Search

This article examines the impact of prearthritic constitutional valgus alignment on medial unicompartmental knee arthroplasty (UKA). The study found that a small percentage of patients with isolated medial osteoarthritis (OA) treated with medial UKA had a valgus alignment. These patients experienced a shift in the limb's mechanical axis after surgery, potentially leading to the progression of OA in the lateral compartment. The study also analyzed the alignment of prosthetic components and found specific angles for the tibial and femoral components. The study suggests that patients with valgus alignment may face challenges in achieving proper ligament balance after surgery and may be at a higher risk of OA progression in the lateral compartment. Further research is needed to confirm these findings and establish clinical correlations. [Extracted from the article]

Purpose: To reveal the outcomes of partial medial meniscus posterior root tears following transtibial pullout repair compared with the outcomes of complete radial meniscus posterior root tears. Materials and methods: We retrospectively evaluated 15 consecutive patients (male/female, 5/10; average age, 64.4 years) who underwent transtibial pullout repair for partial medial meniscus posterior root tears and compared their results with those of 86 consecutive patients who underwent the same surgery for complete medial meniscus posterior root tears. All patients underwent second-look arthroscopy on average 1 year postoperatively, and a semi-quantitative meniscal healing score (anteroposterior width, stability, and synovial coverage, total 10 points) was evaluated. Medial meniscus extrusion was evaluated preoperatively and at second-look arthroscopy. Results: Postoperative clinical scores were not significantly different in the short term. However, second-look arthroscopy revealed a significant difference in repaired meniscal stability (partial tear; 3.3 points, complete tear; 2.3 points, p < 0.001) and total meniscal healing scores (partial tear; 8.3 points, complete tear; 7.1 points, p < 0.001). Medial meniscus extrusion progression was significantly different (partial tear; 0.4 mm, complete tear; 1.0 mm, p < 0.001). Conclusion: Partial medial meniscus posterior root tears showed better meniscal healing and less medial meniscus extrusion progression following pullout repair than complete medial meniscus posterior root tears. [ABSTRACT FROM AUTHOR]

Background: Recent evidence has led to guidelines to refrain from recommending knee arthroscopy for patients with an osteoarthritis diagnosis. The aim of this study was to evaluate the latest changes in the incidence of arthroscopic surgery for degenerative knee disease, changes in the ages of those patients and the delay between knee arthroscopy and arthroplasty, in Finland between 1998 and 2018. Method: The data for were collected from the Finnish National Hospital Discharge Register (NHDR). All knee arthroplasties and arthroscopies performed due to osteoarthritis, degenerative meniscal tears, and traumatic meniscal tears were included. Incidence rates (per 100,000 person-years) as well as the median age of patients were calculated. Results: The incidence of arthroscopy decreased 74% (413 to 106 per 100,000 person-years) and knee arthroplasty increased 179% (94 to 262 per 100,000 person-years) between 1998 and 2018. The incidence of all arthroscopies increased until 2006. Subsequently, the incidence of arthroscopy due to OA decreased by 91% and arthroscopic partial meniscectomy (APM) for degenerative meniscal tears decreased by 77% until 2018. The decrease of traumatic meniscal tears begun later, leading to decrease of 57% between 2011 and 2018. Conversely, the incidence of patients undergoing APM of traumatic meniscal tear increased 375%. The median age of patients who underwent knee arthroscopy decreased from 51 to 46 and from 71 to 69 in knee arthroplasty patients. Conclusions: Increasing evidence that recommends refraining from knee arthroscopy in OA and degenerative meniscal tears has led to a dramatic decrease in the incidence of arthroscopies. Simultaneously, the median age of the patients who undergo these operations has continued to decrease. [ABSTRACT FROM AUTHOR]

Background Patients with partial medial meniscus posterior root tears (MMPRTs) sometimes require arthroscopic pullout repair because of their intolerable/repeated knee pains and continuous disturbance in gait during activities of daily living. However, the predisposing factors for future knee surgery in patients with partial MMPRTs remain unclear. We compared the fndings of magnetic resonance imaging (MRI) between patients who underwent pullout repair and nonoperative management following partial MMPRTs. Methods Twenty-fve patients who required arthroscopic repair for partial MMPRTs and 23 patients who were managed nonoperatively were evaluated during a mean follow-up period of 27.1 months. Sex, age, height, body weight, body mass index, duration from onset to initial MRI, MRI fndings, and medial meniscus (MM) extrusion were compared between the two groups. Linear regression analysis was used to assess the correlation between MM extrusion and duration from onset to MRI examination. Results No signifcant diferences were observed between the pullout repair and nonoperative management groups in terms of patient demographics and the positive ratio of MRI-based root tear signs. However, absolute MM extrusion in the pullout repair group (3.49±0.82 mm) was larger than that in the nonoperative management group (2.48±0.60 mm, P<0.001). Extrusion of the MM (>3 mm) was detected more frequently in the pullout repair group than in the nonoperative management group (P<0.001). The odds ratio in the pullout repair and MM extrusion>3 mm cases was 9.662. Linear regression analysis revealed a fair correlation between the duration from onset to MRI and MM extrusion only in the pullout repair group (0.462 mm/month increase in MM extrusion). Conclusions This study demonstrated that more severe MM extrusions were observed in the pullout repair group than in the nonoperative management group. Major extrusion (>3 mm) was also observed more in the pullout repair group than in the nonoperative group. Assessing MM extrusion and its severity can help determine a valid treatment for patients with partial MMPRTs. Level of evidence IV, Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate liga‑ ment reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgi‑ cal and patient-reported outcomes following concomitant ACLR and medial MAT. Methods We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the US population. P-values<0.05 were considered signifcant. Results The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19–49 years) and mean body mass index (BMI) of 27.9 kg/m² (range 22.5–53.3 kg/m2 ). Mean follow-up time was 56.8 months (range 13–106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated signifcantly with patient satisfaction (p<0.05). Conclusions The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional out‑ comes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds. Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature. Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3–31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0–11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI. Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data. [ABSTRACT FROM AUTHOR]

Background: There are no recommendations for specific suture materials in transtibial pullout repair of medial meniscus posterior root tears. This study aimed to evaluate the clinical outcomes of transtibial pullout repair of medial meniscus posterior root tears using ultrahigh-molecular-weight polyethylene sutures and suture tape. Methods: We retrospectively reviewed the data of 36 patients (27 women and 9 men, mean age 64.1 years) who had undergone transtibial pullout repair of medial meniscus posterior root tears between November 2018 and December 2019. Two groups of 18 patients each received either two different cord-like sutures or suture tape. Clinical parameters were assessed preoperatively and on second-look arthroscopy (mean postoperative period 12 months). The meniscal healing status was assessed using a previously published scoring system (ranging from 0 to 10), and the incidence rate of suture cut-out was assessed on second-look arthroscopy. Results: All clinical scores significantly improved in both groups, with no significant between-group differences on second-look arthroscopy. The arthroscopic meniscal healing scores significantly differed between sutures (mean 6.7 points) and suture tape (mean 7.4 points; p = 0.044). No significant between-group difference in the suture cut-out rate was observed. Conclusions: This study found no significant differences in the clinical outcomes between ultrahigh-molecular-weight polyethylene sutures and suture tape. Favorable clinical outcomes were obtained using both types of suture; however, the usefulness of suture tape appears to be limited. [ABSTRACT FROM AUTHOR]

Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds. Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature. Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3–31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0–11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI. Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data. [ABSTRACT FROM AUTHOR]

Background: Indication for mobile-bearing partial knee replacement (PKR) is made on the basis of a radiological decision aid. This study aimed to reveal the inter-rater reproducibility and accuracy of the decision aid when used by experienced surgeons. Patients and methods: Anonymised radiographic image sets (anteroposterior, lateral, varus/valgus stress in 20° knee flexion, and skyline views) from 20 consecutive patients who underwent knee replacement were assessed by 12 experienced surgeons. Agreements of each section and accuracy were compared by intra-operative inspection of the status of the anterior cruciate ligament (ACL) and medial and lateral cartilage according to the protocol of Radiographic Assessment for Medial Oxford PKR. Fleiss' kappa (κ) values were used as a statistical measure. Results: Full-thickness medial cartilage had the best agreement between the surgeons (κ = 94.7%) and best accuracy (94.2%). Although functioning ACL (90.8%), intact cartilage (91.7%) and full-thickness lateral cartilage defects (86.1%) were accurately diagnosed, diagnoses of deficient ACL (up to 42.5%) and partial-thickness lateral cartilage defects (11.7%) were poor; they were sometimes misdiagnosed as being intact. Moreover, agreement of lateral and valgus stress radiographs regarding intact MCL function, as well as the overall decision, was considered to be inadequate (κ = 0.47, 0.58 and 0.51, respectively). Conclusions: Although the radiological aid is useful for selection of patients who are likely to be suitable for PKR, surgeons should still carefully assess the lateral weight-bearing area for partial-thickness loss and deficiency of the ACL because they were sometimes overlooked by surgeons using radiographs. MRI will be helpful to improve the accuracy of determination of Oxford PKR indication. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment. Materials and Methods: We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups. Results: The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05). Conclusions: Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare clinical outcomes and incidence of concomitant injuries in patients undergoing early vs delayed surgical treatment of single anterior cruciate ligament (ACL) injury and multiligament knee injury (MLKI). Methods: A literature search using PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, and Scopus from their inception to April 30, 2020 was conducted. Studies with levels I to IV evidence reporting the incidence of meniscus or cartilage injury according to early vs delayed surgery in single ACL injuries and MLKIs were included. In the meta-analysis, data based on the number of meniscus and cartilage injuries were extracted and pooled. Lysholm and Tegner scores were analyzed using two-sample Z-tests to calculate the non-weighted mean difference (NMD). A meta-regression analysis was also performed to determine the effect of single ACL injury and MLKI/study design. Results: Sixteen studies on single ACL injury and 14 studies on MLKI were included in this analysis. In the analysis, there were significant decreases in Lysholm score (NMD − 5.3 [95% confidence interval (CI) − 7.37 to − 3.23]) and Tegner score (NMD − 0.25 [95% CI − 0.45 to − 0.05]) and increases in risk of meniscus tear (odds ratio [OR] 1.73 [95% CI 1.1–2.73], p = 0.01) and cartilage injury (OR 2.48 [95% CI 1.46–4.2], p = 0.0007) in the delayed surgery group regardless of single ACL injury or MLKI. The result of the meta-regression analysis indicated that single ACL injury and MLKI/study design were not significant moderators of overall heterogeneity (p > 0.05). Conclusions: Our study suggests that delayed ACL surgery significantly resulted in a higher risk of meniscus tear and cartilage injury and decreased Lysholm and Tegner scores compared to early ACL surgery. The Lysholm scores in the delayed MLKI surgery group were significantly decreased, but the risks of meniscus tear and cartilage injury in the delayed MLKI surgery group remained unclear. Level of evidence: Level III, meta-analysis. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods: All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years' follow-up. Results: A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years' follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years' follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion: Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scafolds may be advantageous following partial meniscal resection. There are three main scafolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actift (Actift, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scafolds. Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actift or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature. Results: Five Level IV studies were found for Actift. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identifed for the NUsurface scafold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actift, 109 with CMI and 65 with NUsurface. Failure rates for Actift were 18% (range 6.3-31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0-11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved signifcantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actift and 53 (45%) for CMI. Conclusion: The evidence for meniscal scafold use is insufcient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actift. On the basis of current evidence, the use of meniscal scafolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data. [ABSTRACT FROM AUTHOR]

Purpose: Medial meniscus posterior root tear (MMPRT) causes progression of medial meniscus extrusion (MME). This study aims to calculate the progression rate of MME based on findings in two preoperative magnetic resonance imaging (MRI) scans and determine the associated factors. Materials and Methods: We retrospectively reviewed 33 patients (27 females and 6 males; mean age, 60 years) who underwent MRI twice, at a mean interval of 48 days. We measured the medial meniscus body width, medial joint space width (MJSW), and MME. The MME progression rate was derived from regression analysis of the increase in MME (ΔMME) between the two MRI scans. In addition, the correlations of the MME increase rate with age, body mass index, femorotibial angle, and MJSW were evaluated. Results: The mean MME increased from 3.4 mm to 4.5 mm (p<0.001). A good correlation was observed between ΔMME and the interval of MRI scans (R2=0.621), and the MME progression rate was 0.020 mm per day. A moderate correlation was observed between the MME increase rate and the MJSW (R2=0.432). Conclusions: The MME progression rate was rapid in MMPRT and narrowing of the MJSW was associated with the progression of MME. Level of Evidence: V, Cross-sectional study [ABSTRACT FROM AUTHOR]

Post-arthroscopic osteonecrosis is a rare complication that mostly occurs in the over 50s. It most commonly occurs in the medial femoral condyle, followed by the lateral femoral condyle then medial tibial plateau. We report the first case of lateral tibial plateau osteonecrosis in a young patient after arthroscopic lateral meniscectomy. This patient developed progressively deteriorating symptoms after uncomplicated arthroscopy; with a subsequent magnetic resonance imaging (MRI) showing bone oedema and some overlying cartilage damage. Conservative measures were unsuccessful, so core decompression was undertaken. This has resulted in improved symptoms and subsequent follow-up MRI demonstrates resolution of oedema with no progressive cartilage change. This is a rare condition with a poor outcome, usually resulting in arthroplasty. This technique may work in the younger patient. However, since post-arthroscopic osteonecrosis is so rare in this age group, there is limited evidence for its success, and it should be evaluated with further study. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical outcomes of arthroscopic partial and subtotal resection of the impinged infrapatellar fat pad (IFP). Materials and Methods: This study enrolled 55 patients with IFP impingement who underwent partial resection (n=29, P group) or subtotal resection (n=26, S group). Clinical outcomes at least 2 years postoperatively were evaluated using a visual analog scale (VAS) for pain, the International Knee Documentation Committee (IKDC) 2000 subjective knee score, and the Lysholm score. Results: In the P group, the preoperative mean VAS, IKDC 2000, and Lysholm scores were 5.6±0.61, 47.5±7.41, and 42.5±7.17, respectively, which improved significantly to 1.4±0.63, 70.9±6.15, and 82.2±7.61, respectively (all, p≤0.001). In the S group, the preoperative mean VAS, IKDC 2000, and Lysholm scores were 5.7±0.43, 47.7±9.09, and 45.2±4.18, respectively, which improved significantly to 1.8±0.77, 71.9±9.33, and 82.3±6.01, respectively (all, p≤0.001). There were no significant differences in any outcome measure between the groups at the final follow-up. Conclusions: Arthroscopic resection of the impinged IFP between the patella and femoral trochlea resulted in favorable clinical outcomes regardless of whether the resection was partial or subtotal. Thus, partial resection can be an appropriate treatment option, considering partial resection was as effective as subtotal resection and retained more of the IFP. [ABSTRACT FROM AUTHOR]

The present study reports our experience of treating four cases of symptomatic discoid medial meniscus, three of which were bilateral. We performed partial meniscectomy with a four-portal technique using a knife leaving a 6 mm peripheral margin after confirmation of magnetic resonance imaging findings. Clinical results were assessed at the end of 2-year follow-up using the Knee Injury and Osteoarthritis Outcome Score and a visual analogue scale. We obtained satisfactory clinical results without recurrence of the symptoms in all cases. [ABSTRACT FROM AUTHOR]

Purpose: Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods: This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results: Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions: The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee. [ABSTRACT FROM AUTHOR]

Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared. [ABSTRACT FROM AUTHOR]

There is a greater incidence of discoid meniscus in Asian countries than in Western countries, and bilateral discoid menisci are also common. The discoid meniscus may be a congenital anomaly, and genetics or family history may play a role in the development of discoid menisci. Because the histology of discoid meniscus is different from that of normal meniscus, it is prone to tearing. Individuals with a discoid meniscus can be asymptomatic or symptomatic. Asymptomatic discoid menisci do not require treatment. However, operative treatment is necessary if there are symptoms. Total meniscectomy leads to an increased risk of osteoarthritis. Therefore, total meniscectomy is generally reserved for rare unsalvageable cases. Partial meniscectomy (saucerization) with preservation of a stable peripheral rim combined with or without peripheral repair is effective, and good short-, mid-, and long-term clinical results have been reported. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the demographics, clinical features, and outcomes of arthroscopic partial meniscectomy (APM) for isolated medial meniscus horizontal cleavage tears (MMHCTs) in patients under 45 years of age. Materials and Methods: We retrospectively reviewed 98 patients (100 knees) under 45 years who underwent APM for MMHCTs. Clinical outcomes were assessed using International Knee Document Committee (IKDC) subjective core, Tegner activity scale, visual analog scale (VAS) pain score, and a question on the symptom relief. Results: 79% were male and 70% had no trauma. The mean symptom duration was 10 months. At arthroscopy, a flap tear was identified in 75%. At a mean of 19-month follow-up, the IKDC subjective score, Tegner activity scale, and VAS pain score were significantly improved compared to the preoperative values (p=0.025, p=0.043, and p=0.032, respectively). While 85% were free of symptoms, 15% had persistent pain. No significant differences in outcomes were observed based on the tear type and the presence of flap tears. No progression or development of radiographic degenerative changes was observed in all knees. Conclusions: Demographics of MMHCTs under age 45 showed a male dominance and higher frequency of non-traumatic tears. APM was beneficial to symptomatic HCTs in this cohort during the short-term follow-up. Type of HCTs and combined flap tears did not affect clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the clinical outcome of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty (TKA). Materials and Methods: From May 1999 to June 2006, 23 patients underwent unilateral total knee arthroplasty and contralateral arthroscopic meniscectomy at the same time. All patients were women and followed for at least 36 months, except 2 patients who died. For clinical assessment, range of motion of the knee joint, Hospital for Special Surgery (HSS) knee score and the Lysholm knee score were evaluated preoperatively and at the last follow-up. At arthroscopy, meniscal pathology and cartilage changes were recorded and classified according to the Outerbridge scale. Progression of osteoarthritis in the contralateral knee to subsequent TKA was also assessed. Results: The mean age of the 21 patients was 67.1 years and the mean follow-up period was 5.7 years. All of the patients were diagnosed with osteoarthritis and had Outerbridge grade 3 or 4 cartilage changes. Eight of the 21 patients had subsequent TKA at an average of 3.1 years after the index operation. The other 13 patients had no further surgery and clinical results including the HSS knee score and the Lysholm score were improved from 74.5 and 60.6 preoperatively to 90.8 and 82.4 postoperatively, respectively (p<0.001). Conclusions: Contralateral arthroscopic meniscectomy performed simultaneously with unilateral TKA produces relatively good results regardless of the presence of cartilage degeneration. [ABSTRACT FROM AUTHOR]

The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well. [ABSTRACT FROM AUTHOR]

Osteonecrosis of the femoral condyle is known as an uncommon complication after arthroscopic meniscectomy. The lesion of osteonecrosis can be irreversible, thus early detection of the disease is crucial for treatment. A 50-year-old male patient without known risk factors of osteonecrosis developed increasing knee pain after arthroscopic partial meniscectomy. Magnetic resonance imaging showed rapid progression of osteonecrosis of the medial femoral condyle. Unicompartmental knee arthroplasty was performed after 9 months of conservative therapy. The patient is now free from pain during daily activities. It might be important to remind that if the patient's pain after arthroscopic partial meniscectomy is severe than expected, clinical doctors should pay attention to the possibility of ongoing osteonecrosis of the femoral condyle. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of arthroscopic microfracture in patients with focal full-thickness cartilage defects in the osteoarthritic knee. Materials and Methods: Seventy-six patients were enrolled in this study. They were divided into group I (n=38) who underwent microfracture plus meniscectomy and group II (n=38) who underwent only meniscectomy. Clinical and radiological evaluations were performed. Results: At the time of the three-year follow-up, a total of five failures (6.6%) were reported: four patients in group I and one in group II. The two groups showed no significant difference in the Lysholm score, the Tegner activity score and the visual analog pain scale score at three years after surgery. However, at the time of the three-month follow-up, group II showed significantly more improvement in the Tegner activity and the visual analog pain score compared with group I. Conclusions: In the osteoarthritic knee, additional microfracture did not confer any additional benefit to meniscectomy. [ABSTRACT FROM AUTHOR]

With recognition of the biomechanical role of the meniscus, such as load distribution and joint stability in the knee joint, there has been a shift in the treatment of meniscal tears from open total meniscectomy to preservation of the meniscal functions as much as possible with symptomatic relief. Recently, technical development of meniscal surgery, with advanced arthroscopic equipment and instruments, enables biological reconstruction of load bearing functions in the meniscus deficient knee through allograft tissue transplantation as well as repair of torn menisci. Meniscal allograft transplantation (MAT) has been considered as one of the few viable treatment options for the young meniscectomized knees based on various animal experiments and clinical studies. Still, there is insufficient evidence for the long-term chondroprotective effect of human MAT. Some long- term follow-up studies showed that the technique resulted in graft degeneration, deformation, and tear, and structural changes in the remodeling process in early MAT cases, disrupting functional restoration of the original meniscus. Nevertheless, advanced outcomes are documented in some recent studies. The purpose of this article is to review the mid- and long-term follow-up results of MAT and to improve understanding of MAT with evaluation methods of meniscal transplants using magnetic resonance imaging or second-look arthroscopy. [ABSTRACT FROM AUTHOR]

Purpose: To introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife. Materials and Methods: From March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), and average follow-up was 26 months (range, 8 to 72 years). In this procedure, using a No. 11 knife holder inserted through the high far anteromedial portal, a stab incision on the anterior meniscal horn and following piecemeal meniscal excision were made. Clinical results were assessed using the scale of Ikeuchi and Lysholm score. Results: Meniscus shape was complete in 32 knees (53.3%) and incomplete in 28 knees (46.6%). The shape of tears in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tears in 10 knees (31.2%) and radial tears in 5 knees (15.6%). Clinical results assessed using the scale of Ikeuchi were excellent in 38 (63.3%), good in 13 (21.6%), fair in 8 (13.3%) and poor in 1 knee (1.6%). The average Lysholm score was improved from 82.8 preoperatively to 95.4 postoperatively. Conclusions: Our new arthroscopic technique in lateral discoid partial meniscectomy suggests convenient methods and successful clinical results. [ABSTRACT FROM AUTHOR]

We introduce a new arthroscopic partial meniscectomy technique using a three portals and a small skin hook retractor to remove unstable inferior leaf in horizontal meniscal tear that involved the anterior portion of the lateral meniscus. The patient is positioned for a standard knee arthroscopy. After careful estimation of the depth and extent of the cleft and stability of the superior and inferior leaves is done through the standard anteromedial portal, a small skin hook retractor is inserted through the standard anterolateral portal to raise the dominant superior leaf of anterior horn, then the unstable inferior leaf is excised with a 90° rotary punch and a motorized shaver through the extreme far anteromedial portal. This technique is useful method to remove unstable inferior leaf of anterior horn of lateral meniscus which is difficult to remove with a standard technique. [ABSTRACT FROM AUTHOR]