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Kim JS, Kim JH, Choi MY, Ha JK, Baek SH, Chung KS. Incidence of symptomatic discoid meniscus in Korea: epidemiologic big data analysis from HIRA database. Knee Surg Relat Res 2024; 36:32. [PMID: 39456078 PMCID: PMC11512506 DOI: 10.1186/s43019-024-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/19/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND There is a lack of evidence of the diagnosis and treatment-related epidemiological studies of symptomatic discoid meniscus. This study analyzed the national epidemiological data for discoid meniscus in South Korea. METHODS From 2011 to 2019, data related to the diagnosis and procedure codes of discoid meniscus were obtained from the Korean Health Insurance Review and Assessment Service database. All patients encoded as discoid meniscus were included. Data were extracted and further analyzed as follows: (1) the total number and the incidence (cases per 100,000) of discoid meniscus diagnosis per year, (2) sex distribution, (3) age distribution, (4) discoid meniscus ratio (total discoid meniscus coding per total meniscus injury coding), and (5) surgical procedures after discoid meniscus injury. RESULTS The total number of discoid meniscus diagnosed was 4576 in 2011 and increased to 6639 in 2019, representing a 45.1% increase. The incidence was 9.5 in 2011 and increased to 13.0 in 2019. Concerning sex, discoid meniscus was more common in females (55%) than in males (45%) over the study period. Regarding age, the peak age of discoid meniscus in 2011 was "under 19," whereas in 2019, the peak age was observed in the 50s. The discoid meniscus ratio range was 2.12-2.60% from 2011 to 2019. The total number of meniscectomy increased by 20% from 2000 in 2011 to 2475 in 2014. However, the total number of meniscus repairs was 318 in 2011 and increased to 502 in 2019, indicating an increase of 58%. CONCLUSIONS The total number and incidence of symptomatic discoid as well as the discoid meniscus ratio and the incidence of total discoid meniscus repair steadily increased from 2011 to 2019. The number of meniscus repair procedures increased more rapidly than that of meniscectomy. The current study helps understand the epidemiology of symptomatic discoid meniscus, its prevention, and cost-saving measures in South Korea.
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Affiliation(s)
- Jin Seong Kim
- Department of Physical Therapy, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Republic of Korea
| | - Moon Young Choi
- Department of Physical Education, College of Humanities, Daegu University, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Jump Orthopedic Clinic, Seoul, Republic of Korea
| | - Seung Hun Baek
- Department of Orthopedic Surgery, College of Medicine, Hanyang University Hospital at Guri, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery, College of Medicine, Hanyang University Hospital at Guri, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea.
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Cho JH, Nam HS, Park SY, Ho JPY, Lee YS. Arthroscopic Meniscal Repair and Meniscectomy for Adult Discoid Lateral Meniscus Results in Progression to Valgus Alignment and Lateral Compartment Degeneration Compared With Nonoperative Treatment and Nondiscoid Lateral Meniscus. Arthroscopy 2024; 40:1223-1233. [PMID: 37717929 DOI: 10.1016/j.arthro.2023.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To analyze the effect of the arthroscopic meniscal procedure in adult discoid lateral meniscus (DLM) according to the age and meniscal-preserving by making comparisons with the nondiscoid lateral meniscus (N-DLM). METHODS From March 2014 to October 2020, a comparative analysis was performed in adults with DLM who underwent arthroscopic meniscal procedures (operative DLM: 134 knees), nonoperative treatment (nonoperative DLM: 56 knees), and adult N-DLM who underwent arthroscopic meniscal procedures (operative N-DLM: 64 knees). These patients were between 20 and 65 years old and completed a minimum follow-up of 2 years. Patients with DLM who underwent arthroscopic procedure were divided into subgroups according to age and extent of the meniscal-preserving. The following parameters were assessed and compared between the groups: (1) coronal limb alignment, (2) osteoarthritis grade, and (3) clinical outcomes and the minimal clinically important difference. RESULTS The coronal limb alignment was significantly changed to valgus in the order of operative DLM, N-DLM, and nonoperative DLM (Δ mechanical hip-knee-ankle angle: 3.23 ± 1.85 vs 1.35 ± 1.03° vs -0.57 ± 1.88°; P < .05). Operative DLM showed most prominent osteoarthritic change in the lateral compartment, followed by the N-DLM and nonoperative DLM groups (40.3% vs 17.2% vs 5.3%; P < .05). These changes in operative DLM were more prominent in older adults who underwent meniscal-sacrificing procedures and resulted in less-satisfactory clinical outcomes (all P < .05). CONCLUSIONS Arthroscopic surgery for adult DLM resulted in progression to valgus alignment and lateral compartment degeneration compared with nonoperative treatment and arthroscopic surgery of the adult N-DLM. Old ager and having a meniscal-sacrificing procedure showed more rapid radiographic changes and lower clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparison study.
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Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
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Qiao Y, Zhang X, Wu C, Xu C, Sun Z, Zhao J, Zhao S. Prevalence and a correlation analysis of discoid meniscus and femoral trochlear dysplasia. BMC Musculoskelet Disord 2023; 24:923. [PMID: 38037030 PMCID: PMC10687981 DOI: 10.1186/s12891-023-06958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them. STUDY DESIGN Retrospective study. METHODS Patients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour's classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated. RESULTS The prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P < 0.001). The DM group has a higher percentage of all types of FTD except type D (P < 0.05), and a higher percentage of both low- and high-grade FTD (P < 0.001). There were 633 cases of type I DM and 370 cases of type II DM. The overall percentage of FTD was not significantly different between the two types (P = 0.106). No significant difference was detected for all types of FTD except type B (P < 0.05). The Type I DM group has a significant higher percentage of high-grade FTD than Type II group (P < 0.05). CONCLUSION Patients with a DM are more likely to have FTD regardless of the type of DM, while those with a type I DM are more prone to have a high grade FTD.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | | | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Zhenkui Sun
- Department of Medical Imaging and Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
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Liu Y, Liu Y, Zhu LQ, Zhen YF, Zhang FY, Wang XD. Efficacy of short-term splint immobilization in the treatment of pediatric discoid lateral meniscus after saucerization management. Medicine (Baltimore) 2023; 102:e33553. [PMID: 37058025 PMCID: PMC10101260 DOI: 10.1097/md.0000000000033553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
There are no universal guidelines for rehabilitation after saucerization for children with discoid lateral meniscus. This study determined if short-term knee splint immobilization and delayed rehabilitation produces the same benefit as early rehabilitation after saucerization in children, in terms of knee function and pain intensity. A retrospective review was performed by categorizing patients into 2 groups depending on whether a splint immobilization was adopted postoperatively: for group A, rehabilitation began early without splint immobilization after surgery, and for group B, a knee splint was immobilized for 2 weeks. Numerical rating scale scores were collected in patients 1, 3, and 7 days, Lysholm scores were measured at 4 and 8 weeks postoperatively, and the gradual return to normal activities was documented. Forty-eight patients and 53 knees were included: group A had 30 patients with 31 knees, and group B had 18 patients with 22 knees. There was no improvement in numerical rating scale scores on the 1st (P=.519), 3rd (P=.421), and 7th (P=.295) postoperative days in group B. The Lysholm scores of group A (62.94 ± 8.68) was higher than that of group B (46.68 ± 9.82) measured 4 weeks following surgery, but there was no difference at 8 weeks (P=.237), and both groups had similar time to return to normal activities (P=.363). For discoid lateral meniscus patients who underwent isolated saucerization, short-term splint immobilization did not significantly help relieve postoperative pain. There was a comparable time-course for return to normal activities in both study groups.
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Affiliation(s)
- Yao Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Ya Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lun-Qing Zhu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yun-Fang Zhen
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Fu-Yong Zhang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Zheng ZR, Ma H, Yang F, Yuan L, Wang GD, Zhao XW, Ma LF. Discoid medial meniscus of both knees: A case report. World J Clin Cases 2022; 10:9020-9027. [PMID: 36157663 PMCID: PMC9477044 DOI: 10.12998/wjcc.v10.i25.9020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Discoid meniscus is a congenital anomaly that typically affects the lateral meniscus. The appearance of the discoid medial meniscus in both knees is extremely rare, with an incidence of only 0.012%.
CASE SUMMARY Our patient was a 30-year-old female. Under no obvious predisposing causes, she began to experience pain in both knees, which worsened while walking and squatting. The pain was aggravated after exercise, and joint flexion and extension activities were accompanied by knee snapping. Apley’s test was positive on physical examination, and there was a pressing pain in the medial articular space. Plain radiographs of both knees revealed no obvious abnormalities in the bilateral knee joint space. Partial meniscectomy as well as menisci reformation were performed on both knees under arthroscopy. Under the guidance of rehabilitation, the patient’s range of motion in both knees returned to normal without pain and knee snapping.
CONCLUSION This study showed that the clinical manifestations of the discoid medial meniscus injury are identical to those of the conventional medial meniscus injury, and arthroscopic surgery is effective.
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Affiliation(s)
- Zhong-Ren Zheng
- School of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Hui Ma
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Fei Yang
- Department of Orthopedics, The People’s Hospital of Bozhou, Bozhou 236800, Anhui Province, China
| | - Long Yuan
- School of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
| | - Guo-Dong Wang
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Xiao-Wei Zhao
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Long-Fei Ma
- Department of Orthopedics, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
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He Y, Chen H, Fan Y, Zhou Y, Bao W. Partial resection of lateral discoid meniscus changes lower limb axial alignment - A retrospective cohort study. Knee 2022; 37:171-179. [PMID: 35809449 DOI: 10.1016/j.knee.2022.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/28/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
AIM This study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus. METHODS Preoperative and postoperative full-length weight-bearing radiographs of the lower limb were obtained from a total of 161 patients with lateral menisci tears from September 2018 to September 2020 who underwent partial meniscal resection. The patients were divided into discoid meniscus group (DMG) and ordinary meniscus group (OMG). The measured mechanical axis deviation (MAD), proximal tibia angle (PTA), and distal femoral angle (DFA) in the axial alignment of the lower limb were determined before and after surgery. Knee joint function on the affected side was determined using the International Knee Documentation Committee (IKDC) subjective scale and the Lysholm knee scoring scale before surgery and at one, six, 12, and 24 months after surgery. RESULTS For MAD and DFA, there were statistically significant differences between the preoperative and postoperative findings within each group (P < 0.01); the MAD and DFA were smaller after surgery. The difference in preoperative and postoperative PTA of the DMG was statistically significant (P < 0.01), meaning that the PTA becomes larger after surgery. The differences in preoperative and postoperative PTA of the OMG, preoperative PTA between the two groups, and postoperative PTA between the two groups were not statistically significant (P > 0.05). Intragroup comparisons of the IKDC subjective scale and the Lysholm knee scoring scale before and after surgery revealed significant differences (P < 0.05). CONCLUSION Arthroscopic partial resection of the discoid lateral meniscus is a safe and effective surgical method that can significantly improve knee joint function. Although the axial arrangement of the lower limbs will be slightly changed in the early stage, it will still be within the normal range after surgery in patients with normal lower limb axial alignment. For patients with varus or valgus before surgery, this procedure should be applied with caution.
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Affiliation(s)
- Yao He
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Hong Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, China
| | - Yuanjun Fan
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Yuandong Zhou
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Wei Bao
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China.
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Araki S, Tsubosaka M, Muratsu H, Inokuchi T, Maruo H, Miya H, Kuroda R, Matsushita T. Evaluation of morphological characteristics for incomplete discoid medial meniscus with an oversized posterior segment. J Orthop Surg Res 2022; 17:245. [PMID: 35443728 PMCID: PMC9022343 DOI: 10.1186/s13018-022-03132-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus. METHODS Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups. RESULTS All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm, P < 0.001), whereas there was no significant difference in the AP length of the anterior segment (9.1 ± 2.1 vs. 9.5 ± 1.9 mm, P = 0.869). The ML width of the mid-body in the normal, oversize, and discoid groups was 9.3 ± 1.8, 19.9 ± 2.6, and 25.8 ± 1.9 mm, respectively (normal vs. oversize group: P < 0.001, oversize vs discoid group: P = 0.01, normal vs. discoid group: P < 0.001). CONCLUSIONS Oversized posterior and normal anterior segments characterize this new type of incomplete discoid medial meniscus as a morphological abnormality.
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Affiliation(s)
- Shotaro Araki
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan.
| | - Takao Inokuchi
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hiroaki Maruo
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Symptomatic discoid lateral meniscus shows a relationship between types and tear patterns, and between causes of clinical symptom onset and the age distribution. Knee Surg Sports Traumatol Arthrosc 2022; 30:1436-1442. [PMID: 34110457 DOI: 10.1007/s00167-021-06635-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Discoid meniscus is a congenital abnormality of the lateral meniscus and is seen more frequently in East Asia. The purpose of this study was to retrospectively assess the relationship between discoid lateral meniscus (DLM) types and tear patterns and causes of age-specific clinical symptom onset. METHODS Of 1650 arthroscopic surgeries over a 20-year period, 138 (105 patients) were performed for DLM and were evaluated in this study. The mean age at surgery was 21.5 ± 15.8 years. The DLM type was classified by Watanabe's classification, and tear patterns were classified by the modified Bin's classification as simple horizontal, complicated horizontal, longitudinal, radial, complex, and no tear. Additionally, patients were divided by age group (< 10, 10-19, 20-39, 40-59, and ≥ 60 years) and classified according to the causes of clinical symptom onset as follows: sports activities, minor trauma in daily living, and no traumatic episode. RESULTS The DLM was complete in 78 (56.5%) knees and incomplete in 60 (43.5%); no Wrisberg type DLM was observed. Simple horizontal and complicated horizontal tears were significantly more frequent in complete DLM, whereas radial tears and no tears were significantly more frequent in incomplete DLM (p < 0.0001). When classified by age group, 74 (53.6%) knees with DLMs were found in teenagers. Sports activities caused symptom onset significantly more often in teenagers, no traumatic episode caused symptom onset in patients aged < 10 years, and minor trauma in daily living caused symptom onset in patients aged 40-59 years and ≥ 60 years (p < 0.0001). No relationship was found between the age distribution and tear patterns; however, the absence of tears tended to be more common in teenaged patients, and complicated horizontal tears were more common in patients over 20 years of age. CONCLUSION Symptomatic DLM occurred most often in teenagers. A relationship was identified between the DLM types and tear patterns, which could be helpful in preoperative planning. Causes of clinical symptom onset in patients with DLM were characterised by age group, which might help clinicians to suspect the presence of DLM. LEVEL OF EVIDENCE Level IV.
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Tsai PH, Wong CC, Chan WP. Radial T2* mapping reveals early meniscal abnormalities in patients with knee osteoarthritis. Eur Radiol 2022; 32:5642-5649. [PMID: 35258674 DOI: 10.1007/s00330-022-08641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/21/2022] [Accepted: 02/06/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to validate a 2D radial T2* mapping method and its ability to reveal subtle alterations in the menisci of patients with knee osteoarthritis (OA). METHODS Of 40 enrolled participants, 20 were diagnosed with OA, and 20 were age- and sex-matched asymptomatic controls. Data from the right knee of each participant were collected using a 1.5-T MRI equipped with a single-channel knee coil. T2* values were acquired using a conventional T2* mapping protocol and a radial T2* mapping method. Mean T2* values in the meniscal white zones, meniscal red zones, and total menisci were calculated. Numerical simulation was performed for validation. RESULTS Both simulation and clinical data confirmed that 2D radial T2* mapping provided better discrimination than the conventional method. Compared to controls, the OA group showed significantly greater mean (standard deviation) T2* values in the white zones (9.33 [2.29] ms vs. 6.04 [1.05] ms), red zones (9.18 [2.03] ms vs. 6.81 [1.28] ms), and total menisci (9.26 [2.06] ms vs. 6.34 [1.14] ms). Correlations were found between the Lequesne index and the meniscal T2* values in all three regions (r = 0.528, p = 0.017; r = 0.635, p = 0.003; and r = 0.556, p = 0.011, respectively). CONCLUSION These findings indicate that in early OA, radial T2* mapping is an alternative means of assessing meniscal degeneration and can be used to monitor its progression. KEY POINTS • Radial T2* mapping outperforms Cartesian T2* mapping. • Radial T2* measurements are useful in assessing meniscal degeneration. • Meniscal T2* values correlate well with disease severity.
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Affiliation(s)
- Ping-Huei Tsai
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, No. 111, Xinglong Road, Section 3, Taipei, 116, Taiwan. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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10
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Vinagre G, Cruz F, Alkhelaifi K, D'Hooghe P. Isolated meniscus injuries in skeletally immature children and adolescents: state of the art. J ISAKOS 2022; 7:19-26. [PMID: 35543655 DOI: 10.1136/jisakos-2020-000496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/28/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.
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Affiliation(s)
- Gustavo Vinagre
- Department of Orthopaedic Surgery and Traumatology, Hospital de Verín, Verín, Galicia, Spain. https://twitter.com/DrGVinagre
| | - Flávio Cruz
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Khalid Alkhelaifi
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. https://twitter.com/Alkhelaifi
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
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Ozeki N, Koga H, Nakamura T, Nakagawa Y, Ohara T, Kohno Y, Sekiya I. Surgical Repair of Symptomatic Wrisberg Variant Discoid Lateral Mensicus with Pull-Out Repair and Capsulodesis. Arthrosc Tech 2021; 11:e61-e68. [PMID: 35127430 PMCID: PMC8807856 DOI: 10.1016/j.eats.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023] Open
Abstract
Wrisberg variant discoid lateral meniscus (DLM) is a congenital anatomic variation of the meniscus in the knee joint, which is an uncommon type of the DLM. We present a surgical technique in a case of symptomatic Wrisberg variant DLM. To improve the instability due to the lack of the posterior attachment of meniscotibial ligament, the posterior portion of DLM was attached to the insertion site of normal LM posterior root using pull-out repair technique. In addition, a longitudinal tear from the anterior to the middle portion of DLM was repaired with outside-in and inside-out techniques. Finally, a capsulodesis using knotless anchors was performed from outside of the joint to prevent the meniscus extrusion after the surgery. Knee symptoms such as pain, catching, and ROM restriction disappeared at 3 months after the surgery. Postoperative magnetic resonance imaging showed a slightly sharpened shape of the DLM, and the attachment of the posterior portion of the DLM was observed. Longitudinal tear of the DLM was healed without cleavage. This procedure is useful to improve the symptoms of the knee joint with Wrisberg variant DLM and to preserve the function of the meniscus.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan,Address correspondence to Nobutake Ozeki, M.D., Ph.D., Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiyuki Ohara
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yuji Kohno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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12
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Jung EY, Jeong S, Kim SK, Lee SS, Ryu DJ, Wang JH. A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus. Knee Surg Relat Res 2021; 33:31. [PMID: 34503579 PMCID: PMC8428092 DOI: 10.1186/s43019-021-00108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment. Materials and Methods We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups. Results The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05). Conclusions Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.
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Affiliation(s)
- Eui Yub Jung
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Seongmin Jeong
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Sun-Kyu Kim
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, South Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University Hospital, Inhan University School of Medicine, Incheon, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea.
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13
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Milewski MD, Coene RP, McFarlane KH, Williams KA, Feldman L, Beck JJ. Nationwide Ethnic/Racial Differences in Surgical Treatment of Discoid Meniscus in Children: A PHIS Database Study. J Pediatr Orthop 2021; 41:490-495. [PMID: 34238865 DOI: 10.1097/bpo.0000000000001894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No US population-based studies have examined the discoid meniscus ethnic/racial distribution. In pediatric patients undergoing meniscus surgery, it is hypothesized that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with medial meniscus tears. METHODS The Pediatric Health Information System was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using International Classification of Diseases, 10th Revision, Clinical Modification codes. A cohort of patients treated surgically for discoid meniscus was compared with a cohort of patients treated surgically for medial meniscal tear. These 2 populations were compared based on age, sex, ethnicity/race, Current Procedural Terminology code, insurance, urban versus rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations. RESULTS A discoid meniscus cohort of 399 children (median age, 13.0 y) was compared with a medial meniscus tear cohort of 3157 children (median age, 16.0 y) (P<0.001). Hispanic/Latino children accounted for 36.8% of the discoid lateral meniscus and 22.7% of the medial meniscus populations (P<0.001). Among pediatric patients that had surgery for discoid lateral meniscus or medial meniscus, Hispanic/Latino children had 2.36 times the odds of surgery for discoid meniscus compared with White patients after adjusting for age and insurance (P<0.001). Asian children also had 2.41 times the odds of surgery for discoid meniscus compared with White patients (P=0.017). CONCLUSIONS This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients undergoing surgery for discoid meniscus, Hispanic/Latino and Asian patients were a significantly larger percentage of the population than White patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a torn discoid meniscus versus a torn medial mensicus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matthew D Milewski
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Ryan P Coene
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
| | - Kelly H McFarlane
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Kathryn A Williams
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
| | - Lanna Feldman
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
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14
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Abstract
Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.
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Affiliation(s)
- Bryan G Adams
- Department of Orthopedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Megan N Houston
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
| | - Kenneth L Cameron
- Department of Orthopedic Surgery, John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, West Point, NY
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15
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Turati M, Anghilieri FM, Accadbled F, Piatti M, Di Benedetto P, Moltrasio F, Zatti G, Zanchi N, Bigoni M. Discoid meniscus in human fetuses: A systematic review. Knee 2021; 30:205-213. [PMID: 33945980 DOI: 10.1016/j.knee.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. METHODS A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation. RESULTS Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. CONCLUSION Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France.
| | | | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Toulouse University Hospital, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Paolo Di Benedetto
- Medical Departement (DAME) - University of Udine, Italy; Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020; 7:81. [PMID: 33044686 PMCID: PMC7550551 DOI: 10.1186/s40634-020-00294-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea
| | - Jin Hwan Ahn
- Department of Orthopedic Surgery, Saeum Hospital, Seoul, South Korea
| | - Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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17
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Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS 2020; 6:14-21. [PMID: 33833041 DOI: 10.1136/jisakos-2017-000162] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
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Affiliation(s)
- Sachin Tapasvi
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Anshu Shekhar
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Karl Eriksson
- Orthopedic Surgery, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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18
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Yang SJ, Ding ZJ, Li J, Xue Y, Chen G. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculoskelet Disord 2020; 21:551. [PMID: 32799843 PMCID: PMC7429813 DOI: 10.1186/s12891-020-03573-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Due to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM. METHODS Patients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes. P < 0.05 was considered statistically significant. RESULTS A total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4 ~ 97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9 ~ 64.9; IQR, 9.7) (P < 0.001). Male sex was predictive of a higher IKDC score (P = 0.023, OR = 1.702). Compared with BMI ≥25 kg/m2, < 18.5 kg/m2 was associated with better IKDC score (P = 0.026, OR = 3.016). Contrasting with age of onset ≥45 years, ≤14 years (P < 0.001, OR = 20.780) and 14 ~ 25 years (P < 0.001, OR = 8.516) were associated with better IKDC score. In comparison with symptoms duration> 24 months, IKDC scores for patients with symptoms duration ≤1 month (P = 0.001, OR = 3.511), 1 ~ 6 months (P < 0.001, OR = 3.463) and 6 ~ 24 months (P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III ~ IV, no injury (P < 0.001, OR = 6.379) and grade I (P = 0.01, OR = 4.332) were associated with higher IKDC score. CONCLUSIONS Arthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5 kg/m2, age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade ≥ 2) reduces postoperative effect.
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Affiliation(s)
- Shun-Jie Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong-Jun Ding
- Department of Orthopedic Surgery, West China Longquan Hospital Sichuan University, No.201, Yihe Group 3, Longquanyi District, Chengdu, 610100, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Yang Xue
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Gang Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
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19
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Farlett J, Wood JR. Ipsilateral Medial and Lateral Discoid Menisci: A Rare Combination of Infrequent Anatomic Variants. J Clin Imaging Sci 2020; 10:11. [PMID: 32257587 PMCID: PMC7109981 DOI: 10.25259/jcis_133_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
A discoid meniscus is a thick, disk-shaped meniscus which is prone to tearing, degeneration, and loss of stability in the knee. A discoid meniscus most commonly affects the lateral meniscus, rarely the medial meniscus. Here, we present a case of an extremely rare medial and lateral discoid meniscus in the ipsilateral knee of a 10-year-old male. Ipsilateral medial and discoid menisci are incredibly rare and one must keep this entity in mind to avoid confusion while interpreting knee magnetic resonance imaging.
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Affiliation(s)
- Johnmark Farlett
- Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Jonathan R Wood
- Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii, USA
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20
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Gee SM, Tennent DJ, Cameron KL, Posner MA. The Burden of Meniscus Injury in Young and Physically Active Populations. Clin Sports Med 2020; 39:13-27. [PMID: 31767103 DOI: 10.1016/j.csm.2019.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Meniscus injuries affect the young and physically active population. Although meniscus injuries are common in many sports, football, soccer, basketball, and wrestling are associated with the greatest risk. In an occupational setting, jobs requiring kneeling, squatting, and increased physical activity level have the greatest risk. Meniscus injury can be isolated to the meniscus or associated with other concomitant injuries, including anterior cruciate ligament tears and tibial plateau fractures. The frequency of meniscal repair is increasing because of a better understanding of meniscal pathophysiology, technological advancements, and a focus on meniscal preservation following injury to mitigate long-term consequences such as osteoarthritis.
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Affiliation(s)
- Shawn M Gee
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
| | - David J Tennent
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996, USA
| | - Matthew A Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996, USA
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21
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Zhou Z, Xiao L, He C, Zhang Y, Xue C, Qiao S, Zhang G, Wang Z. Application of assisted portal under anterior horn of lateral meniscus for the treatment of discoid meniscus injury. Knee 2019; 26:1125-1135. [PMID: 31351849 DOI: 10.1016/j.knee.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/05/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The assisted inferior anterolateral portal under anterior horn of the lateral meniscus (UAHLM portal) was applied to treat the lateral discoid meniscus injury conveniently and the clinical outcomes were evaluated. METHODS A retrospective review was conducted on 60 patients who underwent arthroscopic surgery with a symptomatic discoid lateral meniscus. Normal anterolateral/anteromedial portals assisted with UAHLM portal (1-2 cm inferior to the anterolateral portal) were used. All patients were followed up for 24-48 months (median, 33 months) and evaluated by MRI images and clinical outcomes including clinical findings, Lysholm scores and IKDC scores. RESULTS After meniscus plasty with or without repair, most of the upper layer of lateral meniscuses was retained. A total of 54 patients (16 males and 38 females, 42 ± 17.8 years old) showed satisfactory clinical results without requiring reoperation after a median follow-up time of 33 months. At final follow-up, a full range of motion was achieved in all patients. MRI indicated the thickness of anterior horn of lateral meniscus was (5.38 ± 1.09 mm) before the operation and (4.04 ± 0.71 mm) after the operation at the 2-year follow-up; clinical outcomes were improved significantly than the baseline: positive McMurray test (50 vs. 2, P< 0.001), Lysholm score (64.9 ± 9.0 vs. 94.7 ± 4.9, P< 0.001), and IKDC score (54.4 ± 7.7 vs. 92.6 ± 4.3, P< 0.001). No significant complication was observed during the follow-up. CONCLUSION Thus, this technique with assisted UAHLM portal was convenient for arthroscopic discoid meniscus plasty and meniscus repair and served as an effective method in patients with a symptomatic discoid lateral.
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Affiliation(s)
- Zhiyou Zhou
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Lei Xiao
- The Orthopedics Department, NO.515 Hospital of PLA, Wuxi, China
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yongjin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Chenchen Xue
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Suchi Qiao
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Guobin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
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22
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Zhang H, Chen S, Qiu M, Zhou A, Yan W, Zhang J. Lateral meniscus allograft transplantation with platelet-rich plasma injections: A minimum two-year follow-up study. Knee 2018; 25:568-576. [PMID: 29699841 DOI: 10.1016/j.knee.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to report the short-term clinical and imaging outcomes of lateral meniscus allograft transplantations (LMAT) combined with intra-articular platelet-rich plasma (PRP) injection. METHODS Thirty-three patients who had undergone LMAT combined with intra-articular PRP injection were evaluated. The Lysholm, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index, Tegner activity level scale and visual analog scale for pain scores were used to evaluate the outcomes. Magnetic resonance imaging scans were performed postoperatively to assess graft position and chondral degeneration/damage. RESULTS A total of 31 of the original 33 patients were evaluated over a mean follow-up period of 37.0months. Patients demonstrated statistically significant improvements in all scoring data from the pre-operative to two-year follow-up period. The mean postoperative extrusion was 1.59±1.20mm (range 0-3.9mm). There were no significant differences in the distribution of the grade of chondral damage between the pre-operative and two-year follow-up periods. Three patients (9.7%) showed no improvements or had lower evaluation scores. One patient underwent matrix-induced autologous chondrocyte implantation at one year after LMAT. CONCLUSION Lateral meniscus allograft transplantation combined with intra-articular PRP injection resulted in statistically significant improvements in all functions and pain scores, and clinical improvements in Tegner, IKDC, and Lysholm values during short-term follow-up. A further case-control study with a larger sample size and longer follow-up is required to obtain an overall assessment of the benefits of PRP on MAT patients. Level of evidence IV.
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Affiliation(s)
- Hua Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiyang Chen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Man Qiu
- Department of Endoscopics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Aiguo Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenlong Yan
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med 2018; 53:1268-1278. [PMID: 29886437 PMCID: PMC6837253 DOI: 10.1136/bjsports-2018-099257] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/04/2022]
Abstract
Background Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees. Methods We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity. Results We included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias. Conclusions Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%–14% in adults aged <40 years to 19%–43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.
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Affiliation(s)
- Adam G Culvenor
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.,La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua J Stefanik
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Centre, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
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High tibial osteotomy accelerates lateral compartment osteoarthritis in discoid meniscus patients. Knee Surg Sports Traumatol Arthrosc 2018; 26:1845-1850. [PMID: 28160013 DOI: 10.1007/s00167-017-4422-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The valgus high tibial osteotomy (HTO) in patients with medial osteoarthritis and discoid lateral meniscus can result in increased load on the lateral compartment and hence a higher chances of tear. This may accelerate the progression of osteoarthritis on lateral compartment. We, therefore, carried out the case control study with a hypothesis that an HTO would accelerate the progression of osteoarthritis (OA) on lateral compartment in patients with complete discoid meniscus. METHODS The records of all patients with open wedge HTO from 2008 to 2012 were evaluated for complete lateral discoid meniscus. The patient who had a valgus HTO with or without partial meniscectomy for medial compartmental OA was included for this study. Cases to control were chosen to match age, body mass index (BMI), pre-operative osteoarthritis grade, and deformity angles in ratio 1:2. Patient's records were studied for demographic data, clinical examination records, and pre-operative knee functional scores and radiological scores and were compared with post-operative data. RESULTS Thirty-six patients out of 674 patients, who underwent an HTO, consisted of discoid meniscus group. 72 patients were chosen as control group. Four patients showed progression of OA on the lateral compartment in discoid group compared to none in control group. Although control groups showed a little bit better functional outcomes, there were no statistical differences between two groups (n.s.). CONCLUSION The high tibial osteotomy could result in accelerated lateral compartment osteoarthritis in patients with complete discoid meniscus, and the procedure should be used with caution in such patients. LEVEL OF EVIDENCE IV.
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Relationship between knee osteoarthritis and meniscal shape in observation of Japanese patients by using magnetic resonance imaging. J Orthop Surg Res 2017; 12:97. [PMID: 28651649 PMCID: PMC5485659 DOI: 10.1186/s13018-017-0595-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/09/2017] [Indexed: 12/02/2022] Open
Abstract
Background The aims of this study were to reveal the characteristics of the meniscal shape at each knee osteoarthritis (OA) severity level and to predict trends or patterns of the meniscal shape change as associated with knee OA progression. Methods Fifty-one patients diagnosed with knee OA based on X-ray and magnetic resonance (MR) images were evaluated. They were divided into three groups based on the Kellgren–Lawrence (KL) grade: normal group (KL grade of 0 or 1), mild group (KL grade of 2 or 3), and severe group (KL grade of 4). We measured the patients’ meniscal size and meniscal extrusion using MR images. In addition, semiquantitative measurement was performed using MR images to determine the arthritic status of the corresponding compartment using a whole-organ magnetic resonance imaging score (WORMS). Results The longitudinal diameter and posterior wedge angle of the medial meniscus were significantly larger, and the posterior wedge width of the medial meniscus was significantly smaller in the severe group than in the normal group. The WORMS scores for cartilage and osteophytes in the medial region were significantly different among the groups. The WORMS score of each region was strongly correlated with the longitudinal diameter. The WORMS scores of the lateral region were lower than those of the medial region. Conclusion Our observation of the shape change of the medial meniscus in the posterior region was roughly consistent with that in many previous studies of meniscal degeneration. On the other hand, we saw that the most relevant relation between the progression of the knee OA and the deformation of the meniscus was in the longitudinal direction.
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The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation. Arch Orthop Trauma Surg 2017; 137:837-844. [PMID: 28397004 DOI: 10.1007/s00402-017-2672-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively? METHODS A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy). RESULTS In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1-6). CONCLUSION Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of "isolated degenerative meniscus damage" clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.
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Hoessly ML, Wildi LM. Magnetic Resonance Imaging Findings in the Knee Before and After Long-Distance Running-Documentation of Irreversible Structural Damage? A Systematic Review. Am J Sports Med 2017; 45:1206-1217. [PMID: 27519676 DOI: 10.1177/0363546516656180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various studies have investigated structural knee changes after running, with conflicting results. PURPOSE To perform a systematic review of acute changes in knee structures as detected by magnetic resonance imaging (MRI) after running and assess the reversibility of these changes. STUDY DESIGN Systematic review. METHODS A systematic literature search in Medline, Cochrane, Embase, and Scopus was performed. Articles that fulfilled predefined inclusion criteria were included and systematically reviewed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 19 studies were included in this review. All studies performed standard knee MRI; 6 studies additionally performed T1ρ and T2 mapping. Sixteen studies assessed cartilage or meniscal morphological changes. Ten found no significant morphological changes after running. Six studies showed significant changes at the first follow-up. Six performed a second follow-up. Five showed no change compared with baseline and the first follow-up, and 1 showed a significant recovery compared with the first follow-up and no significant difference compared with baseline. Five of the 6 studies performing T1ρ and T2 mapping found significant changes in T2 and T1ρ values at the first follow-up. Three performed a second follow-up. Two found a significant recovery of T2 but no recovery of T1ρ. One study did not find a significant change compared with baseline. Ten studies assessed the patellar tendon, ligaments, synovial fluid, or subchondral bone. Changes at the first follow-up were not significant. A second follow-up was performed in 5 studies. All studies discovered recovery from the first follow-up. CONCLUSION These data suggest that healthy athletes who have no risk factors for degenerative joint disease may present fleeting quantitative alterations after running. No irreversible, qualitative harmful effects seemed to occur, with the exception of persistent T1ρ elevation representing a proteoglycan depletion. Whether T1ρ changes need more than 3 months to recover or represent permanent structural damage remains to be investigated.
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Affiliation(s)
- Menduri L Hoessly
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas M Wildi
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Kim JG, Han SW, Lee DH. Diagnosis and Treatment of Discoid Meniscus. Knee Surg Relat Res 2016; 28:255-262. [PMID: 27894171 PMCID: PMC5134787 DOI: 10.5792/ksrr.16.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 10/24/2022] Open
Abstract
There is a greater incidence of discoid meniscus in Asian countries than in Western countries, and bilateral discoid menisci are also common. The discoid meniscus may be a congenital anomaly, and genetics or family history may play a role in the development of discoid menisci. Because the histology of discoid meniscus is different from that of normal meniscus, it is prone to tearing. Individuals with a discoid meniscus can be asymptomatic or symptomatic. Asymptomatic discoid menisci do not require treatment. However, operative treatment is necessary if there are symptoms. Total meniscectomy leads to an increased risk of osteoarthritis. Therefore, total meniscectomy is generally reserved for rare unsalvageable cases. Partial meniscectomy (saucerization) with preservation of a stable peripheral rim combined with or without peripheral repair is effective, and good short-, mid-, and long-term clinical results have been reported.
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Affiliation(s)
- Jae-Gyoon Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Seung-Woo Han
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hu Y, Xu X, Pan X, Yu H, Zhang Y, Wen H. Combined outside-in and FasT-Fix sutures for the treatment of serious discoid meniscal tears: A midterm follow-up study. Knee 2016; 23:1143-1147. [PMID: 27651201 DOI: 10.1016/j.knee.2015.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of discoid meniscus is debatable. This study aimed to assess the clinical efficacy of combined outside-in and FasT-Fix sutures for the treatment of serious discoid meniscal tears. METHODS This study included 32 consecutive patients who underwent arthroscopic meniscal plasty for serious discoid meniscal tears (full-thickness vertical, longitudinal tears >10mm) between October 2006 and June 2012. A combination of outside-in and FasT-Fix sutures was used to treat serious discoid meniscal tears. Disappearance of clinical symptoms (locked knee, pain, and clicking) and negative results in the McMurray and Apley grind tests were assessed during follow-up (26 to 47months). The Lysholm, IKDC, and Tegner scores were assessed for therapeutic efficacy. Some patients were followed up with MRI. RESULTS Symptoms (pain, clicking, and locking) disappeared in all patients. The Lysholm score improved from 39.1±9.2 to 89.6±6.7 at six months, and to 90.1±6.3 at the last follow-up. The same trends were observed for the IKDC score (from 38.0±9.5 to 90±6.3, and to 91.1±6.4) and the Tegner score (from 2.8±0.6 to 5.2±0.6, and to 5.2±0.5). Among all patients, 13 were followed up with MRI. Among these patients, four had an unhealed stitched edge, but they did not complain of any discomfort in the knees. CONCLUSIONS The use of a combination of outside-in and FasT-Fix sutures for meniscal plasty had good outcomes for serious discoid meniscal tears and can thus be regarded as a good surgical option.
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Affiliation(s)
- Yuezheng Hu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xinxian Xu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xiaoyun Pan
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Huachen Yu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Hong Wen
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China.
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van der Heijden RA, de Kanter JLM, Bierma-Zeinstra SMA, Verhaar JAN, van Veldhoven PLJ, Krestin GP, Oei EHG, van Middelkoop M. Structural Abnormalities on Magnetic Resonance Imaging in Patients With Patellofemoral Pain: A Cross-sectional Case-Control Study. Am J Sports Med 2016; 44:2339-46. [PMID: 27206691 DOI: 10.1177/0363546516646107] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Structural abnormalities of the patellofemoral joint might play a role in the pathogenesis of patellofemoral pain (PFP), a common knee problem among young and physically active individuals. No previous study has investigated if PFP is associated with structural abnormalities of the patellofemoral joint using high-resolution magnetic resonance imaging (MRI). PURPOSE To investigate the presence of structural abnormalities of the patellofemoral joint on high-resolution MRI in patients with PFP compared with healthy control subjects. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients with PFP and healthy control subjects between 14 and 40 years of age underwent high-resolution 3-T MRI. All images were scored using the Magnetic Resonance Imaging Osteoarthritis Knee Score with the addition of specific patellofemoral features. Associations between PFP and the presence of structural abnormalities were analyzed using logistic regression analyses adjusted for age, body mass index (BMI), sex, and sports participation. RESULTS A total of 64 patients and 70 control subjects were included in the study. Mean ± SD age was 23.2 ± 6.4 years, mean BMI ± SD was 22.9 ± 3.4 kg/m(2), and 56.7% were female. Full-thickness cartilage loss was not present. Minor patellar cartilage defects, patellar bone marrow lesions, and high signal intensity of the Hoffa fat pad were frequently seen in both patients (23%, 53%, and 58%, respectively) and control subjects (21%, 51%, and 51%, respectively). After adjustment for age, BMI, sex, and sports participation, none of the structural abnormalities were statistically significantly associated with PFP. CONCLUSION Structural abnormalities of the patellofemoral joint have been hypothesized as a factor in the pathogenesis of PFP, but the study findings suggest that structural abnormalities of the patellofemoral joint on MRI are not associated with PFP.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janneke L M de Kanter
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Gabriel P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Chen G, Zhang Z, Li J. Symptomatic discoid lateral meniscus: a clinical and arthroscopic study in a Chinese population. BMC Musculoskelet Disord 2016; 17:329. [PMID: 27494952 PMCID: PMC4974684 DOI: 10.1186/s12891-016-1188-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/29/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Discoid lateral meniscus (DLM) is relatively common in East Asia..Symptomatic discoid lateral meniscus (SDLM) is an important indication for knee arthroscopic surgery. However, studies investigating SDLM are rare. The purpose of this study was to evaluate the clinical characteristics and intra-articular variants of SDLM in a Chinese population. METHODS We retrospectively reviewed all patients with SDLM from January 2005 to December 2014 in our hospital. Clinical variables included gender, age, duration, age of onset, affected side, symptoms and trauma history as well as arthroscopic findings: DLM types, tear patterns and concomitant medial meniscus tear, which were evaluated and compared statistically. RESULTS Of the 496 consecutive participants with SDLM, females outnumbered males (69.6 % vs. 30.4 %). The age of onset ranged from 3 to 80 years (median, 31 years), and was significantly higher in females than in males (p < 0.0001). Trauma history in males was significantly higher than in females (45 % vs. 35.1 %, p = 0.0356). Males showed a higher incidence of popping and snapping, while females manifested higher range-of-motion (ROM) limitations (p = 0.0179, and p = 0.0392, respectively). No significant difference in intra-articular variants was observed between genders. The complete type was the most frequent (344, 69.4 %), followed by the incomplete type (149, 30 %), and the Wrisberg type (3, 0.6 %). Significant difference in tear patterns was found between complete and incomplete types (p < 0.0001). Few patients showed medial meniscus tear (11, 2.2 %), at a significantly higher age compared with patients without tear (median, 57 years vs. 33 years, p < 0.0001). CONCLUSIONS The majority of Chinese patients with SDLM are young and middle-aged females. Female patients had an older age of onset, higher incidence of ROM limitation and limited trauma history. The complete type is the most common, with tear patterns varying between complete and incomplete types. The SDLM does not significantly affect the medial meniscus.
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Affiliation(s)
- Gang Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
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Ling CHY, Lai JH, Wong IJ, Levenston ME. Bovine meniscal tissue exhibits age- and interleukin-1 dose-dependent degradation patterns and composition-function relationships. J Orthop Res 2016; 34:801-11. [PMID: 26519862 DOI: 10.1002/jor.23096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/25/2015] [Indexed: 02/04/2023]
Abstract
Despite increasing evidence that meniscal degeneration is an early event in the development of knee osteoarthritis, relatively little is known regarding the sequence or functional implications of cytokine-induced meniscal degradation or how degradation varies with age. This study examined dose-dependent patterns of interleukin-1 (IL-1)-induced matrix degradation in explants from the radially middle regions of juvenile and adult bovine menisci. Tissue explants were cultured for 10 days in the presence of 0, 1.25, 5, or 20 ng/ml recombinant human IL-1α. Juvenile explants exhibited immediate and extensive sulfated glycosaminoglycan (sGAG) loss and subsequent collagen release beginning after 4-6 days, with relatively little IL-1 dose-dependence. Adult explants exhibited a more graded response to IL-1, with dose-dependent sGAG release and a lower fraction of sGAG released (but greater absolute release) than juvenile explants. In contrast to juvenile explants, adult explants exhibited minimal collagen release over the 10-day culture. Compressive and shear moduli reflected the changes in explant composition, with substantial decreases for both ages but a greater relative decrease in juvenile tissue. Dynamic moduli exhibited stronger dependence on explant sGAG content for juvenile tissue, likely reflecting concomitant changes to both proteoglycan and collagen tissue components. The patterns of tissue degradation suggest that, like in articular cartilage, meniscal proteoglycans may partially protect collagen from cell-mediated degeneration. A more detailed view of functional changes in meniscal tissue mechanics with degeneration will help to establish the relevance of in vitro culture models and will advance understanding of how meniscal degeneration contributes to overall joint changes in early stage osteoarthritis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:801-811, 2016.
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Affiliation(s)
- Carrie H-Y Ling
- Department of Mechanical Engineering, Stanford University, Stanford, California, 94305-4038
| | - Janice H Lai
- Department of Mechanical Engineering, Stanford University, Stanford, California, 94305-4038
| | - Ivan J Wong
- Department of Mechanical Engineering, Stanford University, Stanford, California, 94305-4038
| | - Marc E Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, California, 94305-4038
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Wang A, Pedoia V, Su F, Abramson E, Kretzschmar M, Nardo L, Link TM, McCulloch CE, Jin C, Ma CB, Li X. MR T1ρ and T2 of meniscus after acute anterior cruciate ligament injuries. Osteoarthritis Cartilage 2016; 24:631-9. [PMID: 26620091 PMCID: PMC4799742 DOI: 10.1016/j.joca.2015.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 10/22/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate differences in meniscal T1ρ and T2 quantification in patients with acute anterior cruciate ligament (ACL) injuries and to determine correlations of these differences with MR morphological grading and patient-reported outcomes. DESIGN Bilateral knees of 52 patients with acute ACL injury and 20 healthy controls were scanned using 3 T magnetic resonance imaging (MRI) T1ρ and T2 mapping in this prospective study. Quantitative analysis of the meniscus was performed in anterior and posterior horns of the lateral and medial menisci. Morphological meniscal damage was assessed using modified whole-organ MRI scores (WORMS). Measurements were compared between injured, uninjured contralateral, and control knees using a mixed-effects regression model. Correlations between meniscal T1ρ/T2, WORMS and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were examined using partial correlation analysis. RESULTS Mean meniscal T1ρ and T2 values were significantly higher in ACL-injured knees compared to control and contralateral knees. Menisci of ACL-injured knees without tears, including those limited to modified meniscal WORMS grade 0, also had significantly higher T1ρ and T2 values compared to menisci of uninjured knees. Within ACL-injured knees, T1ρ and T2 values showed significant positive associations with meniscal WORMS and significant negative associations with KOOS. CONCLUSION Acute ACL injuries are associated with significantly increased meniscal T1ρ and T2 values in both patients with and without meniscal lesions or tears, suggesting quantitative MRI provides more sensitive measures of meniscal differences compared to traditional morphological MRI sequences. Correlation between meniscal T1ρ/T2 and KOOS suggest that quantitative MRI is reflective of the extent of patients' clinical symptoms.
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Affiliation(s)
- Amy Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Elijah Abramson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, United States.
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
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Miller RE, Tran PB, Sondoqah A, Raghu P, Ishihara S, Miller RJ, Malfait AM. The Role of Peripheral Nociceptive Neurons in the Pathophysiology of Osteoarthritis Pain. Curr Osteoporos Rep 2015; 13:318-26. [PMID: 26233284 PMCID: PMC4596062 DOI: 10.1007/s11914-015-0280-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Knee osteoarthritis is characterized by progressive damage and remodeling of all tissues in the knee joint. Pain is the main symptom associated with knee osteoarthritis. Recent clinical and pre-clinical studies have provided novel insights into the mechanisms that drive the pain associated with joint destruction. In this narrative review, we describe current knowledge regarding the changes in the peripheral and central nervous systems that occur during the progression of osteoarthritis and discuss how therapeutic interventions may provide pain relief.
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Affiliation(s)
- Rachel E. Miller
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
- Department of Biochemistry, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
| | - Phuong B. Tran
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
| | - Alia Sondoqah
- Department of Biochemistry, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
| | - Padmanabhan Raghu
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
| | - Shingo Ishihara
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
| | - Richard J. Miller
- Department of Pharmacology, Northwestern University, Lurie 8-125, 303 E. Superior St, Chicago, IL 60611
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
- Department of Biochemistry, Rush University Medical Center, 1611 W. Harrison St, Suite 510, Chicago, IL 60612
- Corresponding author Anne-Marie Malfait, MD, PhD, Associate Professor of Medicine, , T: 312-563-2925, F: 312-563-2267
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Nishimuta JF, Levenston ME. Meniscus is more susceptible than cartilage to catabolic and anti-anabolic effects of adipokines. Osteoarthritis Cartilage 2015; 23:1551-62. [PMID: 25917638 PMCID: PMC4558246 DOI: 10.1016/j.joca.2015.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 03/21/2015] [Accepted: 04/15/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study compared the effects on cartilage and meniscus matrix catabolism and biosynthesis of several adipokines implicated in osteoarthritis (OA). DESIGN Bovine cartilage and meniscus explants were cultured for 1 or 9 days in serum-free medium alone or with 0.02, 0.2, or 2 μg/ml of leptin, visfatin, adiponectin, or resistin. Media were supplemented with (3)H-proline or (35)S-sodium sulfate to evaluate protein and sulfated glycosaminoglycan (sGAG) accumulation on the last day of culture. Explants were assayed for radiolabel, sGAG, and DNA contents. Cultured media were assayed for sGAG, nitrite and lactate dehydrogenase. RESULTS Cartilage tissue was minimally affected by adipokines, with only the highest resistin dose increasing sGAG release and nitrite production compared to controls. In sharp contrast, meniscus tissue was responsive to several adipokines, with elevated sGAG and nitrite release following treatment with resistin, leptin, or visfatin. Cartilage sGAG content was unaltered by adipokine treatment whereas meniscal sGAG content significantly decreased with resistin dosage. Protein ((3)H) incorporation was unaffected by adipokine treatment in both tissues. sGAG ((35)S) incorporation did not significantly vary with adipokine treatment in cartilage but was inhibited by treatment with leptin, visfatin, and resistin in meniscus. CONCLUSION Our results indicate that meniscal tissue is more susceptible to adipokine-stimulated catabolism than is cartilage. Resistin had the strongest effect of the adipokines tested, inducing sGAG release in both tissues and depleting sGAG content in meniscus. These results suggest that increased adipokine levels due to obesity or joint injury may alter the mechanical integrity of the knee joint through biological pathways.
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Affiliation(s)
- James F. Nishimuta
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305 USA
| | - Marc E. Levenston
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305 USA,Department of Bioengineering, Stanford University, Stanford, CA 94305 USA,Corresponding Author: Marc E. Levenston, Ph.D., Department of Mechanical Engineering, Stanford University, Stanford, CA 94305-4038 USA, Tel: (650) 723-9464, Fax: (650) 725-1587
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Liu WX, Zhao JZ, Huangfu XQ, He YH, Yang XG. Prevalence of bilateral Discoid Lateral Menisci (DLM) in patients operated for symptomatic DLM with a follow-up study on their asymptomatic contralateral knees: a Magnetic Resonance Imaging (MRI) assessment. BMC Musculoskelet Disord 2015. [PMID: 26216358 PMCID: PMC4517640 DOI: 10.1186/s12891-015-0626-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The purpose was to investigate prevalence of bilateral discoid lateral menisci (DLM) in Han Chinese patients who received surgery for symptomatic DLM, as well as a follow-up study of their asymptomatic contralateral knees using magnetic resonance imaging (MRI). Methods A total of 110 patients [50 males and 60 females; average age: 21.95 ± 12.77 years (range: 6 to 67 years)] admitted to our hospital with symptomatic DLM were treated with arthroscopic surgery. The contralateral asymptomatic knees were evaluated for DLM by MRI. Postoperative clinical evaluation was performed using the Lysholm knee scoring scale and International Knee Documentation Committee subjective knee evaluation. Results Eighty (72.73 %) of 110 symptomatic DLM patients had bilateral DLM, of which 68 (85 %) were of homotype (same type). Fourteen of 80 bilateral DLM patients were symptomatic and received operations in both knees. Twelve of remaining 66 bilateral DLM patients with asymptomatic one knee underwent a second arthroscopic surgery as their asymptomatic knees became symptomatic over the five-year interim. Of these 12 cases, seven exhibited no shift and five showed posterocentral meniscal shift. Furthermore, at least two cases showed progression from asymptomatic grade II to symptomatic grade III over the interim. All patients showed significant improvement after surgery. Conclusions The bilateral DLM rate of Han Chinese patients with symptomatic DLM was relatively high at 72.7 %, and 85 % of those were of homotype.
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Affiliation(s)
- Wen-Xin Liu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Jin-Zhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Xiao-Qiao Huangfu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Yao-Hua He
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Xing-Guang Yang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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Wang J, Xiong J, Xu Z, Shi H, Dai J, Jiang Q. Short-term effects of discoid lateral meniscectomy on the axial alignment of the lower limb in adolescents. J Bone Joint Surg Am 2015; 97:201-7. [PMID: 25653320 DOI: 10.2106/jbjs.n.00651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A discoid lateral meniscus in the knee is more common in Asian populations. The aim of this study was to evaluate the influence of arthroscopic meniscectomy of the discoid lateral meniscus on the axial alignment of the lower limb in adolescents (younger than twenty years of age). METHODS We retrospectively reviewed the data from 298 adolescent patients (younger than twenty years of age) who underwent arthroscopic treatment in our center from 2004 to 2013. Patients were divided into three groups according to the meniscus type: torn discoid lateral meniscus (Group A), torn nondiscoid lateral meniscus (Group B), and nondiscoid lateral meniscus without a tear (Group C). The tibiofemoral angle (TFA) and mechanical axis deviation (MAD) of both lower limbs were examined on standing anteroposterior radiographs before and after arthroscopy. RESULTS The preoperative TFA and MAD of the ipsilateral lower limbs demonstrated significantly more varus in Group A than in Group B (p < 0.001) or Group C (p < 0.001) after we controlled for the contralateral lower limbs as a covariate factor. Moreover, the TFA and MAD of the ipsilateral knees were significantly reduced (indicating a reduction in varus inclination) postoperatively, as compared with preoperatively, in Group A (p < 0.001) and Group B (p < 0.001), with no difference between the preoperative and postoperative values in Group C (p > 0.01), after we controlled for the contralateral lower limb as the covariate factor. Additionally, the reductions in the TFA and MAD (varus inclination) in Group A were significantly greater than those observed in Group B (p < 0.001). CONCLUSIONS The axial alignment of the lower limb in adolescents (younger than twenty years of age) with a torn discoid lateral meniscus was altered immediately after arthroscopic meniscectomy: the varus deformity was significantly reduced, and a valgus inclination developed in some of these patients. The valgus inclination was more pronounced in the patients with a torn discoid lateral meniscus compared with those with a torn nondiscoid lateral meniscus.
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Affiliation(s)
- Junfei Wang
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
| | - Jin Xiong
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
| | - Zhihong Xu
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
| | - Hongfei Shi
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
| | - Jin Dai
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
| | - Qing Jiang
- Department of Orthopedics (J.W., J.X., and H.S.) and The Center for Diagnosis and Treatment of Joint Disease (Z.X., J.D., and Q.J.), Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, China. E-mail address for Q. Jiang:
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Kwon SK, Moon HK, Choi CJ, Park SH, Lee JJ, Kim YC, Park YS, Koh YG. Accelerated degeneration of the discoid lateral meniscus after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015. [PMID: 23188498 DOI: 10.1007/s00167-012-2289-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was undertaken to report clinical outcomes after high tibial osteotomy (HTO) in patients with a discoid lateral meniscus and to determine (1) whether discoid lateral meniscus degeneration by magnetic resonance imaging (MRI) progresses after HTO and (2) whether this progression adversely affects clinical results. METHODS The records of 292 patients (292 knees) who underwent medial opening HTO were retrospectively reviewed, and discoid types and grades of lateral meniscus degeneration as determined by MRI were recorded preoperatively. Of the 292 patients, 17 (5.8%) had a discoid lateral meniscus, and postoperative MR images were obtained at least 2 years after HTO for 15 of these 17 patients. RESULTS American Knee Society (AKS) pain, knee and function scores significantly improved in the 15 patients after surgery (p < 0.001). Eight (53%) had an incomplete and 7 (47%) had a complete discoid lateral meniscus. By preoperative MRI, the distribution of meniscal degeneration was as follows: grade 1, 4 patients; grade 2, 7 patients; and grade 3, 4 patients. At the final follow-up, the distribution of degeneration was as follows: grade 1, 2 patients; grade 2, 5 patients; and grade 3, 8 patients. Two patients with grade 3 degeneration who did not undergo partial meniscectomy showed tear progression. Thus, 8 of the 15 patients (53%) experienced progressive discoid meniscal degeneration after HTO. Median AKS pain score was significantly lower in the progression group than in the non-progression group (40 vs 45, respectively). CONCLUSION The results of this study suggest that increased load on the lateral compartment after HTO can accelerate discoid lateral meniscus degeneration by MRI and caution that when a discoid lateral meniscus is found by preoperative MRI, progressive degeneration may occur after HTO and clinical outcome may be adversely affected. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Affiliation(s)
- Sae Kwang Kwon
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 49-3 Yeokgok-dong, Wonmi-gu, Bucheon, 420-100, Korea
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Chiang SW, Tsai PH, Chang YC, Wang CY, Chung HW, Lee HS, Chou MC, Hsu YC, Huang GS. T2 values of posterior horns of knee menisci in asymptomatic subjects. PLoS One 2013; 8:e59769. [PMID: 23555775 PMCID: PMC3610938 DOI: 10.1371/journal.pone.0059769] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/18/2013] [Indexed: 02/07/2023] Open
Abstract
Purpose The magnetic resonance (MR) T2 value of cartilage is a reliable indicator of tissue properties and therefore may be used as an objective diagnostic tool in early meniscal degeneration. The purpose of this study was to investigate age, gender, location, and zonal differences in MR T2 value of the posterior horns of knee menisci in asymptomatic subjects. Methods Sixty asymptomatic volunteers (30 men and 30 women) were enrolled and divided into three different age groups: 20–34, 35–49 and 50–70 years. The inclusion criteria were BMI<30 kg/cm2, normalized Western Ontario and McMaster Universities (WOMAC) pain score of zero, and no evidence of meniscal and ligamentous abnormalities on routine knee MR imaging. The T2 values were measured on images acquired with a T2-weighted fat-suppressed turbo spin-echo sequence at 3T. Results The mean T2 values in both medial and lateral menisci for the 20–34, 35–49, and 50–70 age groups were 9.94 msec±0.94, 10.73 msec±1.55, and 12.36 msec±2.27, respectively, for women and 9.17 msec±0.74, 9.64 msec±0.67, and 10.95 msec±1.33, respectively, for men. The T2 values were significantly higher in the 50–70 age group than the 20–34 age group (P<0.001) and in women than in men (P = 0.001, 0.004, and 0.049 for each respective age group). T2 values were significantly higher in medial menisci than in lateral menisci only in women age 50–70 (3.33 msec, P = 0.006) and in the white zone and red/white zone of the 50–70 and 35–49 age groups than that of the 20–34 age group (2.47, 1.02; 2.77, 1.16 msec, respectively, all P<0.01). Conclusion The MR T2 values of the posterior meniscal horns increase with increasing age in women and are higher in women than in men. The age-related rise of T2 values appears to be more severe in medial menisci than in lateral menisci. Differences exist in the white zone and red/white zone.
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Affiliation(s)
- Shih-Wei Chiang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ping-Huei Tsai
- Imaging Research Center, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Radiology, Wan Fang Hospital, Taipei, Taiwan, ROC
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan, ROC
| | - Chao-Ying Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsiao-Wen Chung
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Herng-Sheng Lee
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ming-Chung Chou
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- * E-mail:
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Stärke C, Kopf S, Lippisch R, Lohmann CH, Becker R. Tensile forces on repaired medial meniscal root tears. Arthroscopy 2013; 29:205-12. [PMID: 23369475 DOI: 10.1016/j.arthro.2012.09.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The goals of this study were to measure the tensile forces acting on repaired medial meniscal root lesions and to investigate how they depend on femorotibial rotation, flexion, and compressive load. METHODS In 6 human cadaveric knees, the posterior medial meniscal root was completely detached and then repaired with a pullout suture. A force transducer was installed such that it measured tensile forces acting on the suture. The resultant tension at the posterior medial meniscal root was measured for flexion angles up to 120° at 2 levels of femorotibial compressive load (100 and 500 N) in neutral, internal, and external rotation of the knee. RESULTS Rotation had a highly significant effect on root tension (P < .001). Internal rotation of the femur increased the resultant tension, whereas external rotation decreased it. The tension at the meniscal root was related to the femorotibial load (P < .001). Although no significance was reached, a trend toward higher flexion angles causing more tension was observed. The highest mean tension of 60.1 ± 20.2 N was generated with internal rotation, a 500-N load, and 90° flexion. CONCLUSIONS Our study shows in a human in vitro model that motion and weight loading of the knee can generate considerable tensile forces in the posterior medial meniscal root. Internal rotation of the femur increases the resultant tension substantially, whereas external rotation has the opposite effect. CLINICAL RELEVANCE The data can potentially aid the surgeon in finding appropriate rehabilitation exercises after a medial meniscal root repair.
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Affiliation(s)
- Christian Stärke
- Department of Orthopaedic Surgery, University Hospital Magdeburg, Magdeburg, Germany.
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Cao H, Zhang Y, Qian W, Cheng XH, Ke Y, Guo XP. Short-term clinical outcomes of 42 cases of arthroscopic meniscectomy for discoid lateral meniscus tears. Exp Ther Med 2012; 4:807-810. [PMID: 23226730 PMCID: PMC3493707 DOI: 10.3892/etm.2012.686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/06/2012] [Indexed: 11/05/2022] Open
Abstract
Discoid lateral meniscus of the knee causes a high morbidity in China. Since the traditional treatment to open the capsule and resect the meniscus often results in arthritis, it is now believed that a discoid lateral meniscus should be treated with arthroscopy to preserve part of the meniscus. The current study aimed to investigate the short-term clinical outcomes of arthroscopic meniscectomy for the treatment of discoid lateral meniscus tears. In the present study, we diagnosed and treated 42 patients (47 knees) with discoid lateral meniscus tears using arthroscopy between February, 2007 and December, 2010. Thirty-seven knees received partial resection of the discoid meniscus, 8 received hypo-complete resection and 2 received complete resection. Thirty-nine of the patients were followed up for a mean of 21 months (ranging from 9 to 53 months). The Lysholm scoring system was used to assess the knee function prior to surgery and during the follow-up. The results were analyzed using a Student’s t-test with SPSS 12.0. Our study showed that patients with treated knees returned to normal activities within 4–6 weeks, and knee functions were more improved at 9 months after operation than 3 months, as measured by the Lysholm score (P<0.05). Arthroscopic meniscectomy is an effective treatment for discoid menisci resulting in minimal invasion, quick recovery and early functional exercise. The use of arthroscopy during surgery aids to preserve the meniscus and to reduce stress, therefore, having a beneficial effect on short-term clinical outcomes.
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Affiliation(s)
- Hong Cao
- Department of Orthopedic Surgery and
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Abstract
Discoid lateral meniscus is an intra-articular knee disorder that typically presents in children and adolescents. The natural history depends on the type of anomaly and the nature and presence of symptoms. Management of this disorder should be directed toward resolution of the symptoms while preserving meniscal tissue and function. Modern surgical techniques make suturing and preservation of meniscal tissue feasible. In the present article, the clinical manifestations, diagnostic criteria and practical management considerations are reviewed.
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Affiliation(s)
- Ye Sun
- The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Ashraf S, Wibberley H, Mapp PI, Hill R, Wilson D, Walsh DA. Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis. Ann Rheum Dis 2011; 70:523-9. [PMID: 21081524 DOI: 10.1136/ard.2010.137844] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Meniscal damage is a recognised feature of knee osteoarthritis (OA), although its clinical relevance remains uncertain. This study describes vascular penetration and nerve growth in human menisci, providing a potential mechanism for the genesis of pain in knee OA. METHODS Menisci obtained post mortem were screened on the basis of high or low macroscopic tibiofemoral chondropathy as a measure of the presence and degree of OA. Forty cases (20 per group) were selected for the study of meniscal vascularity, and 16 (eight per group) for the study of meniscal innervation. Antibodies directed against α-actin and calcitonin gene-related peptide (CGRP) were used to localise blood vessels and nerves by histochemistry. Image analysis was used to compare vascular and nerve densities between groups. Data are presented as median (IQR). RESULTS Menisci from knees with high chondropathy displayed degeneration of collagen bundles in their outer regions, which were more vascular than the inner regions, with an abrupt decrease in vascularity at the fibrocartilage junction. Vascular densities were increased in menisci from the high compared with low chondropathy group both in the synovium (3.8% (IQR 2.6-5.2), 2.0% (IQR 1.4-2.9), p=0.002) and at the fibrocartilage junction (2.3% (IQR 1.7-3.1), 1.1% (IQR 0.8-1.9), p=0.003), with a greater density of perivascular sensory nerve profiles in the outer region (high chondropathy group, 144 nerve profiles/mm(2) (IQR 134-189); low chondropathy group, 119 nerve profiles/mm(2) (IQR 104-144), p=0.049). CONCLUSION Tibiofemoral chondropathy is associated with altered matrix structure, increased vascular penetration, and increased sensory nerve densities in the medial meniscus. The authors suggest therefore that angiogenesis and associated sensory nerve growth in menisci may contribute to pain in knee OA.
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Affiliation(s)
- Sadaf Ashraf
- Academic Rheumatology, Arthritis Research UK Pain Centre, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Zarins Z, Bolbos R, Pialat JB, Link T, Li X, Souza R, Majumdar S. Cartilage and meniscus assessment using T1rho and T2 measurements in healthy subjects and patients with osteoarthritis. Osteoarthritis Cartilage 2010; 18:1408-16. [PMID: 20696262 PMCID: PMC2975868 DOI: 10.1016/j.joca.2010.07.012] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/06/2010] [Accepted: 07/20/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate meniscal degeneration in healthy subjects and subjects with osteoarthritis (OA) using T(1ρ) and T(2) measurements and to examine the interrelationship between cartilage and meniscus abnormalities. METHODS Quantitative assessment of cartilage and meniscus was performed using 3T Magnetic Resonance Imaging (MRI) with a T(1ρ) and T(2) mapping technique in 19 controls and 44 OA patients. A sagittal T(2)-weighted fast spin echo (FSE) fat-saturated image was acquired for cartilage and meniscal Whole-Organ Magnetic Resonance Imaging Score (WORMS) assessment. Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores were obtained to assess clinical symptoms. RESULTS The posterior horn of the medial meniscus (PHMED) had the highest incidence of degeneration. Stratifying subjects on the basis of PHMED grade revealed that the T(1ρ) and the T(2) measurements of the PHMED and the medial tibial (MT) cartilage were higher in subjects having a meniscal tear (meniscal grade 2-4) compared to subjects with a meniscal grade of 0 or 1 (P<0.05). While not statistically significant, there was a trend for T(1ρ) and T(2) being higher in PHMED grade 1 compared to grade 0 (P=0.094, P=0.073 respectively). WOMAC scores had a stronger correlation with meniscus relaxation measures than cartilage measures. CONCLUSIONS Magnetic Resonance (MR) T(1ρ) and T(2) measurements provide a non-invasive means of detecting and quantifying the severity of meniscal degeneration. Meniscal damage has been implicated in OA progression and is correlated with cartilage degeneration. Early detection of meniscal damage represented by elevations in meniscal relaxation measures may identify subjects at increased risk for OA.
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Affiliation(s)
- Z.A. Zarins
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
| | - R.I. Bolbos
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
| | - J. B. Pialat
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA,INSERM Research Unit 831, University of Lyon and Hospices Civils de Lyon, Lyon, France
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
| | | | - R.B. Souza
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA,INSERM Research Unit 831, University of Lyon and Hospices Civils de Lyon, Lyon, France
| | - S. Majumdar
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, USA
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Stärke C, Kopf S, Gröbel KH, Becker R. The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 2010; 26:358-65. [PMID: 20206046 DOI: 10.1016/j.arthro.2009.08.013] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/19/2009] [Accepted: 08/15/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this biomechanical study was to investigate the potential effect of a nonanatomic repair of the meniscal horn attachment on the resultant circumferential tension in a large animal model and to show that the circumferential tension of the meniscus affects the local stress of the cartilage. METHODS All investigations were done in the medial compartment of porcine knees. First, the anterior horn attachment of the meniscus was mechanically separated from the surrounding tibial bone and fitted with a force transducer (n = 8). The femorotibial joint was loaded in compression at different flexion angles, and the resultant tension at the horn attachment was recorded. The measurements were done with the horn attachment at its anatomic position and repeated with the horn attachment being displaced medially or laterally by 3 mm. In the second part the local deformation of the cartilage under a femorotibial compressive load was measured at different levels of meniscal hoop tension (n = 5). RESULTS A nonanatomic position of the horn attachment had a significant effect on the resultant tension (P < .01). Placing the horn attachment 3 mm medially decreased the tension at the horn attachment by 49% to 73%, depending on flexion angle and femorotibial load. The opposite placement resulted in a relative increase in the tension by 28% to 68%. Lower levels of meniscal hoop tension caused increased deformation of the cartilage (P < .05), indicating increased local stress. CONCLUSIONS A nonanatomic position of the horn attachment strongly affects conversion of femorotibial loads into circumferential tension. There is a narrow window for a functionally sufficient repair of meniscal root tears. CLINICAL RELEVANCE Although clinical inferences are limited because the specimens used were from a different species, there seems to be only a narrow window for a mechanically sufficient repair of root tears.
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Affiliation(s)
- Christian Stärke
- Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120Magdeburg, Germany.
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T2 measurements of cartilage in osteoarthritis patients with meniscal tears. AJR Am J Roentgenol 2009; 193:W411-5. [PMID: 19843720 DOI: 10.2214/ajr.08.2256] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study was to quantitatively assess cartilage degeneration via T2 mapping to compare patients with and those without meniscal tears. SUBJECTS AND METHODS Thirty-seven patients (18 men, mean age +/- SD, 65.7 +/- 7.8 years; 19 women, mean age, 63.8 +/- 12.0 years) with clinical symptoms of osteoarthritis were studied on 3-T MRI using a 2D multiecho spin-echo sequence for T2 mapping. Meniscal signal and morphology were qualitatively graded and correlated to the T2 values of cartilage. Analysis of covariance, Bonferroni multiple comparison correction, and Spearman's correlation coefficients were used for statistical analysis. RESULTS Patients with meniscal tears (median +/- interquartile range, 50.1 +/- 6.1 milliseconds) had significantly (p = 0.021) higher T2 values of cartilage than those without meniscal tears (45.7 +/- 4.8 milliseconds). T2 values of cartilage were significantly higher in the medial compartment than in the lateral compartment in patients with medial meniscal tears (p = 0.018). CONCLUSION T2 measurements are increased in patients with meniscal tears; this finding adds support to the theory of an association of osteoarthritis with damage to both the menisci and hyaline cartilage.
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Tsai PH, Chou MC, Lee HS, Lee CH, Chung HW, Chang YC, Huang GS. MR T2 values of the knee menisci in the healthy young population: zonal and sex differences. Osteoarthritis Cartilage 2009; 17:988-94. [PMID: 19332176 DOI: 10.1016/j.joca.2009.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/21/2009] [Accepted: 03/06/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The magnetic resonance (MR) T2 value of the cartilage, which has been shown in the articular cartilage to correlate with collagen fiber orientation and water content, may be helpful for early detection of chondropathy. However, the measurement and significance of MR T2 value for knee meniscus have not been well established. The purpose of this study was to investigate whether the MR T2 values in the diverse zones of the posterior horn of the knee meniscus differ between sexes in a young healthy population. METHOD Twenty healthy volunteers, 10 men and 10 women (aged from 22 to 32 years), were enrolled for MR imaging of the right knee menisci. The T2 values of the posterior horns of the medial and lateral knee menisci were measured for the white zone, red/white zone, and red zone on images acquired with fat-suppressed multislice turbo spin-echo sequence at 3.0 T. RESULTS The T2 value, with medial and lateral menisci considered together, increased significantly from the inner white zone (T2=8.02+/-0.60 ms), to the red/white zone (T2=8.78+/-0.99 ms), and to the outer red zone (T2=12.22+/-0.92 ms) of the posterior horns of the menisci (P<0.001). A generalized estimating equation method and multiple linear regression model showed that the T2 values averaged for the medial and lateral menisci together in the red and red/white zones were significantly lower in men than in women by 1.320 ms (P=0.002) and 0.865 ms (P<0.001), respectively, while the white zone showed no significant difference (P=0.694) between men (8.08+/-0.63 ms) and women (7.98+/-0.60 ms). CONCLUSION Zonal and sex differences in the MR T2 values in the posterior horns of the knee menisci exist in the young healthy population. These differences may be associated with sex differences in the occurrence of knee osteoarthritis.
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Affiliation(s)
- P-H Tsai
- Graduate Institute of Biomedical Electronics and Bioinformatics, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Rytter S, Jensen LK, Bonde JP, Jurik AG, Egund N. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. J Rheumatol 2009; 36:1512-9. [PMID: 19411395 DOI: 10.3899/jrheum.081150] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the association between occupational kneeling and degenerative meniscal tears. METHODS Magnetic resonance imaging (MRI) of both knees was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42-70 yrs). The presence of grade 3 MRI signal intensities indicating degenerative tears of the anterior, middle, and posterior one-third of the lateral and medial menisci was assessed on 1.5-Tesla MRI scans. The odds ratio (OR) of meniscal tears was determined among floor layers compared to graphic designers. Using logistic regression, models were adjusted for age, body mass index, and knee-straining sports. RESULTS Degenerative tears were significantly more prevalent in the medial meniscus among floor layers than among graphic designers [OR 2.28, 95% confidence interval (CI) 1.10-4.98] and significantly more floor layers had medial tears in both knees (OR 3.46, 95% CI 1.41-8.48). Tears extending to the tibial aspect and localized in the middle and posterior one-third of the medial meniscus were most prevalent. Lateral meniscal tears were predominantly unilateral and the prevalence of lateral tears did not differ between the 2 study groups. Knee complaints occurred in about 50% of all floor layers, irrespective of the presence of meniscal tears. CONCLUSION Occupational kneeling increases the risk of degenerative tears in the medial but not the lateral menisci in both knees.
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Affiliation(s)
- Søren Rytter
- Department of Orthopaedics, Regional Hospital Viborg, DK-8800 Viborg, Denmark.
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Rytter S, Jensen LK, Bonde JP. Clinical knee findings in floor layers with focus on meniscal status. BMC Musculoskelet Disord 2008; 9:144. [PMID: 18945344 PMCID: PMC2596134 DOI: 10.1186/1471-2474-9-144] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 10/22/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the prevalence of self-reported and clinical knee morbidity among floor layers compared to a group of graphic designers, with special attention to meniscal status. METHODS We obtained information about knee complaints by questionnaire and conducted a bilateral clinical and radiographic knee examination in 134 male floor layers and 120 male graphic designers. After the exclusion of subjects with reports of earlier knee injuries the odds ratio (OR) with 95% confidence intervals (CI) of knee complaints and clinical findings were computed among floor layers compared to graphic designers, using logistic regression. Estimates were adjusted for effects of body mass index, age and knee straining sports. Using radiographic evaluations, we conducted side-specific sensitivity analyses regarding clinical signs of meniscal lesions after the exclusion of participants with tibiofemoral (TF) osteoarthritis (OA). RESULTS Reports of knee pain (OR = 2.7, 95% CI = 1.5-4.6), pain during stair walking (OR = 2.2, 95% CI = 1.3-3.9) and symptoms of catching of the knee joint (OR = 2.9, 95% CI = 1.4-5.7) were more prevalent among floor layers compared to graphic designers. Additionally, significant more floor layers than graphic designers had clinical signs suggesting possible meniscal lesions: a positive McMurray test (OR = 2.4, 95% CI = 1.1-5.0) and TF joint line tenderness (OR = 5.4, 95% CI = 2.4-12.0). Excluding floor layers (n = 22) and graphic designers (n = 15) with radiographic TF OA did not alter this trend between the two study groups: a positive McMurray test (OR = 2.2, 95% CI = 1.0-4.9), TF joint line tenderness (OR = 5.0, 95% CI = 2.0-12.5). CONCLUSION Results indicate that floor layers have a high prevalence of both self-reported and clinical knee morbidity. Clinical knee findings suggesting possible meniscal lesions were significant more prevalent among floor layers compared to a group of low-level exposed graphic designers and an association with occupational kneeling could be possible. However, causality cannot be confirmed due to the cross-sectional study design.
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Affiliation(s)
- Søren Rytter
- Department of Orthopaedics, Regional Hospital Viborg, Denmark.
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