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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: Meniscal injury is one of the most common knee injuries. It is known that loss of meniscus increases the risk of subsequent development of degenerative changes in the knee This research aimed to evaluate the clinical and functional outcomes of arthroscopic treatment of meniscal tear using the All-inside technique. Methods: This prospective study was conducted on 18 patients with meniscal tears admitted to the Orthopedic Surgery Department, at Zagazig University hospitals. The patients treated with the all-inside repair technique, the range of the patient ages from 18 to 40 years old (mean 26.50 years), with the majority being male (77.8%) and female (22.2%). Results: The mean operative time of all cases was 73.33 ± 26.67 (range 40-100 minutes). The mean operative time of isolated meniscal repair cases was 41.42 ± 5.56 (40-45 minutes). The mean operative time of associated ACL reconstruction cases was 93.63 ± 5.04 (90 - 100 minutes). Fifteen (83.3%) cases had moderate pre-operative pain and three (16.7%) cases had severe pain. while postoperative, 11 cases (61.1%) had no pain, five cases (27.8%) had mild pain, one had moderate pain, and one had severe pain. the test value is 29.250. there is a highly statistically significant difference between pre-operative and post-operative pain. Eighteen (100.0%) cases had painful limited flexion or extension pre-operative, while postoperative, 14 (77.8%) cases had full range, two (11.1%) cases had less than 20 degrees' loss of flexion, one case (5.6%) had loss of 30degree flexion. and one case had a loss of 40 degrees of flexion. There is a highly statistically significant difference between preoperative and post-operative IKDC score. There was a highly statistically significant difference between pre-operative and post-operative Lysholm score. According to the post-operative Lysholm score, there were two poor cases (11.1%), three (16.7%) good cases & 13 (72.2%) excellent cases. Conclusions: Arthroscopic All-inside meniscal repair could be an effective, safe, rapid surgical management with reliable and predictable outcomes and avoid the risks of nerve and vessel injury. [ABSTRACT FROM AUTHOR]

Summary: Obesity is a potential risk factor for meniscal tear (MT). We utilized meta‐analysis of observational studies and Mendelian randomization (MR) analyses to elucidate the association between body mass index (BMI) and MT. In meta‐analysis, a search was performed on June 27, 2022, using PubMed and Embase databases. Odds ratios and 95% confidence intervals were extracted from included studies. In MR analyses, the research utilized summary‐level data on BMI and MT obtained from Genetic Investigation of Anthropometric Traits and the FinnGen Consortium, respectively. In meta‐analysis, four studies comprising 826,383 participants were included. The pooled odds ratio of MT in the high BMI group was 1.32 (95% confidence interval, 0.83–2.09), compared with the nonhigh BMI group. The pooled odds ratio in the under 30 group was 1.76 (95% confidence interval, 0.61–5.03). In MR analyses, one standard deviation increase in genetically predicted BMI was associated with meniscus derangement as a chronic subtype of MT (odds ratio, 1.36; 95% confidential interval, 1.17–1.59). We found that a high BMI was not associated with an increased likelihood of MT based on meta‐analysis of observational studies; however, by complementing MR analyses, we elucidated the causality of BMI increase on meniscus derangement as a chronic subtype of MT. [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.

The latest studies agree that meniscal tears that require surgery should be repaired whenever possible to avoid early-onset osteoarthritis secondary to meniscectomy. Unfortunately, there are several limitations associated with meniscal sutures, making it difficult to put into practice the theory behind the concept of saving the meniscus. Meanwhile, there is an exponential growth in the use of tissue adhesives for surgery, but finding one suited to meniscal repair remains a struggle. This review has two main goals (1) to compile the various bioadhesives used in this field and (2) to list the criteria for an ideal meniscal bioadhesive. The review was conducted in PubMed, Google Scholar, and Web of Science in November 2023 without date restrictions. The inclusion criteria were: Studies published in English and focusing on meniscal repair using bioadhesives. The exclusion criteria were: Studies published in languages other than English. Adhesives used in combination with sutures, as the aim was to determine the adhesive's capabilities for meniscal repair alone. Synthetic adhesives such as polycyanoacrylates, polyethylene glycol, polyurethanes, and polyesters. Among the 11 bioadhesives found, fibrin is the only one that has been studied in humans. There are advantages and disadvantages to all the bioadhesives identified but none that fully meet the requirements for meniscal repair. The anatomy of meniscal tissue is complex and poses unique challenges that are compounded by arthroscopic stresses. The future of meniscal repair probably lies in combining the advantages of several bioadhesives, and this area should be the focus of future research. [ABSTRACT FROM AUTHOR]

BACKGROUND: A prevalent concern, meniscal tears impact a substantial portion of the population, frequently necessitating surgical intervention due to severe pain. Attaining physical and functional fitness following meniscal surgery presents a notable challenge for both patients and physiotherapists. This case underscores the importance of effective rehabilitation strategies along with application of transfer energy capacitive and resistive (TECAR) therapy. CASE PRESENTATION: A 51-year-old female, after arthroscopic surgery for a meniscal tear, sought a focused 4-week rehabilitation program. Integrating TECAR therapy and targeted exercises addressed pain, range of motion, muscle strength, gait, and balance. OUTCOME AND FOLLOW-UP: Significant improvements were observed, including pain reduction, increased knee flexion, enhanced muscle strength, improved gait, and balance. Knee injury and Osteoarthritis Outcome Score results reflected comprehensive improvement in knee-related domains. DISCUSSION: TECAR therapy played a pivotal role in pain management, while mobilization and targeted exercises positively impacted knee range of motion and muscle strength. Gait analysis and the Star Excursion Balance Test highlighted improved gait parameters and balance, affirming the effectiveness of a multidisciplinary rehabilitation approach. JOSPT Cases 2024;4(2):84-93. Epub 18 April 2024. doi:10.2519/josptcases.2024.0033 [ABSTRACT FROM AUTHOR]

Randomized controlled trials (RCTs) are a gold standard for estimating the benefits of clinical interventions, but their decision-making utility can be limited by relatively short follow-up time. Longer-term follow-up of RCT participants is essential to support treatment decisions. However, as time from randomization accrues, loss to follow-up and competing events can introduce biases and require covariate adjustment even for intention-to-treat effects. We describe a process for synthesizing expert knowledge and apply this to long-term follow-up of an RCT of treatments for meniscal tears in patients with knee osteoarthritis (OA). We identified 2 post-randomization events likely to impact accurate assessment of pain outcomes beyond 5 years in trial participants: loss to follow-up and total knee replacement (TKR). We conducted literature searches for covariates related to pain and TKR in individuals with knee OA and combined these with expert input. We synthesized the evidence into graphical models. We identified 94 potential covariates potentially related to pain and/or TKR among individuals with knee OA. Of these, 46 were identified in the literature review and 48 by expert panelists. We determined that adjustment for 50 covariates may be required to estimate the long-term effects of knee OA treatments on pain. We present a process for combining literature reviews with expert input to synthesize existing knowledge and improve covariate selection. We apply this process to the long-term follow-up of a randomized trial and show that expert input provides additional information not obtainable from literature reviews alone. [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.

Purpose: The number of anterior cruciate ligament (ACL) injuries has considerably increased in the recent years, especially in young adults and adolescents. Associated meniscal tears increase anterior and rotary laxity. Posterior peripheral meniscocapsular tear of medial meniscus is also called ramp lesion. Prevalence of 9% to 17% in adults and up to 23% in pediatric population has been reported. The aim of this study was to determine anterior laxity of cadaveric ACL-deficient knees with several size of ramp lesions. Methods: Fresh cadaveric knees were explored. Major osteoarthritis and/or ACL and meniscal tears on arthroscopy were exclusion criteria. Mean age at death was 86 years old. Dynamic laximetry with GNRB® device was made in several conditions: Knee prior to any procedure, after arthroscopic exploration, after ACL section, and then after increasing sizes of ramp lesions up to 30 mm. Anteroposterior laxity was measured with 2 loading forces successively (134N and 200N). Results: After ACL section only, tibiofemoral joint anterior laxity was significantly increased. Mean increase was 156% regardless of the loading force. No statistical laxity difference was found between knees with ACL section only and knees with ACL and meniscal section for any size of ramp lesions. Increasing size of ramp lesion was not correlated with increasing of laxity. Conclusion: We could not find a threshold size of ramp lesion which increases knee anterior laxity. We were not able to determine a threshold recommending a ramp lesion repair. [ABSTRACT FROM AUTHOR]

Background: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. Purpose: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. Results: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. Conclusion: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees. [ABSTRACT FROM AUTHOR]

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]

Purpose: Elucidating subchondral bone remodeling in preclinical models of traumatic meniscus injury may address clinically relevant questions about determinants of knee osteoarthritis (OA). Methods: Studies on subchondral bone remodeling in larger animal models applying meniscal injuries as standardizing entity were systematically analyzed. Of the identified 5367 papers reporting total or partial meniscectomy, meniscal transection or destabilization, 0.4% (in guinea pigs, rabbits, dogs, minipigs, sheep) remained eligible. Results: Only early or mid-term time points were available. Larger joint sizes allow reporting higher topographical details. The most frequently reported parameters were BV/TV (61%), BMD (41%), osteophytes (41%) and subchondral bone plate thickness (39%). Subchondral bone plate microstructure is not comprehensively, subarticular spongiosa microstructure is well characterized. The subarticular spongiosa is altered shortly before the subchondral bone plate. These early changes involve degradation of subarticular trabecular elements, reduction of their number, loss of bone volume and reduced mineralization. Soon thereafter, the previously normal subchondral bone plate becomes thicker. Its porosity first increases, then decreases. Conclusion: The specific human topographical pattern of a thinner subchondral bone plate in the region below both menisci is present solely in the larger species (partly in rabbits), but absent in rodents, an important fact to consider when designing animal studies examining subchondral consequences of meniscus damage. Large animal models are capable of providing high topographical detail, suggesting that they may represent suitable study systems reflecting the clinical complexities. For advanced OA, significant gaps of knowledge exist. Future investigations assessing the subchondral bone in a standardized fashion are warranted. [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. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair for a traumatic meniscal tear is increasingly used to preserve the meniscus. Interpreting postoperative magnetic resonance imaging (MRI) scans remains challenging, especially in symptomatic patients. There is a lack of reliable MRI criteria to affirm the healed character of a traumatic meniscal injury repair. Purpose: To identify relevant MRI criteria for meniscal healing after meniscal repair. Study Design: Case series; Level of evidence, 4. Methods: We prospectively included all patients with a traumatic meniscal injury who underwent either an isolated meniscal repair or a repair during a concomitant anterior cruciate ligament reconstruction. A standardized preoperative and postoperative clinical evaluation was performed, along with collection of functional scores—Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, Lysholm Score, and 36-Item Short Form Health Survey. An MRI scan was performed 1 year postoperatively and compared with the preoperative MRI scan. The following MRI aspects were analyzed: variation of morphology and fat-saturated (FS) T2 intensity signal and pre- and postoperative tear diastasis measurement. Results: Fifty patients (age, mean ± SD, 28.7 ± 8.5 years [range, 16-45 years]) who were 1 year postoperative were included. All patients were considered clinically healed had the same MRI characteristics. A signal change (FS T2) was observed from a high signal intensity fluid to a nonfluid moderate signal intensity. The morphology of the lesion was more complex: from the initial lesion, line ramifications appeared, creating the appearance of tree branches. The tear diastasis decreased (from 2.3 ± 0.5 mm [range, 1.3-3.5] to 1.1 ± 0.28 mm [range, 0.5-1.5]). Conclusion: MRI criteria confirming meniscal healing after traumatic meniscal repair at 1 year were identified: a change in the intrameniscal signal becoming nonfluid and moderate in intensity; a reduction in tear diastasis to <1.5 mm; and a change in the signal morphology of the repaired meniscus. [ABSTRACT FROM AUTHOR]

Meniscal injuries are increasingly reported in pediatric patients due to early sports participation and are commonly encountered during anterior cruciate ligament reconstruction. Preoperative identification of meniscal tears is crucial, particularly when involving the posteromedial meniscocapsular junction (ramp lesion). MRI plays an important role in detecting this particular type of meniscal injury. Consequently, pediatric radiologists should be aware of particular MRI findings related to ramp lesions including the presence of a medial meniscal tear, peripheral meniscal irregularity, meniscocapsular junctional fluid-like signal intensity, and capsular ligament tears. Thus, we illustrate the lessons we have learned from our institutional multidisciplinary arthroscopic-MR correlation conference for retrospectively identified posterior horn medial meniscal tears and ramp lesions. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. Purpose: To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). Results: In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P <.001), peripheral rim instability (P =.005), and longitudinal tears (P =.015) and require a meniscal repair (P <.001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P =.015) and require additional debridement beyond the physiologic rim (P =.003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. Conclusion: To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years. [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]

Purpose: The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. Methods: Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16–60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3–6 months (388; 29%), 6–12 months (248; 19%) and > 12 months (254; 19%). Results: Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). Conclusion: Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. Level of Evidence: Level III. [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]

Purpose: Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown. Methods: We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment. Results: CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions. Conclusion: On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary. [ABSTRACT FROM AUTHOR]

Background: Lateral discoid meniscus accounts for most meniscal tears in children 10 years of age and younger. The role of bony morphology in discoid meniscus has been previously studied in a limited capacity using radiographs. Purpose: To use magnetic resonance imaging to measure features of the femoral condyles and tibial plateaus in patients with discoid meniscus to assess potential determinants of symptoms and subsequent surgery and to compare with matched controls to investigate age-related changes in bony features. Study Design: Cross-sectional study; Level of evidence, 3. Methods: After institutional review board approval, detailed morphology of the femoral condyles and tibial plateau was measured in 177 patients (3-18 years of age; 56% female) with confirmed lateral discoid meniscus. Measurements from 269 participants (3-18 years of age; 55% female) with asymptomatic knees were used as controls. Two-way analysis of variance with Holm-Šídák post hoc was used to compare measurements between discoid menisci and matched controls. Independent t tests were used to compare aspects of bony morphology within the discoid meniscus cohort. Results: Compared with controls, patients with a lateral discoid meniscus had a larger bicondylar width and notch width (7- to 10-year-old and 15- to 18-year-old age groups; P <.05), larger tibial plateau width (11- to 14-year-old and 15- to 18-year-old age groups; P <.001), and smaller lateral (P <.02) and coronal (P <.02) tibial slopes across all age groups. Among patients with a discoid meniscus, larger bicondylar width, larger tibial plateau width, larger notch width, and a flatter lateral femoral condyle were associated with pain (P <.005) and lateral meniscal tears (P <.02). Larger notch width and notch width index were also associated with subsequent surgery (P <.05). Conclusion: There are clinically significant abnormalities in bony morphology in patients with a discoid meniscus, including larger femoral condyles and tibial plateaus and a flatter tibial plateau. Additionally, femoral size, femoral curvature, and tibial plateau size may influence the likelihood of knee pain, meniscal tear, and need for surgery. These findings highlight the importance of bony morphology in discoid meniscus pathophysiology in children and adolescents. Such measurements may also aid radiographic detection of discoid meniscus and guide decisions regarding the timing of potential surgical intervention. [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]

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.

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.

Background: Medial meniscus posterior root tears (MMPRTs) cause pain and dysfunction and are associated with poor clinical outcomes with nonoperative management at short-term follow-up. However, little is known about the long-term natural history of these tears. Purpose: The purpose of this study was to (1) provide an update to a previous minimum 2-year study on the natural progression of these tears and (2) evaluate long-term patient-reported and radiographic outcomes. Study Design: Case series (prognosis); Level of evidence, 4. Methods: A retrospective review was performed on a cohort of patients with untreated MMPRTs, diagnosed between 2005 and 2013, who were followed clinically using International Knee Documentation Committee (IKDC), visual analog scale for pain, and Tegner activity scores as well as radiographically at a minimum 10-year follow-up. Failure was defined as conversion to arthroplasty or a severely abnormal subjective IKDC score <75.4. Results: Overall, 5 (10%) of the original 52 patients with minimum 2-year outcomes were subsequently lost to follow-up. The remaining 47 patients (21 male, 26 female) were followed for a mean of 14 ± 2 years (range, 11-18 years). At final follow-up, 25 patients (53%) had progressed to total knee arthroplasty, 8 (17%) were deceased, and 14 (30%) had not progressed to total knee arthroplasty. The mean IKDC and Tegner activity scores for the 14 patients with remaining MMPRTs were 51.6 ± 22.2 and 3.1 ± 1.1, respectively, and the mean visual analog scale score was 4.4 ± 3.0. Radiographically, the mean Kellgren-Lawrence grade progressed from 1.2 ± 0.7 at baseline to 2.6 ± 0.5 at final follow-up (P <.001). At a minimum 10-year follow-up, 37 of 39 living patients (95%) had failed nonoperative treatment. Conclusion: Poor clinical and radiographic outcomes were associated with the nonoperative treatment of degenerative MMPRTs at long-term follow-up. This study provides a valuable update on the natural history and long-term prognosis of nonoperatively treated MMPRTs. [ABSTRACT FROM AUTHOR]

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]

Meniscal tears are the most common injury of the knee. Tears of medial meniscus are seen more frequently as compared to lateral meniscus. Most often tears result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee. As the majority of our population resides in peripheries where access to arthroscopy and imaging modalities is difficult so we need a clinical test for evaluation of medial meniscal tears. And then this technique can be opted in our practice for early diagnosis of meniscal tears to take proper management for reducing morbidity of these particularpatient, if its diagnostic accuracy comes out to high. Objective: To determine the diagnostic accuracy of McMurray test in diagnosing medial meniscal tears, taking arthroscopy as gold standard. Material and Methods: ThisCross-sectional validation study was carried out in Orthopedic Department of Hospital from September 2020 to August 2021. In this study a total of 149 patients were observed. McMurray test was performed by a single and same consultant and was looked for medial meniscal tear (present/absent) .After this arthroscopy was done in each patient by the consultant orthopedic surgeon who has examined the patient and presence or absence of medial meniscal tear was noted. McMurray test results were compared with arthroscopy result. Results: In this study mean age was 30 years with SD ± 11.35.85% patients were male and 15% patients were female. Diagnostic accuracy of Mcmurray Test findings taking arthroscopy as gold standard was analyzed as the sensitivity was 76.55%, specificity was 75%, Positive predictive value was 99.10%, Negative predictive value was 8.10%. So the overall diagnostic accuracy was 76.51%. Conclusion: This study concludes that the McMurray test had sensitivity 76.55%, specificity 75%, Positive predictive value 99.10%, Negative predictive value 8.10% and the diagnostic accuracy 76.51% in diagnosis of meniscal tear keeping knee arthroscopy as gold standard. [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]

Purpose: Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). Methods: This study is a retrospective case–control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren–Lawrence classification. Demographic characteristics were noted. Results: There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). Conclusion: The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: High-grade knee laxity and excessive anterior tibial subluxation (ATS) are correlated with poor clinical outcomes in patients with anterior cruciate ligament (ACL) deficiency and share similar risk factors; however, the association between excessive ATS and high-grade knee laxity remains unclear. Purpose: To identify the association between excessive ATS and high-grade knee laxity in patients with ACL deficiency and determine the possibility that ATS can predict high-grade knee laxity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 226 patients who underwent ACL reconstruction between May 2018 and March 2022 were analyzed in the present study; the high-grade group consisted of 113 patients who had a grade 3 result on the preoperative anterior drawer test, Lachman test, or pivot-shift test while under anesthesia, and the low-grade group consisted of 113 matched patients. The ATS values for medial and lateral compartments (ATSMC and ATSLC) were measured on magnetic resonance imaging while patients relaxed the quadriceps in the supine position under no anesthesia. The optimal cutoff values of ATSMC and ATSLC for high-grade knee laxity were determined using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses with stratification were performed to identify the association between excessive ATS and high-grade knee laxity. Results: Compared with the low-grade group, the high-grade group had a longer time from injury to surgery; higher rates of medial meniscus posterior horn tear (MMPHT), lateral meniscus posterior horn tear (LMPHT), and anterolateral ligament (ALL) abnormality; and larger lateral tibial slope, ATSMC, and ATSLC. The optimal cutoff value was 2.6 mm (sensitivity, 52.2%; specificity, 76.1%) for ATSMC and 4.5 mm (sensitivity, 67.3%; specificity, 64.6%) for ATSLC in predicting high-grade knee laxity. After adjustment for covariates, ATSLC ≥4.5 mm (odds ratio [OR], 2.94; 95% CI, 1.56-5.55; P =.001), MMPHT (OR, 2.62; 95% CI, 1.35-5.08; P =.004), LMPHT (OR, 2.39; 95% CI, 1.20-4.78; P =.014), and ALL abnormality (OR, 2.09; 95% CI, 1.13-3.89; P =.019) were associated with high-grade knee laxity. The association between excessive ATSLC and high-grade knee laxity was validated in patients with acute ACL injury as well as those with chronic ACL injury. Conclusion: Excessive ATSLC was associated with high-grade knee laxity in patients who had ACL deficiency, with a predictive cutoff value of 4.5 mm. This study may help surgeons estimate the degree of knee instability more accurately before anesthesia and may facilitate preliminary surgical decision-making, such as appropriate graft choices and consideration of extra-articular augmentation. [ABSTRACT FROM AUTHOR]

Meniscal tears are one of the most common knee pathologies, and arthroscopic meniscectomy is a frequently performed procedure. The importance of preserving the meniscus, due to its role in chondroprotection and secondary knee stability, is well-accepted. Meniscal repair techniques have evolved over time from initial open repairs to arthroscopic inside-out and outside-in repairs, and more recently to repairs using all-inside devices. In this article, the authors reviewed the function, anatomy and biomechanics of the meniscus, and discussed the literature to support the argument for repairing meniscal tears. [ABSTRACT FROM AUTHOR]

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]

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.

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

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.

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.