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Background: Visual impairment can cause balance problems. Therefore, visual impairment caused by an increase in corneal deviations can lead to sudden and unstable loads in the lower extremities. We aimed to investigate the possible relationship between low-energy meniscal injuries and corneal structural measures. Methods: This prospective, observational study included individuals aged between 18–40 years with a normal body-mass index. The study group consisted of 54 patients with grade 2 or 3 meniscus injuries after low-energy activity. The control group consisted of 54 healthy individuals without any complaints in the knee joint. The corneal parameters of all participants were evaluated with a Scheimpflug corneal topography and specular microscopy device. Simulated keratometry (SimK), minimum central corneal thickness (MCCT), cylindrical diopter (ClyD), corneal volume (CVol) spheric aberrations (SphAbb), high-order aberration (HOA), coma values, and endothelial parameters were recorded. Results: The research and control groups were similar in terms of age, body mass index, and gender distribution. There was no significant difference between the groups in the corneal SimK and CylD, parameters. However, HOA, Coma, SphAbb, and cell variability (Cv) values were significantly higher in the study group, and contrarily MCCT, CVol, and endothelial count (Cd) values were significantly lower. Conclusions: Our findings suggest that individuals with relatively lower MCCT values tend to develop meniscal damage after low-energy activity. Hence, the loss of corneal strength in these patients may be a sign of possible weakness in the meniscus. The HOA value above 0.26, the coma value above 0.16, and the SphAbb value above 0.1 may significantly increase the possible meniscus injury. [ABSTRACT FROM AUTHOR]

Background: Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood. Purpose: To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures—including insurance deductibles, coinsurance, and net insurance payments—in the 2 years after diagnosis. Procedures included were as follows: (1) surgery—including meniscectomy or meniscal repair; (2) physical therapy; (3) medication—including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections—including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment. Results: The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) (P <.001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management. Conclusion: Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier. [ABSTRACT FROM AUTHOR]

Abstract Background Visual impairment can cause balance problems. Therefore, visual impairment caused by an increase in corneal deviations can lead to sudden and unstable loads in the lower extremities. We aimed to investigate the possible relationship between low-energy meniscal injuries and corneal structural measures. Methods This prospective, observational study included individuals aged between 18–40 years with a normal body-mass index. The study group consisted of 54 patients with grade 2 or 3 meniscus injuries after low-energy activity. The control group consisted of 54 healthy individuals without any complaints in the knee joint. The corneal parameters of all participants were evaluated with a Scheimpflug corneal topography and specular microscopy device. Simulated keratometry (SimK), minimum central corneal thickness (MCCT), cylindrical diopter (ClyD), corneal volume (CVol) spheric aberrations (SphAbb), high-order aberration (HOA), coma values, and endothelial parameters were recorded. Results The research and control groups were similar in terms of age, body mass index, and gender distribution. There was no significant difference between the groups in the corneal SimK and CylD, parameters. However, HOA, Coma, SphAbb, and cell variability (Cv) values were significantly higher in the study group, and contrarily MCCT, CVol, and endothelial count (Cd) values were significantly lower. Conclusions Our findings suggest that individuals with relatively lower MCCT values tend to develop meniscal damage after low-energy activity. Hence, the loss of corneal strength in these patients may be a sign of possible weakness in the meniscus. The HOA value above 0.26, the coma value above 0.16, and the SphAbb value above 0.1 may significantly increase the possible meniscus injury.

Repair of meniscal tears in the avascular zone represents an obstacle for orthopedic surgeons. Several therapeutic methods have been suggested to mange these tears including meniscectomy and meniscal allografts; however, their clinical application was restricted due to their disadvantages. These limitations inspired the necessity to develop products that possess the ability to initiate healing in such avascular tears. Hence, the goal of the current study is to assess and compare the regenerative capability of bone marrow aspirate (BMA) and platelet-rich plasma (PRP) to enhance repair of avascular meniscal tears. After preparation of BMA and PRP, meniscal tear was conducted in the inner avascular zones in dogs and left untreated as control or treated with either BMA or PRP. Clinical observation of weight bearing, lameness, pain on manipulation, gait, and functional disability were investigated after 3, 6, 9, and 12 weeks of surgery. In addition, gross and histological evaluations were performed at weeks 4, 8, and 12 after surgery. Both materials demonstrated a positive improvement in clinical observations compared to the control group. Furthermore, repair of meniscal tears was stimulated in tears treated with either BMA or PRP with better gross and histological outcomes in PRP-treated group than BMA-treated group. To conclude, our findings showed that BMA and PRP possess the potential to enhance the healing process of meniscal tears in the inner avascular region with the superiority of PRP. [ABSTRACT FROM AUTHOR]

Background: The treatment of anterior cruciate ligament (ACL) injury includes ACL reconstruction (ACL-R) or ligament preservation, where the former is considered the gold standard. But in meniscal injury, though commonly followed is menisectomy, meniscal repair has gained popularity and success which necessitates the analysis of outcome between ACL-R + meniscal repair and ACL-R + menisectomy as clear consensus have not been established so far in deciding the better overall procedure with respect to function. Methods: This is a prospective, comparative study done in 122 patients with ACL injury and medial/ lateral meniscus in south Indian population at a single center. Where meniscal repair (61) and menisectomy (partial/complete, n=61) with ACL-R were carried out and were evaluated pre-operatively, during the postoperative period at 6 weeks, 3 months, and 6 months of follow-up for function and compared. The primary outcome evaluated was pain and other symptoms like limping, giving way, swelling and locking were also noted and analysed using KOOS, IKDC and Lysholm scores. Results: The mean difference in KOOS score in postoperative period, at 3 and 6months were significantly higher among the ACL-R + meniscal repair group than the ACL-R + meniscectomy group which is statistically significant. Moreover the median percentage change in IKDC and Lysholm scores from baseline to postoperative 3 and 6 months were significantly higher in ACL-R + meniscal repair group than the other. Conclusion: The meniscal repair with ACL-R has a lower failure rate and shows better functional outcomes than the other group which underwent ACL-R and meniscectomy.

Aiming to address the problem of low classification accuracy caused by the different shapes of meniscus tears in the computer-aided diagnosis (CAD) system for meniscus, a multidimensional information fusion network (MDIFNet) model for menissus tear classification was proposed. Firstly, a convolutional neural network (CNN) architecture consisting of four sub-networks was used to obtain meniscus feature information from different perspectives and dimensions. Simultaneously, multi-scale attention mechanism was proposed to enrich fine-grained features. Finally, a multi kernel model based on support vector machines (SVM) was constructed as the final classifier. The experimental results on the MRNet dataset show that the proposed method has a meniscal tear classification accuracy of 0.782, which has promotion compared to the existing state-of-the-art meniscus tear classification methods based on deep learning.

In the present study, 24 rabbits were firstly used to evaluate the apoptosis index and matrix degeneration after untreated adult meniscal tears. Vertical tears (0.25 cm in length) were prepared in the avascular zone of the anterior horn. Specimens were harvested at 1, 3, 6, 12 weeks postoperatively. The apoptosis index around tear sites stayed at a high level throughout the whole follow-up period. The depletion of glycosaminoglycans (GAG) and aggrecan at the tear site was observed, while the deposition of COL I and COL II was not affected, even at the last follow-up of 12 weeks after operation. The expression of SOX9 decreased significantly; no cellularity was observed at the wound interface at all timepoints. Secondly, another 20 rabbits were included to evaluate the effects of anti-apoptosis therapy on rescuing meniscal cells and enhancing meniscus repair. Longitudinal vertical tears (0.5 cm in length) were made in the meniscal avascular body. Tears were repaired by the inside-out suture technique, or repaired with sutures in addition to fibrin gel and blank silica nanoparticles, or silica nanoparticles encapsulating apoptosis inhibitors (z-vad-fmk). Samples were harvested at 12 months postoperatively. We found the locally administered z-vad-fmk agent at the wound interface significantly alleviated meniscal cell apoptosis and matrix degradation, and enhanced meniscal repair in the avascular zone at 12 months after operation. Thus, local administration of caspase inhibitors (z-vad-fmk) is a promising therapeutic strategy for alleviating meniscal cell loss and enhancing meniscal repair after adult meniscal tears in the avascular zone. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that meniscal and chondral lesions are more common at the time of revision anterior cruciate ligament reconstruction (ACLR) compared with primary surgery; however, few have evaluated the same patients through both primary and revision surgery. Purpose: To describe the prevalence of meniscal and chondral lesions at the time of primary and subsequent revision ACLR and to determine the effect of age and femoral tunnel drilling technique on the development of intra-articular pathology over time. Study Design: Case series; Level of evidence, 4. Methods: All patients who had primary and subsequent revision ACLR in the same knee between 1997 and 2022 were identified from a prospectively collated database. The grading of chondral surfaces in each compartment, the presence of any meniscal tears, and treatment performed were recorded. Patients were grouped according to age and femoral tunnel drilling technique to allow subgroup analysis. Results: Overall, 262 patients were included. Median age at primary surgery was 20.2 years. Lateral meniscal tears were more prevalent than medial tears at both primary (34.7% vs 28.2%; P =.11) and revision surgery (44.3% vs 40.8%; P =.43). Chondral lesions were most frequently found on the patella (8.8%) and the medial femoral condyle (MFC; 8.0%) at primary surgery. Between surgeries, new lesions developed most commonly on the MFC (13.0%) and the lateral femoral condyle (LFC; 11.1%). It was significantly more common for lateral meniscal tears treated with repair or left in situ at primary surgery to be healed at the time of revision surgery than medial tears (P =.01). Significantly more patients who had transtibial drilling of the femoral tunnel had a new meniscal tear at revision surgery (P =.001). Age did not have a significant influence on the prevalence of meniscal pathology. Conclusion: The prevalence of intra-articular pathology increased between primary and revision ACLR. Lateral meniscal tears were more prevalent than medial tears at both surgeries. At revision surgery, new chondral lesions were more commonly found on the MFC than the LFC. The higher incidence of new meniscal tears observed in the transtibial group may reflect the more vertical graft orientation with this technique and its inferior ability to control rotation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the effect of arthroscopic partial meniscectomy in dogs with bucket handle meniscal tears and tibial plateau leveling osteotomy (TPLO), compared with dogs with cranial cruciate ligament rupture and no meniscal tear treated by TPLO alone. ANIMALS: 30 client-owned dogs with cranial cruciate rupture treated by either TPLO and arthroscopy alone if the meniscus was normal (normal meniscus [NM] group, n = 14) or by TPLO and an arthroscopic partial meniscectomy if a bucket handle tear was diagnosed (meniscal tear [MT] group, n = 16). METHODS: Medical records, lameness score, and symmetry gait analysis parameters were retrospectively collected from patient records preoperatively (PreO), then at 1, 3, and 6 months postoperatively (M1, M3, and M6, respectively). Osteoarthritic (OA) radiographic score was performed and compared at PreO and M6. RESULTS: PreO gait analysis parameters were lower in the MT group (P < 0.005). In the MT group, the lameness score significantly improved between PreO and M1, and there were no significant differences between groups at M6. OA score was significantly higher in the MT group at PreO and M6. However, postoperative progression of OA did not differ between the 2 groups (P = 0.16). CLINICAL RELEVANCE: Treatment for meniscal tear results in a significant improvement in lameness, with postoperative outcomes at 6 months comparable with dogs with intact menisci. Despite having significant osteoarthritic lesions at all time points, the progression of osteoarthritis is similar between dogs with meniscal tears and those with intact menisci. [ABSTRACT FROM AUTHOR]

Background: Delayed anterior cruciate ligament (ACL) reconstruction has been associated with an increased risk of meniscal tears. However, studies comparing early versus delayed ACL reconstruction have not clearly demonstrated that meniscal tears diagnosed arthroscopically are new injuries as opposed to concomitant injuries sustained during ACL rupture. Purpose: To determine whether and how delay of ACL reconstruction is associated with risk of "new" meniscal tears (defined as those visualized arthroscopically that had not been detected on magnetic resonance imaging [MRI]) in adult and pediatric patients. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively identified patients who underwent primary ACL reconstruction between 2013 and 2022 at our institution. To ensure that MRI reflected initial intra-articular pathology, we included only patients who had an MRI scan within 3 weeks after injury (173 pediatric and 369 adult patients). Multivariate Poisson regression was performed to calculate the adjusted relative risk (ARR) of new meniscal tears after delayed (≥8 weeks from injury) operative treatment. Results: The mean (± SD) time from injury to MRI was 1.0 ± 0.8 weeks for pediatric patients and 1.1 ± 0.7 weeks for adults. Less than half of the meniscal tears observed arthroscopically had been absent on initial MRI. New medial meniscal tears occurred in 15% of pediatric patients and 16% of adults. New lateral meniscal tears occurred in 48% of pediatric patients and 34% of adults. Among pediatric patients, delayed ACL reconstruction was associated with higher risk of new medial tears (ARR, 3.9; 95% CI, 1.5-10) but not lateral tears (ARR, 0.8; 95% CI, 0.4-1.5). In contrast, adults had no significant increase in risk of meniscal tears associated with operative delay. Conclusion: Delayed ACL reconstruction may be acceptable in adults, who may be less active and less injury-prone than children and adolescents. [ABSTRACT FROM AUTHOR]

Arthroscopic partial meniscectomy (APM) strives to preserve knee biomechanics and function after the meniscal rupture. However, patients undergoing APM experience long-term impacts like proprioceptive deficit and functional decline. This study aimed to examine and compare the effects of aquatic and leg cycling trainings on young athletes undergone APM. Ninety-seven male athletes with APM were assigned to aquatic training group (ATG, n = 49) and cycling training group (CTG, n = 48). Both intervention trainings were conducted three times a week for 6 weeks after 2 weeks of APM. The rehabilitation training was the same in each session. The International Knee Documentation Committee (IKDC) questionnaire scores, knee joint position sense, Y-balance test, and isokinetic knee strength were measured before and after the interventions. Significant improvements were observed after the trainings regarding measured variables for both ATG and CTG groups. Comparison of the two groups found that ATG group had higher scores in IKDC and Y-balance test, greater muscle power, and lower absolute error in the joint position sense test compared to the CTG group. ATG and CTG are thus considered effective training interventions in early rehabilitation phase following the APM. Moreover, ATG may be more conducive than CTG in improving subjective knee symptoms, proprioception, and muscle power.

Repair of meniscal tears in the avascular zone represents an obstacle for orthopedic surgeons. Several therapeutic methods have been suggested to mange these tears including meniscectomy and meniscal allografts; however, their clinical application was restricted due to their disadvantages. These limitations inspired the necessity to develop products that possess the ability to initiate healing in such avascular tears. Hence, the goal of the current study is to assess and compare the regenerative capability of bone marrow aspirate (BMA) and platelet-rich plasma (PRP) to enhance repair of avascular meniscal tears. After preparation of BMA and PRP, meniscal tear was conducted in the inner avascular zones in dogs and left untreated as control or treated with either BMA or PRP. Clinical observation of weight bearing, lameness, pain on manipulation, gait, and functional disability were investigated after 3, 6, 9, and 12 weeks of surgery. In addition, gross and histological evaluations were performed at weeks 4, 8, and 12 after surgery. Both materials demonstrated a positive improvement in clinical observations compared to the control group. Furthermore, repair of meniscal tears was stimulated in tears treated with either BMA or PRP with better gross and histological outcomes in PRP-treated group than BMA-treated group. To conclude, our findings showed that BMA and PRP possess the potential to enhance the healing process of meniscal tears in the inner avascular region with the superiority of PRP.

Background: Platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have gained popularity in recent years as biologic approaches to potentially augment healing after meniscus repair. There have been few studies comparing outcomes in patients undergoing meniscus repair with versus without biologic augmentation and, furthermore, little clarity on the role of biologic augmentation for meniscus repairs performed with concomitant anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the association of BMAC or PRP augmentation with revision surgery after both isolated meniscus repair and meniscus repair performed concomitantly with ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The PearlDiver Mariner dataset was queried to identify all patients who underwent primary meniscus repair, both with and without concomitant ACLR, and who received ipsilateral BMAC or PRP at the time of surgery. Patients who underwent similar surgery but without BMAC or PRP augmentation were then identified and matched in a 5:1 ratio according to age, sex, body mass index, and various comorbidities to 3 separate BMAC/PRP augmentation groups: overall cohort (with and without ACLR), repair with concomitant ACLR, and isolated repair. The primary outcome was revision meniscus surgery (meniscectomy or revision meniscus repair). Results: Overall, 3420 patients (570 with BMAC/PRP augmentation; 2850 matched controls without augmentation) were included. There were no significant differences in the reported demographics or comorbidities between any of the BMAC/PRP groups and their respective matched controls (P >.05 for all comparisons). There was no difference in revision rate between BMAC/PRP-augmented isolated meniscus repairs and matched controls (P =.235). Patients who underwent BMAC/PRP-augmented meniscus repair with concomitant ACLR experienced a significantly lower incidence of revision surgery compared with matched controls without BMAC/PRP augmentation (5.2% vs 7.9% respectively; odds ratio, 0.41; 95% CI, 0.27-0.63; P <.001), but the number of revisions was relatively small. Conclusion: There was no association between BMAC or PRP augmentation and the incidence of revision surgery after isolated primary meniscus repair. There was a statistically significant decrease in the rate of revision meniscus surgery when BMAC or PRP was used to augment meniscus repairs in the setting of concurrent ACLR; however, the overall revision rates were small. [ABSTRACT FROM AUTHOR]

Background: The role of meniscal lesions and repair in combination with anterior cruciate ligament (ACL) injury and reconstruction has not been extensively investigated in vivo and under weightbearing conditions. Purpose: The purposes of this study were to (1) compare the in vivo knee kinematics between patients with ACL tear and those with combined ACL and medial meniscal tears and (2) investigate kinematic differences between isolated ACL reconstruction and ACL reconstruction plus medial meniscal repair (MR). It was hypothesized that concomitant posterior horn medial meniscal tear and ACL deficiency would affect knee internal-external rotation and anterior-posterior translation but MR would restore these parameters. Study Design: Controlled laboratory study. Methods: Nineteen patients who underwent ACL reconstruction were included: 10 had intact menisci (IM group) and 9 had a medial meniscal injury that was repaired during ACL reconstruction using an all-inside technique (MR group). Preoperatively and 18 months postoperatively, active knee kinematics under weightbearing conditions was evaluated during a single-leg squat using a dynamic biplane x-ray imaging system. The general linear model was used to investigate the differences between group (IM vs MR) and time (preoperative vs follow-up) and their interactions. Results: Tibial internal rotation was higher in the MR group than the IM group both before and after surgery (P =.007). Knee valgus rotation was higher in the MR group preoperatively (P <.001), while no differences were found postoperatively because of an increase of valgus rotation in the IM group, which was significant in the descendant phase (P <.001). Preoperatively, the IM group showed a more medial tibial translation compared with the MR group in the descendant phase (P =.006). Conclusion: When performing a single-leg squat, patients with ACL-deficient knees and a medial meniscal tear demonstrated a more valgus rotation, tibial internal rotation, and lateral tibial translation versus those with intact menisci. After ACL reconstruction and MR, these patients demonstrated significantly higher tibial internal rotation when compared with patients who underwent isolated ACL reconstruction. Clinical Relevance: Surgeons should be aware that MR does not fully restore knee kinematics in vivo and under weightbearing conditions in the context of ACL reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: To assess physical activity and knee function, the two methods of conventional supervised exercise and the arthroscopic partial meniscectomy trailed by exercise were evaluated after a nontraumatic meniscal (medial) tear that was confirmed on magnetic resonance imaging (MRI). Materials and Methods: One hundred adult subjects were assessed for the current prospective research. The pain in the knee was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale (LKSS), Tegner Activity Scale (TAS), and Visual Analogue Scale (VAS). All the parameters were compared at the start of the study and 2 and 6 months after the intervention. All the data were compared using the analysis of variance (ANOVA) with P < 0.05 considered as significant. Results: According to the outcome scores, exercising by itself did not result in a larger improvement than an arthroscopic partial medial meniscectomy. There was a significant reduction in discomfort, improved function, and satisfaction for subjects in the two groups (P < 0.0001). After six months, 40% of the subjects reported that the activity levels were similar to the incidence of the injury. Conclusion: The quality of life was reported to be comparable in the arthroscopy subjects and the conventional group subjects. Hence, arthroscopy can be delayed for the meniscal tear in the adult subjects who are best managed by the conservatively managed.

ObjectivesTo compare regional differences in subchondral trabecular structure using high-resolution MRI in meniscus-covered/meniscus-uncovered tibia in cadaveric knees with intact/torn menisci.Materials and methods3D proton density CUBE MRI of 6 cadaveric knees without significant osteoarthritis (OA) was acquired, 0.25-mm resolution. Menisci were evaluated and classified intact or torn. MR data were transferred to ImageJ program to segment tibial 3D volume of interest (VOI). Data was subdivided into meniscus-covered/meniscus-uncovered regions. Segmented VOI was classified into binary data, trabeculae/bone marrow. The trabecular bone data was used to measure MR biomarkers (apparent subchondral plate-connected bone density (adapted from spine MR), apparent trabecular bone volume fraction, apparent mean trabecular thickness, apparent connectivity density, and structure model index (SMI)). Mean value of parameters was analyzed for the effects of meniscal tear/tibial coverage.ResultsNine torn menisci and 3 intact menisci were present. MR measures of bone varied significantly due to meniscal coverage/tear. Subchondral plate-connected bone density under covered meniscus regions increased from 10.9 to 23.5% with meniscal tear. Values increased in uncovered regions, 19.3% (intact) and 32.4% (torn). This reflects higher density when uncovered (p = 0.048) with meniscal tear (p = 0.007). Similar patterns were found for trabecular bone fraction (coverage p

Menisci of the knee are semilunar-shaped structures located between the condyles of the femur and tibia, together with articular surfaces of the tibial condyles form the acetabulum of the knee joint. They have multiple functions, affecting the proper joint biomechanics, even though in the past they were perceived as embryonic remnants. Menisci are involved in such vital functions as: load bearing, joint stability, joint congruity, increasing joint contact area, decreasing joint contact stresses, protection of articular cartilage, shock absorption, lubrication, limitation of extreme movement and proprioception.Menisci arise from a condensation of the intermediate layer of mesenchymal tissue. At later stages of development, it is observed a gradual decrease in the cellularity of the structure and increase of the collagen fibers, where collagen type I is a major fibrillar component. The meniscus is composed of an extracellular matrix mainly filled with water (72%) and collagen (22%), with a minority of proteoglycans, glycoproteins, peptides, and local cells - fibrochondrocytes.When it comes to vascularization, two main areas are present in the structure of meniscus: red-red zone - vascular, white-white zone – rather avascular, and in between the red-white zone. Major vascularization is ensured by the popliteal artery branches: medial, lateral and middle geniculate arteries. It was shown that meniscus can be vascularized in each zone, what is linked with the hypovascular zone regenerative potential. The vascularization pattern and nutritional status of a torn meniscus and the morphological pattern of the tear are crucial factors determining the success of a meniscus surgery. The healing potential of a torn meniscus is directly dependent on its blood supply.At present, it is known that proper performance of the knee joint is directly proportional to the amount of meniscus tissue. Their involvement in the multiple important functions leads to modern solutions focused on saving meniscus tissue.

Background: Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes. Purpose: To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology. Results: Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear. Conclusion: ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism. [ABSTRACT FROM AUTHOR]

Background: Professional baseball pitchers sustain 75% of knee injuries while at the pitcher's mound, yet no pitching motion has been associated directly with such injuries. Stride width is a potential, modifiable risk factor worth investigating. Hypothesis: Increased stride width in both the positive and negative directions (deviations from neutral stride width) would correlate with increased incidence of knee injury in pitchers. Study Design: Descriptive laboratory. Level of Evidence: Level 5. Methods: Professional pitchers (n = 199) were evaluated with motion capture (480 Hz) while pitching. Injury history over 10 years was recorded at face-to-face interviews with pitchers. Players were subsequently grouped into stride width tertiles, compared for previous injury incidence of the lower extremities. Regressions were performed to observe performance benefits of stride width with ball velocity, accuracy, or consistency in pitch location as secondary outcomes. Results: Of the 40 lower extremity injuries reported, meniscal injury (27.5%) was the most common, followed by foot stress fracture (20.0%). Significant differences in injury incidence were noted between the least and most positive stride width tertiles: lower extremity (10.4% vs 25.8%, respectively; P = 0.03), knee (3.0% vs 15.2%, respectively; P = 0.02), and meniscal (0.0% vs 12.1%; P = 0.00). Stride width of pitchers with meniscal injury in the lead (32.6 ± 7.1 cm, n = 5; P = 0.02) and stance leg (33.5 ± 10.6 cm, n = 5; P = 0.03) was significantly more positive than that of uninjured pitchers (21.1 ± 11.5 cm, n = 164). No significant relationships were established between stride width and ball velocity (P = 0.54) or pitch location metrics (P > 0.05). Conclusion: Pitchers with increased positive, stride width had significantly higher incidence of lower extremity injury (knee and meniscus). Wider, positive stride width may increase the degree of external rotation on the lead knee in a loaded state, which can place the medial side of the knee (and meniscus) at higher risk of injury. Clinical Relevance: Decreasing stride width may be beneficial for professional pitchers to reduce the rate of lower extremity injury, while also preserving performance metric outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of meniscal tears in patients with anterior cruciate ligament (ACL) injury increases with extended time between injury and ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to determine if there is a relationship between time from magnetic resonance imaging (MRI) to ACL reconstruction and the predictive value of MRI to diagnose meniscal tears in the young active population. It was hypothesized that increased time between MRI and ACL reconstruction would lead to a decrease in the negative predictive value of MRI in diagnosing meniscal tears, as more injuries may accrue over time in the ACL-deficient knee. Study Design: Case series; Level of evidence, 4. Methods: Included were patients aged 13 to 25 years at the authors' institution who underwent primary ACL reconstruction from January 2017 to June 2020. Time from MRI to surgery as well as descriptions of medial and lateral meniscal tears on both MRI and operative reports were documented. Time from MRI to surgery was divided into 4 intervals: 0 to 6 weeks, >6 weeks to 3 months, >3 to 6 months, and beyond 6 months. Multivariable analysis was used to determine the positive and negative predictive values of MRI in diagnosing a meniscal tear as compared with arthroscopic findings. Results: A total of 432 patients were included with a mean age of 17.9 ± 3.4 years. The mean time from MRI to surgery was 70.5 ± 98 days. There was a significant decrease in the negative predictive value of MRI to identify a medial meniscal tear in patients who underwent ACL reconstruction >6 months after imaging (odds ratio, 0.16 [95% CI, 0.05-0.53]; P =.003). This same relationship was not shown for lateral meniscal tears, nor was any other predictor significant. Conclusion: The utility of MRI to rule out a medial meniscal tear significantly diminished in the young athletic population when >6 months passed between MRI and ACL reconstruction. These data suggest these tears occur between the time of the MRI and surgery and that the medial meniscus is more susceptible than the lateral meniscus to new injury once the ACL has torn. [ABSTRACT FROM AUTHOR]

In the present study, 24 rabbits were firstly used to evaluate the apoptosis index and matrix degeneration after untreated adult meniscal tears. Vertical tears (0.25 cm in length) were prepared in the avascular zone of the anterior horn. Specimens were harvested at 1, 3, 6, 12 weeks postoperatively. The apoptosis index around tear sites stayed at a high level throughout the whole follow-up period. The depletion of glycosaminoglycans (GAG) and aggrecan at the tear site was observed, while the deposition of COL I and COL II was not affected, even at the last follow-up of 12 weeks after operation. The expression of SOX9 decreased significantly; no cellularity was observed at the wound interface at all timepoints. Secondly, another 20 rabbits were included to evaluate the effects of anti-apoptosis therapy on rescuing meniscal cells and enhancing meniscus repair. Longitudinal vertical tears (0.5 cm in length) were made in the meniscal avascular body. Tears were repaired by the inside-out suture technique, or repaired with sutures in addition to fibrin gel and blank silica nanoparticles, or silica nanoparticles encapsulating apoptosis inhibitors (z-vad-fmk). Samples were harvested at 12 months postoperatively. We found the locally administered z-vad-fmk agent at the wound interface significantly alleviated meniscal cell apoptosis and matrix degradation, and enhanced meniscal repair in the avascular zone at 12 months after operation. Thus, local administration of caspase inhibitors (z-vad-fmk) is a promising therapeutic strategy for alleviating meniscal cell loss and enhancing meniscal repair after adult meniscal tears in the avascular zone.

Background: Meniscal lesions are the commonest lesions in the knee, and usually caused by athletic activities. Meniscal lesions diagnosis may need costly imaging modalities like magnetic resonance imaging [MRI]. However, MRI is not available in all medical facilities, especially peripheral and rural continents. Thus, there is a need for a readily available imaging tool. Knee ultrasound may be used as diagnostic modality as it is devoid of economic burden of MRI.Aim of the work: The current work aimed to estimate the diagnostic accuracy of knee ultrasound and to correlate it with the results of MRI for diagnosis of knee meniscal lesions.Patients and methods: Fourty patients with acute or chronic knee pain, swelling or movement restrictions were included. All were assessed by referral physician and submitted to knee ultrasound and MRI. Then results of ultrasound were correlated with that of MRI and diagnostic accuracy measures of ultrasound were calculated [sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and overall accuracy].Result: Out of included patients, 28 were males. Their mean age was 36.7 ± 14.4 years [ranged from 15 to 60 years]. The ultrasound detected meniscal tear in 90%, degeneration in 47.5%, Para-meniscal cyst in 25% and discoid meniscus in 40%. The MRI detected meniscal tear in 80%, degeneration in 65%, para-meniscal cyst in 25% and discoid meniscus in 37.5%. For meniscal tear, the ultrasound had 83.3% sensitivity, 50.0% specificity, 93.7% PPV, 25.0% NPV and overall accuracy of 80.0%. Otherwise, the overall accuracy was 75.0% for degenerative changes and 95.0% for para meniscal cyst. Finally, it was 67.5% for discoid meniscus.Conclusion: Ultrasound has shown reasonable diagnostic accuracy in detecting meniscal lesions. It could be used as a screening tool to prevent unnecessary and costly MRI.

Objective: To provide a framework for conducting clinical trial site visits virtually over videoconference, and to report on our experience doing so during the twelve-year follow-up of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. Design: Using published FDA guidance and prior literature, we created a structure for virtual site visits that prioritized monitoring for protocol compliance, safety, and data integrity. We conducted site visits in three stages: preparation for the visit, the virtual meeting itself, and follow-up. The preparation phase involved a review of relevant site-specific documents and a written report on the findings prior to the visit. The virtual visit itself was focused on any questions the site staff had about the pre-visit report, observing a mock study visit, touring physical spaces, and understanding the site staff's work environment. In the follow-up phase, we wrote a post-visit report summarizing the discussion during the visit and feedback given by the coordinating site. Results: We found that the virtual site visits conducted as part of the MeTeOR trial follow-up ran smoothly. Although we could not directly compare in-person and virtual site visits, site staff unanimously appreciated the efficiency and effectiveness of the virtual site visits. We noted that displaying physical workspaces over videoconferencing was difficult, and a notable drawback to this method. Conclusions: To our knowledge, this is the first published framework for conducting virtual clinical trial site visits. Conducting these visits virtually confer several advantages in terms of time, money, and efficiency.

Introduction Medial discoid meniscus is estimated to occur in 0.06% to 0.3% of the population, being bilateral medial discoid menisci. The current tendency to be very conservative in treating meniscal lesions should be applied to the discoid meniscus, too, so that the cauterization and suture of a torn discoid meniscus are gaining support. Case presentation We present the case of a 13-years-old Caucasian male competitive football player with a diagnosis of bilateral medial discoid menisci. Arthroscopy of the left symptomatic knee found an incomplete medial discoid meniscus, with an atypical hypertrophic posterior horn and root with a lack of rear tibial attachments. Saucerization to obtain a standard semilunar shape plus outside-in sutures to repair the horizontal tear and stabilize the meniscus's peripheral rim was performed. The asymptomatic right knee was treated conservatively. After seven months, complete resolution of the symptoms in the left knee and no worsening of symptoms in the right knee was reported. Conclusion Bilateral discoid medial meniscus is a rare abnormality involving active young patients. The conservative treatment is the preferred option in asymptomatic patients. Sauceriziation and eventual repair represent the suggested surgical treatment in symptomatic cases. [ABSTRACT FROM AUTHOR]

Purpose of Review: Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. Recent Findings: In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Summary: Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management. [ABSTRACT FROM AUTHOR]

Among various osseous, ligamentous structures around knee meniscus play important role in decreasing load on articular cartilage, smooth movement, reducing friction between opposing articular surfaces of femur, tibia during movement. An accurate diagnosis regarding site, type, grade of meniscal tear along with other associated injury is essential for early operative treatment or non-operative conservative management. This was a descriptive retrospective comparative study to determine the role of MRI in evaluating spectrum and grading of meniscal injuries of knee joint and correlate the findings with arthroscopy. A total of 30 patients clinically suspected of having meniscal injury were evaluated over a period of 1 ½ year from July 2018 to December 2019. Clinical evaluation for meniscal injury with emphasis on medial and lateral joint tenderness, McMurrey test, Appley grinding test were performed by experienced an orthopedician. MRI was performed on 1.5 tesla machine followed by arthroscopy in all patients. Taking arthroscopy as gold standard; sensitivity, specificity, PPV, NPV, accuracy of MRI was determined. In our study, most common meniscal injury was medial meniscal injury (63.3%). Lateral meniscal injury comprised of 33.3%, both menisci were injured in 3.3% of cases. Most common type of tear was longitudinal tear and Grade III tear was most common in both medial and lateral menisci. The sensitivity, specificity, PPV, NPV accuracy of MRI for medial meniscal injury was 94.4%, 83.3%, 89.5%, 90.5%, 90.5%. The sensitivity, specificity, PPV, NPV accuracy of MRI for lateral meniscal injury was 90.0%, 95.0%, 90.0%, 95.0%, 93.3%. There is a good correlation between MRI and arthroscopy findings for meniscal injuries thus supporting MRI as excellent primary non invasive diagnostic tool prior to any invasive arthroscopy. [J Med Allied Sci. 2022; 12(1): 22-27]

OBJECTIVE:To determine the relationship of meniscal damage to magnetic resonance imaging (MRI) features of compartment-specific patellofemoral joint (PFJ) osteoarthritis (OA) at baseline and 2 years later. METHOD:Individuals from a prospective cohort of individuals aged 50-79 with or at risk of knee OA were included. At the 60-month and 84-month study visit, Whole-Organ MRI Score (WORMS) was used to assess meniscal tears and extrusions as well as cartilage damage and bone marrow lesions (BMLs) in the medial and lateral patella and trochlea. Worsening of structural features was defined as any increase in WORMS score from 60 to 84 months. Logistic regression was used to determine the cross-sectional and longitudinal relation of meniscus damage to features of compartment-specific PFJ OA. RESULTS:Relative to knees without lateral meniscal pathology at baseline, those with grades 3-4 lateral meniscal tear and extrusion had greater risk of worsening of cartilage damage in the lateral PFJ 2 years later (Risk ratio: 1.7 [95% CI: 1.1-2.7) and (1.7 [1.2-2.5]), respectively. Relative to those without medial meniscal pathology at baseline, those with grades 1-2 (0.6 [0.4-0.9]) and 3-4 (0.7 [0.5-1.0]) medial meniscal tears had lower risk of worsening of BMLs in the medial PFJ 2 years later. CONCLUSION:Meniscal tear and extrusion are associated with increased risk of medial and lateral PFJ OA and more severe meniscal pathology is associated with worsening of PFJ OA 2 years later. Lateral meniscal pathology appears to be more detrimental to the lateral PFJ.

Background: Little is known about the benefits and outcomes of meniscal repair in patients older than 60 years. Purpose: To (1) report the clinical and radiographic outcomes of meniscal repair in patients aged ≥60 years and compare them with matched patients who underwent meniscectomy and (2) identify procedural failures. Study Design: Cohort study; Level of evidence, 2. Methods: We included 32 knees in 32 patients aged ≥60 years (20 female, 12 male; mean age, 64.5 ± 4.6 years) who underwent meniscal repair surgery at a single medical institution between 2010 and 2020. Patients were matched according to age, sex, body mass index, and meniscal tear type with a comparison cohort who underwent meniscectomy (n = 49 patients [49 knees]; 32 female, 17 male). For all patients, demographic information, clinical history, physical examination findings, treatment details, and radiographic images were reviewed and analyzed. At final follow-up (mean, 42.2 months; range, 13-128 months), patients completed the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Clinical failure was defined as revision surgery and/or progression to total knee arthroplasty (TKA). A matched-pairs t test was used to analyze differences between the 2 treatment groups, and Kaplan-Meier analysis was used to determine the rates of knee osteoarthritis and progression to TKA. Results: The majority of patients had a medial meniscal tear (72.8%), whereas the lateral meniscus was torn in 27.2% of cases. Most tears were located in the meniscal root (56.8%), followed by the posterior horn (34.6%) and midbody (8.6%). At final follow-up, all outcome scores were higher in the repair group compared with the meniscectomy group (IKDC, 78.9 ± 13.4 vs 56.0 ± 15.4; KOOS, 86.6 ± 11.9 vs 61.7 ± 16.2; Lysholm, 88.3 ± 13.3 vs 68.7 ± 15.2, respectively; P <.001 for all). Clinical failure was observed in 22% of patients in the repair group. Conclusion: All clinical outcome scores were higher in the meniscal repair group compared with the matched meniscectomy group at final follow-up. The clinical failure rate of the repair group was 22%. These findings support meniscal repair in selected patients aged ≥60 years. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether race- or insurance-based disparities in health care exist regarding baseline knee pain, knee function, complete meniscal tear, or articular cartilage damage in patients who undergo anterior cruciate ligament reconstruction (ACLR). Hypothesis: Black patients and patients with Medicaid evaluated for ACLR would have worse baseline knee pain, worse knee function, and greater odds of having a complete meniscal tear. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cohort of patients (N = 1463; 81% White, 14% Black, 5% Other race; median age, 22 years) who underwent ACLR between February 2015 and December 2018 was selected from an institutional database. Patients who underwent concomitant procedures and patients of undisclosed race or self-pay status were excluded. The associations of race with preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, KOOS Function subscale, and intraoperatively assessed complete meniscal tear (tear that extended through both the superior and the inferior meniscal surfaces) were determined via multivariate modeling with adjustment for age, sex, insurance status, years of education, smoking status, body mass index (BMI), meniscal tear location, and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS). Results: The 3 factors most strongly associated with worse KOOS Pain and KOOS Function were lower VR-12 MCS score, increased BMI, and increased age. Except for age, the other two factors had an unequal distribution between Black and White patients. Univariate analysis demonstrated equal baseline median KOOS Pain scores (Black, 72.2; White, 72.2) and KOOS Function scores (Black, 68.2; White, 68.2). After adjusting for confounding variables, there was no significant difference between Black and White patients in KOOS Pain, KOOS Function, or complete meniscal tears. Insurance status was not a significant predictor of KOOS Pain, KOOS Function, or complete meniscal tear. Conclusion: There were clinically significant differences between Black and White patients evaluated for ACLR. After accounting for confounding factors, no difference was observed between Black and White patients in knee pain, knee function, or complete meniscal tear. Insurance was not a clinically significant predictor of knee pain, knee function, or complete meniscal tear. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to examine the relationship among patients' characteristics, intraoperative pathology and pre/post-operative symptoms in a cohort of patients undergoing arthroscopic partial meniscectomy for symptomatic meniscal tears. Methods: Clinical data were collected (age, sex, body mass index, time to surgery, trauma). Intraoperative cartilage pathology was assessed with Outerbridge score. Meniscal tears were graded with the ISAKOS classification. Synovial inflammation was scored using the Macro-score. Patient symptoms were assessed pre/post-operatively using the KOOS instrument. Results: In the series of 109 patients (median age 47 years), 50% of the meniscal tears were traumatic; 85% of patients showed mild to moderate synovitis; 52 (47.7%) patients had multiple cartilage defects and 31 (28.4%) exhibited a single focal chondral lesion. Outerbridge scores significantly correlated with patient age, BMI and synovial inflammation. There was a correlation between severity of chondral pathology and high-grade synovial hyperplasia. Pre-operative KOOS correlated with BMI, meniscal degenerative changes and symptom duration. Obesity, time to surgery, presence of high-grade synovial hyperplasia and high-grade cartilage lesions were independent predictors of worse post-operative pain and function. Conclusion: We demonstrated that pre-operative symptoms and post-operative outcomes correlate with synovitis severity and cartilage pathology, particularly in old and obese patients that underwent arthroscopic partial meniscectomy. Importantly, patients with a degenerative meniscal pattern and with longer time to surgery experienced more severe cartilage damage and, consequentially, pain and dysfunction. These findings are fundamental to identify patients suitable for earlier interventions. [ABSTRACT FROM AUTHOR]

Background: Injuries to the meniscus are particularly prevalent in soccer players, with an incidence of 0.448 injuries per 1000 hours of playing. However, in the adolescent soccer player population, it has been reported that up to 63% of asymptomatic knees may demonstrate horizontal or oblique tears on MRI. These results may negatively influence clinical decision-making and plan of management for adolescent soccer players with knee problems. Case presentation: A case of a 15-year-old soccer player is presented after having been diagnosed by his family physician with a left lateral meniscus tear as per MRI, following a 10-week period of anterior knee pain. He presented to a chiropractor for a second opinion before consulting with the orthopedic surgeon. Management and outcome: Recommendations for progressive rehabilitation owing to the lack of clinical evidence for meniscal abnormality were made. A primary diagnosis of left patellar tendinopathy was determined and after a 6-week comprehensive rehabilitation program, the patient made a complete recovery. Summary: A thorough history, physical examination, and understanding of the patient's injury mechanism are suggested before confirming/refuting suspicions of meniscal abnormalities via MRI. This will help to inform better clinical decision-making as well as decrease the occurrence of unnecessary imaging. [ABSTRACT FROM AUTHOR]

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Abstract 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

Several studies have investigated cartilage degeneration and inflammatory subchondral bone and synovial membrane changes using magnetic resonance (MR) in osteoarthritis (OA) patients. Conversely, there is a paucity of data exploring the role of knee ligaments, infrapatellar fat pad (IFP), and suprapatellar fat pad (SFP) in knee OA compared to post-traumatic cohorts of patients. Therefore, the aim of this study was to analyze the volumetric and morphometric characteristics of the following joint tissues: IFP (volume, surface, depth, femoral and tibial arch lengths), SFP (volume, surface, oblique, antero–posterior, and cranio–caudal lengths), anterior (ACL) and posterior cruciate ligament (PCL) (volume, surface, and length), and patellar ligament (PL) (volume, surface, arc, depth, and length). Eighty-nine MR images were collected in the following three groups: (a) 32 patients with meniscal tears, (b) 29 patients with ACL rupture (ACLR), and (c) 28 patients affected by end-stage OA. Volume, surface, and length of both ACL and PCL were determined in groups a and c. A statistical decrease of IFP volume, surface, depth, femoral and tibial arch lengths was found in end-stage OA compared to patients with meniscal tear (p = 0.002, p = 0.008, p < 0.0001, p = 0.028 and p < 0.001, respectively) and patients with ACLR (p < 0.0001, p < 0.0001, p = 0.008 and p = 0.011, respectively). An increment of volume and surface SFP was observed in group b compared to both groups a and c, while no differences were found in oblique, antero–posterior, and cranio–caudal lengths of SFP among the groups. No statistical differences were highlighted comparing volume, surface, arc, and length of PL between the groups, while PL depth was observed to be decreased in end-OA patients compared with meniscal tear patients (p = 0.023). No statistical differences were observed comparing ACL and PCL lengths between patients undergoing meniscectomy and TKR. Our study confirms that IFP MR morphometric characteristics are different between controls and OA, supporting an important role of IFP in OA pathology and progression in accordance with previously published studies. In addition, PL depth changes seem to be associated with OA pathology. Multivariate analysis confirmed that OA patients had a smaller IFP compared to patients with meniscal tears, confirming its involvement in OA. [ABSTRACT FROM AUTHOR]

Purpose To review patient outcomes in the literature following arthroscopic partial meniscectomy (APM) in order to identify when patients report reaching subjective maximal improvement postoperatively. Methods A systematic review of the literature from January 2004 to August 2019 was conducted using PRISMA guidelines to identify articles evaluating patient-reported outcome measures (PROMs) up to a minimum of 6 months after APM in patients >18 years old. Studies were excluded if additional interventions were performed such as repairs, ligamentous reconstruction or repair, cartilaginous manipulation, or revision surgery. PROMs were pooled between studies at preoperative, 3 months, 6 months, 1 year, and 2 year time points. Weighted averages were used within a mixed model method in order to account for the differences in sample size and variance among studies. Significant improvements in PROMs at various time intervals were statistically analyzed using minimal clinically important difference. Results A total of 12 studies including 1663 patients who underwent APM were selected for the review. The pooled cohort consisted of 1033 (62%) males and 630 (38%) females. Significant improvements were demonstrated from preoperative scores to 3 months postoperatively in Knee Injury and Osteoarthritis Outcome Score subcategories, Lysholm, and visual analog scale scores while no differences were found for Tegner and International Knee Documentation Committee scores. Although statistically significant improvement in PROMs remained at all postoperative time points compared to preoperative scores, no significant differences were observed after 3 months postoperatively. Conclusions Patients undergoing APM had significant mean changes in legacy PROMs by 3 months postoperatively that exceeded given minimal clinically important difference values, without further clinically important improvement reported up to 2 years postoperatively. Study design Level III, systematic review. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Train and apply natural language processing (NLP) algorithms for automated radiology-arthroscopy correlation of meniscal tears.Materials and Methods: In this retrospective single-institution study, we trained supervised machine learning models (logistic regression, support vector machine, and random forest) to detect medial or lateral meniscus tears on free-text MRI reports. We trained and evaluated model performances with cross-validation using 3593 manually annotated knee MRI reports. To assess radiology-arthroscopy correlation, we then randomly partitioned this dataset 80:20 for training and testing, where 108 test set MRIs were followed by knee arthroscopy within 1 year. These free-text arthroscopy reports were also manually annotated. The NLP algorithms trained on the knee MRI training dataset were then evaluated on the MRI and arthroscopy report test datasets. We assessed radiology-arthroscopy agreement using the ensembled NLP-extracted findings versus manually annotated findings.Results: The NLP models showed high cross-validation performance for meniscal tear detection on knee MRI reports (medial meniscus F1 scores 0.93-0.94, lateral meniscus F1 scores 0.86-0.88). When these algorithms were evaluated on arthroscopy reports, despite never training on arthroscopy reports, performance was similar, though higher with model ensembling (medial meniscus F1 score 0.97, lateral meniscus F1 score 0.99). However, ensembling did not improve performance on knee MRI reports. In the radiology-arthroscopy test set, the ensembled NLP models were able to detect mismatches between MRI and arthroscopy reports with sensitivity 79% and specificity 87%.Conclusion: Radiology-arthroscopy correlation can be automated for knee meniscal tears using NLP algorithms, which shows promise for education and quality improvement. [ABSTRACT FROM AUTHOR]

PurposeAnterior cruciate ligament (ACL) rupture is increasingly common in adolescents. Time between ACL rupture and surgical reconstruction, surgical wait time, is related to concurrent meniscal tear incidence and possibly tear pattern. This study defines the relationship between meniscal tear characteristics and surgical wait time in adolescents with ACL rupture.MethodsOne-hundred and twenty-one consecutive adolescent (median age 16.1 years, range 9-19 years) ACL rupture patients undergoing primary ACL reconstruction were studied. All had documented surgical wait time, preoperative and 6-month post-operative outcome (Lysholm and pedi-IKDC) scores, and intraoperative meniscus tear characteristics. Meniscal tear severity was graded according to the Lawrence and Anderson system: non-surgical: grade 1; reparable: grade 2-3; irreparable: grade 4-5. Significant tears were defined as at least grade 2.ResultsAverage age at surgery was 16.1 years. 48.7 % had surgical wait time greater than 6 months. 42.5 % of menisci were torn. With surgical wait time 6 months, medial tear incidence increased (50 vs 21 %, p 6 months. Public insurance was a risk factor for longer surgical wait time and meniscus tear.

Meniscus injuries are the most common traumatic conditions of the knee. If until the early 2000s, menisci were considered structures of no major importance in the knee joint, subsequent studies have shown their importance in the biomechanics of the knee. Their role is not only for the natural suspension of the joint, but also for the protection of the cartilage or the achievement of the efficient and uniform circulation of the synovial fluid. Therefore, disruption of this joint balance can lead, in the absence of a well-conducted treatment, to premature knee wear. Most of the time, these meniscal tears are accompanied by associated lessions, ligaments or more severely cartilaginous lessions, creating a real challenge for the physician, specially for young pacients. There are many conservative treatments of the damaged meniscus, imagined precisely in the idea of preserving the menisci as much as possible. However, this is not always possible, especially due to the type of traumatic injury.

Background and Aim Meniscal tears are one of the most frequent disorders affecting the knee joint in athletes and normal people. MRI the first choice of imaging of knee joint but in recent days, ultrasound (US) has made strides in imaging of musculoskeletal disorders due to improvement of imaging qualities. This study aimed to investigate the role of US in diagnosis of meniscus tears as compared to MRI. Patients and Methods A total of 100 patients examined by high definition US and under go to MRI examination of the knee joint. Results Regarding the diagnostic performance of US compared to MRI, the sensitivity reached (89.1%), specificity (∼72.2%), positive predictive value (∼90.1%), negative predictive value (70.1%), and accuracy (84.7%). Conclusion Ultrasonography may be used as a screening tool before arthroscopy in selected cases where MRI was a contraindication or is not available or if the patient was not affording. Ultrasonography showed a dynamic image of the meniscus and thus may prove useful if studied in conjunction with correct clinical examination.

Objective: To identify and summarize literature related to the association between mechanical symptoms (catching and locking of the knee), the presence of meniscal tear, and outcomes after arthroscopic surgery.Design: We searched PubMed and hand-searched reference lists for relevant articles and selected 38 for analysis.Results: Mechanical symptoms appear to have modest sensitivity (ranging 0.32-0.69), specificity (ranging 0.45-0.74) and positive predictive value (ranging 0.75-0.81) for meniscal tear. There is also very little evidence to suggest that those with mechanical symptoms experience better outcomes after arthroscopic surgery.Conclusion: Our examination of the literature does not support the hypothesis that mechanical symptoms are related to the presence of meniscal tear or portend better outcomes after arthroscopic surgery. [ABSTRACT FROM AUTHOR]