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Background: The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.Methods: We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.Results: A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).Conclusions: Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the effect of debridement (CL-Deb) versus observation (CL-noDeb) of unstable chondral lesions on knee pain 5 years after arthroscopic partial meniscectomy (APM) in patients enrolled in the Chondral Lesions And Meniscus Procedures (ChAMP) Trial. Secondarily, other knee symptoms, function, general health, and the rate of additional surgery on the affected knee were examined.Methods: Patients aged ≥30 years who had an unstable Outerbridge grade-II, III, or IV chondral lesion when undergoing APM were randomly allocated to the CL-Deb (n = 98) or CL-noDeb (n = 92) group; ∼80% in each group completed a 5-year follow-up. Outcomes were measured preoperatively and at 5 years postoperatively, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Short Form-36 (SF-36), physical knee measurements, knee radiographs, and rate of additional knee surgery at 5 years. The primary outcome was the 5-year WOMAC pain score. Group comparisons were made using the t test for continuous outcomes and the Fisher exact test for categorical outcomes.Results: There were no significant differences between the groups with respect to the primary outcome, the WOMAC pain score (CL-Deb: 86.0 [95% confidence interval (CI): 82.9 to 89.1]) versus CL-noDeb: 88.3 [95% CI: 85.5 to 91.1]; p = 0.27), or secondary outcomes at 5 years. There were also no differences in radiographic measurements of joint-space narrowing in any compartment (medial or lateral tibiofemoral or medial, central, or lateral patellofemoral) as well as no difference in the rate of additional knee surgery within 5 years after APM between the CL-Deb and CL-noDeb groups.Conclusions: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 5 years postoperatively, suggesting that there is no long-term benefit of arthroscopic debridement of chondral lesions encountered during APM.Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Traditionally defined "meniscal" and "mechanical" symptoms are thought to arise from meniscal tears. Yet meniscal tears and cartilage damage commonly coexist in symptomatic knees. To better characterize the primary driver of these symptoms, we investigated whether the presence of preoperative patient-reported knee symptoms (PRKS), including knee catching/locking, grinding/clicking/popping, and pain with pivoting, are associated with various intra-articular pathological conditions diagnosed at knee arthroscopy.Methods: We collected prospective data from 565 consecutive patients who underwent knee arthroscopy from 2012 to 2019 and had PRKS collected via the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The diagnosis of meniscal pathology and concomitant cartilage damage was confirmed and classified intraoperatively. We used multivariable regression models, adjusting for possible confounders, to examine the association of specific pathological conditions of the knee with the presence of preoperative PRKS.Results: Tricompartmental cartilage damage was strongly associated with significantly worse PRKS, with an increase of 0.33 point (95% confidence interval [CI] = 0.08 to 0.58; p = 0.01) on a 0 to 4-point scale. We did not observe an association between meniscal pathology and preoperative PRKS.Conclusions: Contrary to current dogma, this study demonstrates that traditionally defined "meniscal" and "mechanical" knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Lesions of the posterior segment of the medial meniscus are the most common intraarticular lesions associated with ACL injuries. Ramp lesions are tears in the peripheral attachment of the posterior horn of the medial meniscus. Such injuries are difficult to detect on preoperative MRI. Arthroscopically, the prevalence of these lesions can reach 24%. Anatomical descriptions of the posterior horn of the medial meniscus are becoming clearer, however, histological descriptions are lacking, especially with regard to the presence or absence of capillaries.Questions/purposes: The present qualitative histologic study focused on the posterior segment of the medial meniscus and the meniscocapsular and meniscotibial junctions. Specifically, the objective of this study was to analyze the posterior segment of the medial meniscus and the meniscosynovial junction and to determine whether the meniscus tibial ligament exists.Methods: We dissected 10 unpaired cadaveric knees (five male, five female, age range 55 to 66 years), five left and five right, from the French "Don du corps" body donation program via a posterior approach to the posteromedial capsule. We excluded specimens with intra-articular abnormalities (ACL rupture, meniscal tear, arthrosis) preceding dissection by arthrotomy. We thus accessed the posterior segment of the medial meniscus and the meniscosynovial junction. The proximal capsule, posterior segment of the medial meniscus, entire meniscal capsular-tibial junction, and a fragment of the tibia were removed en bloc. For each knee, three sagittal spaced sections of the posterior segment of the medial meniscus (Zone 4 as defined by Śmigielski) were performed. Two experienced pathologists performed qualitative histological analysis on the 30 samples after Hematoxylin and eosin staining, and Safranin O staining.Results: Macroscopically, the meniscotibial attachments were pellucid and homogeneous, as were the meniscocapsular attachments; however, the meniscocapsular attachments appeared to be denser in both the anterior and posterior regions of the capsule. Microscopy of the meniscosynovial junction revealed loose collagen fibers that were partially oriented but not parallel, a cellular network featuring a few fibroblasts and adipocytes, and several capillaries. No between-attachment histologic differences were apparent; both tissues shared a site of attachment to the posterior horn of the medial meniscus. We did not detect the meniscotibial ligament, macroscopically or microscopically.Conclusions: A ramp lesion may not be a ligamentous injury because the meniscotibial ligament was not detected. Rather, it appears that a ramp lesion is a tear in the common attachment point between the posterior horn of the medial meniscus and meniscocapsular and meniscotibial junctions. This structure is vascularized, and contains nonoriented low cellularity collagen of moderate density.Clinical Relevance: Based on our results, a better rationale for the recommendation of surgical repair of a ramp appears to be needed, given the absence of a meniscotibial ligament, and the presence of capillaries in the meniscocapsular and meniscotibial attachments. [ABSTRACT FROM AUTHOR]

Background: Appropriate postoperative lower limb alignment is one important element of a successful unicompartmental knee arthroplasty (UKA). To predict postoperative alignment, it is important to investigate the association between preoperative imaging evaluations and lower limb alignment after medial UKA.Questions/purposes: (1) Do preoperative valgus stress radiographic and MRI measurements (% mechanical axis, hip-knee-ankle angle, medial meniscal extrusion distance, and osteophyte area at the medial femur and tibia) correlate with postoperative lower limb alignment after UKA; and (2) Can useful cutoffs be calculated in advance of surgery for those findings that were associated with coronal-plane overcorrection?Methods: We retrospectively analyzed 125 patients with medial knee pain who underwent UKA from January 2012 to October 2018. Valgus stress radiography and MRI were performed routinely to assess the knee. Valgus stress radiography was obtained with the patient supine with the knee in full extension and a firm manual valgus force applied to the knee. Full-length weightbearing radiography was performed 3 months after surgery. There were 12% (15) of patients who did not undergo MRI, and 4% (five) of patients who did not receive the postoperative full-length weightbearing radiograph and they were excluded, leaving 84% (105) of patients available for analysis. There were 27 men and 78 women with a mean (range) age of 77 years ± 6 years (60 to 87). The preoperative diagnosis was medial osteoarthritis in 99 patients and osteonecrosis of the medial femoral condyle in six. To investigate the associations, we routinely measured % mechanical axis using radiography, and also measured the medial meniscal extrusion distance and osteophyte area at the medial femur and tibia using MRI after surgery. Medial meniscus extrusion distance was defined as the distance from the outermost edge of the medial meniscus to a line connecting the femoral and tibial cortices. From these parameters, postoperative alignment was estimated using regression and receiver operating characteristic curve analyses. Variables with p < 0.05 were included.Results: The % mechanical axis on the valgus stress radiograph and medial meniscal extrusion distance were correlated with postoperative lower limb alignment after UKA (adjusted correlation coefficient 0.72; p < 0.001, adjusted correlation coefficient 0.2; p = 0.003, respectively). The estimated % mechanical axis on the postoperative weightbearing radiograph was equal to -0.27 + 0.86% (% mechanical axis on valgus stress radiograph) + 1.14 mm (medial meniscal extrusion distance). Using a cutoff point of 36%, the % mechanical axis on valgus stress radiograph was associated with overcorrection after UKA (area under the curve: 0.89; odds ratio 14 [95% CI 0.75 to 0.95]; p < 0.001, sensitivity 77.8%, specificity 80.9%).Conclusions: The overcorrection of a varus knee on a valgus stress radiograph before UKA and the increased extrusion of the medial meniscus on preoperative MRI was associated with a greater likelihood of overcorrected alignment after UKA. Future studies should conduct long-term follow-up of malalignment patients to assess the possible complications.Level Of Evidence: Level III, diagnostic study. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplantation (MAT) is considered a viable surgical treatment option in the symptomatic, post-meniscectomy knee and as a concomitant procedure with ACL revision and articular cartilage repair. Although promising outcomes have recently been reported in active and athletic populations, MAT has not been well-studied in the high-demand military population.Questions/purposes: (1) What proportion of active-duty military patients who underwent MAT returned to full, unrestricted duty? (2) What demographic and surgical variables, if any, correlated with return to full, unrestricted duty?Methods: Between 2005 and 2015, three fellowship-trained sports surgeons (TMD, SJS, BDO) performed 110 MAT procedures in active-duty military patients, of which 95% (104 patients) were available for follow-up at a minimum 2 years (mean 2.8 ± SD 1.1 year). During the study period, indications for MAT generally included unicompartmental pain and swelling in a post-meniscectomized knee and as a concomitant procedure when a meniscal-deficient compartment was associated with either an ACL revision reconstruction or cartilage repair. Demographic and surgical variables were collected and analyzed. The primary endpoints were the decision for permanent profile activity restrictions and military duty termination by a medical board. The term "medical board" implies termination of military service because of medical reasons. We elected to set statistical significance at p < 0.001 to reduce the potential for spurious statistical findings in the setting of a relatively small sample size.Results: Forty-six percent (48 of 104) of eligible patients had permanent profile activity restrictions and 50% (52 of 104) eventually had their military duty terminated by a military board. Only 20% (21 of 104) had neither permanent profile activity restrictions nor medical-board termination and were subsequently able to return to full duty, and only 13% (13 of 104) continued unrestricted military service beyond 2 years after surgery. Age, gender, tobacco use, and BMI did not correlate with return to full duty. Combat arms soldiers were less likely to have permanent profile activity restrictions (odds ratio 4.76 [95% CI 1.93 to 11.8]; p = 0.001) and were more likely to return to full duty than soldiers in support roles (OR 0.24 [95% CI 0.09 to 0.65]; p = 0.005), although these findings did not reach statistical significance. Officers were more likely to return to full duty than enlisted soldiers at more than 2 years after surgery (OR 17.44 [95% CI 4.56 to 66.65]; p < 0.001). No surgical variables correlated with return-to-duty endpoints.Conclusions: Surgeons should be aware of the low likelihood of return to military duty at more than 2 years after MAT and counsel patients accordingly. Based on this study, MAT does not appear to be compatible with continued unrestricted military duty for most patients.Level Of Evidence: IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Case: A 17-year-old boy had persistent knee pain 1 year after medial meniscal root repair augmented with bone marrow aspirate concentrate injection. Radiographs and magnetic resonance imaging (MRI) demonstrated an intrameniscal ossicle which was not present on MRI performed before 6 months. He underwent arthroscopic excision of the meniscal ossicle. At the 7-month follow-up, he had complete relief of his pain. Conclusions: It is possible that the meniscal ossicle developed because of osteoinductive cells and cytokines from the injected bone marrow or the drill hole for root repair and should be considered as a possible complication of this procedure. [ABSTRACT FROM AUTHOR]

The article discusses the function and anatomy of the themeniscus, examines the implications of meniscectomy and evaluates the surgical techniques and results after meniscal repair. Topics include the significant role of the menisci in load-bearing and shock absorption, the limited healing capacity of meniscus, and various factors that affect the healing of the meniscus such as poor vascularity and acellularity.

Background: It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM.Methods: Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported.Results: There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02).Conclusions: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ.Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR., Methods: This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05., Results: A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006)., Conclusions: This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated., Level of Evidence: Level IV; retrospective cohort study., Competing Interests: D.W.G.: AAOS: Board or committee member. AO Trauma International: Paid presenter or speaker. Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker. Current Opinion in Pediatrics: Editorial or governing board; Publishing royalties, financial or material support. New York County Medical Society: Board or committee member. New York State Society of Orthopaedic Surgeons: Board or committee member. PatelloFemoral Foundation: Board or committee member. Pediatric Orthopaedic Soceity of North America: Board or committee member. Pediatric Research in Sport Medicine: Board or committee member. Pega Medical: IP royalties. Wolters Kluwer Health—Lippincott Williams and Wilkins: Publishing royalties, financial or material support. P.D.F.: Clinical Orthopaedics and Related Research: Editorial or Governing board. Pediatric Orthopaedic Society of North America: Board or committee member. Osso VR: Stock or stock options. Wish Bone Orthopaedics: Paid consultant. Research in Osteochondritis of the Knee (ROCK): Board or committee member. The remaining authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The article provides update concerning the study of musculoskeletal tissues and basic research findings relevant to orthopaedic surgery. An overview on the major thematic areas of orthopaedic research, is provided. Also examined is the in vitro and preclinical (animal) research on stem cells but but limited clinical investigation in humans.

Case: We describe the cases of two patients with a previously unreported complication associated with the all-inside FAST-FIX meniscal repair system. In both cases, anchors came loose postoperatively. Conclusion: Surgeons need to be aware of this potential complication in the event that a patient presents with pain and mechanical symptoms after meniscal repair. [ABSTRACT FROM AUTHOR]

Background: Imaging is of great importance in diagnosing meniscal tears. The aim of this study was to assess the accuracy of high-resolution ultrasound in the diagnosis of meniscal tears, with arthroscopic examination as the standard reference, after resolution was confirmed with a target-mounted reference phantom. An additional goal was to elucidate the area of the meniscus that could be visualized with the same ultrasound machine after placement of markers into the menisci of cadaveric knees. Methods: Seventy patients were included for the assessment of the accuracy of a high-resolution ultrasound machine with a 14.0 to 6.0-MHz linear transducer. The preoperative ultrasound diagnosis, in terms of the presence and type of tear, was compared with that in the surgical reports. In the cadaveric studies, nine needles were placed in the peripheral zone of the menisci at regular intervals and the number of needles that could be observed with the system was recorded. Results: The overall sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound examination for meniscal tears were 88%, 85%, 85%, and 88%, respectively. These statistical parameters did not differ significantly between the medial and lateral menisci. The sensitivity for diagnosing horizontal, vertical, radial, flap, buckethandle, and complex tears and for detecting discoid lateral menisci was 83%, 64%, 0%, 64%, 54%, 90%, and 80%, respectively. Ten percent of the lateral menisci could not be evaluated because of poor images. The cadaveric studies revealed that the ultrasound visualized the entire meniscus except for the anterior horn. Conclusions: The findings of this study suggest that ultrasound examination may be suitable for screening for meniscal tears. The fact that almost 10% of the lateral menisci could not be evaluated because of poor images appears to be a weakness of ultrasound. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluates whether platelet-rich plasma (PRP) augmentation during index meniscal repair decreases meniscectomy and if PRP augmentation influence functional outcome measures in arthroscopic meniscus repair. Topics include using the International Knee Documentation Committee (IKDC), reconstruction of anterior cruciate ligament (ACL), and studies on meniscal repair.

Background: A discoid lateral meniscus in the knee is more common in Asian populations. The aim of this study was to evaluate the influence of arthroscopic meniscectomy of the discoid lateral meniscus on the axial alignment of the lower limb in adolescents (younger than twenty years of age). Methods: We retrospectively reviewed the data from 298 adolescent patients (younger than twenty years of age) who underwent arthroscopic treatment in our center from 2004 to 2013. Patients were divided into three groups according to the meniscus type: torn discoid lateral meniscus (Group A), torn nondiscoid lateral meniscus (Group B), and nondiscoid lateral meniscus without a tear (Group C). The tibiofemoral angle (TFA) and mechanical axis deviation (MAD) of both lower limbs were examined on standing anteroposterior radiographs before and after arthroscopy. Results: The preoperative TFA and MAD of the ipsilateral lower limbs demonstrated significantly more varus in Group A than in Group B (p < 0.001) or Group C (p < 0.001) after we controlled for the contralateral lower limbs as a covariate factor. Moreover, the TFA and MAD of the ipsilateral knees were significantly reduced (indicating a reduction in varus inclination) postoperatively, as compared with preoperatively, in Group A (p < 0.001) and Group B (p < 0.001), with no difference between the preoperative and postoperative values in Group C (p > 0.01), after we controlled for the contralateral lower limb as the covariate factor. Additionally, the reductions in the TFA and MAD (varus inclination) in Group A were significantly greater than those observed in Group B (p < 0.001). Conclusions: The axial alignment of the lower limb in adolescents (younger than twenty years of age) with a torn discoid lateral meniscus was altered immediately after arthroscopic meniscectomy: the varus deformity was significantly reduced, and a valgus inclination developed in some of these patients. The valgus inclination was more pronounced in the patients with a torn discoid lateral meniscus compared with those with a torn nondiscoid lateral meniscus. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

An interview with orthopedic surgeon Ichiro Sekiya is presented. Topics discussed include ways to overcome language barriers between basic scientists and clinicians, recommendations for clinicians to review at least three related research papers to get idea on the language use in the articles, and various experiments on transplantations of synovium-derived mesenchymal stem cells after meniscus injury.

The article discuses the the complications of meniscal repair associated with preoperative, intraoperative and postoperative errors. It informs that the repair technique should be tailored for the tear location and size and the potential complications related to each technique. It also presents information on the risks of saphenous nerve and vein and medial repairs and the peroneal nerve is at risk with lateral repairs.

The article presents a study which investigates the effectivess of hyaluronic acid as a short-term analgesic in improving the functional outcomes following knee arthroscopy. The findings of the study reveal that administration of HA injection immediately after knee arthroscopy has no beneficial effects in the first 6 weeks after the operation. The study suggests that the routine use of HA during this type of surgery is not advisable.

The article discusses the meniscus tears in the skeletally immature athlete and the physician's diagnosis. It higlights the anatomy and development of the menisci, the diagnosis and classification of meniscal tears in children, and the management and outcome of the treatment. Details on discoid meniscus and meniscal cysts are discussed.

The article describes the meniscal transplant technique developed by Ramon Cugat which is carried out without bone blocks. It references previous studies on meniscectomy. A detailed discussion on the surgical technique that includes patient selection, specific requirements of the graft and graft preparation, is presented. It describes the procedure of tunnel drilling for meniscal horn anchorage and the placement of the graft.

The article offers information on meniscectomy, a surgical technique for the preservation of meniscal. According to the article, meniscal injury is a common cause of knee pain and major cause of functional impairment of the knee among young athletes. The replacement of total meniscectomy by arthroscopic partial meniscectomy is discussed. Factors to consider in treatment choice of a meniscal pathologies include patient's age, health, lifestyle and sporting activity level. Also discussed are meniscal tear classification and resection procedures.

The article offers information on the indications, advantages and disadvantages of meniscal sutures. The difference between stable and unstable meniscal tisue is explained. Factors to consider in meniscal sutures include location of the lesion, the association of an anterior cruciate ligament lesion, tear age and patient age. Other topics discussed include the biomechanics of the meniscus, indications for meniscal suture, meniscal repair techniques and meniscal screw fixation technique.

The article discusses the procedure of allograft meniscus transplantation (AMT). Comprising of a semilunate wedge-shaped fibrocartilage tissue mass, meniscus contributes to the shock absorption, load transmission, lubrication and stabilization of knee joint. A historical overview of meniscal allograft transplantation is presented, along with indications and contraindications of the procedure. The transplantation procedure aims to correct anatomic positioning and peripheral fixation of the graft.

BACKGROUND: Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. METHODS: Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0°, 30°, 60°, and 90°. The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus,(3).a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. RESULTS: In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak con- tact pressure compared with that found in the intact condition (p < 0.001). Repair restored the peak contact pressure to normal. No difference was detected between the peak contact pressure after the total medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98° and 0.84 mm, respectively) and the meniscectomy (4.45° and 0.80 mm, respectively), and these increases were corrected by the repair. CONCLUSIONS: This study demonstrated significant changes in contact pressure and knee joint kinematics due to a posterior root tear of the medial meniscus. Root repair was successful in restoring joint biomechanics to within normal conditions. CLINICAL RELEVANCE: This study provides a biomechanical rationale for surgical repair of posterior root tears of the medial meniscus. Clinical studies are required to define the appropriate patient population for, and to determine the clinical efficacy of, surgical treatment of this injury. [ABSTRACT FROM AUTHOR]

Abstract  Giant cell tumor of bone sometimes is an aggressive benign skeletal tumor. Historically, curettage and bone grafting have a high recurrence with satisfactory function whereas wide resection has a reduced recurrence rate with compromise of limb function. Thus, maintaining joint function and achieving adequately wide resection introduces contradictory surgical goals. We developed a method for achieving both goals for giant cell tumors located in only one lateral plateau of the proximal tibia. We reconstructed 13 knees preserving the meniscus and reconstructing the tibial plateau with an iliac plate autograft after resection of a giant cell tumor involving one tibial plateau. Four patients had primary tumors and nine had recurrences after curettage. The minimum followup was 5 years (mean, 9.1 years; range, 5–12.75 years). We used the system of Enneking et al. to evaluate function. One patient had recurrence and underwent prosthesis replacement. No patient experienced collapse, instability, or pain, and knee function was restored to near normal. The mean functional score was 95%. While resecting the tumor, the normal anatomic structures of the knee can be preserved or restored in many patients. This method can be used in selected patients to reconstruct the knee after resection of tumors involving one tibial plateau. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Loss of meniscal tissue leads to increased pain and decreased clinical function and activity levels. We hypothesized that patients receiving a collagen meniscus implant would have better clinical outcomes than patients treated with partial medial meniscectomy alone. Methods: Three hundred and eleven patients with an irreparable injury of the medial meniscus or a previous partial medial meniscectomy, treated by a total of twenty-six surgeon-investigators at sixteen sites, were enrolled in the study. There were two study arms, one consisting of 157 patients who had had no prior surgery on the involved meniscus (the `acute" arm of the study) and one consisting of 154 patients who had had one, two, or three prior meniscal surgical procedures (the "chronic" arm). Patients were randomized either to receive the collagen meniscus implant or to serve as a control subject treated with a partial meniscectomy only. Patients underwent frequent clinical follow-up examinations over two years and completed validated outcomes questionnaires over seven years. The patients who had received a collagen meniscus implant were required by protocol to have second-look arthroscopy at one year to determine the amount of new tissue growth and to perform a biopsy to assess tissue quality. Reoperation and survival rates were determined. Results: In the acute group, seventy-five patients received a collagen meniscus implant and eighty-two were controls. In the chronic group, eighty-five patients received the implant and sixty-nine were controls. The mean duration of follow-up was fifty-nine months (range, sixteen to ninety-two months). The 141 repeat arthroscopies done at one year showed that the collagen meniscus implants had resulted in significantly (p = 0.001) increased meniscal tissue compared with that seen after the original index partial meniscectomy. The implant supported meniscus-like matrix production and integration as it was assimilated and resorbed. In the chronic group, the patients who had received an implant regained significantly more of their lost activity than did the controls (p = 0.02) and they underwent significantly fewer non-protocol reoperations (p = 0.04). No differences were detected between the two treatment groups in the acute arm of the study. Conclusions: New biomechanically competent meniscus-like tissue forms after placement of a collagen meniscus implant, and use of the implant appears safe. The collagen meniscus implant supports new tissue ingrowth that appears to be adequate to enhance meniscal function as evidenced by improved clinical outcomes in patients with a chronic meniscal injury. The collagen meniscus implant has the utility to be used to replace irreparable or lost meniscal tissue in patients with a chronic meniscal injury. The implant was not found to have any benefit for patients with an acute injury. [ABSTRACT FROM AUTHOR]

The article discusses the technique of arthroscopic meniscus repair with autograft tendon fibers. A historical overview of arthroscopic meniscus repair is presented, along with its indications and contraindications. The technique involves several procedures including arthroscopic examination and meniscal wound management. The most common complication associated with the technique is injury of infrapatellar branch of saphenous nerve.

The human meniscus is important for normal knee function and distributes loads, aids in joint lubrication, congruence, stability, and proprioception. Repair of appropriate meniscal tears is possible and several methods exist to accomplish this including suture repairs and device repairs. Clinical evidence suggests that meniscal repairs can result in acceptable healing rates although adverse events have been reported for some devices. New self-adjusting suture devices have facilitated the accurate and effective repair of the torn meniscus. Technique descriptions for these devices are presented. [ABSTRACT FROM AUTHOR]

This article discusses methods of repairing meniscus and its clinical results. A torn meniscus should be repaired immediately because its functions are vital to the well-being of the knee. There are several methods available for repairing meniscus, such as inside-out, outside-in and all-inside methods. Inside-out method is still the standard method and treatment choice for repairing meniscus.

Meniscal allograft transplantation was introduced into clinical practice now over 20 years ago for the treatment of the symptomatic postmeniscectomy patient who has not yet developed osteoarthritis. Over the years, the indications have been fine-tuned and certain risk factors for failure have been identified. As the number of publications increases steadily, we now know that meniscal allografting significantly reduces pain and improves function. Recent data also suggest a potential chondroprotective effect in a subpopulation of patients. However, the major drawback in all meniscus allograft studies is the general lack of a control population. To improve our knowledge, future prospective studies should include objective outcome tools to evaluate the status of the allograft in addition to the clinical scoring systems. Future research should focus to elucidate the biologic and cellular processes involved in graft repopulation and remodelation. [ABSTRACT FROM AUTHOR]

Arthroscopic partial meniscectomy is one of the most common orthopedic surgical procedures performed. Numerous clinical and biomechanical studies have shown the long-term consequences of the meniscus-deficient knee, which includes increased loading of the cartilage. This leads to chondromalacia, and ultimately pain and dysfunction. Few treatment options are available for the young patient with pain in the tibiofemoral compartment secondary to meniscus deficiency. Meniscal allograft transplantation is a viable treatment option in this group of patients as short-term results have shown pain relief and functional improvement. Biomechanical studies have shown that the allograft meniscal transplant functions most like a native, intact meniscus when specific surgical principles are followed. Surgical techniques for meniscal allograft transplantation have advanced along with instrumentation. An improvement in function and pain relief can be expected when strict criteria are followed in patient selection and surgical technique. [ABSTRACT FROM AUTHOR]

The article focuses on the RapidLoc meniscus repair technique. It offers a historical perspective on the open repair of the human meniscus and on the development of the all-inside meniscus repair technique. It explains the indications and contraindications for a meniscal repair. It describes the key features, capabilities and advantages of the RapidLoc all-inside meniscal repair device.

The article focuses on the use of the BioStinger rigid meniscal tack repair system. It provides a historical perspective on the development of various techniques for meniscal repair. It examines the composition, indications for use, methods of insertion, as well as the advantages and drawbacks of the BioStinger rigid meniscal tack repair system. It also explores the complications, possible concerns and future of the technique.

The article discusses the use of the arthroscopic inside-out suture technique in meniscal repair. It offers a historical perspective on meniscal injuries and the arthroscopic inside-out suture repair. It lists some of the factors to consider when defining the appropriate candidate for meniscal repair, including tear characteristics, the presence of secondary tears and the chronicity of the tear. It explains the advantages of using the inside-out repair techniques in meniscal repair.

The article explores the use of platelet-rich plasma (PRP) in meniscal repair. It discusses the preoperative and postoperative management of meniscal repair using PRP. It describes the key features, advantages, indications for use, as well as the complications associated with the use of PRP in meniscal repair. It cites the result of a study on the use of PRP to augment meniscal repairs.

The article describes the use of the FasT-Fix meniscal fixator in meniscus repair. It stresses the significance of the meniscus in joint stability, load bearing, shock absorption, lubrication and proprioception. It cites the indications and contraindications for meniscal repair. It describes the key features, advantages, indications for use, methods of insertion, as well as the complications associated with the use of the FasT-Fix meniscal fixator.

All-inside meniscus repairs are becoming more common with the invention of meniscal arrows, darts, screws, staples, and other suture devices. With the rising popularity of these new all-inside meniscal repair devices, it is necessary to assess the effectiveness of various all-inside surgical interventions used in the treatment of meniscal tears. We performed an evidence based review of the outcomes of all-inside meniscus repair devices. Seventy-seven percent of identified studies were case series; 10% were retrospective comparative studies; 6.5% were prospective comparative studies; and 6.5% were prospective randomized studies. The failure rates ranged from 0 to 43.5%. We found no substantial differences in the failure rates among various meniscus devices. We also found no substantial differences in failure rates with length of followup. Given the paucity of randomized controlled studies comparing different all-inside meniscal repairs, no definite conclusions can be made regarding the difference in clinical outcomes of various all-inside meniscal repair devices.Level of Evidence: Level IV, systematic review. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Preservation of the menisci is increasingly emphasized in orthopedic care of the knee. Techniques are rapidly emerging that allow easier accomplishment of this goal. In particular, the development of all-inside arthroscopic meniscal repair devices has facilitated more ready repair. A number of laboratory and clinical studies have examined these devices and comparisons with more traditional techniques have been made. Numerous reports of potential complications from these new technologies have also been described in the literature. This review covers the current options for treatment of meniscal repair, laboratory and clinical data, and also potential complications. [ABSTRACT FROM AUTHOR]

Injuries to the knee meniscus, particularly those in the avascular region, pose a complex problem and a possible solution is tissue engineering of a replacement tissue. Tissue engineering of the meniscus involves scaffold selection, addition of cells, and stimulation of the construct to synthesize, maintain, or enhance matrix production. An acellular collagen implant is currently in clinical trials and there are promising results with other scaffolds, composed of both polymeric and natural materials. The addition of cells to these constructs may promote good matrix production in vitro, but has been studied in a limited manner in animal studies. Cell sources ranging from fibroblasts to stem cells could be used to overcome challenges in cell procurement, expansion, and synthetic capacity currently encountered in studies with fibrochondrocytes. Manipulation of construct culture with exogenous growth factors and mechanical stimulation will also likely play a role in these strategies. [ABSTRACT FROM AUTHOR]

The article focuses on the function of bioabsorbable polymers in knee surgery. It was found that meniscus arrows do not offer as much fixation strength as compared to suture techniques. It cites the incidence of neurovascular complications which are linked with the suturing procedures used for meniscal repair with bioabsorbable implants. It states the benefits of using bioabsorbable materials in knee surgery.

The article discusses a study which investigated the recovery benchmarks that occur in post-partial meniscectomy patients whose therapy consists of a home exercise program. Outcome measures included the following: Hughston Clinic knee self-assessment questionnaire, EQ-5D Tariff for assessment of quality of life, number of days taken to return to work, knee passive range of motion and knee swelling evaluated by knee circumference. The following factors were considered: age, body mass index and period from injury to surgery.

Osteochondral autograft transplant (mosaicplasty) is a cartilage repair procedure for patients with knee articular cartilage lesions of a substantial size (.3 cm2). Patient selection is key to a successful result; patients with established osteoarthritis or systematic disorders such as rheumatoid arthritis should not undergo surgery. An exercise program involving neuromuscular training for a minimum of 3 months should be attempted before proceeding to osteochondral autograft transplant. The procedure can, in many cases, be performed arthroscopically. Patients should, however, provide consent for a mini-arthrotomy as this might be needed to achieve optimal access for graft harvesting and insertion. The procedure, in general, consists of 4 major steps. (1) At the initial arthroscopic examination, the size and localization of the defect are assessed after a proper debridement has been performed. The number and size of autografts needed can thereafter be assessed. (2) Graft harvesting is then performed from the periphery of the non-weight-bearing trochlea. (3) To prepare for graft insertion at the recipient site, a drill guide is inserted perpendicular to the joint surface in the defect to allow graft sockets to be reamed. (4) Grafts should be spaced approximately 3 mm apart to avoid confluence of tunnels and weakening of condyles. The orientation and depth of insertion of the grafts are key to mimic the native curvature of the affected joint surface. After an initial phase of non-weight-bearing focusing on range of motion, a gradual increase in neuromuscular exercises is recommended. Patients are typically advised to delay their return to sports until 6 months at the earliest. Results after mosaicplasty have shown that the procedure improves subjective outcomes, compared with baseline function, for up to 10 years after surgery. The additional effect over traditional microfracture treatment is, however, reduced over time. A study evaluating early factors affecting outcomes after cartilage repair procedures (including mosaicplasty) found that a series of factors, such as the time from the onset of symptoms to surgery, number and size of lesions, location and quality of surrounding cartilage, as well as concomitant meniscal injuries, were important3. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this study was to prospectively evaluate the results of meniscal transplantation in a consecutive series of younger patients treated for pain in the tibiofemoral compartment following a previous meniscectomy. METHODS: Forty cryopreserved menisci were implanted into thirty-eight patients. Sixteen knees also had an osteochondral autograft transfer, and nine had a knee ligament reconstruction. The clinical outcome and failure rate of all transplants were evaluated at a mean of forty months postoperatively. Meniscal allograft characteristics were determined with use of a rating system that combined subjective, clinical, and magnetic resonance imaging factors. RESULTS: Thirty-four, (89%) of the thirty-eight patients rated the knee condition as improved. Before surgery, thirty patients (79%) had pain with daily activities, but only four (11%) had such pain at the time of the latest follow-up. While noteworthy pain was present in the tibiofemoral compartment in all forty knees before surgery, twenty-seven knees (68%) had no pain and thirteen (33%) had only mild compartment pain at the time of the latest follow-up. Twenty-nine patients (76%) returned to light low-impact sports without problems. Concomitant osteochondral autograft transfer and knee ligament reconstruction procedures improved knee function and did not increase the rate of complications. Meniscal allograft characteristics were normal in seventeen knees (43%), altered in twelve (30%), and failed in eleven (28%). CONCLUSIONS: The short-term results of meniscal transplantation are encouraging in terms of reducing knee pain and increasing function; however, long-term transplant function and any chondroprotective effects remain unknown and require further investigation. [ABSTRACT FROM AUTHOR]

Background: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. Methods: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5° of knee flexion, and the Thessaly test at 20° of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. Results: The Thessaly test at 20° of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. Conclusions: The Thessaly test at 20° of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods. Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Meniscus surgery and in particular arthroscopic meniscectomy remains one of the most commonly performed arthroscopic orthopedic procedures. The prevalence of meniscal pathology and increased numbers of procedures being performed has placed meniscus surgery within the forefront and mainstream of orthopedic practice. There have been numerous significant advances in the approach to meniscal tears as a better understanding of the biomechanical function and importance of the menisci has evolved. Concurrently, technical improvements and novel methodologies particularly in the area of arthroscopy have heightened the precision and refined the approach to carrying out meniscal resection and more specifically meniscal repair. This has increased the demand for predictable and successful outcomes after meniscal surgery and raised the interest in treatment complications and morbidity. Although arthroscopic meniscal surgery may be incorrectly assumed to be routine and infrequently associated with morbidity, complications do in fact occur and untoward incidents and complications may actually go underreported. More recently, as all-arthroscopic methods continue to evolve particularly as far as newer meniscal repair techniques are concerned, complications that are uniquely associated with these updated techniques and their attendant learning curves may be encountered. Various meniscal surgical complications are described and reported. The approach to these complications is reviewed both in terms of recognition of morbidity as well as prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to prospectively evaluate the results of meniscal transplantation in a consecutive series of younger patients treated for pain in the tibiofemoral compartment following a previous meniscectomy.Methods: Forty cryopreserved menisci were implanted into thirty-eight patients. Sixteen knees also had an osteochondral autograft transfer, and nine had a knee ligament reconstruction. The clinical outcome and failure rate of all transplants were evaluated at a mean of forty months postoperatively. Meniscal allograft characteristics were determined with use of a rating system that combined subjective, clinical, and magnetic resonance imaging factors.Results: Thirty-four (89%) of the thirty-eight patients rated the knee condition as improved. Before surgery, thirty patients (79%) had pain with daily activities, but only four (11%) had such pain at the time of the latest follow-up. While noteworthy pain was present in the tibiofemoral compartment in all forty knees before surgery, twenty-seven knees (68%) had no pain and thirteen (33%) had only mild compartment pain at the time of the latest follow-up. Twenty-nine patients (76%) returned to light low-impact sports without problems. Concomitant osteochondral autograft transfer and knee ligament reconstruction procedures improved knee function and did not increase the rate of complications. Meniscal allograft characteristics were normal in seventeen knees (43%), altered in twelve (30%), and failed in eleven (28%).Conclusions: The short-term results of meniscal transplantation are encouraging in terms of reducing knee pain and increasing function; however, long-term transplant function and any chondroprotective effects remain unknown and require further investigation. [ABSTRACT FROM AUTHOR]

SUMMARY: Meniscal allograft transplantation is now gradually transforming from an interesting alternative in meniscal restoration algorithms to a reliable treatment of unicompartmental knee pain after meniscectomy. The past decade has allowed refinements in sizing, preservation, and fixation of the meniscal allograft. Current techniques focus on adherence to biomechanical principles in attempting to duplicate the force transfer of an intact meniscal tibial plateau construct. Although intermediate term outcome results are promising in regards to pain relief, the long term objective of articular cartilage preservation remains a goal. [ABSTRACT FROM AUTHOR]

SUMMARY: Meniscal resection often leads to degeneration of the joint. Future developments in the treatment of meniscal injury will likely be directed to improve on current fixation techniques, stimulate biologic healing, and improve on current allograft replacements. Tissue engineering is very attractive as a potential means to create a sophisticated meniscal replacement. [ABSTRACT FROM AUTHOR]

SUMMARY: Meniscal tears in children and adolescents are uncommon but well-recognized injuries. Because meniscal tears and other more common acute injuries to the skeletally immature knee-such as fractures and patellar dislocations-typically present with hemarthrosis, careful diagnosis including history, physical examination, and imaging studies should occur. Options for treatment of meniscal tears include observation, partial resection, or repair. The recommended repair approach includes an inside-out technique for medial and lateral tears, an outside-in repair for more anterior tears, and all-inside repair techniques. Greater vascularity in the meniscus of the skeletally immature patient makes it more amenable to repair than its adult counterpart. [ABSTRACT FROM AUTHOR]