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Objective: This study aims to enhance our understanding of the morphological pattern, causes and pathogenesis of meniscal root injuries in the Indian population. Materials and Methods: Sixty-four patients with meniscus root tears were included in the study. The patients were categorized into two groups based on the location of the meniscus tear: Group 1 (n = 41) comprised patients with lateral meniscus root injury (LMRI), and Group 2 (n = 23) included patients with medial meniscus root injury (MMRI). Demographic and patient-specific data, such as age, gender, BMI, history of injury, and injury type, were recorded. All patients underwent surgical treatment, and intraoperative findings (chondral damage grade, type of root injury, associated ligamentous injuries) were documented. Meniscus root tears are further classified into 5 categories depending upon their morphological types. A minimum 12-month follow-up assessed functional outcomes using the Lysholm and IKDC knee scores. Results: The mean age for MMRI and LMRI was 50.3 years and 29.4 years, respectively. In the MMRI group, 48% (11/23) were female compared to only 15% (6/41) in the LMRI group. The mean BMI in the MMRI and LMRI groups was 30.1 and 25.4, respectively. Nine patients in MMRI and 4 patients in LMRI group exhibited grade 3 or higher chondral damage. Type 2 meniscus root tear was most common type in both the groups (51% in MMRI vs. 74% in LMRI). Both LMRI and MMRI groups demonstrated significant improvement in functional outcomes. Conclusions: Medial meniscus root injuries predominantly occur in the elderly without a significant history of trauma, often associated with a high grade of medial femoral chondral damage, suggesting a degenerative etiology. In contrast, lateral meniscus root injuries tend to occur in younger patients with a notable history of knee injury, indicative of a traumatic etiology for LMRI. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair in bucket-handle tears has proven to be effective. However, when such lesions are chronically displaced and adhered to intercondylar soft tissues, their repair may be considered unfeasible. Accordingly, the objective of this study is to show the surgical technique for the reduction and repair of this type of injury and to evaluate the long-term outcomes of such repairs. Materials and Methods: We conducted a retrospective case series of eight patients who were identified between 2006 and 2015 and presented with chronically displaced, medial meniscus bucket-handle tears. The bucket-handle tears were reduced, and the medial meniscus was repaired in all cases. The knee was immobilized in full extension and maintained nonweight bearing for 2 weeks. Then, the range of movement was limited from 0° to 90° and kept partially weight bearing for 4 more weeks. Results: The mean age of the patients was 27.2 years. The mean time to surgery was 7.12 ± 4.4 months, and the mean follow-up time was 10.0 ± 3.4 years. The average preoperative and postoperative Lysholm score was 58.0 ± 16.2 and 95.9 ± 3.4, respectively (P = 0.008). The mean preoperative and postoperative Tegner was 5.5 ± 1.1 and 5.1 ± 1.1, respectively (P = 0.109). The average KT-1000 of the participants was 1.2 ± 1.2, and the mean International Knee Documentation Committee was 92.9 ± 5.0. The average Ählback score at follow-up was 0.83 ± 0.4. Conclusions: The treatment of chronically dislocated bucket-handle tears can be successfully achieved by the sequential release and suture of the torn meniscus. Good outcomes and low rates of osteoarthritis were observed at 10-year follow-up. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Purpose: The optimal management of degenerative meniscal tears remains controversial. Extracorporeal shockwave therapy (ESWT) has been shown to promote tissue repair in both preclinical and clinical studies; however, its effect on degenerative meniscal tears remains unknown. This study aimed to examine whether ESWT improves meniscal degeneration. Methods: This randomized trial was conducted between 2020 and 2022 and involved patients with degenerative medial meniscal tears. Patients were allocated to receive either focused ESWT (0.25 mJ/mm2, 2000 impulses, 3 sessions with a 1‐week interval) or sham treatment. Patients were evaluated using magnetic resonance imaging (MRI) before treatment and at 12 months after treatment. The primary endpoint was improvement in meniscal degeneration, as assessed by the change in T2 relaxation time from baseline on MRI T2 mapping. Knee pain and clinical outcomes were also examined at the same time. Results: Of 29 randomized patients, 27 patients (mean age 63.9 ± 8.7 years; females 37%; ESWT group 14 patients; control group 13 patients) were included in the final analysis. At 12 months postintervention, patients in the ESWT group showed a greater decrease in the T2 relaxation time (ESWT group −2.9 ± 1.7 ms vs. control group 1.0 ± 1.9 ms; p < 0.001) and had less knee pain (p = 0.04). The clinical outcomes at 12 months post‐treatment were not statistically significant. No adverse events were reported. Conclusion: ESWT decreased the T2 relaxation time in the meniscus at 12 months post‐treatment. ESWT also provided pain relief, but no differences were observed in clinical outcomes. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Objective: Arthroscopic partial meniscectomy is a widely used surgical technique for treating meniscus injuries, while individual differences in postoperative outcomes remain a significant concern. This retrospective study aimed to identify the factors influencing clinical outcomes following arthroscopic partial meniscectomy. Methods: We retrospectively examined the clinical data of 52 patients who underwent arthroscopic partial meniscectomy at our institution from January to May 2022. Observation indicators, including gender, age, type of medical insurance, various surgeons, the self‐pay portion of hospital costs, and total hospital costs, were systematically recorded. Subjective symptoms were evaluated with ΔTenger, ΔLysholm, and International Knee Documentation Committee (IKDC) scores during follow‐up. The trends of the above questionnaires and potential predictors were statistically evaluated through regression analysis. Results: Binary logistic analysis revealed that female patients (OR: 32.42; 95% confidence interval [CI]: 2.22, 473.86) and higher preoperative visual analog scale (VAS) (odds ratio [OR]: 3.58; 95% CI: 1.55, 8.28) were significantly associated with FP Lysholm score. Similarly, patients with elevated preoperative VAS (OR: 1.47; 95% CI: 1.01, 2.15) were significantly more likely to have FP IKDC scores. Multiple linear regression analysis revealed that traumatic meniscus tear (β = −0.324; 95% CI: −0.948, −0.036; p = 0.035) emerged as a negative independent predictor of ΔTegner, while higher preoperative VAS scores (β = 0.330; 95% CI: 0.013, 0.217; p = 0.028) were identified as positive independent predictors of ΔTegner. The duration of symptoms (β = −0.327; 95% CI: −0.010, −0.001; p = 0.023) had a negative impact on the ΔLysholm scores. Factors such as body mass index (BMI) (β = −0.250; 95% CI: −1.000, −0.020; p = 0.042), duration of symptoms (β = −0.302; 95% CI: −0.009, −0.001; p = 0.014), and preoperative VAS (β = −0.332; 95% CI: −1.813, −0.250; p = 0.011) were negatively associated with ΔIKDC scores. Conclusion: The study offers insights into multiple factors for patient outcomes after arthroscopic partial meniscectomy. Orthopedic surgeons need to consider variables such as gender, BMI, duration of symptoms, preoperative VAS, and the traumatic/degenerative types of meniscal tears to optimize postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Meniscus tears are a common knee joint disease. MRI is considered the gold standard for diagnosing knee joint pathology. This study aimed to evaluate meniscus tears and associated conditions using multiplanar MRI. Methods and Results: A retrospective cross-section study was conducted at King Salman Medical City and involved 115 patients (81 males and 34 females) aged between 10 and 60 years diagnosed with meniscus tears by multiplanar MRI. The research findings indicated that individuals between the ages of 31 and 40, as well as those aged 21-30 and 51-60 years, were the most affected by meniscal tears. Furthermore, males displayed a greater vulnerability to meniscal tears than females, with approximately 70.4% of cases. The research findings indicated that the medial meniscus was the most prominently affected, accounting for 63.5% of cases, followed by the lateral meniscus (26.1%) and bilateral involvement (23.5%). Among the affected menisci, over half (56.6%) of the cases exhibited transverse tears, while radial and longitudinal tears were less prevalent. Furthermore, complete tears were more prevalent than partial tears, accounting for 68.7% of cases. Most patients were affected by Grade 1 tears, constituting 62.6% of the total sample. The most frequently concomitant feature with meniscus tears was joint effusion (37.4%), followed by osteoarthritis (17.4%) and anterior cruciate ligament tears (15.7%). There was a significant association between the transverse type of meniscal tears and joint effusion (P=0.047). Conclusion: The research findings imply that, in some clinical situations, MRI without contrast can be a useful and trustworthy method for identifying meniscus tears.

Purpose: Meniscus tears in the setting of anterior cruciate ligament (ACL) injury can affect post-operative outcomes and stability when not treated correctly. To reduce post-operative osteoarthritis and to improve outcomes, accurate diagnosis and treatment options must be selected. The purpose of this review was to review recent evidence regarding biomechanics and diagnosis of meniscus injury as well as treatment options for meniscus tears, which are often complicated by ACL injuries. Methods: Studies and topics on concomitant meniscus tears in the presence of ACL injury were searched. Results: Various risk factors have been identified for meniscus tears associated with ACL injuries. As some meniscus tears are difficult to identify on magnetic resonance imaging (MRI), arthroscopic diagnosis of meniscal pathology plays a crucial role. Indications for meniscectomy should be limited due to subsequent exacerbation of post-operative instability and contribution to osteoarthritic changes. Although meniscal repair is the standard treatment for bucket handle tears, ramp lesions, lateral meniscus posterior root tears, and lateral meniscus oblique radial tears, non-operative treatment may be also effective to a certain extent for stable meniscal tears. However, the indication for non-operative treatment should be carefully considered owing to potential enlargement of the torn area. Conclusions: Inadequate treatment of concomitant meniscus tears can result in residual instability and poor outcomes despite successful ACL reconstruction. High-quality evidence on the long-term outcomes of meniscus tears complicating ACL injuries is scarce and hence future studies are required.

Objective: To analyze the biomechanical characteristics of the knee joint under different lateral cut angles and ground contact modes using the validated finite element model of the knee joint, which provided a theoretical basis for preventing lateral cut sports injuries in football players and formulating rehabilitation training programs after injury. Method: Fifteen male football players (all of whom are national second-level athletes and above) were recruited to perform cutting movements at the angles of 45°, 90° and 135° in front and rear touchdown modes at a speed of 6m/s±10%. The kinematics and dynamics data of the knee joint were calculated by Visual 3D software, and the peak moment of ground reaction force in the six touchdown actions was numerically simulated based on the verified knee joint model. Result: ①The cutting angle is positively correlated with the peak knee flexion angle (P<0.05), indicating that as the cutting angle increases, while vertical ground reaction force decreases significantly with increase cutting angle (P<0.05). ②Significant differences in kinematics and dynamics exist between forefoot and rearfoot striking (P<0.05). In the forefoot striking mode, there are larger knee flexion angles, external rotation, and internal rotation peak angles, along with higher upward ground reaction force. ③At the moment of side cutting contact, the distribution of Von Mises stress in the meniscus and the contact stress in the femoral cartilage show characteristics related to the cutting angle and the mode of foot contact. In the 90° rearfoot striking mode, there is a noticeable concentration of stress on the external edge of the medial meniscus and the medial femoral cartilage, which may indicate an increased risk of knee joint injury under these conditions. Conclusion: Performing a 90° cut with a rearfoot striking pattern may lead to an imbalance in internal knee joint stress, particularly causing significant stress concentration on the external edge of the medial meniscus, indicating a higher risk of injury. [ABSTRACT FROM AUTHOR]

Introduction: Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries. Objective: The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available. Materials and methods: Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered. Results: Seventy patients with MLKIs were included, with a mean age of 30.69 years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89–26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%. Conclusion: The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns. It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs. [ABSTRACT FROM AUTHOR]

Objectives: To review and compare the accuracy of convolutional neural networks (CNN) for the diagnosis of meniscal tears in the current literature and analyze the decision-making processes utilized by these CNN algorithms. Materials and methods: PubMed, MEDLINE, EMBASE, and Cochrane databases up to December 2022 were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Risk of analysis was used for all identified articles. Predictive performance values, including sensitivity and specificity, were extracted for quantitative analysis. The meta-analysis was divided between AI prediction models identifying the presence of meniscus tears and the location of meniscus tears. Results: Eleven articles were included in the final review, with a total of 13,467 patients and 57,551 images. Heterogeneity was statistically significantly large for the sensitivity of the tear identification analysis (I2 = 79%). A higher level of accuracy was observed in identifying the presence of a meniscal tear over locating tears in specific regions of the meniscus (AUC, 0.939 vs 0.905). Pooled sensitivity and specificity were 0.87 (95% confidence interval (CI) 0.80–0.91) and 0.89 (95% CI 0.83–0.93) for meniscus tear identification and 0.88 (95% CI 0.82–0.91) and 0.84 (95% CI 0.81–0.85) for locating the tears. Conclusions: AI prediction models achieved favorable performance in the diagnosis, but not location, of meniscus tears. Further studies on the clinical utilities of deep learning should include standardized reporting, external validation, and full reports of the predictive performances of these models, with a view to localizing tears more accurately. Clinical relevance statement: Meniscus tears are hard to diagnose in the knee magnetic resonance images. AI prediction models may play an important role in improving the diagnostic accuracy of clinicians and radiologists. Key Points: •Artificial intelligence (AI) provides great potential in improving the diagnosis of meniscus tears. •The pooled diagnostic performance for artificial intelligence (AI) in identifying meniscus tears was better (sensitivity 87%, specificity 89%) than locating the tears (sensitivity 88%, specificity 84%). •AI is good at confirming the diagnosis of meniscus tears, but future work is required to guide the management of the disease. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have reported successful clinical outcomes of meniscal allograft transplantation (MAT) or meniscal scaffold implantation (MSI), the difference between the outcome of MAT and MSI remains unclear. Purpose: To compare the overall outcomes and survival rates of MAT and MSI, aiming to provide comprehensive evidence for determining the optimal treatment strategy for meniscal defects. Methods: A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of MAT or MSI were included according to the inclusion and exclusion criteria. The Lysholm score was chosen as the primary outcome measure, while secondary outcomes encompassed patient-reported outcome measures (PROMs), return to sports (RTS) rates, survival rates, and complication rates. The outcomes were stratified into two groups: MAT group and MSI group, followed by statistical comparison (P< 0.05). The quality of the included studies was assessed by the Cochrane Risk of Bias 2 (RoB2) assessment tool for randomized controlled trials (RCTs) and the Coleman Methodology Score (CMS) for non-randomized controlled trials. Results: A total of 3932 patients (2859 MAT, 1073 MSI) in 83 studies (51 MAT, 32 MSI) had the overall significant improvement in all clinical scores. The group MSI had a higher Lysholm score of both preoperative (P= 0.002) and postoperative (P<0.001) than group MAT; however, the mean improvements were similar between the two groups (P=0.105). Additionally, MSI had higher improvements of IKDC (P<0.001), KOOS symptom (P= 0.010), KOOS pain (P= 0.036), and KOOS ADL (P=0.004) than MAT. Interestingly, MAT had higher preoperative (P=0.018) and less postoperative VAS pain (P= 0.006), which was more improved in MAT (P< 0.001). Compared with MAT, MSI had a higher 10-year survival rate (P=0.034), a similar mid-term survival rate MAT (P =0.964), and a lower complication rate (P< 0.001). Conclusion: Both MAT and MSI could have good clinical outcomes after surgery with a similar improvement in Lysholm score. MSI had a higher 10-year survival rate and fewer complications than MAT. Level of evidence: Level IV, systematic review. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. Recent Findings: Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21–64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8–24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. Summary: There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted. [ABSTRACT FROM AUTHOR]

PURPOSE: Proximal fibula fractures are often associated with tibial plateau fractures, but their relationship is poorly characterized. The purpose of this study was to better define the relationship between tibial plateau injury severity and presence of associated soft tissue injuries. METHODS: A retrospective review was performed on all operatively treated tibial plateau fractures at a Level 1 trauma center over a 5-year period. Patient demographics, injury radiographs, CT scans, operative reports and follow-up were reviewed. RESULTS: Queried tibial plateau fractures from 2014 to 2019 totaled 217 fractures in 215 patients. Fifty-two percent were classified as AO/OTA 41B and 48% were AO/OTA 41C. Thirty-nine percent had an associated proximal fibula fracture. The presence of a proximal fibula fracture had significant correlation with AO/OTA 41C fractures, as compared with AO/OTA 41B fractures (chi-square, p

Giant meniscus cysts combined with mixed tears are relatively uncommon in clinical practice. The primary objective of rehabilitation is to restore knee joint function and prevent cyst recurrence. In this article, we discuss a series of rehabilitation strategies implemented for a patient who experienced both a giant meniscus cyst and a mixed tear.

Abstract Meniscus pathologies (damage, extrusion) and synovitis are associated with knee osteoarthritis (KOA); however, whether synovitis mediates the relationship between meniscus pathologies and KOA radiographic progression remains unclear. We conducted an observational study in the Osteoarthritis Initiative (OAI) cohort, with a 48-month follow-up. Meniscus pathology and synovitis were measured by MRI osteoarthritis knee score (MOAKS) at baseline and 24 months, and a comprehensive synovitis score was calculated using effusion and Hoffa synovitis scores. The knee osteoarthritis radiographic progression was considered that Kellgren–Lawrence (KL) grade and joint space narrowing (JSN) grade at 48 months were increased compared to those at baseline. This study included a total of 589 participants, with KL grades mainly being KL1 (26.5%), KL2 (34.1%), and KL3 (30.2%) at baseline, while JSN grades were mostly 0 at baseline. A logistic regression model was used to analyze the relationship between meniscus pathology, synovitis, and KOA progression. Mediation analysis was used to evaluate the mediation effect of synovitis. The average age of the participants was 61 years old, 62% of which were female. The medial meniscus extrusion was longitudinally correlated with the progression of KL (odds ratio [OR]: 2.271, 95% confidence interval [CI]: 1.412–3.694) and medial JSN (OR: 3.211, 95% CI: 2.040–5.054). Additionally, the longitudinal correlation between medial meniscus damage and progression of KOA (OR: 1.853, 95% CI: 1.177–2.941) and medial JSN (OR: 1.655, 95% CI: 1.053–2.602) was significant. Synovitis was found to mediate the relationship between medial meniscus extrusion and KL and medial JSN progression at baseline (β: 0.029, 95% CI: 0.010–0.053; β: 0.022, 95% CI: 0.005–0.046) and beyond 24 months (β: 0.039, 95% CI: 0.016–0.068; β: 0.047, 95% CI: 0.020–0.078). However, we did not find evidence of synovitis mediating the relationship between meniscal damage and KOA progression. Synovitis mediates the relationship between medial meniscus extrusion (rather than meniscus damage) and KOA progression.

Objectives: This study aims to demonstrate the preprocessing steps for knee MRI images to detect meniscal lesions using deep learning models and highlight their practical implications in diagnosing knee conditions, especially meniscal injuries, often caused by degeneration or trauma. Magnetic resonance imaging (MRI) is key in this field, especially when combined with ligament evaluations, and our research underscores the relevance and applicability of these techniques in real-world scenarios. Importantly, our findings suggest a promising future for the diagnosis of knee conditions. Materials and methods: We initially worked with DICOM-format images, the standard for medical imaging, utilizing the Python packages PyDicom and SimpleITK for preprocessing. We also addressed the NIfTI format commonly used in research. Our preprocessing methods, designed with efficiency in mind, encompassed modality-specific adjustments, orientation, spatial resampling, intensity normalization, standardization and conversion to algorithm input format. These steps ensure efficient data handling, accelerate training speeds, and reassure the audience about the effectiveness of our research. Results: Our study processed PD-sagittal images from 188 patients to create a test set for training a deep learning segmentation model. We successfully completed all preprocessing steps, including accessing DICOM header information using hexadecimal encoded identifiers and utilizing SimpleITK for efficient handling of both 2D and 3D DICOM data. Resampling was performed for all 188 sets. Additionally, manual segmentation was conducted on 188 MRI scans, focusing on regions of interest (ROIs), such as normal tissue and meniscus tears in both the medial and lateral menisci. This involved contrast adjustment and precise hand-tracing of the structures within the ROIs, demonstrating the effectiveness and potential of our research in diagnosing knee conditions, and offering hope for the future of knee MRI diagnosis. Conclusions: Our study introduces innovative preprocessing methods that have the potential to advance the field. By enhancing researchers' understanding of the importance of preprocessing steps, we anticipate that our techniques will streamline the preparation of standardized formats for deep learning model training and significantly benefit radiologists and orthopedic surgeons. These techniques could reduce time and effort in tasks like meniscal tear segmentation or localization, inspiring hope for more efficient and effective achievements in the field. [ABSTRACT FROM AUTHOR]

Objectives: This study delves into the cutting-edge field of deep learning techniques, particularly deep convolutional neural networks (DCNNs), which have demonstrated unprecedented potential in assisting radiologists and orthopedic surgeons in precisely identifying meniscal tears. This research aims to evaluate the effectiveness of deep learning models in recognizing, localizing, describing, and categorizing meniscal tears in magnetic resonance images (MRIs). Materials and methods: This systematic review was rigorously conducted, strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extensive searches were conducted on MEDLINE (PubMed), Web of Science, Cochrane Library, and Google Scholar. All identified articles underwent a comprehensive risk of bias analysis. Predictive performance values were either extracted or calculated for quantitative analysis, including sensitivity and specificity. The meta-analysis was performed for all prediction models that identified the presence and location of meniscus tears. Results: This study's findings underscore that a range of deep learning models exhibit robust performance in detecting and classifying meniscal tears, in one case surpassing the expertise of musculoskeletal radiologists. Most studies in this review concentrated on identifying tears in the medial or lateral meniscus and even precisely locating tears—whether in the anterior or posterior horn—with exceptional accuracy, as demonstrated by AUC values ranging from 0.83 to 0.94. Conclusions: Based on these findings, deep learning models have showcased significant potential in analyzing knee MR images by learning intricate details within images. They offer precise outcomes across diverse tasks, including segmenting specific anatomical structures and identifying pathological regions. Contributions: This study focused exclusively on DL models for identifying and localizing meniscus tears. It presents a meta-analysis that includes eight studies for detecting the presence of a torn meniscus and a meta-analysis of three studies with low heterogeneity that localize and classify the menisci. Another novelty is the analysis of arthroscopic surgery as ground truth. The quality of the studies was assessed against the CLAIM checklist, and the risk of bias was determined using the QUADAS-2 tool. [ABSTRACT FROM AUTHOR]

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation. [ABSTRACT FROM AUTHOR]

Objective: Preserving and restoring meniscus function is crucial for maintaining knee biomechanics and overall functionality. To enhance the healing process after meniscus repair, various biological techniques have been introduced. In this study, three treatment approaches examined were bone marrow venting with stem cells (BMVP), anterior cruciate ligament reconstruction (ACLR) with meniscus repair, and isolated meniscus repair. Materials and Methods: From 2015 to 2019, we retrospectively analyzed data from 83 patients who presented with complaints of knee pain or pain in addition to instability, were diagnosed with vertical/longitudinal meniscus tears, and underwent arthroscopic repair (30 with isolated repair, 28 with ACLR repair, and 25 with BMVP) at our University Hospital. Among the 28 patients with anterior cruciate ligament rupture, pain and instability were the predominant complaints, whereas 55 patients with meniscus tear primarily complained pain. Clinical and functional conditions were assessed using Lysholm, WOMAC, IKDC, and VAS scores before and 18 months after surgery. Surgical success was evaluated based on Barrett's criteria. Causes of failure were analyzed considering demographic data, smoking status, injury time, tear location, shape, zone, and suture type and number. Results: Of the participants, 58 were male, 25 were female, 61 had medial meniscus lesions, and 22 had lateral meniscus lesions. The tear types included 51 simple longitudinal tears, 18 bucket handle tears, and 14 complex tears. A significant improvement was observed in the postoperative 18 month Lysholm, WOMAC, and IKDC values in all three groups (p: 0.001). At the 18 month mark, clinical and functional outcomes were comparable between BMVP and ACLR repair groups (Lysholm p: 0.951, WOMAC p: 0.241, IKDC p: 0.984). Both of these procedures yielded better results compared to isolated meniscus repair (Lysholm p: 0.001, WOMAC p: 0.027, IKDC p: 0.001). Conclusion: The superior clinical and functional outcomes observed after meniscus repair with BMVP and ACLR, compared to isolated meniscus repair, indicate positive effects of bone marrow stem cells, blood components, and tissue healing factors on meniscus repair and knee function. [ABSTRACT FROM AUTHOR]

Meniscal tearing can increase the contact pressure between the tibia and femur by causing gapping of torn meniscus tissue. The aim of this study was to quantify gapping behavior of radial and longitudinal tears and their impact on peak contact pressure and mean contact area. Twelve porcine knee joints underwent unicondylar, convertible osteotomy for exact tear application and consecutive suturing. Six tantalum marker beads were positioned along meniscus tears. The joints were preloaded with sinusoidal loading cycles ranging between 0 N and 350 N. Peak load was held constant and two synchronized Roentgen stereophotogrammetric analysis x‐ray images were obtained to evaluate gapping, peak contact pressure and mean contact area in the native, torn and repaired states. There was no change in gapping or peak contact pressure in longitudinal tear. By contrast, the radial tear led to a significant gapping when compared to the native state, while the inside‐out suture was able to restore gapping in parts of the meniscus. An increase in contact pressure after radial tear was detected, which was again normalized after suturing. The most important finding of the study is that longitudinal tears did not gap under pure axial loading, whereas radial tears tended to separate the tear interfaces. [ABSTRACT FROM AUTHOR]

Meniscus tears in the avascular region undergoing partial or full meniscectomy lead to knee osteoarthritis and concurrent lifestyle hindrances in the young and aged alike. Here they reported ingenious photo‐polymerizable autologous growth factor loaded 3D printed scaffolds to potentially treat meniscal defects. A shear‐thinning photo‐crosslinkable silk fibroin methacrylate–gelatin methacrylate–polyethylene glycol dimethacrylate biomaterial‐ink is formulated and loaded with freeze‐dried growth factor rich plasma (GFRP). The biomaterial‐ink exhibits optimal rheological properties and shape fidelity for 3D printing. Initial evaluation revealed that the 3D printed scaffolds mimic mechanical characteristics of meniscus, possess favourable porosity and swelling characteristics, and demonstrate sustained GFRP release. GFRP laden 3D scaffolds are screened with human neo‐natal stem cells in vitro and biomaterial‐ink comprising of 25 mg mL−1 of GFRP (GFRP25) is found to be amicable for meniscus tissue engineering. GFRP25 ink demonstrated rigorous rheological compliance, and printed constructs demonstrated long term degradability (>6 weeks), GFRP release (>5 weeks), and mechanical durability (3 weeks). GFRP25 scaffolds aided in proliferation of seeded human neo‐natal stem cellsand their meniscus‐specific fibrochondrogenic differentiation. GFRP25 constructs show amenable inflammatory response in vitro and in vivo. GFRP25 biomaterial‐ink and printed GFRP25 scaffolds could be potential patient‐specific treatment modalities for meniscal defects. [ABSTRACT FROM AUTHOR]

Meniscus tears, a prevalent knee joint injury, can significantly hinder joint functionality. Thus, the control of meniscus tears holds significant importance in preserving the joint's regular functionality. A non-invasive approach involves the recommendation of off-loading insoles; which therapists often prescribe based on their clinical experience. Based on the variety of meniscus tear types, it is essential to assess the effectiveness of different insoles when interacting with these distinct tears. This evaluation can be achieved through biomechanical investigations. To address this requirement, the present study utilized medical imaging to establish the precise lower limb geometry. To refine the acquired geometry, both longitudinal and radial tears were applied to the meniscus's geometry. The subsequent phase entails reconstructing the design of three off-loading insole models currently available in the Iranian market. The outcomes of these models demonstrate that the three-layer insole without honeycombs leads to a stress reduction of 1.1% at the apex of the radial tear. When dealing with a longitudinal tear situated on the inner meniscus, the application of a three-layer insole equipped with a honeycomb structure results in a 15% stress reduction. Utilizing a single layer silicone insole results in an 8% decrease in stress on the external meniscus during longitudinal tears. Hence, the three-layer insole incorporating a honeycomb design is effective for managing longitudinal tears on the inner meniscus. Moreover, the research outcomes indicate that, when comparing the two tear types, longitudinal tears carry a greater risk than radial tears, exhibiting an increased likelihood of worsening. [ABSTRACT FROM AUTHOR]

Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking. [ABSTRACT FROM AUTHOR]

The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries.

Abstract Background The posterior medial meniscal root tear (PMMRT) seriously impacts the tibiofemoral joint biomechanics. Two available techniques for PMMRT repair include the transtibial pullout (TPO) repair and all-suture anchor (ASA) repair techniques. These techniques have not been compared biomechanically. Methods A total of 20 fresh porcine cadaveric knee specimens were used. All 20 knees were randomly and evenly distributed into four groups (five specimens per group): (1) intact posterior meniscal root, (2) PMMRT, (3) TPO repair technique for PMMRT, and (4) ASA repair technique for PMMRT. The tibiofemoral contact mechanics were investigated using a pressure sensor. All knee specimens were tested by being loaded with 600 N axial compressive force at three different flexion angles (0°, 45°, and 90°). The contact surface area, contact pressure, peak pressure, and time-zero displacement were recorded. Results The PMMRT caused a significant decrease in contact surface area, an increase in contact pressure, and peak pressure from the reference values observed in the intact meniscus group (P = 0.05, 0.016, and 0.008, respectively). After fixation, no significant difference was observed between the ASA and intact group. Meanwhile, significant differences were found between the TPO and intact group in terms of contact surface area, contact pressure, and peak pressure. In the comparison between the two techniques, the ASA group demonstrated higher contact surface area than the TPO group at the average knee flexion angle (p = 0.05). Conclusion For most testing conditions, the ASA technique demonstrated superior biomechanical property in terms of contact surface area compared with the TPO technique under compressive loading conditions. The ASA technique could also restore the tibiofemoral contact mechanics to be comparable with those of the native intact knee. Meanwhile, a significant difference in tibiofemoral mechanics, compared with the intact knee, could be observed in the TPO technique.

Purpose of Review: Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries—ligament injury, meniscus injury, and patellar dislocation injury—will be discussed via a case-based practical approach. Recent Findings: Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1 year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Summary: Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm. [ABSTRACT FROM AUTHOR]

The menisci increase the contact area of load bearing in the knee and thus disperse the mechanical stress via their circumferential tensile fibers. Traumatic meniscus injuries cause mechanical symptoms in the knee, and are more prevalent amongst younger, more active patients, compared to degenerative tears amongst the elderly population. Traumatic meniscus tears typically result from the load-and-shear mechanism in the knee joint. The treatment depends on the size, location, and pattern of the tear. For non-repairable tears, partial or total meniscal resection decreases its tensile stress and increases joint contact stress, thus potentiating the risk of arthritis. A longitudinal vertical tear pattern at the peripheral third red-red zone leads to higher healing potential after repair. The postoperative rehabilitation protocols after repair range from immediate weight-bearing with no range of motion restrictions to non-weight bearing and delayed mobilization for weeks. Pediatric and adolescent patients may require special considerations due to their activity levels, or distinct pathologies such as a discoid meniscus. Further biomechanical and biologic evidence is needed to guide surgical management, postoperative rehabilitation protocols, and future technology applications for traumatic meniscus injuries. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R). Methods This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher’s exact, and independent samples t-tests. Results A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group. Conclusions Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury. Level of evidence Level III.

Numerous studies have assessed the performance of magnetic resonance imaging (MRI) in detecting tears of the knee menisci using arthroscopy results as the gold standard, but few have concentrated on the nature of discordant findings. The purpose of this study was to analyze the discordances between 3T MRI and arthroscopic evaluation of the knee meniscus. Medical records of 112 patients who underwent 3T MRI and subsequent arthroscopy of the knee were retrospectively analyzed to determine the accuracy of diagnoses of meniscal tear. Compared with arthroscopy, there were 22 false-negative and 14 false-positive MR interpretations of meniscal tear occurring in 32 patients. Images with errors in diagnosis were retrospectively reviewed by two musculoskeletal radiologists in consensus and all errors were categorized as either unavoidable, equivocal or as interpretation error. Of 36 MR diagnostic errors, there were 16 (44%) unavoidable, 5 (14%) interpretation errors and 15 (42%) equivocal for meniscal tear. The largest categories of errors were unavoidable false-positive MRI diagnoses (71%) and equivocal false-negative MRI diagnoses (50%). All meniscal tears missed by MRI were treated with partial meniscectomy (n = 14) or meniscal repair (n = 8). Discordant findings between 3T MRI and arthroscopic evaluation of the knee meniscus remain a concern and primarily occur due to unavoidable and equivocal errors. Clinicians involved in the diagnosis and treatment of patients with meniscal tears should understand why and how the findings seen on knee MRI and arthroscopy may sometimes differ. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. Methods: Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost–benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. Results: Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. Conclusion: Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. Level of evidence: Systematic review of level IV studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: The medial meniscus extrusion beyond the edge of the tibial plateau can be observed on MR images of the medial meniscus of the knee joint during injury. It is worth exploring whether the external protuberance is related to the mode of medial meniscus injury and the degree of medial interventricular cartilage injury of the knee joint. OBJECTIVE: To quantitatively measure the extrusion of medial meniscus under magnetic resonance imaging, and to study the factors affecting the value of medial meniscus extrusion, and whether it is related to the injury mode of medial meniscus and the degree of cartilage injury in medial compartment. METHODS: In this study, 117 patients diagnosed as knee meniscus posterior horn injury by sports injury in First Affiliated Hospital of Anhui Medical University were selected. They underwent knee joint MRI scan and knee arthroscopic meniscus surgery. The meniscus extrusion value (medial meniscus extrusion) was measured under MRI in each patient. The body mass index of each patient, whether due to acute injury, the mode of meniscus injury confirmed by arthroscopy and the grade of cartilage injury in the medial compartment were recorded from the medical record, and the correlation between the meniscus extrusion value and the above-mentioned factors was analyzed. RESULTS AND CONCLUSION: (1) There were 31 (26.5%) acute injury patients with definite recall, 86 (73.5%) acute injury patients with no clear recall; there was a significant difference in the meniscus extrusion value between the two groups (P=0.001). (2) There were 56 (47.9%) patients with low body mass index (body mass index ≤ 25 kg/m² ) and 61 patients (52.1%) with high body mass index (body mass index > 25 kg/m² ); there was a significant difference in the meniscus extrusion value between the two groups (P=0.008). (3) According to the site of meniscus injury, there were meniscus posterior body injury group (60 cases, 51.2%), posterior horn injury group (37 cases, 31.6%), and posterior root fracture group (20 cases, 17.1%); there was a significant difference in the meniscus extrusion value between the two groups (P=0.000). (4) According to the injury confirmed by arthroscopy, patients with non-medial meniscus posterior root rupture were divided into compound meniscus fracture group (n=49) and non-compound meniscus fracture group (n=48); there was a significant difference in the meniscus extrusion value between the two groups (P=0.000). (5) The areas under receiver operating characteristic curve of moderate and severe cartilage injury in medial compartment and medial meniscus posterior root tearing predicted by medial meniscus extrusion were 0.794 and 0.942, respectively. (6) It is indicated that the size of medial meniscus extrusion reflects the presence or absence of acute trauma in the patient's disease course, their body mass index, and pattern of medial meniscus injury. Medial meniscus extrusion has a good predictive value for medial meniscus posterior root rupture. [ABSTRACT FROM AUTHOR]

Background: The posterior medial meniscal root tear (PMMRT) seriously impacts the tibiofemoral joint biomechanics. Two available techniques for PMMRT repair include the transtibial pullout (TPO) repair and all-suture anchor (ASA) repair techniques. These techniques have not been compared biomechanically. Methods: A total of 20 fresh porcine cadaveric knee specimens were used. All 20 knees were randomly and evenly distributed into four groups (five specimens per group): (1) intact posterior meniscal root, (2) PMMRT, (3) TPO repair technique for PMMRT, and (4) ASA repair technique for PMMRT. The tibiofemoral contact mechanics were investigated using a pressure sensor. All knee specimens were tested by being loaded with 600 N axial compressive force at three different flexion angles (0°, 45°, and 90°). The contact surface area, contact pressure, peak pressure, and time-zero displacement were recorded. Results: The PMMRT caused a significant decrease in contact surface area, an increase in contact pressure, and peak pressure from the reference values observed in the intact meniscus group (P = 0.05, 0.016, and 0.008, respectively). After fixation, no significant difference was observed between the ASA and intact group. Meanwhile, significant differences were found between the TPO and intact group in terms of contact surface area, contact pressure, and peak pressure. In the comparison between the two techniques, the ASA group demonstrated higher contact surface area than the TPO group at the average knee flexion angle (p = 0.05). Conclusion: For most testing conditions, the ASA technique demonstrated superior biomechanical property in terms of contact surface area compared with the TPO technique under compressive loading conditions. The ASA technique could also restore the tibiofemoral contact mechanics to be comparable with those of the native intact knee. Meanwhile, a significant difference in tibiofemoral mechanics, compared with the intact knee, could be observed in the TPO technique. [ABSTRACT FROM AUTHOR]

Purpose: Posterior lateral meniscus root (PLMR) tears are injuries that commonly occur together with anterior cruciate ligament (ACL) tears. The aim of this study was to evaluate the clinical and radiological outcome of PLMR repair accompanying ACL reconstruction. Specifically, PLMR healing rates, meniscal extrusion behavior and their influence on patient-reported outcome measures (PROMs) were analyzed. It was hypothesized that PLMR repair shows satisfactory healing rates and coronal meniscal extrusion does not increase significantly following PLMR repair. Methods: Patients that underwent PLMR repair between 2014 and 2019 were evaluated at least 12 months postoperatively. At follow-up, magnetic resonance imaging (MRI) was performed in order to evaluate the PLMR healing behavior (complete vs. partial vs. no healing) as well as the coronal and sagittal meniscal extrusion in comparison with the preoperative MRI. Additionally, patient-reported outcome measures (PROMs; Lysholm score, International Knee Documentation Committee subjective knee form [IKDC]) were compiled. Pre- and postoperative meniscal extrusion were tested for statistical significance using the paired t test. The Kruskal–Wallis test was used to compare extrusion values and PROMs in relation to different healing states. A correlation analysis was conducted using the Pearson correlation coefficient between differences in meniscal extrusion and PROMs. Results: Out of 25 patients, 18 patients (72.0%; 11 male and seven female) were available for final assessment at a mean follow-up of 40.8 ± SD 17.5 months. One revision PLMR repair was performed five months after the initial repair. In 14 cases (77.8%), healing of the lateral meniscus was observed (6 × complete, 8 × partial). Coronal extrusion of the lateral meniscus did not increase significantly following PLMR repair (2.0 ± 1.5 mm vs. 2.1 ± 1.3 mm; p = 0.645). Sagittal extrusion increased significantly (25.7 ± 2.4 mm vs. 27.0 ± 1.4 mm; p < 0.001). The healing status of the PLMR showed no significant association with meniscal extrusion or PROMs (p > 0.05). But a higher increase in coronal meniscal extrusion negatively affected PROMs (Lysholm score: p = 0.046, r = − 0.475; IKDC: p = 0.003, r = − 0.651). Conclusion: High healing rates of the PLMR and no significant increase in coronal extrusion may be expected following combined PLMR repair and ACL reconstruction. But a greater increase in postoperative coronal meniscal extrusion correlates with less favorable clinical results. A greater increase in sagittal extrusion was observed, but this did not influence the clinical outcome. Level of evidence: Retrospective Case Series; IV. [ABSTRACT FROM AUTHOR]

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Transtibial pullout repair is increasingly being utilized for repair of meniscal root tears. Loosening and suture pullout may occur after such a repair but has not been reported in the radiology literature. We present a case of a transtibial pullout repair complicated by suture pullout, recognized on MRI and confirmed on subsequent arthroscopy. This complication may occur in the immediate postoperative period and is important to recognize as it requires surgical management.

Introduction: Isolated meniscal repair has been suggested as one of the contributing factors in unhealed meniscal repair. The purpose of this study was to compare the healing rate between isolated meniscal repair and meniscal repair with concomitant anterior cruciate ligament reconstruction (ACLR) using a standardised assessment method after propensity score matching. Materials and methods: Accuracy of the Crues' grading system for meniscal healing was validated using second-look arthroscopy as the reference standard in 17 patients. Propensity score matching (one-to-one) was performed between 26 patients who underwent isolated meniscal repair and 98 patients who underwent meniscal repair with concomitant ACLR. Patients were matched for sex, age, side and zone of the meniscal repair, and number of sutures. Healing rates at one year which were evaluated with magnetic resonance imaging (MRI) were compared between the two groups. Results: The sensitivity and specificity of the Crues' grading system on multiple plane MRI for meniscal healing were 100% and 83.3%, respectively. Both the isolated meniscal repair group and the meniscal repair with concomitant ACLR group included 21 patients after propensity score matching. Baseline characteristics did not differ significantly between the two groups. The healing rate was significantly lower in the isolated meniscal repairs group (14.3%) than in the meniscal repair concomitant with ACLR group (47.6%, P=0.04). Conclusion: The healing rate for isolated meniscal repair using a standardised MRI assessment method was inferior to that of meniscal repair with concomitant ACLR after propensity score matching.

Abstract Background The diagnostic results of magnetic resonance imaging (MRI) are essential references for arthroscopy as an invasive procedure. A deviation between medical imaging diagnosis and arthroscopy results may cause irreversible damage to patients and lead to excessive medical treatment. To improve the accurate diagnosis of meniscus injury, it is urgent to develop auxiliary diagnosis algorithms to improve the accuracy of radiological diagnosis. Purpose This study aims to present a fully automatic 3D deep convolutional neural network (DCNN) for meniscus segmentation and detects arthroscopically proven meniscus tears. Materials and methods Our institution retrospectively included 533 patients with 546 knees who underwent knee magnetic resonance imaging (MRI) and knee arthroscopy. Sagittal proton density-weighted (PDW) images in MRI of 382 knees were regarded as a training set to train our 3D-Mask RCNN. The remaining data from 164 knees were used to validate the trained network as a test set. The masks were hand-drawn by an experienced radiologist, and the reference standard is arthroscopic surgical reports. The performance statistics included Dice accuracy, sensitivity, specificity, FROC, receiver operating characteristic (ROC) curve analysis, and bootstrap test statistics. The segmentation performance was compared with a 3D-Unet, and the detection performance was compared with radiological evaluation by two experienced musculoskeletal radiologists without knowledge of the arthroscopic surgical diagnosis. Results Our model produced strong Dice coefficients for sagittal PDW of 0.924, 0.95 sensitivity with 0.823 FPs/knee. 3D-Unet produced a Dice coefficient for sagittal PDW of 0.891, 0.95 sensitivity with 1.355 FPs/knee. The difference in the areas under 3D-Mask-RCNN FROC and 3D-Unet FROC was statistically significant (p = 0.0011) by bootstrap test. Our model detection performance achieved an area under the curve (AUC) value, accuracy, and sensitivity of 0.907, 0.924, 0.941, and 0.785, respectively. Based on the radiological evaluations, the AUC value, accuracy, sensitivity, and specificity were 0.834, 0.835, 0.889, and 0.754, respectively. The difference in the areas between 3D-Mask-RCNN ROC and radiological evaluation ROC was statistically significant (p = 0.0009) by bootstrap test. 3D Mask RCNN significantly outperformed the 3D-Unet and radiological evaluation demonstrated by these results. Conclusions 3D-Mask RCNN has demonstrated efficacy and precision for meniscus segmentation and tear detection in knee MRI, which can assist radiologists in improving the accuracy and efficiency of diagnosis. It can also provide effective diagnostic indicators for orthopedic surgeons before arthroscopic surgery and further promote precise treatment.

Purpose of Review: The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. Recent Findings: Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration. Meniscus extrusion has been associated with degenerative joint disease, posterior root and radial meniscal tears, and acute trauma. Meniscus centralization and meniscotibial ligament repair have been proposed as techniques to address meniscal extrusion with promising biomechanical, animal model, and early clinical reports. Summary: Further studies on the epidemiology of meniscus extrusion and associated long-term nonoperative outcomes will help to elucidate its role in meniscus dysfunction and resultant arthritic development. Understanding and appreciation for the anatomic attachments of the meniscus will help to inform future repair techniques. Long-term reporting on the clinical outcomes of meniscus centralization techniques will yield insights into the clinical significance of meniscus extrusion correction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R). Methods: This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher's exact, and independent samples t-tests. Results: A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group. Conclusions: Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Introduction: As resident evaluation moves to a competency-based system, validated tools for assessment of surgical skill are increasingly important. We created and validated a checklist to measure resident surgical skill for arthroscopic management of meniscal tear. Materials and Methods: Using a Delphi survey method, we created an objective, structured assessment of surgical skill for treatment of meniscal tears. The Meniscus Treatment Task List (MTTL) comprises 5 domains: diagnostic arthroscopy, medial meniscectomy, lateral meniscectomy, medial meniscal repair, and lateral meniscal repair. Orthopaedic surgery residents were recruited to perform diagnostic arthroscopy, partial meniscectomies, and all-inside meniscal repairs with cadaveric models. Arthroscopic videos were graded by fellowship-trained surgeons using the MTTL and the validated Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale (GRS). Postgraduate year (PGY), operative time, and case logs were recorded for each resident. Data were analysed using bivariate correlation, analysis of variance, pairwise comparison, Pearson's correlation coefficient, and intraclass correlation coefficient. α=0.05. Results: Twenty-two orthopaedic surgery residents (PGY1–PGY4) participated. MTTL scores were higher in the PGY4 class than in the PGY1 class (mean difference, 11 points, p = 0.04). Operative time was inversely correlated with number of cases logged (r = –0.53, p = 0.01), number of arthroscopic cases logged (r = –0.50, p = 0.02), and MTTL score (r = –0.46, p = 0.03). MTTL score was positively correlated with number of cases (r = 0.44, p = 0.04) and number of arthroscopic cases logged (r = 0.50, p = 0.02). MTTL scores were positively correlated with the ASSET GRS (r = 0.71, p

Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.

AimsTo fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle.MethodsIn this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle.ResultsThe ACL tensile force in the intact knee was significantly affected with increasing PTS angle. Considerable differences were observed in kinematics and initial posterior femoral translation between the intact and ACLD joints as the PTS angles increased by more than 2.5° (beyond 11.4°). Additionally, a higher contact stress was detected in the peripheral posterior horn areas of the menisci with increasing PTS angle during the gait cycle. The maximum tensile force on the horn of the medial meniscus increased from 73.9 N to 172.4 N in the ACLD joint with increasing PTS angles.ConclusionKnee joint instability and larger loading on the medial meniscus were found on the ACLD knee even at a 2.5° increase in PTS angle (larger than 11.4°). Our biomechanical findings support recent clinical evidence of a high risk of failure of ACL reconstruction with steeper PTS and the necessity of ACL reconstruction, which would prevent meniscus tear and thus the development or progression of osteoarthritis.Cite this article: Bone Joint Res 2022;11(10):739–750.

Background: Radial tear is a vertical tear mostly occur in young individuals with traumatic incidence, which is perpendicular to the long axis of the meniscus and to the tibial plateau, sectioning the circumferential collagen fibers of the meniscus, affect the ability of the menisci to transmit the tibiofemoral load and the hoop stresses associated with weight-bearing. Aim of the Work: A systematic review to compare clinical and MRI outcomes of arthroscopic repair and menisectomy for radial meniscal tears. Patients and Methods: After conducting an initial search of PubMed, Embase, and Scopus databases using the keywords: meniscus, meniscus tear, radial tear, menisectomy, and meniscus repair, we found a total of 1170 articles. However, after screening the full-text analysis against the inclusion and exclusion criteria, only 11 studies on radial meniscus tear were deemed suitable for inclusion criteria. Results: Following an analysis of 11 studies that involved 235 patients with radial meniscal tears, it was discovered that 180 of them underwent arthroscopic repair, while 55 underwent menisectomy. Patient-reported outcomes for both procedures were promising, with improvement in activity (IKCD and Tegner) scores recorded during the final follow-up in comparison to pre-surgery scores. Imaging and second look arthroscopy showed that the majority of patients experienced complete or partial healing, with a low occurrence of failure. These results indicate that both arthroscopic repair and menisectomy can serve as effective treatments for radial meniscus tears. Conclusion: It has been found through short- and long-term follow-up that sparing the meniscus, either through repair or partial menisectomy, has excellent outcomes for radial tears. [ABSTRACT FROM AUTHOR]