Actualización en Patología Meniscal / Update in Meniscal Pathology

Las lesiones meniscales constituyen una de las patologías más frecuentes localizadas en la rodilla. El estudio y conocimiento de la anatomía y de la función de estas estructuras ha ido evolucionando ampliamente en los últimos años, pasando de ser considerada una estructura vestigial embrionaria sin utilidad a una estructura de gran trascendencia en la distribución de cargas de la rodilla, su lubricación y su congruencia articular. El tratamiento de estas lesiones ha ido evolucionando con diferentes técnicas, partiendo de meniscectomías totales hasta la nueva filosofía de preservación del menisco (“Save the meniscus”), incluyendo diferentes procedimientos de reparación que hoy día siguen renovándose a una velocidad vertiginosa. Todo ello dependerá del mecanismo lesional, naturaleza y edad del paciente. Actualmente es todo un desafío desarrollar nuevas terapias y métodos quirúrgicos que conserven la función meniscal. La gran morbilidad musculoesquelética que comportan sus daños obliga a permanecer actualizado en todo momento al profesional para optimizar los tratamientos de los pacientes. Las lesiones meniscales en la actualidad son motivo de una gran cantidad de estudios, en los que se describen múltiples técnicas e interpretación de las diferentes lesiones.(AU)

Meniscal injuries are one of the most frequent pathologies located in the knee. The study and knowledge of the anatomy and the function of these structures has evolved widely in recent years, going from being considered an unuseless embryonic vestigial structure to a structure of great importance in the distribution of loads on the knee, its lubrication and its articular congruence. The treatment of these lesions has evolved with different techniques, starting from total meniscectomies to the new philosophy of meniscus preservation (“save the meniscus”), including different repair procedures that nowadays are still renewing constantly. These techniques will depend on the injury mechanism, nature and age of the patient. At the present time it is a challenge to develop new therapies and surgical methods that preserve meniscal function. The great musculoskeletal morbidity caused by its damage forces the professional to remain updated everytime to optimize patient treatments.Meniscal injuries are currently the subject of a large number of studies, which describe multiple techniques and interpretation of the different injuries.(AU)

Vuelta a la actividad física en pacientes intervenidos de rotura meniscal en asa de cubo en el Hospital Universitario Reina Sofía / Return to physical activity in patients operated on for bucket handle meniscal tear at the Reina Sofía University Hospital

Objetivos: Comparar la vuelta a la actividad deportiva, según el score de Tegner, en los pacientes tratados con meniscectomía o sutura meniscal, en roturas de menisco en asa de cubo. Material y métodos: Se analizaron retrospectivamente 83 pacientes con diagnóstico de rotura meniscal en asa de cubo tratados en el Hospital Reina Sofía de Córdoba entre los años 2014 y 2019.. Se recogieron los datos a través del sistema informático Diraya y mediante encuesta telefónica, debido a la situación actual de pandemia. Se comparó el score de Tegner de aquellos pacientes intervenidos mediante meniscectomía con los que se intervinieron con sutura meniscal. Resultados: 68 pacientes cumplían los criterios de inclusión, 35 fueron tratados con meniscectomía y 33 mediante sutura meniscal. No se encontraron diferencias estadísticamente significativas entre pacientes tratados con meniscectomía o sutura meniscal, con respecto a la vuelta a la actividad física, con el score de Tegner (P=0,5). El IMC influye en la vuelta a la actividad deportiva, con respecto al score de Tegner, de manera significativa (P=0,005). El tiempo de evolución desde la rotura hasta la intervención no influía de manera significativa, en la vuelta a la actividad deportiva con respecto al score de Tegner (P=0,25). Conclusiones: No hemos encontrado diferencias entre realizar sutura meniscal o meniscectomía en la vuelta a la actividad física de los pacientes intervenidos. Hemos encontrado diferencias en el Tegner postoperatorio en los pacientes intervenidos, en función del IMC.(AU)

Background: Bucket-handle meniscal tear is a common pathology that can cause pain and significant disability and that often requires surgery. Surgical treatment can be mainly divided into meniscectomy or meniscal suture. When it comes to rejoining physical activity, which patients return to sport before? Do these procedures achieve the same level of physical activity prior to surgery? ObjectivesTo compare the level of physical activity and return to sports according to Tegner Activity score, in patients who underwent meniscectomy or meniscal suture, in bucket-handle meniscal tears. Design and Methods: Eighty-three patients diagnosed with bucket-handle meniscal tear treated at the Reina Sofía Hospital in Córdoba between 2014 and 2019 were included in this retrospective analysis. Surgeon chose the procedure intraoperatively Patients who did not want to participate in the study and those who did not exercise or play sports regularly were excluded. Data were collected through Diraya health information system and telephone survey, due to the current pandemic situation. The Tegner Activity score of those patients who underwent meniscectomy was compared with those who underwent meniscal suture. Data were analyzed using the SPSS 23 operating system. A p value <0.05 was considered statistically significant. Results: 68 patients met the inclusion criteria, 35 were treated with meniscectomy and 33 with meniscal suture. The mean age of patients who underwent meniscal suture was 29.03 years ± 11.24, in the meniscectomy group it was 35.54 years ± 11.42. The mean BMI of patients with meniscal suture was 25.92 ± 3.71...(AU)

Septic arthritis caused by Staphylococcus caprae following arthroscopic meniscus tear repair in a patient without any foreign device / Artritis séptica causada por Staphylococcus caprae tras reparación artroscópica de menisco en paciente sin material protésico

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Fabella and cyamella of the human knee joint: discovery by dissection and ultrasound examination

Perhaps due to the lack of clinical relevance, several anatomical structures such as the fabella and cyamella of the knee have been overlooked or not included in anatomical textbooks, suggesting that they are not significant enough to be acknowledged. This occurs despite studies that have demonstrated recurrent presence of these particular structures. The purpose of the current study was to characterize the finding of two sesamoid bones from the human knee: the fabella and cyamella. The basis of this study used 111 knees of embalmed cadavers from 74 individuals from the donor bequest programme at The University of Sydney. Of these, 37 were paired knees and 37 were unilateral knees (39 female, 35 male). The mean age of the donors was 84 years (range 45- 97 years). Comparative analysis using ultrasound imaging was performed followed by dissection to confirm findings. Overall, 63 fabellae were found, with 60.8% of the cadavers having at least one fabella (65.7% in male and 56.4% in female). Three cyamellae were found in three donors respectively. Considering all cadavers, the incidence of cyamellae was 2.7%, making this an incidental finding rather than an anatomical variant. Due to the low prevalence, imaging diagnostic techniques may be useful in identifying these anatomical structures and characterising their variations in detail. Furthermore, they could provide an insight to these 'forgotten' structures and their potential roles in failure correlated with surgical techniques, misdiagnoses or prevalence of chronic pathologies of the knee

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