Negative Pain Thoughts Questionnaire Short Form (NPTQ-SF) Scores and Outcomes After Arthroscopic Meniscectomy.

BACKGROUND: Pain is multifactorial, and pain intensity has been shown to be influenced by patients' thoughts. The Negative Pain Thoughts Questionnaire Short Form (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between negative pain thoughts and orthopaedic surgery outcomes is not known. PURPOSE: To evaluate the prevalence of negative pain thoughts in patients undergoing arthroscopic meniscectomy using the NPTQ-SF survey and assess the relationship these thoughts have to knee function, general health, pain, and satisfaction before and after surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In total, 146 patients undergoing arthroscopic meniscectomy were administered the 4-item NPTQ-SF, 12-item Short Form Survey (SF-12), International Knee Documentation Committee (IKDC) questionnaire, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed at a minimum of 3 months and no later than 1 year postoperatively by 92 patients confirmed to have undergone meniscectomy. RESULTS: NPTQ-SF scores were correlated with IKDC, SF-12, and satisfaction score preoperatively and at least 3 months postoperatively (mean, 108.5 ± 43.7 days). Preoperative NPTQ-SF scores were significantly negatively correlated with postoperative IKDC (R = -0.284), SF-12 (R = -0.266 and -0.328), and visual analog scale pain (R = 0.294) scores, while a relationship with postoperative satisfaction did not reach statistical significance (P = .067). Patients with a preoperative NPTQ-SF score >8 were less likely to achieve a Patient Acceptable Symptom State on the postoperative IKDC questionnaire (39% vs 63%; P = .03). Patients with a history of a psychiatric or chronic pain diagnoses have worse NPTQ-SF, SF-12, and IKDC scores pre- and postoperatively. CONCLUSION: The level of negative pain thoughts in patients undergoing meniscectomy is related to knee function, general health, and pain. Patients with a high level of negative pain thoughts are less likely to achieve a favorable outcome from meniscectomy, with a score ≥8 representing a clinically significant threshold for preoperative screening.

Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study.

BACKGROUND: Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus. HYPOTHESIS: Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy. STUDY DESIGN: Controlled laboratory study. METHODS: Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint. RESULTS: Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° (P = .008 and P < .001, respectively), increased peak contact pressure at 30° (P = .04), and decreased mean contact area in all flexion angles compared with the native condition (P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° (P = .002 and P = .003, respectively) and increased contact area at 30° and 60° (P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy (P > .05). CONCLUSION: The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status. CLINICAL RELEVANCE: Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 10-Year Follow-up of a Prospective, Randomized Controlled Trial.

BACKGROUND: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. PURPOSE: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. RESULTS: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P≥ .999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P = .301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. CONCLUSION: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment-including exercise therapy for ≥3 months-does not relieve patient's symptoms. REGISTRATION: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier).

Resiliency Does Not Correlate With Outcome Scores After Meniscectomy.

BACKGROUND: Resilience is a psychometric parameter defined as one's ability to recover or bounce back from stressful events and has been shown to correlate with better outcomes following multiple orthopedic procedures. The purpose of this study was to analyze the correlation between resiliency, as measured using the Brief Resiliency Scale (BRS) and various knee outcome scores, including the International Knee Documentation Committee (IKDC), Lysholm, Single Assessment Numeric Evaluation (SANE), and Return to Work, following isolated partial meniscectomy. METHODS: One hundred patients who had undergone an isolated partial meniscectomy during a 3-year period at a single institution were successfully recruited to participate in the study. The BRS and knee outcome scores (IKDC, Lysholm, SANE, Return to Work) were obtained via phone. Radiographs for each patient were obtained and graded for arthritis severity using the Kellgren-Lawrence classification system. RESULTS: Brief Resiliency Scale scores ranged 15.0 to 23.0 with a mean of 18.2 ± 1.3. Mean knee outcome scores for IKDC, Lysholm, SANE, and Return to Work were 66.3, 77.1, 70.6, and 41.0, respectively. Outcome scores did not correlate with BRS scores. The severe arthritis group significantly correlated (p < 0.05) with worse IKDC, Lysholm, and Return to Work scores compared to mild arthritis scores. Additionally, analysis of the mild arthritis group revealed that resiliency significantly correlated with higher Return to Work scores compared to low resilience groups. CONCLUSION: This study suggests that there is no significant relationship between patient resiliency and outcomes following partial meniscectomy. However, those with poorer outcomes had more severe arthritis.

Low meniscus reoperation rates following meniscus repair during anterior cruciate ligament reconstruction in Turkey: an in-depth national analysis of 8-years.

BACKGROUND: Concomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise. PURPOSE: The objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR. METHODS: All patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group. RESULTS: A total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% (p < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates. CONCLUSION: The propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.

Secondary Meniscectomy Rates and Risk Factors for Failed Repair of Ramp Lesions Performed at the Time of Primary ACL Reconstruction: An Analysis of 1037 Patients From the SANTI Study Group.

BACKGROUND: Studies evaluating secondary meniscectomy rates and risk factors for failure of ramp repair are sparse and limited by small numbers and heterogeneity. PURPOSES/HYPOTHESIS: The purposes were to determine the secondary meniscectomy rate for failure of ramp repair performed using a posteromedial portal suture hook at the time of anterior cruciate ligament reconstruction (ACLR) and to identify risk factors for secondary meniscectomy. It was hypothesized that patients who underwent ACLR combined with a lateral extra-articular procedure (LEAP) would experience significantly lower rates of secondary meniscectomy compared with those undergoing isolated ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Patients undergoing primary ACLR and ramp repair between 2013 and 2020 were included in the study. Final follow-up for each patient was defined by his or her last appointment recorded in a prospective database (with a study end date of March 2023). The database and medical records were used to determine whether patients had undergone secondary meniscectomy for failure of ramp repair. Survivorship of ramp repair (using secondary meniscectomy as an endpoint) was determined using the Kaplan-Meier method. Multivariate analysis was used to investigate possible risk factors. RESULTS: A total of 1037 patients were included in the study. The secondary meniscectomy rate after ramp repair was 7.7% at a mean final follow-up of 72.4 months. Patients without combined ACLR + LEAP were >2-fold more likely to undergo a secondary medial meniscectomy compared with those with combined ACLR + LEAP (hazard ratio, 2.455; 95% CI, 1.457-4.135; P = .0007). Age, sex, preoperative Tegner score, and time between injury and surgery were not significant risk factors for failure. CONCLUSION: The rate of secondary meniscectomy after ramp repair performed through a posteromedial portal at the time of primary ACLR was low. Patients who underwent isolated ACLR (rather than ACLR + LEAP) were >2-fold more likely to undergo a secondary medial meniscectomy for failure of ramp repair. Additional risk factors for failure of ramp repair were not identified.

Using a combination of three clinical tests for detecting meniscal tears increases the accuracy of the clinical examination.

BACKGROUND: Recent studies indicate that using combination of two or more clinical tests for detecting meniscal tear gets a higher sensitivity and specificity than any clinical test performed individually. METHODS: The study involved 84 participants who were divided into two groups: the "OP group" consisting of participants diagnosed with a meniscal tear and who consequently underwent arthroscopic meniscectomy, and the "CN group" comprising of healthy participants with no history of knee injury. Two independent observers (orthopedic surgeons) recorded the results of six clinical tests: Thessaly Test, joint line tenderness, McMurray Test, Ege Test, Steinmann I Test, and atrophy of the thigh muscles. The tests were grouped into two combinations of three tests each. The first combination included Thessaly Test, joint line tenderness and McMurray Test, while the second combination comprised of remaining three tests. Cochran's Q Test was used to calculate interobserver variability for both combinations of clinical tests and for each test performed individually. RESULTS: First combination of three clinical tests when considering the combination positive if two tests are positive had high sensitivity of 95%, specificity of 90.9%, and an overall accuracy of 92.9%. Furthermore, when compared to clinical tests performed individually, the combination demonstrated superior results. CONCLUSIONS: This study shows that using a combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test), when considering the combination positive if two tests are positive, has greater accuracy than six clinical tests performed individually. There were no statistically significant differences between observers.

Arthroscopic Partial Meniscectomy for a Degenerative Meniscus Tear Is Not Cost Effective Compared With Placebo Surgery: An Economic Evaluation Based on the FIDELITY Trial Data.

BACKGROUND: In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial meniscectomy (APM) over conservative treatment or placebo surgery. Yet, advocates of APM still argue that APM is cost effective. Giving advocates of APM their due, we note that there is evidence from the treatment of other musculoskeletal complaints to suggest that a treatment may prove cost effective even in the absence of improvements in efficacy outcomes, as it may lead to other benefits, such as diminished productivity loss and reduced costs, and so the question of cost effectiveness needs to be answered for APM. QUESTIONS/PURPOSES: (1) Does APM result in lower postoperative costs compared with placebo surgery? (2) Is APM cost-effective compared with placebo surgery? METHODS: One hundred forty-six adults aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis according to the American College of Rheumatology clinical criteria were randomized to APM (n = 70) or placebo surgery (n = 76). In the APM and placebo surgery groups, mean age was 52 ± 7 years and 52 ± 7 years, and 60% (42 of 70) and 62% (47 of 76) of participants were men, respectively. There were no between-group differences in baseline characteristics. In both groups, a standard diagnostic arthroscopy was first performed. Thereafter, in the APM group, the torn meniscus was trimmed to solid meniscus tissue, whereas in the placebo surgery group, APM was carefully mimicked but no resection of meniscal tissue was performed; as such, surgical costs were the same in both arms and were not included in the analyses. All patients received identical postoperative care including a graduated home-based exercise program. At the 2-year follow-up, two patients were lost to follow-up, both in the placebo surgery group. Cost effectiveness over the 2-year trial period was computed as incremental net monetary benefit (INMB) for improvements in quality-adjusted life years (QALY), using both the societal (primary) and healthcare system (secondary) perspectives. To be able to consider APM cost effective, the CEA analysis should yield a positive INMB value. Nonparametric bootstrapping was used to assess uncertainty. Several one-way sensitivity analyses were also performed. RESULTS: APM did not deliver lower postoperative costs, nor did it convincingly improve quality of life scores when compared with placebo surgery. From a societal perspective, APM was associated with € 971 (95% CI -2013 to 4017) higher costs and 0.015 (95% CI -0.011 to 0.041) improved QALYs over 2-year follow-up compared with placebo surgery. Both differences were statistically inconclusive (a wide 95% CI that crossed the line of no difference). Using the conventional willingness to pay (WTP) threshold of € 35,000 per QALY, APM resulted in a negative INMB of € -460 (95% CI -3757 to 2698). In our analysis, APM would result in a positive INMB only when the WTP threshold rises to about € 65,000 per QALY. The wide 95% CIs suggests uncertain cost effectiveness irrespective of chosen WTP threshold. CONCLUSION: The results of this study lend further support to clinical practice guidelines recommending against the use of APM in patients with a degenerative meniscus tear. Given the robustness of existing evidence demonstrating no benefit or cost effectiveness of APM over nonsurgical treatment or placebo surgery, future research is unlikely to alter this conclusion.Level of Evidence Level III, economic analysis.

Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (MeTeOR2): a study protocol.

INTRODUCTION: Pain and disability after meniscectomy can be a substantial lifelong problem. There are few treatment options, especially for young people. Non-surgical management (rehabilitation) is an option but increasingly surgeons are performing meniscal allograft transplants (MATs) for these individuals. However, this is still an uncommon procedure, and availability and usage of MAT vary widely both in the UK and internationally. It is not known which treatment option is the most effective and cost-effective. METHODS AND ANALYSIS: The Meniscal Transplant surgery or Optimised Rehabilitation trial is an international, multicentre, randomised controlled trial. The aim is to compare the clinical and cost effectiveness of MAT versus an optimised package of individualised, progressive, rehabilitation that we have called personalised knee therapy (PKT).Participants will be recruited from sites across the UK, Australia, Canada and Belgium. The planned 144 participants provide at least 90% power to detect a 10-point difference in the Knee injury and Osteoarthritis Outcome Score (KOOS4) at 24-months post randomisation (primary outcome). A prospectively planned economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including health utility, occupational status, sports participation, mental well-being, further treatment, and adverse events will be collected at 3, 6, 12, 18, and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement. ETHICS AND DISSEMINATION: The trial was approved by the London-Bloomsbury Research Ethics Committee on 19 August 2022 (22/LO/0327) and Northern Sydney Local Health District Human Research Ethics Committee, NSW, Australia on the 13 March 2023 (2022/ETH01890).Trial results will be disseminated via peer-reviewed publications, presentations at international conferences, in lay summaries and using social media as appropriate.This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. TRIAL REGISTRATION NUMBER: ISRCTN87336549.

Higher odds of meniscectomy compared with meniscus repair in a young patient population with increased neighbourhood disadvantage.

OBJECTIVES: To investigate the impact of demographic and socioeconomic factors on the management of isolated meniscus tears in young patients and to identify trends in surgical management of meniscus tears based on surgeon volume. METHODS: Data from a large healthcare system on patients aged 14-44 years who underwent isolated meniscus surgery between 2016 and 2022 were analysed. Patient demographics, socioeconomic factors and surgeon volume were recorded. Patient age was categorised as 14-29 years and 30-44 years old. Area Deprivation Index (ADI), a measure of neighbourhood disadvantage with increased ADI corresponding to more disadvantage, was grouped as <25th, 25-75th and >75th percentile. Multivariate comparisons were made between procedure groups while univariate comparisons were made between surgeon groups. RESULTS: The study included 1552 patients treated by 84 orthopaedic surgeons. Older age and higher ADI were associated with higher odds of undergoing meniscectomy. Patients of older age and with non-private insurance were more likely to undergo treatment by a lower-volume knee surgeon. Apart from the year 2022, higher-volume knee surgeons performed significantly higher rates of meniscus repair compared with lower-volume knee surgeons. When controlling for surgeon volume, higher ADI remained a significant predictor of undergoing meniscectomy over meniscus repair. CONCLUSION: Significant associations exist between patient factors and surgical choices for isolated meniscus tears in younger patients. Patients of older age and with increased neighbourhood disadvantage were more likely to undergo meniscectomy versus meniscus repair. While higher-volume knee surgeons favoured meniscus repair, a growing trend of meniscus repair rates was observed among lower-volume knee surgeons. LEVEL OF EVIDENCE: Retrospective cohort study, level III.

The pie-crusting release of the medial collateral ligament in arthroscopic partial meniscectomy is associated with improved clinical outcomes without altering radiological measurements.

PURPOSE: The aim of this study was to evaluate how the pie-crusting technique affects clinical and radiological outcomes in patients undergoing arthroscopic partial meniscectomy. METHODS: A total of 68 patients with Kellgren-Lawrence (K-L) grade 2 who underwent arthroscopic partial meniscectomy between 2015 and 2021 were evaluated and divided into two groups as arthroscopic partial meniscectomy (36 patients) and arthroscopic partial meniscectomy with pie-crusting (32 patients) according to whether the pie-crusting technique was applied or not. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and Visual Analogue Scale (VAS) score. To assess the impact of the pie-crusting technique, radiological measurements were conducted using radiographs taken before and after pie-crusting, as well as postoperative radiographs. RESULTS: Lysholm, Tegner, IKDC and VAS scores exhibited statistically significant differences after surgery compared to preoperative evaluations in both groups (p < 0.05). Furthermore, these scores were significantly superior in the arthroscopic partial meniscectomy with pie-crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively (p < 0.05). While the radiological measurements in the arthroscopic partial meniscectomy with pie-crusting group showed statistically significant differences before and after pie-crusting (p < 0.05), no significant difference was observed between before pie-crusting and 12 and 24 months postoperatively (n.s.). CONCLUSION: The current study is the first to demonstrate the true effectiveness of the pie-crusting technique. The application of the pie-crusting technique when necessary results in a statistically significant improvement in clinical scores without affecting radiological measurements for patients undergoing arthroscopic partial meniscectomy compared to not utilising it. LEVEL OF EVIDENCE: Level III.

Osteoarthritis Development Following Meniscectomy vs. Meniscal Repair for Posterior Medial Meniscus Injuries: A Systematic Review.

This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.

High-resolution magnetic resonance imaging can predict osteoarthritic progression after medial meniscus posterior root injury: randomized in vivo experimental study in a rabbit model.

IMPORTANCE: The field of meniscal root preservation has undergone significant advancement over the past decades; however, the challenge remains to fully understand whether meniscal root repair can ultimately arrest or delay osteoarthritic changes. OBJECTIVE: To assess longitudinal changes in articular cartilage, subchondral bone, and progression to meniscal extrusion (ME) using high-resolution magnetic resonance imaging (MRI). METHODS: Medial meniscus posterior root tear was surgically induced in 39 New Zealand white rabbits. Animals were randomly assigned into three experimental groups: partial meniscectomy after root tear (PM, n â€‹= â€‹13); root tear left in situ (CT, n â€‹= â€‹13); and transtibial root repair (RR, n â€‹= â€‹13). Contralateral limbs were used as healthy controls. High resolution 4.7 Tesla MRI of the knee joint was performed at baseline, after 2-, and 4-months of post-surgery. Cartilage thickness was calculated in medial and lateral compartments. In addition, the evaluation of ME, subchondral bone edema and healing potential after root repair were assessed too. RESULTS: Progressive cartilage thinning, ME, and subchondral bone edema were evident in all 3 study groups after 4-months of follow-up. The mean cartilage thickness in the PM group was 0.53 â€‹mm (±0.050), 0.57 â€‹mm (±0.05) in the CT group, and 0.60 â€‹mm (±0.08) in the RR group. The PM group exhibited significantly higher cartilage loss when compared to the CT and RR groups (p â€‹< â€‹0.001). Moreover, progressive ME and subchondral bone edema were associated with a more severe cartilage loss at the final follow-up. CONCLUSION: Meniscal root repair did not halt but rather reduced the progression of osteoarthritis (OA). Degenerative changes worsened at a rapid rate in the PM group compared to the RR and CT groups. Early cartilage swelling, persistent subchondral edema, and progressive ME predicted a more severe progression to knee OA in the CT and RR groups. LEVEL OF EVIDENCE: II.

Conversion to knee arthroplasty is more common after meniscectomy than meniscus repair in patients older than age 40.

PURPOSE: To describe rates of conversion to unicompartmental or total knee arthroplasty (KA) in patients over the age of 40 years (at initial surgery) after partial meniscectomy (ME) or meniscal repair (MR). METHODS: Patients over the age of 40 undergoing isolated ME or MR between 2016 and 2018 were extracted from a single healthcare provider database. Data on patient characteristics, type of initial surgery, number of returns to the operating room, as well as performed procedures, including conversion to KA, were recorded. Comparative group statistics as well as a Kaplan-Meier survival rate analysis were performed. RESULTS: A total of 3638 patients (47.8% female) were included, with 3520 (96.8%) undergoing ME and 118 (3.2%) MR. Overall, 378 (10.4%) patients returned to the OR at an average of 22.7 ± 17.3 months postoperatively. Conversion to KA was performed more frequently in patients after primary ME (n = 270, 7.7%) compared to those with MR (2.5%, n = 3, odds ratio [OR]: 3.2, p = 0.03). Compared to ME (2.3%, n = 82), two times as many patients undergoing MR returned for subsequent meniscus surgery (MR: 5.9%, n = 7, OR: 2.6, p = 0.02). Time from primary surgery to KA (ME: 22 ± 17 months, MR: 25 ± 15 months, p = 0.96) did not differ between the treatment groups. Survivorship was 95% for ME and 98.2% for MR after 24 months (p = 0.76) and 92.5% and 98.2% after 60 months (p = 0.07), respectively. CONCLUSION: The overall reoperation rate after meniscal surgery was 10.4% in patients over the age of 40 years. Patients treated with primary ME have over three times higher odds to undergo subsequent KA compared to those treated with MR. However, patients with primary MR have a higher rate of subsequent meniscus surgery compared to those undergoing primary ME. This information is important when considering and treating a patient over the age of 40 and meniscal injury. LEVEL OF EVIDENCE: Level III study.

Preoperative Predictors of Patient-Reported Outcomes Following Arthroscopic Partial Meniscectomy.

The purpose of this study is to evaluate the effect of patient demographics and injury characteristics on post-arthroscopic partial meniscectomy (post-APM) patient-reported outcomes (PROs). We hypothesize that the presence of high-grade (Kellgren-Lawrence grades 3-4) arthritis at any location of the knee (medial and lateral compartments, patella, trochlea), comorbidities (psychiatric history, chronic pain, diabetes, smoking, body mass index [BMI] ≥ 30), and lower scores on preoperative patient-reported measures (36-Item Short Form Health Survey [SF-36]) would predict poor outcomes after APM. We conducted a single-center prospective study of 92 patients who underwent APM surgery for associated knee pain. General demographic information and PROs were prospectively collected using SF-12, SF-36, and International Knee Documentation Committee (IKDC) surveys presurgery and at 6-month follow-up. Postsurgery outcomes were patient-reported satisfaction (yes/no) and obtaining a patient-acceptable symptom state (PASS) on IKDC. Data were analyzed with odds ratios (ORs), binomial logistic regression, and Mann-Whitney U test using IBM SPSS software. Demographic and injury characteristics that were poor prognostic indicators (had a decreased likelihood of obtaining PASS on IKDC postsurgery) included having Medicaid insurance (OR: 0.056; 0.003-1.00), chronic pain (OR: 0.106; 0.013-0.873), acute injury (OR: 0.387; 0.164-0.914), and high-grade (KL grades 3-4) medial compartment arthritis (OR: 0.412; 0.174-0.980), and preoperative SF-36 physical health score (PHS; p = 0.023) and mental health score (MHS; p = 0.006) values less than 47 and 48, respectively. Additionally, former smoking history (OR: 0.271; 0.079-0.928) showed a lower likelihood of being satisfied postsurgery. Not having psychiatric history (OR: 14.925; p < 0.001; increased likelihood of obtaining PASS on IKDC score postsurgery) and not having patellar arthritis (OR: 4.082; p = 0.025; increased likelihood of PASS on IKDC) were positive prognostic indicators. This study identifies predictive factors of poor outcomes post-APM; particularly, it highlights the usefulness of SF-36 surveys prior to APM surgery. Patients with low SF-36 score preoperatively may not find APM acceptable. Additional attention should be put on patient demographics (such as psychiatric history, chronic pain, and insurance type) and injury characteristics (presence of arthritis and acute injury) prior to performing APM. LEVEL OF EVIDENCE: II.

Arthroscopic inferior leaf meniscectomy of the involved anterior horn in the lateral meniscus horizontal tear via an accessary extreme far anteromedial portal.

BACKGROUND: An accessory extreme far anteromedial portal can improve visualisation and ease inferior leaf meniscectomy in patients with lateral meniscal anterior horn horizontal tears. However, the therapeutic outcomes of adding an accessory extreme far anteromedial portal remain unclear. This study aimed to evaluate the clinical efficacy of adding an accessory extreme far anteromedial portal for treating lateral meniscal horizontal tears involving the anterior horns. METHODS: This retrospective study included 101 patients with anterior horn involvement in lateral meniscal horizontal tears who underwent arthroscopic unstable inferior leaf meniscectomy between January 2016 and December 2020. The pathologies were diagnosed using physical examinations and magnetic resonance imaging. The anterior horn involved in the lateral meniscal horizontal tears was treated using inferior leaf meniscectomy. The primary endpoints were changes in the visual analogue scale, Lysholm, International Knee Documentation Committee, and Tegner scores at the final follow-up. The secondary endpoint was meniscal cure rate at 3 months postoperatively. The preoperative and postoperative functional scores were compared. The occurrence of complications was recorded. RESULTS: All patients were followed up for an average of 4.9 ± 1.2 years (range 2.3-7.5 years). After 4 months, none of the patients experienced pain, weakness, instability, or tenderness in the lateral joint line, achieving an imaging cure rate of 98%. At the final follow-up, significant postoperative improvements were observed in the average values of the visual analogue scale score (3.5 ± 0.7 vs. 0.7 ± 0.6), Lysholm score (62.7 ± 4.4 vs. 91.8 ± 3.1), International Knee Documentation Committee score (61.9 ± 3.7 vs. 91.7 ± 9.5), and Tegner score (2.0 ± 0.7 vs. 6.1 ± 0.7). Excellent Lysholm scores were obtained in 81 patients, and good outcomes were obtained in 18 patients, with an excellent-to-good rate of 98.0%. CONCLUSIONS: Inferior leaf resection via the accessory far anteromedial portal is a safe treatment option for the involved anterior horn in lateral meniscal horizontal tears. This approach enhances visibility and facilitates surgical procedures, with minimal complications.