17][18][19][20]. ...
... There are numerous reports of results in meniscectomy [2][3][4][5][6][7][8]10,[22][23][24] and meniscal repair [25][26][27][28][29], comparisons between the two [20,30,31] and meta-analyses [32][33][34]. Interpretation, however, is hindered by numerous biases: meniscal surgery was either isolated or associated to anterior cruciate ligament surgery; patient ages and clinical and radiological assessment scoring systems differed; follow-up was short or variable; and initial meniscal lesion type, repair technique, meniscectomy extent and initial chondral status were not always specified. ...
... Meniscectomy and meniscal repair are two surgical options to treat meniscal lesions. Meniscectomy is known to incur a long-term risk of osteoarthritis [1][2][3][4][5][6][7][8][9][10], while meniscal repair has a more difficult immediate postoperative course [11][12][13][14][15], with higher rates of surgical revision and complications [16][17][18][19][20]. ...
... There are numerous reports of results in meniscectomy [2][3][4][5][6][7][8]10,[22][23][24] and meniscal repair [25][26][27][28][29], comparisons between the two [20,30,31] and meta-analyses [32][33][34]. Interpretation, however, is hindered by numerous biases: meniscal surgery was either isolated or associated to anterior cruciate ligament surgery; patient ages and clinical and radiological assessment scoring systems differed; follow-up was short or variable; and initial meniscal lesion type, repair technique, meniscectomy extent and initial chondral status were not always specified. ...
Article
Introduction: Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy. Patients and method: A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10–13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45 ± 12.3 years (range, 9–47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. Results: Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98 ± 4.69 versus 77.38 ± 21.97 for symptoms (P = 0.0043), 96.89 ± 7.20 versus 78.57 ± 18.9 for pain (P = 0.0052), 99.89 ± 0.33 versus 80.88 ± 19.6 for daily life activities (P = 0.0002), 96.11 ± 9.83 versus 54.05 ± 32.85 for sport and leisure (P = 0.0005), but 91 ± 16.87 versus 68.15 ± 37.7 for quality of life (P = 0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22 ± 0.44) in-group R and 2 (mean, 2.19 ± 0.98) in group M (P < 0.0001). Discussion: At more than 10 year’s follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. Level of evidence: IV; retrospective study.
... Between 1982 and 1991, Scheller et al. [24] also conducted a retrospective case-control study to determine the clinical, functional and radiographic long-term results of patients who underwent APLM in an otherwise normal knee. The series was composed of 107 APLM, and 75 of these patients had an isolated lateral meniscal tear. ...
... Again deterioration of functional and especially radiographic results occurred with time, and the longer the follow-up, the more radiographic changes have to be expected. In spite of the high percentage of radiological changes, no significant correlation between subjective symptoms nor with functional outcome could be established [24]. ...
Chapter
The menisci perform crucial tasks for the normal functioning and homeostasis of the knee. Meniscus removal, which is still necessary in many instances, reduces the contact areas and increases the peak stresses in the femorotibial joint which in turn may cause cartilage wear, pain and loss of knee function. The greater the tissue mass excised, the more important the degenerative changes. This process, so-called postmeniscectomy syndrome, is worse in the lateral compartment, due to its particular features. Arthroscopic partial lateral meniscectomies gives excellent short-term outcomes. However, their results deteriorate overtime and are associated with a high incidence of arthritic changes and low functional outcomes. A cautious meniscal removal policy is warranted to avoid these deleterious effects.
... I n recent years there has been an increased emphasis on meniscus-preserving treatments over partial or total meniscectomy because of a reported risk of degenerative changes in the tibiofemoral articular cartilage. [1][2][3][4][5][6] As a load is placed on the knee, the meniscus functions to convert axial loads into circumferentially oriented hoop stresses, thereby sparing the articular cartilage from excessive stress that may lead to arthritic changes. 7,8 When meniscus tissue is lost or damaged, increased peak and mean contact pressures are transmitted to the tibial plateau because of decreased meniscus contact areas and disruption of circumferential load-transmitting meniscus fibers. ...
Article
The purpose of this study was to evaluate the clinical and structural outcomes after resorbable collagen meniscus scaffold implantation through a systematic review of the published literature. A systematic search of both the PubMed and Embase databases was undertaken to identify all studies that reported clinical and/or structural outcomes after resorbable collagen meniscus scaffold implantation for the treatment of defects involving either the medial or lateral meniscus. Extracted data included study characteristics; surgical methods and rehabilitation protocols; objective outcomes; and preoperative and postoperative subjective outcome scores including Lysholm, Tegner, International Knee Documentation Committee, and visual analog scale scores. Thirteen studies were included in this review. There were 10 Level IV studies, 2 Level II studies, and 1 Level I study with follow-up intervals ranging from 3 months to 12.5 years. With a few exceptions, the study designs used in each study generally followed those which had been previously performed. Substantial differences in rehabilitation protocols and concomitant procedures were noted that may have had an effect on overall clinical outcomes. Objective findings were mostly consistent and typically showed minimal degenerative changes on postoperative radiographs, decreased signal intensity of the scaffold over time on magnetic resonance imaging, the presence of meniscus-like tissue at second-look arthroscopy, and good integration of new tissue as evidenced by histologic analysis of biopsy specimens. Most studies reported satisfactory clinical outcomes, and most patients showed substantial improvements in comparison with mean preoperative baseline values. On the basis of this systematic review, implantation of resorbable collagen scaffolds for the treatment of meniscus defects provides satisfactory clinical and structural outcomes in most cases. There is evidence that collagen meniscus scaffold implantation provides superior clinical outcomes when compared with partial meniscectomy alone. Level IV, systematic review of Level I, II, and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
... Historically, surgeons treated meniscal tears with total meniscectomy which led to radiographic findings of osteoarthritis. [4][5][6] The poor outcomes associated with meniscectomy has increased interest in meniscal preservation and repair. 7 The goals of meniscal surgery are to reduce mechanical symptoms and pain and restore the function of the meniscus, while preserving the maximal amount of meniscal tissue. ...
Article
Meniscal injury is a common knee injury in a young athletic population. Maintaining the integrity of the meniscus is critical to reducing contact pressures on the tibiofemoral articulation. The purpose of this study is to analyze the outcomes of meniscal repair in a young military population. We conducted a retrospective review of all meniscal repairs performed on active duty Army personnel at a Military Medical Center from January 2002 to December 2012. One hundred seventy-eight active duty patients, mean age 28 (19-48) years underwent 178 meniscal repairs. Postoperatively, 33 (18.5%) patients were medically separated from the military at an average time of 29 months. Fifty (28%) patients required a permanent duty restricting profile. Ninety-five (53.5%) patients required no profile after meniscal repair at an average follow-up of 5 (1.5-12.3) years. Meniscal repair in this young military population allowed 81.5% of patients to return to duty; however, 34% of those required a permanent duty restricting profile. Approximately 20% of patients required medical separation from the military after meniscal repair. Older age was significantly associated with the ability to remain on active duty ( p = 0.01). © Association of Military Surgeons of the U.S. All rights reserved.
... Meniscectomy-the surgical removal of a portion or the entirety of an injured meniscus-is one of the most frequently performed orthopedic procedures [1] . It is known, however, to have deleterious consequences such as degenerative joint changes and accelerated onset of osteoarthritis (OA) [2,3] . Accurate assessment of the effects of meniscectomy on joint motion and contact congruity is an initial but critical step in understanding how patho-mechanics instigates the development of OA [4] . ...
Article
Full-text available
We investigated the effects of isolated meniscectomy on tibiofemoral skeletal kinematics and cartilage contact arthrokinematics in vivo. We recruited nine patients who had undergone isolated medial or lateral meniscectomy, and used a dynamic stereo-radiography (DSX) system to image the patients' knee motion during decline walking. A volumetric model-based tracking process determined 3D tibiofemoral kinematics from the recorded DSX images. Cartilage contact arthrokinematics was derived from the intersection between tibial and femoral cartilage models co-registered to the bones. The kinematics and arthrokinematics were analyzed for early stance and loading response phase (30% of a gait cycle), comparing the affected and intact knees. Results showed that four patients with medial meniscectomy had significantly greater contact centroid excursions in the meniscectomized medial compartments while five patients with lateral meniscectomy had significantly greater cartilage contact area and lateral shift of contact centroid path in the meniscectomized lateral compartments, comparing to those of the same compartments in the contralateral intact knees. No consistent difference however was identified in the skeletal kinematics. The current study demonstrated that cartilage-based intra-articular arthrokinematics is more sensitive and insightful than the skeletal kinematics in assessing the meniscectomy effects.
... While tears in the peripheral vascularized zone of the meniscus may undergo surgical repair, the vast majority of meniscus tears are treated with partial meniscectomy [2,3]. Clinical outcome following partial meniscectomy is generally good especially in the younger patient population [4][5][6][7]. However, many individuals sustain subsequent knee injuries or have persistent pain following surgery which requires additional evaluation to exclude the possibility of a re-tear of the post-operative meniscus. ...
Article
Full-text available
Objective: To compare magnetic resonance imaging (MRI) characteristics of torn and untorn post-operative menisci. Methods: The study group consisted of 140 patients with 148 partially resected menisci who were evaluated with a repeat knee MRI examination and subsequent repeat arthroscopic knee surgery. Two musculoskeletal radiologists retrospectively assessed the following MRI characteristics of the post-operative meniscus: contour (smooth or irregular), T2 line through the meniscus (no line, intermediate signal line, intermediate-to-high signal line, and high fluid-like signal line), displaced meniscus fragment, and change in signal pattern through the meniscus compared with baseline MRI. Positive predictive values (PPV) and negative predictive values (NPV) were calculated using arthroscopy as the reference standard. Results: All 36 post-operative menisci with no T2 line were untorn at surgery (100% NPV), whereas 46 of the 79 post-operative menisci with intermediate T2 line, 16 of the 18 post-operative menisci with intermediate-to-high T2 line, and 14 of the 15 post-operative menisci with high T2 line were torn at surgery (58.2%, 88.9%, and 93.3% PPV respectively). Additional MRI characteristics associated with torn post-operative meniscus at surgery were irregular meniscus contour (PPV 85.7%), displaced meniscus fragment (PPV 100%), and change in signal pattern through the meniscus (PPV 99.4%). Conclusions: Post-operative menisci with no T2 signal line were untorn at surgery. The most useful MRI characteristics for predicting torn post-operative menisci at surgery were change in signal pattern through the meniscus compared with baseline MRI, and displaced meniscus fragment followed by high T2 line through the meniscus, intermediate-to-high T2 line through the meniscus, and irregular meniscus contour.
... This functionality is strongly affected by various lesions. For example, Scheller et al. (2001) found frequent degenerative changes after meniscectomy. Similar degenerative changes were reported by Jackson (1968) and Crevoisier et al. (2001). ...
Article
Objective. A three-dimensional finite-elements model of the femorofibial joint was developed to identify contact areas and the distribution of pressures between the meniscus and articular cartilage, and to investigate the effects of meniscectomy. Materials and methods. Using images of a healthy knee obtained by magnetic resonance imaging (MRI), a finite-element geometric model was prepared and different types of meniscectomy were modeled. We studied the behavior of the knee in different situations to analyze the effects on the articular cartilage: healthy meniscus, meniscal tear, after partial meniscectomy, and after total meniscectomy. Results. In the model of a longitudinal meniscal tear, the appearance of traction forces at the edge of the meniscal injury could explain the instability of these lesions and their propagation. In the partial meniscectomy model, compression of the articular cartilage increased in zones that were initially unloaded. Finally, in the total meniscectomy model, the lateral meniscus absorbed all the contact, resulting in important changes in the cartilage of the lateral femoral condyle. Conclusions. In view of the results obtained, we conclude that both the zone and amount of meniscal tissue removed are influential factors. In addition, meniscal tears are unstable in the long term. Likewise, we confirmed that partial meniscectomy alters normal joint behavior, particularly the articular cartilage, by increasing compression forces by up to 126%, which could explain the resulting deterioration.
... Auch schon bei der partiel-len Meniskektomie treten durch die verminderte femorotibiale Kontaktfläche und der gestörten femorotibialen Kraftübertragung stark erhöhte Spitzenkontaktdrücke im betroffenen Kompartiment auf [5,6]. Die hierdurch vorzeitig auftretenden arthrotischen Veränderungen im Mittel-bis Langzeitverlauf sind sowohl klinisch als auch radiologisch verifizierbar [7][8][9]. ...
Article
Full-text available
Knieverletzungen beim Sportler gehen häufig mit Meniskusschäden einher. Primäres Ziel sollte immer der Versuch einer Meniskusnaht sein. Ist diese nicht durchführbar, besteht die Alternative eines Me-niskusteilersatzes durch Implantate. Derzeit sind mit dem Collagen Meniskus Implantat (CMI) sowie dem Actifit 2 Me-niskusimplantate zugelassen. Sowohl die Mittel-und Lang-zeitergebnisse über das seit fast 20 Jahren im Einsatz befindli-che CMI als auch die neuen Studien zu dem erst seit 2008 zugelassenen Actifit zeigen positive Ergebnisse bzgl. der Ver-besserung der klinischen Scores sowie einer langsameren Progression von arthrotischen Veränderungen im Vergleich zur Meniskusteilresektion. Daher ist der Einsatz beim Sportler bei entsprechender Indikation und mit Berücksichtigung der Begleitpathologien sowohl primär nach Trauma als auch se-kundär, z.B. nach Karriereende beim Profisportler, zu empfehlen. Knee injuries in athletes are frequently associated with meniscal tears. The primary goal should always be an attempt at meniscal repair. If this is not feasible there is the alternative of a partial meniscal replacement by implants. With the CMI and the Actifit there are currently 2 meniscal implants approved. The medium-to long-term results of nearly 20 years of experience for the CMI and the new studies for Actifit, approved in 2008, show positive results regarding the improvement of clinical scores as well as a slower progression of osteoarthritis compared to partial me-niscectomy. Therefore the use in athletes can be recommended when indicated, with consideration of the concomi-tant pathologies, primarily after trauma or secondary, for example at the end of career for professional athletes.
... Poor long-term clinical results have been reported by many investigators following partial and total meniscectomy. 8,49,75,118,125,139,170,181,183,184,189,199 For instance, Scheller and coworkers 189 followed 75 patients who underwent partial lateral meniscectomy 5 to 15 years postoperatively and noted that 78% had Fairbank ' s signs of radiographic deterioration. Rockborn and Messner 181 reported a 50% rate of radiographic osteoarthritis in 30 patients a mean of 13 years after meniscectomy. ...
... The lateral compartment is more often affected because the load distribution is more frequently modified following lateral meniscectomy [21] , and because the lateral meniscus absorbs 70 % of the lateral load whereas the medial meniscus absorbs only 50 % [22] . After a meniscectomy, there is sagittal , frontal and rotational articular instability [23, 24] that can go unnoticed on physical examination [25], but it can, according to some authors [4] , favor chondrolysis, especially if it is associated with intense physical activity. In our case, we hypothesize that there is medial damage due to excessive pressure post-meniscectomy causing probable articular damage. ...
Article
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Background: Rapidly destructive osteoarthritis of the hip and rapid chondrolysis of the lateral compartment of the knee or the shoulder are rare, but have been previously described in the medical literature. To the best of our knowledge, no case of medial femorotibial compartment chondrolysis after arthroscopy has yet been described. We therefore submit the first case report. Case presentation: A 64-year-old white European man presented with right knee pain due to a medial meniscal tear with no other abnormality found on examination or imaging. An arthroscopic partial medial meniscectomy was performed and early evolution was favorable with no signs of infection. He developed knee pain 2 months later. X-rays showed a thinning of the medial compartment which was confirmed by computed tomography arthrogram. There was no articular effusion, mobility was conserved (0/0/125°), there was no laxity, and pain was localized to the medial femorotibial compartment, with no meniscal signs. There was a 8° varus deviation (versus 3° for his uninjured left knee). His blood work was normal. As there were no signs of infection, no aspiration was performed. Viscosupplementation was offered but refused by the patient. He is now waiting for a partial knee replacement. Conclusions: To the best of our knowledge, this is the first description of such a case. Rapid chondrolysis has been described in the hip, shoulder, and the lateral compartment of the knee. Infiltration of bupivacaine and lateral meniscectomy are the most frequently sited offending procedures. Concerning the medial compartment, cases of avascular necrosis have been reported after meniscectomy or use of radiofrequency devices. This case underlines the necessity of a thorough physical examination and complete radiological work up before any surgery. It must also drive us to use caution regarding meniscectomy, especially in patients over 60 years of age, and reminds us that patients must be informed of this potential complication.
... [18][19][20][21][22] X-ray images after resection of the lateral meniscus has shown osteoarthritis in 38% to 84% of knees. [12,18,23,24] Age >40 years, obesity (BMI> 30 kg/m 2 ), lower limb alignment (valgus knee), and cartilage degeneration during initial arthroscopy were found to be risk factors for osteoarthritis after resection of the lateral meniscus. [12] Moreover, the risk of OA is higher after total than partial resection of the meniscus, [22] with stress being positively associated with the extent of meniscal resection, particularly following total resection of the meniscus with the 3D finite element knee model. ...
Article
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The aim of this study was to perform quantitative evaluation of degeneration of joint cartilage using T2 mapping in magnetic resonance imaging (MRI) after arthroscopic partial resection of the lateral meniscus. The subjects were 21 patients (23 knees) treated with arthroscopic partial resection of the lateral meniscus. MRI was performed for all knees before surgery and 6 months after surgery to evaluate the center of the lateral condyle of the femur in sagittal images for T2 mapping. Ten regions of interest (ROIs) on the articular cartilage were established at 10-degree intervals, from the point at which the femur shaft crossed the lateral femoral condyle joint to the articular cartilage 90° relative to the femur shaft. Preoperative and postoperative T2 values were evaluated at each ROI. Age, sex, body mass index, femorotibial angle, Tegner score, and amount of meniscal resection were evaluated when the T2 value increased more than 6% at 30°. T2 values at approximately 10 °, 20 °, 30 °, 40 °, 50 °, and 60 ° degrees relative to the anatomical axis of the femur were significantly greater postoperatively (3.1, 3.6, 5.5, 4.4, 5.0, 6.4%, respectively) than preoperatively. A >6% increase at 30° was associated with total resection of any segment of the meniscus. Degeneration of the articular cartilage, as shown by the disorganization of collagen arrays at positions approximately 10 °, 20 °, 30 °, 40 °, 50 °, and 60 ° relative to the anatomical axis of the femur, may start soon after arthroscopic lateral meniscectomy. Total resection of any segment of the lateral meniscus may cause T2 elevation of articular cartilage of lateral femoral condyle.
... However, that study did not look at the status of the meniscus at the time of rACLR. The current study confirms that an intact meniscus at the time of rACLR reduces the risk of articular cartilage damage which is not surprising given that meniscus tears are associated with chondrosis and osteoarthritis in the knee 5,25,31,36,38 . While one previous study reported six times more arthrosis in knees with concomitant partial meniscectomy at the time of ACL reconstruction 28 , another study did not find any association between the development of arthrosis and meniscal injury at the time of ACL reconstruction 12 . ...
Article
Knees undergoing revision anterior cruciate ligament reconstruction (rACLR) have a high prevalence of articular cartilage lesions. The prevalence of chondrosis at the time of rACLR is associated with meniscal status and lower extremity alignment. Cross-sectional study; Level of evidence, 3. Data from the prospective Multicenter ACL Revision Study (MARS) cohort were reviewed to identify patients with preoperative lower extremity alignment films. Lower extremity alignment was defined by the weightbearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weightbearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Mean (±SD) patient age was 26.9 ± 9.5 years and body mass index (BMI) was 26.4 ± 4.6. The medial compartment had more chondrosis (grade 2/3, 42%; grade 4, 6.5%) than did the lateral compartment (grade 2/3, 26%; grade 4, 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The mean WBL was 0.43 ± 0.13. Medial compartment chondrosis was associated with BMI (P = .025), alignment (P = .002), and medial meniscal status (P = .001). None of the knees with the WBL lateral to 0.625 had grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (P = .013) and lateral meniscal status (P < .001). Subjects with "intact" menisci were found to decrease their odds of having chondrosis by 64% to 84%. The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower extremity alignment and BMI are associated with medial compartment chondrosis. © 2015 The Author(s).
... The important protective role of the lateral meniscus for the cartilage (Beaufils et al. 2006) is reflected in the correlation of thickness between the articular cartilage in the submeniscal periphery and the lateral meniscus. The clinical observation that cartilage lesions proceed much faster after lateral than after medial meniscectomy, and that the clinical outcomes of lateral meniscectomy are significantly worse than after medial meniscectomy underscore the delicate balance between the lateral meniscus and the articular cartilage (Bolano & Grana 1993;Hoser et al. 2001;Macnicol & Thomas 2000;Scheller et al. 2001;Heijink et al. 2012). As valgus HTO leads to an increase in the pressure in the lateral compartment, the subsequent question was whether HTO results in structural changes in the lateral tibiofemoral osteochondral unit and lateral meniscus, and whether these changes depend in the extent of correction; reflective of the pressure in the lateral compartment. ...
Article
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Large animal models play a crucial role in sports surgery of the knee, as they are critical for the exploration of new experimental strategies and the clinical translation of novel techniques. The purpose of this contribution is to provide critical aspects of relevant animal models in this field, with a focus on paediatric anterior cruciate ligament (ACL) reconstruction, high tibial osteotomy, and articular cartilage repair. Although there is no single large animal model strictly replicating the human knee joint, the sheep stifle joint shares strong similarities. Studies in large animal models of paediatric ACL reconstruction identified specific risk factors associated with the different surgical techniques. The sheep model of high tibial osteotomy is a powerful new tool to advance the understanding of the effect of axial alignment on the lower extremity on specific issues of the knee joint. Large animal models of both focal chondral and osteochondral defects and of osteoarthritis have brought new findings about the mechanisms of cartilage repair and treatment options. The clinical application of a magnetic device for targeted cell delivery serves as a suitable example of how data from such animal models are directly translated into in clinical cartilage repair. As novel insights from studies in these translational models will advance the basic science, close cooperation in this important field of clinical translation will improve current reconstructive surgical options and open novel avenues for regenerative therapies of musculoskeletal disorders.
... [22][23][24] Paletta et al. 25 demonstrated the biomechanical importance of root fixation, and a recent meta-analysis found that the technique of root fixation did not influence clinical outcomes. 26 While radiographic and clinical findings do not always correlate, multiple authors have found radiographic signs of severe degenerative changes as well as symptoms of pain and dysfunction in patients with previous total meniscectomy at 17 to 22 years postoperatively 5 and 5 to 15 years postoperatively, 27 including in 89% of patients at 14.5 years postmeniscectomy. 28 In 1983, Northmore-Ball et al. 29 published a study showing far higher postoperative satisfaction following arthroscopic partial meniscectomy than following open total meniscectomy (90% vs. 68%). ...
Article
Objective: To identify the 50 most-cited articles in meniscal allograft transplantation (MAT) research and analyze their characteristics. Design: In September 2017, the Scopus database was queried to identify the 50 most-cited articles in MAT research. Variables analyzed include number of citations, publication year, journal, institution, country of origin, article type, study design, and level of evidence. Citation density was calculated for each article. The correlation between citation density and publication year and the correlation between level of evidence and number of citations, citation density, and publication year were computed. Results: The 50 most-cited articles were published in 12 journals between 1986 and 2011. The number of citations ranged from 59 to 290 (109.3 ± 48.6). Citation density ranged from 2.7 to 17.6 citations per year (7.0 ± 3.3). There was a positive correlation between citation density and publication year ( r = +0.489, P < 0.001). Overall, 56% of the articles were clinical and 44% were basic science. Of the 28 clinical articles, 61% were level IV or V evidence. Level of evidence was not significantly correlated with number of citations ( r = -0.059, P = 0.766), citation density ( r = +0.030, P = 0.880), or publication year ( r = -0.0009, P = 0.996). Conclusion: This analysis provides the orthopedic community with a readily accessible list of the classic citations in MAT research and provides insight into the historical development of this procedure. Although there was a moderate positive correlation between citation density and publication year, articles with stronger levels of evidence were not more frequently cited despite the increasing trend toward evidence-based practice.
... Furthermore, although partial meniscectomy is considered the mainstay of treatment for radial/oblique tears, meniscectomy has unfavorable effects on contact mechanics [4]. Consequently, the incidence of degenerative and osteoarthritic changes increases markedly [7,8]. ...
Article
Background: Radial/oblique tears of the midbody of the lateral meniscus significantly impair the ability of the meniscus to withstand the tibiofemoral load, requiring meniscal repair. However, healing status after meniscal repair has not been fully elucidated. This study aimed to evaluate arthroscopic findings after inside-out suture repair for isolated radial/oblique tears of the midbody of the lateral meniscus. Methods: From 2011 to 2015, 18 consecutive patients with isolated radial/oblique tears of the midbody of the lateral meniscus underwent arthroscopic inside-out repair with the tie-grip suture technique. All knees were stable with no previous surgery. All patients were evaluated by second-look arthroscopy at six months postoperatively. Activities including jogging were not allowed until meniscal status was evaluated arthroscopically. To analyze factors associated with healing rates, age, time from injury to initial surgery, and tear zone were compared. Results: Second-look arthroscopy revealed complete healing in four (22%) patients, partial healing in seven (39%), and failure to heal in seven (39%). Significant differences were observed for tear zone (p < 0.0001), but not for age and timing of repair. Conclusions: Arthroscopic evaluation revealed that inside-out repair with the tie-grip suture technique for isolated radial/oblique tears of the midbody of the lateral meniscus achieved complete or partial healing only in 61% of patients. Satisfactory results were observed particularly in patients with tears extending to the vascular zone, whereas those with tears in the avascular zone failed to achieve healing. Therefore, the operative indication of inside-out repair for radial/oblique tears of the midbody of the lateral meniscus might be limited to tears extending into the vascular zone. Given that 39% of cases were arthroscopically considered a failure even if patients complained of no symptoms in daily life, decisions should be made carefully to allow patients to return to sports activities.
... Before 1950, surgeons preferred to perform total meniscectomy for all meniscal tears, but later, began to perform partial meniscectomy to preserve as much meniscus as possible [8][9][10][11]. This is due to the fact that total meniscectomies caused more damage than partial meniscectomies [12][13][14] and long-term follow-up studies have shown a high rate of reoperations after total meniscectomies [15]. Especially, when the tear occurs in the avascular zone that includes less blood supply than in other zone of menisci, partial meniscectomy becomes standard treatment [16]. ...
Article
The menisci play a vital role in the mechanical function of knee joint. Unfortunately, meniscal tears often occur. Meniscectomy is a surgical treatment for meniscal tears, however, mechanical changes in the knee joint after meniscectomy is a risk factor to osteoarthritis. The objective of this study was to investigate the altered cartilage mechanics of different medial meniscectomies using a poromechanical model of the knee joint. The cartilaginous tissues were modeled as nonlinear fibril-reinforced porous materials with full saturation. A compressive creep load of ¾ body weight was applied in full extension of the right knee during 200 seconds standing. Four finite element models were developed to simulate different meniscectomies of the joint using the intact model as the reference for comparison. The modeling results showed a higher load support in the lateral than medial compartment in the intact joint, and the difference in the load share between the compartments was augmented with medial meniscectomy. Similarly, the contact and fluid pressures were higher in the lateral compartment. On the other hand, the medial meniscus in the normal joint experienced more loading than the lateral one. Furthermore, the contact pressure distribution changed with creep, resulting in a load transfer between cartilage and meniscus within each compartment while the total load born by the compartment remained unchanged. The present study has quantified the altered contact mechanics on the type and size of meniscectomies, which may be used to understand meniscal tear or support surgical decisions.
... The deleterious effects of meniscectomy on tibiofemoral compartment articular cartilage have been demonstrated in multiple experimental studies [8,21,[31][32][33][34]. In addition, poor long-term clinical results have been reported by many investigators following partial and total meniscectomy [11,14,[35][36][37][38][39][40][41][42][43]. Meniscus tears frequently occur simultaneously with anterior cruciate ligament (ACL) ruptures [44][45][46][47]. ...
Chapter
This chapter summarizes data in the current literature regarding return to sport (RTS) after meniscus surgery from 58 studies encompassing 2755 patients. There were 755 patients in 15 studies that underwent meniscectomy, 948 patients in 25 studies that had meniscus repair, and 1052 patients in 18 studies that underwent meniscus transplantation. Rates for return to preinjury sport, return to any type of sport, failures (meniscus repairs and transplants), and progression of knee osteoarthritis are provided. An analysis of the postoperative rehabilitation criteria for RTS described by each study is presented. Although high RTS rates were noted in a few meniscectomy studies in this chapter, these were offset by deterioration in radiographic knee osteoarthritis in 60–90% of patients followed >6 years postoperatively. A recommendation is made to preserve meniscus tissue and function through modern repair procedures whenever possible, especially in children and adolescent athletes. While sports are feasible after meniscus transplantation, the majority of studies recommend return to only low-impact or general athletic training due to pre-existing articular cartilage damage.
... There are several studies with midterm to long-term follow-up showing good clinical outcomes and patient satisfaction after APMs for degenerative meniscal tears. [4][5][6][7] However, more recent randomized controlled trials (RCTs) have shown no difference in outcomes between APM and conservative management or sham surgery. [8][9][10][11] There have been major methodologic criticisms of these RCTs, such as the lack of patients with mechanical symptoms and the high rates of crossover into the APM group, that have resulted in various guidelines recommending APM for symptomatic degenerative meniscal tears that persist despite a course of conservative management. ...
Article
Purpose: To report the trends in arthroscopic partial meniscectomy (APM) for degenerative meniscal tears in a large private insurance database among patients older than 50 years. Methods: The Humana database between 2007 and 2015 was queried for this study. Patients meeting the inclusion criteria with degenerative meniscal tears who underwent APMs were identified by International Classification of Diseases, Ninth Revision codes, followed by Current Procedural Terminology codes. A linear regression analysis was performed with a significance level set at F < 0.05. Results: A total of 21,759 APMs were performed between 2007 and 2015 in patients older than 50 years. Normalized data for total yearly enrollment showed a significant increase in APMs performed from 2007 to 2010 (R2 = 0.986, P = .007). The average percentage increase per year from 2007 to 2010 was 18.59%. However, there was a significant decrease in APMs performed from 2010 to 2015 (R2 = 0.748, P = .026). The average percentage decrease per year from 2010 to 2015 was 7.74%. The percentage decrease overall from 2010 to 2015 was 71.68%. No difference in statistical significance was found when age was broken into 5-year age intervals. We found a significant difference in APM based on region (P < .001). Conclusions: The rate of APMs in patients older than 50 years increased from 2007 until 2010. Since 2010, the rate of APMs in patients older than 50 years has significantly decreased. These trends are likely multifactorial. Regardless of cause, it appears that the orthopaedic surgery community is performing fewer APMs in this patient population. Level of evidence: Level III, retrospective database epidemiological study.
... Meanwhile, with respect to long-term surgery satisfaction after spinal surgery, studies of 8-10 years' follow-up period in patients with disc disorder or stenosis [37,38] reported that patients with stenosis who received surgical treatment and those who received nonsurgical treatment showed comparable levels of medical service satisfaction, whereas those with disc disorders who received surgical treatment were more satisfied with their current status. Among patients with knee disorders, those who received meniscectomy reported favorable prognosis in an 8-year follow-up [39]. ...
Article
Full-text available
This study aimed to assess the costs, health status, and medical service satisfaction with Korean and conventional medicine use before and after surgery of patients visiting Korean medicine hospitals for postsurgical musculoskeletal pain. The study population comprised patients who visited KM hospitals for the first time between June and November 2017 for persistent or recurrent pain and discomfort after low back, neck, shoulder, or knee surgery. Various validated questionnaires were used to collect data. A total of 100 participants were enrolled, and the majority had undergone low back surgery (n = 82). The participants had received 1.3 ± 0.7 magnetic resonance imaging (MRI) examinations and 2.4 ± 2.8 X-rays before surgery. Conventional interventions used before surgery were physical therapy (43%), medications (34%), and injections (28%), in descending order, while 48% of patients reported having received acupuncture 51.3 ± 81.1 times. The mean satisfaction score for surgery was 5.5 ± 2.8 points based on a 9-point Likert scale, while that for KM-based interventions was 6.3 ± 1.7 points. With respect to health-related information, the mean scores were 6.0 ± 2.2 points on the Numeric Rating Scale (NRS), 0.6 ± 0.2 points on the 5-Level EuroQol-5 Dimension (EQ-5D-5L), and 15.3 ± 10.2 on Beck’s Depression Index II (BDI-II). The mean score on the Oswestry Disability Index (ODI) in patients with low back pain was 40.1 ± 19.2 points. Work impairment, as measured using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH), was 62.5 ± 47.8%, while activity impairment was 5.9 ± 2.6%. Participants tended to show low satisfaction regarding surgery and high preference for KM-based interventions. In particular, low back surgery patients reported high ODI scores, indicating high dysfunctional levels and poor prognosis after surgery. It can be inferred that it is therefore important to provide appropriate presurgical and postsurgical care for patients with musculoskeletal pain to improve pain, function, and quality of life. 1. Introduction Musculoskeletal disorders refer to conditions in which pain or dysfunction in the muscles, ligaments, bones, or joints has occurred, generally due to injury or accumulative trauma, and low back and neck pain are reported to be the leading causes of disability and decreased quality of life [1]. Currently, chronic pain treatments include medications, such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants, and muscle relaxants, and nonpharmacological interventions, such as injections, implantable devices, and surgery. Various treatment modalities may be used in conjunction for more effective pain reduction [2]. Patients who are unable to achieve satisfactory pain relief using nonsurgical interventions often turn to surgical means. This behavior is partly reflected in the increasing trends in orthopedic surgery in Korea, where the number of spinal and joint surgery cases is steadily increasing. There was a 1.4-fold increase in the number of general spinal surgeries between 2007 and 2015; a 4-fold increase in the number of knee arthroplasties between 2001 and 2010; and a 10-fold increase in the number of rotator cuff surgeries between 2007 and 2015, respectively [3, 4]. While prevalence of spine and joint surgery steadily increases, many patients continue to suffer from persistent or recurrent pain after surgery, which incurs considerable medical expenditure and social burden. When such pain persists for 3 months or longer, it is referred to as chronic postsurgical pain (CPSP) [5, 6]. While the etiology and risk factors of CPSP have not yet been clearly identified, approximately 10–50% of patients undergoing surgery are known to experience CPSP [7]. Of surgery types, risk of CPSP is roughly 3 times higher for orthopedic surgery than other surgery types [8], which acts as an added difficultly in achieving satisfactory relief from pain and discomfort after orthopedic surgery. CPSP can lead to decreased satisfaction regarding medical services due to impeded postsurgical rehabilitation and decreased quality of life [9]. Medical service satisfaction is influenced by expectations patients have about received medical services, and postsurgical pain can be a major cause of dissatisfaction, especially in orthopedic surgery, as the main expectation from surgery in orthopedic surgery cases would be pain relief [10]. In Korea, the cost of surgery for disc disorders or stenosis is more than 9 times that of nonsurgical interventions [11], and CPSP increments the burden of medical expenses. In a US questionnaire survey on patients with posttraumatic and postsurgical neuropathic pain, the financial burden was reported to increase in linear fashion with pain intensity [12]. In many countries, including Korea, Japan, and China, complementary and alternative medicine (CAM) is used to treat pain, including postsurgical pain [13]. Conventional medicine and traditional Korean medicine (KM) coexist within the dual medical system in Korea, and, as a type of CAM, KM covers such treatments as acupuncture, cupping, moxibustion, pharmacopuncture, Chuna manual medicine, and herbal medicine. Patient satisfaction with CAM is generally high [14], with some patients seeking CAM due to dissatisfaction with conventional medicine treatment and outcomes [3]. In a questionnaire-based study on CAM (KM) in Korea, 47% of the respondents reported that they were equally satisfied with conventional medicine and CAM (KM), while 25% reported higher satisfaction with CAM (KM) [15]. Studies on medical service satisfaction and costs in CPSP patients are few, and those on usage and preference regarding integrative medicine or conventional and nonconventional medicine use are even scarcer. The present survey study therefore employed various validated questionnaires to comprehensively assess medical expenditure and satisfaction with regard to conventional and Korean medicine use in postsurgical patients who chose to visit KM hospitals for postsurgical musculoskeletal pain in Korea. 2. Materials and Methods 2.1. Characteristics of Participants and Research Institution The present study was designed as a multicenter, cross-sectional survey study targeting patients visiting KM hospitals for postsurgical musculoskeletal pain treatment. Jaseng Hospital of Korean Medicine (JHKM) is a spine-specialty hospital that employs integrative medicine consisting of conventional and Korean medicine [16], and the present study recruited patients from the main branch of JHKM located in Seoul and three branches located in Daejeon, Bucheon, and Busan, respectively. Inclusion criteria included patients with history of low back, neck, knee, or shoulder surgery visiting KM hospitals for the first time between June and November 2017. No promotional or advertising campaigns were conducted to recruit participants, and most participants visited JHKM based on personal choice and preference. 2.2. Procedures and Methods for Data Collection The preliminary consultation process was similar for all patients. As such, all patients with a chief complaint of low back, neck, knee, or shoulder pain with history of surgery were considered to be eligible. Among these patients, those who voluntarily consented to participate in the study were interviewed by the clinical investigator from each center to determine whether they met the inclusion/exclusion criteria. The inclusion criteria were as follows: having a chief complaint(s) of at least one or more of the following: low back pain (or radiating leg pain), neck pain (or radiating arm pain), knee pain, or shoulder pain; having a history of musculoskeletal surgery related to the chief complaint(s); being capable of effectively communicating with the researcher(s) and understanding the survey items; and providing written informed consent. The exclusion criteria were as follows: having no history of musculoskeletal surgery associated with the low back, neck, shoulder, or knee region(s); having pain that was mainly attributed to a traffic accident injury; being incapable of answering the interview and survey items; and having any other reason rendering study participation inappropriate, as judged by the researcher(s). 2.3. List of Data Collected Participants completed a questionnaire containing items about demographic information, surgery-related information, medical cost, and health status. Each participant required approximately 30 minutes to complete the questionnaire, and data for each item were collected by researchers following preliminary consultation, screening, and written informed consent and prior to treatment according to a predetermined standard operating procedure. 2.4. Sociodemographic and Surgery-Related Information For identification of basic information about the participants, data regarding age, sex, height, and weight were collected. Comorbidities consisted of only diseases that were being treated or controlled by medication at the time of the survey, including hypertension, diabetes, depression, cardiovascular disease, pulmonary disease, and gastrointestinal disease. Data were also collected on occupational status, alcohol consumption status, standardized alcohol consumption amount according to standards set by the Korea Ministry of Food and Drug Safety, smoking status, and amount of smoking. The site of previous surgery and site of major pain at the time of survey were checked. The participants were also asked to provide responses on the cause of pain that led to the initial surgery and associated medical costs. 2.5. Medical Costs before and after Surgery For in-depth analysis of the details of utilization of medical resources at different periods, the participants were instructed to provide answers to each question on utilization of medical resources before and after the initial surgery. The items were standardized for all pain regions, and participants were instructed to provide answers to questions pertaining to diagnoses, tests, and treatments involving the initial surgery site. Items were divided into conventional diagnostic tests, conventional interventions, KM diagnostic tests, and KM interventions. A list identifying Korean national health insurance coverage and noncoverage items was created. For participants who underwent two or more surgeries, “resurgery” was selected from the list of conventional interventions after surgery. For each medical service item, data were collected on the number of times the service was used and the mean cost per instance of service use. Data for conventional medications and herbal decoctions were calculated as daily cost. 2.6. Outcome Measures: Medical Service Satisfaction and Health Information To measure the medical service satisfaction of the participants with respect to the following five categories: initial surgery, conventional diagnostic tests, conventional interventions, KM diagnostic tests, and KM interventions, questions based on a 9-point Likert scale were used. The question asked was, “How helpful do you think this test or treatment was to your health? Please respond with 1 point for not helpful at all to 9 points for very helpful.” The participants who did not receive that particular test or treatment were also allowed to answer the question, to help determine individual preferences. To assess the current health status, quality of life, and degree of dysfunction of the participants, a health-related questionnaire survey was conducted. The survey used the Numeric Rating Scale (NRS), 5-Level EuroQol-5 Dimension (EQ-5D-5L), Beck’s Depression Index II (BDI-II), and Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH) scale. The NRS is widely used to assess the level of pain in patients with chronic pain [17]. It employs an 11-point scale for rating the “level of pain felt while performing daily activities today.” The EQ-5D-5L [18] comprises descriptive 5-level scale items and the EuroQol-Visual Analogue Scale (EQ-VAS). The present study used the validated Korean version of the EQ-5D-5L questionnaire provided by the EuroQol Group and the descriptive scale with formulas validated for the Korean population in calculating total scores. For functional assessment of the low back, neck, knee, and shoulder, validated Korean versions of the Oswestry Disability Index (ODI) [19], Neck Disability Index (NDI) [20], Western Ontario and McMaster Universities Arthritis Index (WOMAC) [21], and Shoulder Pain and Disability Index (SPADI) [22] were used, respectively. For these assessments, participants responded only to the scale that corresponded to their respective surgery site. A validated Korean version of the BDI-II [23], translated by Korean researchers, was used for the clinical assessment of depression. In keeping with recommendations of the Institutional Review Board (IRB) at JHKM, participants who were found to show borderline clinical depression or higher were told that they may need psychiatric counseling, separately from the study. The WPAI-GH is designed to estimate the influence of health status and disease-related symptoms on daily activity and work performance [24]. The present study used the officially supplied 6-item Korean version. The survey results were converted into the daily activity impairment percentage index calculated based on all patients’ scores and the work impairment percentage index calculated from participants who were actively employed. 2.7. Data Analysis The study was initially planned to classify participants into 4 groups according to surgery site (low back, neck, knee, and shoulder). However, as over 80% of participants was low back surgery patients, the patient population was dichotomized into the low back surgery and other surgery patient groups in actual analysis. The data from the completed questionnaires were processed by double entry method by two researchers (JHK, HYM). IBM SPSS version 25 was used to conduct the statistical analysis (SPSS Inc., Chicago, IL). Categorical variables were expressed as frequency and percentage, while continuous variables were expressed as mean ± standard deviation. was considered to be statistically significant. 3. Results A total of 16,657 patients visited one or more of the four KM hospital study sites during the study period. Among these patients, 232 were identified as having a past history of surgery that matched the site of their chief complaint. After excluding patients who did not consent to study participation or those who could not be included due to noncompliant research schedules, 100 patients (low back: 82l; neck: 7; knee: 10; and shoulder: 1, respectively) participated in the study and completed the questionnaires (Figure 1).
... It has previously been thought futile to repair these tears since only the peripheral portion of a radial tear has a good blood supply and because 'side to side' repair with simple horizontal sutures have weak pull-out strength [54] due to the sutures being aligned with the longitudinal fibres of the meniscus. However, repair usually leads to healing and decreased articular contact pressures, likely protecting the chondral surfaces in the short and long terms [15,62,79]. It is for this reason that the authors strongly encourage repair of these tears in athletes. ...
Article
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Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid not only to the pathology, but also to a player’s contract status, time in the season, specific demands of his/her sport and position on the field, and future consequences. Successful treatment requires the clinician to understand the player’s goals and needs, communicate effectively between all stakeholders, and a have knowledge of the challenges posed by the different types of meniscal tear seen in this population. Paramount is the distinction between injuries to the medial and lateral meniscus. Deficiency of the lateral meniscus, as a result of a tear or a meniscectomy, leads to frequent early problems and inexorably to chondral degeneration thereby affecting an athlete’s ability to perform. Therefore, it is strongly recommended to repair the majority of lateral meniscal tears. Medial meniscal tears pose a more challenging treatment dilemma, as the success of partial meniscectomy in achieving reproducible, early return to play must be balanced against the long-term degenerative consequences. Many meniscal tears are correctly treated non-operatively.Level of evidence V.
... 5 If the meniscus is torn, it loses these functions, and detrimental changes can occur. 15,23 Biomechanical studies have shown that LM posterior horn tears can increase tibiofemoral contact pressure, because the tears result in the loss of meniscal circumferential hoop stress, and that repair can normalize the contact pressure down to almost normal values. 7,16 Furthermore, repair could restore knee stability. ...
Article
Background Meniscal function after repair of radial/flap tears of the posterior horn of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated. Purpose To evaluate not only the clinical and radiographic outcomes of patients with repair of radial/flap tears of the posterior LM with ACLR but also the healing status of the repaired meniscus and changes of chondral status with second-look arthroscopy. Study Design Case series; Level of evidence, 4. Methods From January 2008 to April 2016, 41 patients of a consecutive series of 505 primary anatomic ACLR cases had a concomitant radial/flap tear of the posterior horn of the LM and underwent side-to-side repair with an inside-out or all-inside technique. All patients were followed for >2 years, evaluated clinically and radiologically (radiograph and magnetic resonance imaging [MRI]), and compared with a control group without any concomitant injuries that underwent ACLR. Of the 41 patients, 30 were assessed by second-look arthroscopy 2 years postoperatively. Results The mean follow-up times of the study and control groups were 3.4 and 3.9 years, respectively. The study group showed no significant differences in clinical findings, lateral joint space narrowing on radiograph, and coronal extrusion on MRI as compared with the control group, whereas sagittal extrusion on MRI progressed significantly in the study group (1.2 ± 1.5 mm vs 0.32 ± 1.0 mm, P < .001). Eighteen patients (60%) obtained complete healing; 9 (30%) showed partial healing; and 3 (10%) failed to heal on second-look arthroscopy. Changes of chondral status in the femoral condyle showed no significant difference between the groups ( P = .29). However, chondral status of the lateral tibial plateau worsened significantly in the study group ( P = .0011). Conclusion The clinical and radiographic outcomes after repair of radial/flap tears of the posterior horn of the LM as combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at a mean postoperative follow-up of 3.4 years, except for sagittal extrusion on MRI. Chondral lesions of the lateral tibial plateau deteriorated regardless of meniscal healing at 2 years postoperatively. Surgeons should keep in mind that chondral injuries might progress over the midterm.
... Different studies demonstrated a correlation between meniscectomy and knee degeneration (Allen et al., 1984;Faunø & Nielsen, 1992;Scheller et al., 2001). ...
Article
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Background: Meniscus allograft transplantation (MAT) is a surgical procedure performed in patients complaining post-meniscectomy syndrome. Although the effectiveness of MAT on knee stability has been already demonstrated in cadaveric studies, its biomechanical role has been poorly evaluated in-vivo. Methods: A narrative review of the biomechanical effect of meniscectomy and MAT was performed. Furthermore, two cases were presented, of one patient who underwent Medial MAT and Anterior Cruciate Ligament (ACL) reconstruction, and one who underwent Lateral MAT. During the surgery, knee laxity was evaluated using a surgical navigation system. Results: AP laxity and IE rotation were reduced of 25% to 50% at both 30° and 90° of knee flexion after MAT transplantation. Discussion: In both cases, almost all the tests performed showed a reduction of knee laxity after meniscus transplant, when compared with pre-operative knee laxity. This assessment confirms the insights of previous in-vitro studies and underline a crucial role of MAT in knee biomechanics.
Chapter
Meniscal injuries are a frequently encountered clinical scenario and at present in patients of all age groups and activity levels. They have been known to occur as a result of trauma as well as joint degeneration, and whether they are a cause or consequence of osteoarthritis remains unclear. It is now known that a meniscal injury has both a biochemical and a biomechanical consequence, which results in the onset of joint degradation. In the past, meniscal tears were addressed by meniscectomy, but recent literature and evolving techniques have favoured repair strategies to preserve as much of the meniscus tissue as possible; however, these repairs have still been unable to restore the meniscal function. Addressing the biochemical changes in the knee joint post-meniscal injury and improving meniscal repair strategies with the addition of biological regenerative therapies result in better meniscal healing and, therefore, may reduce the incidence of osteoarthritis. In this chapter, we discuss meniscal injuries, their association with early osteoarthritis, and the current treatment trends and results for addressing meniscal injuries.
Article
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Anterior cruciate ligament (ACL) tears can be associated with injuries to the lateral meniscus (LM) in about 20-30% cases. The lateral meniscus is more mobile than the medial and besides contributing to load transmission, it also stabilizes the knee in pivot-shift testing. The LM tears more often in the acute setting and its incidence does not rise in cases of chronic ACL instability. Lateral meniscus tears can be minor or major depending how severely the knee function gets impaired. Major tears are the complete radial tears, longitudinal bucket handle tears and posterior root tears. Male gender, high body mass index and contact injury mechanism are all risk factors for an LM tear. Anatomic factors which can contribute to LM tears include a high posterior tibial slope, varus malalignment and greater asymmetry between medial and lateral slopes. The lateral meniscus must be saved and repaired whenever possible to prevent residual knee instability and progressive lateral compartment arthritis, which can set in soon after a meniscectomy. The development of techniques and technology have rendered most tears amenable to repair. Longitudinal tears can be repaired by the all-inside or inside-out technique and the needles and devices must be inserted through a high anteromedial or transpatellar portal to prevent injury to the popliteal neurovascular structures. A lateral safety incision must always be used for inside-out repairs. Radial tears can be repaired by two horizontal sutures, a cross stich, a cross-tag or a hash-tag suture configuration. Lateral meniscus posterior root repairs are repaired by transtibial technique, either by drilling an independent anatomic tunnel or the sutures pulled out via the ACL tibial tunnel. The lateral meniscus has high healing rates and repairs yield improvement in functional outcome, beside delaying radiographic arthritis.
Article
The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.
Article
Résumé Introduction Le traitement chirurgical d’une lésion méniscale consiste en une méniscectomie ou une réparation. Si les réparations donnent des suites immédiates plus contraignantes et un taux de ré-interventions et de complications plus important, le potentiel arthrogène des méniscectomies est bien connu. L’objectif de l’étude était de comparer les résultats cliniques et radiologiques à 10 ans de recul des méniscectomies et des réparations pour des lésions verticales isolées sur genou stable. Notre hypothèse était qu’il y avait un bénéfice fonctionnel et radiologique de la réparation par rapport à la méniscectomie. Patients et méthode Il s’agissait d’une série rétrospective, multicentrique, comparative de 32 patients, 24 hommes et 8 femmes. Le recul moyen était de 10,6 ans (10–13). Il y avait 10 réparations (groupe R) et 22 méniscectomies (groupe M) réparties sur 17 genoux droits et 15 gauches. L’âge moyen au moment de la chirurgie était de 33,45 ± 12,3 ans (9–47). Il y avait 28 lésions du ménisque médial et 4 du ménisque latéral, 26 étaient en zone 1 et 6 en zone 2. Résultats Score fonctionnel : le score KOOS était significativement supérieur pour le groupe R par rapport au groupe M pour presque tous les items : 98 ± 4,69 versus 77,38 ± 21,97 pour les symptômes (p = 0,0043), 96,89 ± 7,20 versus 78,57 ± 18,9 pour la douleur (p = 0,0052), 99,89 ± 0,33 versus 80,88 ± 19,6 pour la vie quotidienne (p = 0,0002), 96,11 ± 9,83 versus 54,05 ± 32,85 pour sport et loisir (p = 0,0005), mais 91 ± 16,87 versus 68,15 ± 37,7 pour la qualité de vie (p = 0,1048) ; score radiologique : pour le groupe R, 7 patients n’avaient pas d’arthrose et 2 une arthrose de grade 1. Dans le groupe M, 5 patients avaient une arthrose de grade 1, 10 de grade 2, 3 de grade 3 et 3 de grade 4. Concernant le score quantitatif, la médiane était de 0 (moyenne 0,22 ± 0,44) pour le groupe R et de 2 (moyenne 2,19 ± 0,98) pour le groupe M (p < 0,0001). Discussion À plus de 10 ans de recul, le score fonctionnel était significativement supérieur après réparation méniscale qu’après méniscectomie pour l’ensemble des items du score KOOS hormis la qualité de la vie. Les scores fonctionnels et radiologiques étaient fortement corrélés. Notre étude a démontré que la réparation méniscale des lésions verticales sur genou stable a un rôle protecteur par rapport à l’arthrose et est donc fortement recommandée. Niveau de preuve Étude rétrospective. Niveau IV.
Article
PurposeAll-inside meniscal repair devices have evolved to allow surgeons to undertake complex repairs in a timely and efficient manner. This is advantageous in active patients, where meniscus preservation is critical in preserving joint function and stability. The aim of the study was to evaluate the failure rate of all-inside meniscal repair performed in patients undergoing reconstructive ligament surgery using a particular meniscal repair device.Methods Patients were identified using a single-site prospectively maintained patient registry. Primary outcome was failure, defined as return to surgery with documented failure of repair. Complication rates and functional scores were also recorded. Patients in whom meniscal repair failure was identified were further assessed, to identify any common features.ResultsOver an 8-year period, 323 patients underwent meniscal repair at the time of ligament reconstruction, compared to 244 meniscectomies. Of these, 286 patients underwent repair using an all-inside suture device. One-hundred and twenty-seven repairs were to the medial meniscus only, 124 were lateral, and in 35 patients both menisci were repaired. Follow-up was to a median of 51.5 months. There were 31 (9.7%) failures reported at a median of 22 months post-operatively (IQR 13.5–41.5). Medial repair failures were seen more frequently than lateral (13.6% versus 5.6% OR 2.62 95% CI 1.17–5.88 p = 0.022). Failure of ACL reconstruction was associated with meniscal repair failure (OR 5.83 95% CI 1.55–21.95 p = 0.0039). Multi-ligament reconstruction was undertaken in 70/286 patients receiving meniscal repair and was not associated with failure (OR 1.3 95% CI 0.57–2.98 p = 0.51). Mode number of all-inside sutures used was 3 in both medial and lateral repairs (Range 1–9 lateral; 1–7 medial).Conclusions All-inside repair is a safe and versatile technique which can be used in the majority of meniscal tears encountered during ligament reconstruction with excellent mid-term success. Failure is seen more commonly in medial sided repairs and with failure of ACL reconstruction.Level of evidenceIV.
Article
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Background Although arthroscopic partial meniscectomy is a widely implemented surgical procedure, studies investigating the time to return to activity (RTA) are rare. Purpose To explore which factors are associated with the RTA times after arthroscopic partial meniscectomy and to investigate whether those factors can also improve short-term patient-reported outcomes. Study Design Case-control study; Level of evidence, 3. Methods The authors reviewed the records of patients who underwent isolated partial meniscectomy in their institution from January 2017 to December 2019. Patient and injury characteristics were documented, and time to RTA was obtained via phone interview in January 2021. Pre- and postoperative outcomes were assessed with the Lysholm score and International Knee Documentation Committee (IKDC) score. The chi-square test and independent-samples t test were used to evaluate differences in outcome scores and time to RTA according to the patient and injury characteristics, and risk factors with a P value <.1 in the univariate analysis were used in the binary regression. Results Included were 215 patients (87 men and 128 women; mean age, 33.7 years [range, 24-75 years]). Of these patients, 204 provided information on time to RTA (mean, 3.3 months). By 3 months postoperatively, 49.5% (101/204) of patients could perform activities without knee-related restriction; this improved to 69.6% (142/204) at 6 months and 90.2% (184/204) at 12 months. On multivariate logistic regression analysis, age (OR, 0.39; 95% CI, 0.21-1.19; P = .044) and injury duration (OR, 0.20; 95% CI, 0.19-1.07; P = .032) were significantly associated with the time to RTA. IKDC scores improved significantly from 41.2 preoperatively to 76.7 postoperatively, and in the multivariate logistic regression model, female sex (OR, 2.67; 95% CI, 1.10-6.47; P = .030), body mass index (BMI) ≥27 kg/m ² (OR, 2.96; 95% CI, 1.02-8.66; P = .047), and medial meniscal tear (OR, 0.20; 95% CI, 0.04-1.00; P = .050) were associated with inferior outcome scores. Conclusion Patients aged 40 years and younger who underwent partial meniscectomy surgery within 6 months after a meniscal tear were more likely to have a shorter time to RTA, and female patients with obesity (BMI ≥27 kg/m2), especially those with medial meniscal tears, tended to have inferior clinical outcomes.
Article
Background: Partial meniscectomy is one of the most commonly performed orthopaedic procedures for a meniscus tear. Decreased contact area and increased contact pressure have been seen in partial meniscectomies from treatment of various types of meniscal tears; however, the biomechanical effect of a horizontal cleavage tear in the lateral meniscus and subsequent treatment are unknown. Questions/purposes: This study asked whether a horizontal cleavage tear of the lateral meniscus, resecting the inferior leaf, and further resecting the superior leaf would (1) decrease contact area and (2) increase peak contact pressure. Methods: Eleven fresh-frozen human cadaveric knees were evaluated under five conditions of intact meniscus, horizontal cleavage tear, inferior leaf resection, and resection of the inferior and superior leaves of the lateral meniscus. Tibiofemoral contact area and pressure were measured at 0° and 60° knee flexion under an 800-N load, normalized to that at the intact condition of the corresponding knee flexion, and compared across the five previously described conditions. Results: At 0° knee flexion, normalized contact area with inferior leaf resection (65.4% ± 14.1%) was smaller than that at the intact condition (100% ± 0.0%, p < 0.001); smaller than horizontal cleavage tear (94.1% ± 5.8%, p = 0.001) contact area; and smaller than repaired horizontal tear (92.8% ± 8.2%, p = 0.001) contact area. Normalized contact area with further superior leaf resection (50.5% ± 7.3%) was smaller than that at the intact condition (100% ± 0.0%, p < 0.001); smaller than horizontal cleavage tear (94.1% ± 5.8%, p < 0.001) contact area; and smaller than repaired horizontal tear (92.8% ± 8.2%, p < 0.001) contact area. At 60° flexion, normalized contact area with inferior leaf resection (76.1% ± 14.8%) was smaller than that at the intact condition (100% ± 0.0%, p = 0.004); smaller than horizontal cleavage tear (101.8% ± 7.2%, p = 0.006) contact area; and smaller than repaired horizontal tear (104.0% ± 13.3%, p < 0.001) contact area. Normalized contact area with further superior leaf resection (52.1% ± 16.7%) was smaller than that at the intact condition (100% ± 0.0%, p < 0.001); smaller than horizontal cleavage tear (101.8% ± 7.2%, p < 0.001) contact area; and smaller than repaired horizontal tear (104.0% ± 13.3%, p < 0.001) contact area. At 60° flexion, contact area with both leaf resection (52.1% ± 16.7%) was smaller than that with inferior leaf resection (76.1% ± 14.8%, p = 0.039). At 0° knee flexion, peak pressure increased to 127.0% ± 22.1% with inferior leaf resection (p = 0.026) and to 138.6% ± 24.3% with further superior leaf resection (p = 0.002) compared with that at the intact condition (100% ± 0.0%). At 60° flexion, compared with that at the intact condition (100% ± 0.0%), peak pressure increased to 139% ± 33.6% with inferior leaf resection (p = 0.035) and to 155.5% ± 34.7% (p = 0.004) with further superior leaf resection. Conclusions: Resection of the inferior leaf or both leaves of the lateral meniscus after a horizontal cleavage tear resulted in decreased contact area and increased peak contact pressure at 0° and 60° knee flexion. Clinical relevance: In vitro resection of one or both leaves of a horizontal cleavage tear of the lateral meniscus causes increases in peak pressure, consistent with other types of partial meniscectomies associated in a clinical setting with excessive loading and damage to knee cartilage. Clinical outcomes in patients undergoing partial leaf meniscectomy could confirm this theory. Avoidance of resection may be relatively beneficial for long-term function. The findings of this in vitro study lend biomechanical support for nonoperative management.
Article
Background: It is important to restore the normal anatomy of the native meniscus in meniscal allograft transplantation (MAT) for successful surgical results. Purpose/hypothesis: The purpose of this study was to compare the anatomic positions of the anterior horn (AH) and posterior horn (PH) between the preoperative lateral meniscus and postoperative meniscal allograft after lateral MAT using the keyhole technique. We hypothesized that the keyhole technique could restore the preoperative anatomy of the native lateral meniscus. Study design: Case series; Level of evidence, 4. Methods: Between December 2012 and December 2014, a total of 70 patients underwent lateral MAT using the keyhole technique. The anatomic positions of both horns of the native lateral meniscus and the meniscal allograft were measured on magnetic resonance imaging (MRI). Preoperative MRI was performed 1 day before lateral MAT, while postoperative MRI was performed 2 days after lateral MAT. A percentage reference method was used to measure the location of both horns. Results: For the AH, the mean delta value of the absolute position was 0.7 ± 1.8 mm (95% CI, 0.3-1.1 mm) in the coronal plane and 0.5 ± 1.6 mm (95% CI, 0.2-0.9 mm) in the sagittal plane, and the mean delta value of the relative position was 1.0% ± 2.3% (95% CI, 0.5%-1.6%) in the coronal plane and 1.1% ± 3.3% (95% CI, 0.2%-1.8%) in the sagittal plane. For the PH, the mean delta value of the absolute position was 2.4 ± 2.6 mm (95% CI, 1.8 to 3.1 mm) in the coronal plane and -0.1 ± 2.1 mm (95% CI, -0.6 to 0.4 mm) in the sagittal plane, and the mean delta value of the relative position was 3.3% ± 3.5% (95% CI, 2.5% to 4.2%) in the coronal plane and -0.3% ± 4.4% (95% CI, -1.3% to 0.8%) in the sagittal plane. Therefore, the AH moved by a mean of 0.7 mm laterally and 0.5 mm anteriorly (absolute values) and 1.0% laterally and 1.1% anteriorly (relative values) compared with the preoperative position. The PH moved by a mean of 2.4 mm laterally and 0.1 mm posteriorly (absolute values) and 3.3% laterally and 0.3% posteriorly (relative values) compared with the preoperative position. For the AH, the proportion of patients with an absolute delta value of ≥5 mm was 4.3% in the coronal plane and 2.9% in the sagittal plane. For the PH, the proportion of patients with an absolute delta value of ≥5 mm was 18.6% in the coronal plane and 4.3% in the sagittal plane. Conclusion: When comparing the position of the horns preoperatively and postoperatively, both horns showed mean relative postoperative positional changes of <5% of relative values and <5 mm of absolute values in both the coronal and sagittal planes. The keyhole technique in lateral MAT can reconstruct the lateral meniscus close to its native anatomic position by avoiding displacement of >5 mm in both the coronal and sagittal planes.
Chapter
Historically the anatomical and functional role of menisci has been recognized through the extensive literature that had been performed the past decades. This crucial role is not only limited in load transmission and shock absorption by covering the contact area of the tibiofemoral joint but also expanded in contribution of accessory anteroposterior stabilization and proprioception of the knee joint and, additionally, nutrition and lubrication of the articular cartilage [1?17].
Article
Objectives: Joint space narrowing and osteophyte formation, radiographic features of knee osteoarthritis (OA), are not necessarily synchronous processes. We evaluated the relationship between medial minimum joint space width (mJSW) and osteophyte formation. Methods: We conducted a retrospective study of 1050 individuals (424 males; 626 females; mean age 64.9 years) who underwent knee radiography as part of a health screening program, between 2011 and 2013. mJSW and tibial osteophyte area (OF) were quantified using automated software. The mJSW range was subdivided into tertiles, and OF, mJSW, and quality of life (QOL) were compared among them. Correlation between OF and mJSW was evaluated. Results: In females, OF was largest and correlated with mJSW only in the lowest tertile group. Patients in the lowest mJSW tertile group had a lower QOL and higher pain than those in the other two groups. Based on our generalized additive models and a receiver operating characteristic curve analysis, an mJSW cutoff point of 3.5 mm was apparent in females, with no significant cutoff identified in males. Conclusions: OF correlates with mJSW below a cutoff value of about 3.5 mm in females. OA symptoms, namely physical function impairment and pain, increases significantly as mJSW decreases below the cutoff.
Article
The meniscus plays an important, complex role in maintaining the homeostasis and health of the knee. Meniscal tears are a risk factor for early chondral injury and eventually knee osteoarthritis. There is a growing body of evidence about the early biological changes associated with meniscal injury that likely start the process of joint degeneration. This review highlights the basic science, translational and clinical studies of the detrimental effects of meniscal injury and deficiency on the biology of the knee.
Article
Background: Meniscal extrusion is related to degeneration of the native knee joint. However, the clinical effect of the phenomenon after meniscal allograft transplantation (MAT) has not been clearly identified. Purpose/Hypothesis: The purpose of this study was to evaluate the change in meniscal extrusion in both the coronal and sagittal planes after lateral MAT through the midterm follow-up period. We hypothesized that meniscal extrusion does not progress during the midterm follow-up period. Study design: Case series; Level of evidence, 4. Methods: A total of 46 patients with a mean follow-up of 51.1 ± 7.1 months were included in the study. The patients underwent lateral MAT using the keyhole technique. Postoperative magnetic resonance imaging (MRI) was performed at 6-week, 1-year, and midterm (3- to 5-year) follow-up. In the coronal plane, the absolute value of meniscal subluxation and the relative percentage of extrusion (RPE) were measured. In the sagittal plane, meniscal subluxation was measured as the absolute and relative anterior cartilage meniscal distance (ACMD) and posterior cartilage meniscal distance (PCMD). The joint-space width (JSW) on weightbearing radiographs with 2 different knee positions was measured preoperatively and at 1-year and midterm follow-up. The Lysholm score was assessed at the same time points. Results: In the coronal plane, the mean absolute meniscal extrusion at 6-week, 1-year, and final follow-up was 2.90 ± 0.94, 2.85 ± 0.97, and 2.83 ± 0.89 mm, respectively, and the mean RPE was 27.0% ± 9.4%, 27.1% ± 10.1%, and 27.8% ± 9.7%, respectively. There were no statistically significant differences in absolute and relative coronal extrusion among the 3 time periods ( P > .05). The percentage of patients with meniscal extrusion (≥3 mm) was 37.0% at 6-week follow-up and 34.8% at 1-year and final follow-up. In the sagittal plane, the mean absolute ACMD was 2.59 ± 1.75, 2.58 ± 1.85, and 2.37 ± 1.60 mm, respectively, and the mean relative ACMD was 20.7% ± 13.1%, 20.6% ± 13.8%, and 19.0% ± 12.2%, respectively, at the 3 follow-up time points. The mean absolute PCMD was -1.23 ± 3.34, -1.28 ± 3.08, and -1.42 ± 2.77 mm, respectively, and the mean relative PCMD was -10.3% ± 25.9%, -11.0% ± 24.6%, and -12.2% ± 23.2%, respectively, at the same time points. Sagittal extrusion was not significantly different between the time points ( P > .05). The mean JSW at 2 days preoperatively, 1 year postoperatively, and midterm follow-up was 5.40 ± 1.07, 5.44 ± 1.04, and 5.43 ± 0.98 mm, respectively, on anterior-posterior radiographs with full extension, and it was 4.90 ± 0.94, 4.94 ± 0.98, and 4.89 ± 0.96 mm, respectively, on posterior-anterior radiographs with 45° of flexion. The mean JSW values were not significantly different between the 3 different time points ( P > .05). The mean preoperative Lysholm score was 58. 9 ± 8.3; the score increased to 90.4 ± 9.7 at 1 year postoperatively and 90.5 ± 10.1 at final follow-up, which is a significant improvement compared with the preoperative status ( P < .05). There was no statistically significant difference between the scores at the 2 postoperative time points ( P > .05). Conclusion: This study demonstrated that extrusion of the meniscal allograft did not significantly progress either in the coronal or sagittal plane after lateral MAT during the midterm follow-up period.
Article
Background Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood. Purpose/Hypothesis We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up. Study Design Case series; Level of evidence, 4. Methods Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and >8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score. Results A total of 27 patients were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at >8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at >8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively. Conclusion During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.
Chapter
Over the years, the concept of the meniscus has greatly evolved from being just a useless vestigial structure to a multifunctional and essential part of the knee. Currently, menisci are considered to be responsible for load transmission, joint lubrication, shock absorption, and joint stability [1, 2]. Since they are essential to normal functioning of the knee, it is not surprising that meniscus repair has become a common procedure. With increasing attention to meniscus repair, the need to devise a reliable and reproducible classification of meniscus tears has also arisen.
Article
Background: The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated. Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery. The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone. Purpose: To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms. Study design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients, aged 45 to 64 years, 150 were randomized to (1) a 3-month exercise program (nonsurgery group) or (2) the same as group 1 plus knee arthroscopic surgery within 4 weeks (surgery group). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore of pain between baseline and the 3-year follow-up. Results from the 1-year follow-up have been published previously. Results: Both treatment groups improved significantly in the KOOS pain subscore at 3 years' follow-up in the intention-to-treat and as-treated analyses ( P < .001). The between-group difference for the change in the KOOS pain subscore between baseline and the 3-year follow-up was no longer statistically significant, neither in the intention-to-treat analysis (7.6 points; 95% CI, -0.6 to 15.9; P = .068) nor in the as-treated analysis (5.3 points; 95% CI, -3.1 to 13.8; P = .216). The factorial analysis of the effect of the intervention and age, onset of pain, and mechanical symptoms indicated that older patients improved more, regardless of treatment, and surgery may be more beneficial for patients without mechanical symptoms (as-treated analysis). The effect of the predictive factors on the KOOS pain subscore was uncertain because of the small sample size in the subgroup analyses. Conclusion: The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant. Clinical relevance: Knee arthroscopic surgery may be beneficial for middle-aged patients with meniscal symptoms in addition to an exercise program. Older age and absence of mechanical symptoms should not be contraindications to surgery. Registration: NCT01288768 ( ClinicalTrials.gov identifier).
Article
NHS-Prospero registration number 42016048592 Objective In order to make a more evidence-based selection of patients who would benefit the most from arthroscopic partial meniscectomy (APM), knowledge of prognostic factors is essential. We conducted a systematic review of predictors for the clinical outcome following APM. Design Systematic review Data sources Medline, Embase, Cochrane Central Register, Web of Science, SPORTDiscus, PubMed Publisher, Google Scholar Inclusion criteria Report an association between factor(s) and clinical outcome; validated questionnaire; follow-up >1 year. Exclusion criteria <20 subjects; anterior cruciate ligament-deficient patients; discoid menisci; meniscus repair, transplantation or implants; total or open meniscectomy. Methods One reviewer extracted the data, two reviewers assessed the risk of bias and performed a best-evidence synthesis. Results Finally, 32 studies met the inclusion criteria. Moderate evidence was found, that the presence of radiological knee osteoarthritis at baseline and longer duration of symptoms (>1 year) are associated with worse clinical outcome following APM. In addition, resecting >50% of meniscal tissue and leaving a non-intact meniscal rim after meniscectomy are intra-articular predictive factors for worse clinical outcome. Moderate evidence was found that sex, onset of symptoms (acute or chronic), tear type or preoperative sport level are not predictors for clinical outcome. Conflicting evidence was found for the prognostic value of age, perioperative chondral damage, body mass index and leg alignment. Summary/conclusion Long duration of symptoms (>1 year), radiological knee osteoarthritis and resecting >50% of meniscus are associated with a worse clinical outcome following APM. These prognostic factors should be considered in clinical decision making for patients with meniscal tears.
Article
Objective To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury. Design Systematic review and meta-analysis. Data sources MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018. Eligibility criteria for selecting studies Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls. Study appraisal and synthesis Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis. Results 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I ² =92%), 6.3 (95% CI 3.8 to 10.5; I ² =95%) and 6.4 (95% CI 4.9 to 8.3; I ² =62%) for patients with ACL injury, meniscal injury and combined injuries, respectively. Conclusion The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates. Clinical relevance Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development. PROSPERO registration number CRD42015016900
Article
Full-text available
Many different methods of evaluating disability after knee ligament injury exist. Most of them differ in design. Some are based on only patients' symptoms. Other include patients' symptoms, activity grading, performance in a test, and clinical findings. The rating in these evaluating systems can be either numerical, as in a score, or binary, with yes/no answers. Comparison between a symptom-related score and a score of more complex design showed that the symptom-related score gave a more differentiated picture of the disability. It was also shown that the binary rating system gave less detailed information than a score and that differences in a binary rating can depend on at what level the symptoms are regarded as "significant." A new activity grading scale, where work and sport activities were graded numerically, was constructed as complement to the functional score. When evaluating knee ligament injuries, stability testing, functional knee score, performance test, and activity grading are all important. However, the relative importance varies during the course of treatment, and therefore they should not all be included in one and the same score.
Article
The shape of the menisci and the orientation of the collagen fibers are optimal for weight bearing and shock absorption. The menisci are of clinical importance to knee biomechanics as they function to maintain knee joint stability and congruity, resist capsular and synovial impingement during knee motion, support the screw home mechanism, and distribute load over a large area of the articular surface. Because of these vital roles, an attempt should be made to save viable meniscus when performing knee surgery.
Article
The effect of chondral damage and age on the long-term prognosis after partial meniscectomy was investigated in two matched groups of patients (n=40), one with intact and the other with severely disrupted cartilage at the time of operation. Twelve to 15 years after meniscectomy a clinical and radiographic examination was done. Significantly more patients with intact cartilage (85%) than with chondral damage at operation (50%) had excellent or good knee function (P<0.05). The activity levels decreased from active individual sports to physical fitness activities (P<0.001), equally in both groups. Joint space reduction on roentgenograms was seen in 16 patients (80%) with chondral damage and in 6 patients (30%) with intact cartilage (P<0.001). In addition to chondral damage, age over 30 years (P<0.04) at the time of operation was associated with a worse functional (P<0.03) and radiographic (P<0.01) outcome.
Article
To better define the role that the lateral meniscus plays in stabilizing the knee, a study was made of twenty-six patients who had an uncomplicated lateral meniscectomy between 1972 and 1977. Patients with any degree of ligament instability, cruciate or collateral, prior to lateral meniscectomy were eliminated from the study. Also eliminated were any patients with roentgenographic evidence of degenerative arthrits, osteochondritis dissecans, or loose bodies. Only patients whose operative reports stated that the articular cartilage of the lateral compartment was either grossly normal or showed Grade-1 chondromalacia (less than one centimeter in diameter and only softening of the cartilage) at the time of surgery were included in the review. The meniscal lesions included bucket-handle tears, horizontal cleavage tears, and multiple linear defects. No grossly cystic menisci were included in the study. Two menisci demonstrated cystic degenerative changes on histological section. In sixteen patients some degree of ligament instability developed. The longer the interval between injury to the meniscus and its excision, the less satisfactory the result. Only fifteen (54 per cent) of the patients reported satisfactory results, and twenty lost some motion of the knee. We concluded that stability of the knee joint is a multifactorial problem, in which the lateral meniscus certainly plays an important part.
Article
Knee specimens were placed in an apparatus which imposed cyclic anterior-posterior or rotatory forces, with various compressive loads applied to the joint. Force-displacement graphs or torque-rotation graphs were automatically plotted, giving the laxity under various conditions. The ligaments, capsule, and menisci provided joint stability under no-load conditions. However, under compressive loads, the conformity of the condylar surfaces was an important factor in stabilizing the knee. The mechanism proposed was the uphill movement of the femur as the femur and the tibia were displaced or twisted relative to one another.
Article
A follow-up study was conducted to clarify the clinical and radiological long-term consequences of arthroscopic meniscus resection. One hundred thirty-six patients who had unilateral arthroscopic resection of an isolated meniscal tear attended for an interview and a physical and radiological examination. Follow-up averaged 8.5 years, with a range of 7.9-11.6 years. The reoperation rate was as high as 22.8%, but was the lowest in the bucket handle tear group (13%). Pain after exercise was less frequent among patients treated for a bucket handle tear compared to other lesions. Fifty-three percent of the patients had at least one of the Fairbanks change in the operated knee and only 22% in the control knees. The radiographic result was not influenced by the type of meniscus lesion nor were high age or intraoperatively described cartilage damage factors of significance. Malalignment less than 4 degrees of valgus and greater than 10 degrees of valgus was found to be a significant risk factor for the development of degenerative changes following meniscus resection.
Article
Fifty knees with a mean follow-up time of greater than 5 years after arthroscopic meniscectomy were evaluated clinically and roentgenographically. Clinically, patients did well, with 98% patient satisfaction and 90% good or excellent results based on a modified Lysholm score. Although postoperative roentgenography showed some progression of Fairbank's changes in 61% with significant progression in 15% of knees, when changes in the nonoperative knee were considered, only 40% of operative knees showed progression, with only 4% of these knees showing significant progression. Normal results on preoperative anteroposterior roentgenography with the patient weight bearing and an anatomic tibiofemoral axis of greater than or equal to 4 degrees of valgus correlated with better long-term roentgenographic results.
Article
The shape of the menisci and the orientation of the collagen fibers are optimal for weight bearing and shock absorption. The menisci are of clinical importance to knee biomechanics as they function to maintain knee joint stability and congruity, resist capsular and synovial impingement during knee motion, support the screw home mechanism, and distribute load over a large area of the articular surface. Because of these vital roles, an attempt should be made to save viable meniscus when performing knee surgery.
Article
The long-term effects of single meniscectomy in 89 children have been analyzed at an average of 16.8 years after surgery. Seventy-four percent were pleased with the outcome, but only 52% or 58% had objectively satisfactory results according to the two scoring systems used. Significantly poorer results were achieved with lateral meniscectomies. The range of movement was significantly decreased after lateral meniscectomy. Minor instabilities were recorded in 45% of the patients and major instabilities in 15%. Anteroposterior and rotatory instabilities were objectively measured, and a significant increase was noted in knees that had lateral meniscectomy. Grade I gonarthrosis was recorded in 39% of the surgically treated knees and Grades II and III gonarthroses in 9%. The joint space was significantly reduced in all knees irrespective of the injured compartment.
Article
We reviewed 230 patients an average of 34 months after they had undergone partial or total meniscectomy by surgeons of different experience in a busy unit. Open and arthroscopic meniscectomies were compared. Arthroscopic partial meniscectomy resulted in a significant reduction of inpatient stay and earlier return to work and sport. Analysis of the type of meniscal damage showed that arthroscopic removal of "bucket handles" achieved better results than open techniques. Comparatively poor results were found for lateral meniscectomy.
Article
The role of the meniscus in load transmission across the knee has long been a subject of debate. In this study, we examined the biomechanical consequences of the operative treatments for bucket-handle and pe ripheral meniscal tears. Contact areas and instanta neous intraarticular pressure distributions were meas ured in two groups of human cadaver knees. In Group I, consisting of four knees, we created a bucket-handle tear involving the inner one-third of the meniscus, followed by partial, and then total meniscec tomy. Knees were tested in an Instron testing machine after each procedure, using a 400 pound load at 0° or 30° flexion. Contact areas and local stresses were measured using Prescale, a pressure-sensitive film. After partial meniscectomy, contact areas decreased approximately 10%, and peak local contact stresses (PLCS) increased approximately 65%. After total men iscectomy, contact areas decreased approximately 75%, and PLCS increased approximately 235%. In Group II, consisting of three additional knees, we created a 2 cm peripheral tear of the posterior meniscal horn, followed by open repair, arthroscopic repair, seg mental, and then total meniscectomy. Repair of the tear was accomplished with either vertically placed sutures by an open technique or horizontally placed sutures by an arthroscopic technique. Knees were tested in the neutral position in the Instron machine and contact areas and local stresses measured using Prescale. PLCSs and contact areas were found to be the same using either repair technique. There was, however, a 110% increase in PLCS after segmental meniscectomy of that portion of the meniscus involved in the peripheral tear. These data suggest that the meniscus does have a weightbearing role. Contact stresses increased in pro portion to the amount of meniscus removed and the degree to which the structure of the meniscus was disrupted. Furthermore, there was no difference in the weightbearing characteristics of the meniscus when repaired by open versus arthroscopic technique when the knee is loaded at 0° flexion.
Article
We report the results of a prospective longitudinal study of 147 athletes who had had a meniscectomy for an isolated meniscus injury. The patients were reviewed in detail after median periods of 4.5 years and 14.5 years and the results analysed. The frequency of complaints related to the operation increased from 53% at 4.5 years to 67% at 14.5 years, while demonstrable knee instability increased from 10% to 36%. The incidence of radiographic changes of degeneration rose from 40% to 89% and at late review 8% of patients had definite osteoarthritis by the criteria of Ahlbäck (1968). In consequence 46% had given up or reduced their sporting activity, and 6.5% had changed their occupation. Radiographic deterioration started after the 4.5-year review in 49% of the patients and was more frequent after lateral than medial meniscectomy.
Article
Partial arthroscopic meniscectomy has been performed in the First Orthopedic Clinic of the University of Florence since 1981. We have reviewed the first 100 cases with an average follow-up of 18 months. The results were graded according to a numerical rating system and were satisfactory in 85% of the cases. The main advantage of this difficult technique is the fast recovery rate. Other advantages are the low morbidity and short hospital stay. When meniscectomy was performed in the ACL unstable knee, the results were inferior but still acceptable in terms of reduction of the mechanical symptoms. The influence of age, sex, medial or lateral meniscectomy, and type of tear was not statistically significant. Thigh atrophy or chondromalacia significantly decreased the knee score. We believe that the single most important technical factor is to make sure that a stable, well balanced and healthy rim is left in the knee.
Article
Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.
Article
Two hundred thirteen patients with uncomplicated meniscus injuries were studied from ten to thirty years after their meniscectomy in order to determine the late effects of surgery. Delay of operation after injury did not affect the ultimate result. Patients less than twenty years old at the time of operation had fewer excellent and good results. The diagnosis is more difficult, and the benefit of meniscectomy is less certain, in women than in men. There was no difference in results between total and partial meniscectomy except in bucket-handle tears. Leaving the peripheral rim intact in uncomplicated bucket-handle tears produced the most excellent results. Persistence in a physical occupation or participation in non-contact sports seems not to alter the course after meniscectomy. It was usually, but not invariably, possible to correlate roentgenographic appearance with the clinical result. The meniscectomy site was readily apparent in ninety-four of 110 patients (85 per cent). Sixty-eight per cent of patients in our series had satisfactory clinical results, but only 45 per cent of men and 10 per cent of women had symptom-free knees.
Article
Review of the records at the time of final office visits of one hundred and thirty-four patients who underwent arthroscopic subtotal meniscectomy and interview of one hundred and two of these patients three to four years after surgery revealed that symptoms related to disruption of the meniscus can be totally or significantly relieved in 99.3% of cases. Meniscal symptoms did not recur in the absence of reinjury three to four years later, despite the occasional presence of associated pathologic joint conditions. Arthroscopic meniscectomy has proved safe and effective, and it is associated with low postoperative morbidity and early return to function. Preservation of a peripheral rim of meniscus in contrast to total meniscectomy offers the theoretic advantages of preservation of some degree of joint stability and load distribution to diminish the risk of premature degenerative articular changes.
Article
Late degenerative changes are known to follow meniscectomy, but there is little agreement on their incidence or on which patients are most at risk. A total of 210 patients have been reviewed 10 to 22 years after meniscectomy, and long leg radiographs taken of both knees. Radiological degeneration was seen in 18%, while 7% had significant symptoms and signs. Statistical analysis showed increased changes in older patients, in those with abnormal leg alignment, and in those who had undergone lateral as against medial meniscectomy. Our findings emphasise the important mechanical function of the meniscus and support the current cautious approach to meniscectomy, especially for patients in high risk groups. They also indicate the value of early high tibial osteotomy for symptomatic varus deformity after medial meniscectomy.
Article
The results of three different types of meniscectomy have been compared in 219 knees, 71 treated by arthroscopic partial meniscectomy, 45 treated by open partial meniscectomy, and 103 treated by open total meniscectomy, with a mean follow-up of 4.3 years. Knees which had undergone previous operations or had other simultaneous operative procedures or ligamentous damage were excluded. Knees with chondromalacia were included provided that this did not amount to frank osteoarthritis. Simple indicators were used for the rate of early recovery from the operation, and the Tapper and Hoover scale was used to record the symptomatic results in the longer term. It was found that knees treated by arthroscopic partial meniscectomy did considerably better than the others by all the criteria used. In most parts of the study there was a clear gradation between the results of the three types of treatment: arthroscopic techniques did better than open operations, and partial meniscectomy did better than total meniscectomy.
Article
We have designed a scoring scale for knee ligament surgery follow-up emphasizing evaluation of symptoms of instability. Instability is defined as "giving way" during activity. Our scoring scale was compared to a slightly modified Larson scale in patients with anteromedial and/or anterolateral instability, posterolateral and straight posterior instability, chondromalacia patellae, and meniscus lesion. The two scales gave basically the same results in patients with meniscus rupture. In patients with unstable knees, the new scale gave a significantly lower total score. Thus, the new scale evaluates functional impairment due to clinical instability better than the modified Larson scale. The total score, with the new scoring scale, corresponded to the patients' own opinion of function and to the presence or absence of signs of instability.
Article
Detailed analysis of a series of 99 arthroscopic partial meniscectomies with a minimum follow-up time of 2.1 years (mean, 3 years; maximum, 4.5 years) showed that the spectacularly good early results were maintained in the longer term. Group I knees (67) had no previous surgery or ligamentous insufficiency, but those with chondromalacia were included. The remaining knees were designated Group II and analyzed separately. Group I showed 51.5% excellent and 39% good results, using criteria based on those of Tapper and Hoover. When only results in bucket handle tears were considered, 73% were excellent and 19% were good. Results in Group I also depended on the presence or absence of chondromalacia. Results in Group II were poorer than in Group I, but were still satisfactory in 67% of knees, although many had a torn anterior cruciate ligament of frank osteoarthritis. The arthroscopic technique should, where possible, become the standard method of treatment if patients require meniscectomy.
Article
A retrospective review of patients who underwent arthroscopic partial lateral meniscectomy for lateral meniscus tears in otherwise normal knees was conducted to review the long-term functional, clinical, and radiographic results. Twenty-six patients (27 knees) were evaluated by questionnaire; 20 patients (21 knees) also underwent physical examination and radiographic analysis. Minimum follow-up was 5 years and mean follow-up was 8 years. Patient data were obtained from detailed questionnaires, knee examinations, and radiographs. Excellent or good results decreased from 92% at the time of maximal improvement to 62% at the most recent follow-up: 85% of patients were initially able to return to their preinjury activity level; however, only 48% were able to maintain this level of activity at the most recent follow-up. Seventy-two percent of patients had either one or no Fairbank changes and there was no statistical difference when comparing radiographic criteria in the operated and nonoperated knee. Early results for partial lateral meniscectomy can be quite good; however, significant deterioration of functional results and decreased activity level can occur. Radiographic changes did not correlate with subjective symptoms and functional outcome in our patient population. Our findings suggest that the functional outcome for patients undergoing partial lateral meniscectomy may deteriorate with time and it may be helpful to counsel patients concerning long-term expectations.
Article
Arthroscopic partial lateral meniscectomies performed for isolated meniscal tears, without associated ligamentous injury, in 41 athletes between August 1, 1988 and June 1, 1991 were reviewed for clinical and functional outcome. The study population was composed of 27 males and 14 females, with an average age of 26 years (range 17-40). Thirty-seven patients (90%) reported previous trauma to the knee. At an average follow-up of 3 years (range 2-5), 85% of the patients had excellent/good results, and 98% of the athletes returned to full sports activities after an average of 55 days. Patients' prognoses depended on (a) type of meniscal tear and (b) presence/absence of an articular cartilaginous lesion. Athletes who had isolated, longitudinal type tears of the lateral meniscus had the best outcome: 100% achieved excellent/good results and averaged 41 days to return to full sports activities. Athletes with complex meniscal tears and tears associated with articular cartilaginous lesions had the poorest results, achieving 79% and 64% excellent/good results, respectively, and averaging 64 and 78 days, respectively, for return to full sports activities.
Article
Fifty patients who underwent isolated arthroscopic par tial meniscectomy with a minimum followup of 5 years were analyzed retrospectively. To analyze the factors associated with a satisfactory or an unsatisfactory clin ical result, we looked at the patient's age, duration of symptoms, type of meniscal lesion, and articular carti lage abnormalities. The patients were graded with a functional knee score (Lysholm-Gillquist), and activity level before surgery and at followup was determined. The data also included radiographic evaluation of 29 of the 50 patients. Tibiofemoral alignment was measured, and osteoarthritic changes were graded and correlated with the type of meniscal abnormality and functional result. Eighty-two percent of our patients had satisfactory knee function, and the activity level was maintained. The factors associated with a satisfactory result after a partial meniscectomy included age less than 40 years, symptoms less than 12 months duration, type of tear, and chondromalacia less than grade II. Fairbank's changes were present in 50% of the patients, with significant grade III and IV changes identified in 30%. Although the radiographic changes did not necessarily correlate with the functional result, we felt that the changes were significant and indicative of abnormal stress transfer to articular cartilage and bone.
Article
We retrospectively matched 42 patients with unilateral chondral damage in the weightbearing zone of one knee compartment according to sex, age, location of chondral damage, and follow-up time. Two groups of 21 patients were formed. One group had chondral damage only. The other group had chondral damage and a meniscal tear treated with partial meniscectomy. After 12 to 15 years, all patients were reexamined. Twenty-nine percent (N = 6) of the patients who had a partial meniscectomy needed repeat meniscal surgery during followup. No patients with isolated chondral damage developed meniscal symptoms, and only three patients underwent minor surgeries (P < 0.02). At the follow-up evaluation, both groups had similar knee function with a mean Lysholm score of 87 points. However, most patients had reduced their sports activities from competitive individual sports before injury to noncompetitive physical fitness exercise at followup. At the roentgenologic examination, patients who had partial meniscectomies had more severe roentgenologic signs of osteoarthritis than patients who had chondral damage only (P < 0.03). Meniscectomy, varus knee alignment at the follow-up evaluation (P < 0.04), and age older than 30 years (P < 0.04) at the time of the operation were associated with a higher incidence of osteoarthritis.
Article
The effect of chondral damage and age on the long-term prognosis after partial meniscectomy was investigated in two matched groups of patients (n = 40), one with intact and the other with severely disrupted cartilage at the time of operation. Twelve to 15 years after meniscectomy a clinical and radiographic examination was done. Significantly more patients with intact cartilage (85%) than with chondral damage at operation (50%) had excellent or good knee function (P < 0.05). The activity levels decreased from active individual sports to physical fitness activities (P < 0.001), equally in both groups. Joint space reduction on roentgenograms was seen in 16 patients (80%) with chondral damage and in 6 patients (30%) with intact cartilage (P < 0.001). In addition to chondral damage, age over 30 years (P < 0.04) at the time of operation was associated with a worse functional (P < 0.03) and radiographic (P < 0.01) outcome.
Article
A retrospective analysis of 68 knees from 65 patients older than 40 years, who had undergone a partial medial meniscectomy, was carried out. The average age of the patients was 49.7 years (range, 40 to 74), and the mean follow-up period was 7.8 years (range, 5 to 11). The patients were divided into two groups based on the degree of articular cartilage degeneration. Group I consisted of 53 knees that did not have any significant articular cartilage damage beyond grade I or II. Group II consisted of 15 knees that had grade III or IV cartilage damage. Overall, excellent results were obtained in 44 patients (47 knees), good results in 10 patients, fair results in six patients, and poor results in five patients. In group I, 46 knees (87%) had an excellent outcome, and only one patient had a poor result. In contrast, patients in group II had significantly worse results, with only one knee (7%) having excellent outcome, and four knees had a poor result. A specific history of trauma did not affect the clinical outcome. Forty-two patients (64%) were able to resume normal athletic activities without any restrictions. Arthroscopic partial medial meniscectomy in patients older than 40 years is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage.
Article
From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate ligament-stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of > 0 degree valgus compared with < or = 0 degree and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing.
Isolated lateral meniscectomy
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Arthroscopic partial medial meniscectomy: An analysis of unsatisfactory results
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