Definition of Synovial Mesenchymal Stem Cells for Meniscus Regeneration by the Mechanism of Action and General Amp1200 Gene Expression.

The quality control (QC) of pharmaceutical-grade cell-therapy products, such as mesenchymal stem cells (MSCs), is challenging. Attempts to develop such products have been hampered by difficulties defining cell-type-specific characteristics and therapeutic mechanisms of action (MoAs). Although we have developed a cell therapy product, FF-31501, consisting of human synovial MSCs (SyMSCs), it was difficult to find specific markers for SyMSCs and to define the cells separately from other MSCs. The purpose of this study was to create a method for identifying and defining SyMSCs from other tissue-derived MSCs and to delve deeper into the mechanism of action of SyMSC-induced meniscus regeneration. Specifically, as a cell-type-dependent approach, we constructed a set of 1143 genes (Amp1200) reported to be associated with MSCs and established a method to evaluate them by correlating gene expression patterns. As a result, it was possible to define SyMSCs separately from other tissue-derived MSCs and non-MSCs. In addition, the gene expression analysis also highlighted TNSF-15. The in vivo rat model of meniscus injury found TNSF-15 to be an essential molecule for meniscus regeneration via SyMSC administration. This molecule and previously reported MoA molecules allowed an MoA-dependent approach to define the mechanism of action for SyMSCs. Therefore, SyMSCs for meniscus regeneration were defined by means of two approaches: the method to separate them from other MSCs and the identification of the MoA molecules. These approaches would be useful for the QC of cell therapy products.

Hyaluronic acid/chitin thermosensitive hydrogel loaded with TGF-ß1 promotes meniscus repair in rabbit meniscus full-thickness tear model.

Repair of the damaged meniscus is a scientific challenge owing to the poor self-healing potential of the white area of the meniscus. Tissue engineering provides a new method for the repair of meniscus injuries. In this study, we explored the superiority of 2% hyaluronic acid chitin hydrogel in temperature sensitivity, in vitro degradation, biocompatibility, cell adhesion, and other biological characteristics, and investigated the advantages of hyaluronic acid (HA) and Transforming Growth Factor ß1 (TGF-ß1) in promoting cell proliferation and a matrix formation phenotype. The hydrogel loaded with HA and TGF-ß1 promoted cell proliferation. The HA + TGF-ß1 mixed group showed the highest glycosaminoglycan (GAG) content and promoted cell migration. Hydroxypropyl chitin (HPCH), HA, and TGF-ß1 were combined to form a composite hydrogel with a concentration of 2% after physical cross-linking, and this was injected into a rabbit model of a meniscus full-thickness tear. After 12 weeks of implantation, the TGF-ß1 + HA/HPCH composite hydrogel was significantly better than HPCH, HA/HPCH, TGF-ß1 + HPCH, and the control group in promoting meniscus repair. In addition, the new meniscus tissue of the TGF-ß1 + HA/HPCH composite hydrogel had a tissue structure and biochemical content similar to that of the normal meniscus tissue.

Iatrogenic Common Peroneal Nerve Injuries From Inside-out Lateral Meniscus Repair: A Report of 2 Cases.

CASES: We report 2 cases of common peroneal nerve (CPN) palsy after inside-out lateral meniscus (LM) repair with very different presentations, occurring despite the standard surgical precautions (open counter incision and proper retraction between the biceps femoris tendon, lateral gastrocnemius, and capsule). On exploration, needle was found to have penetrated the nerve in one case and the nerve sheath in the other case. Patient 1 had near-complete neurological recovery, while patient 2 had partial neurological recovery after suture removal and neurolysis. CONCLUSION: CPN palsy can occur despite following all precautions during LM repair and should be managed as an iatrogenic injury unless proven otherwise.

[Recommendations regarding arthroscopic surgery in the knee joint and the updated National Guidelines for Musculoskeletal Diseases]. / Att göra eller inte göra ­ kloka val kan ibland vara svåra.

The article discusses the Swedish National Board of Health and Welfare's recommendations regarding arthroscopic surgery in the knee joint and the updated National Guidelines for Musculoskeletal Diseases from 2021. It emphasizes the ongoing discussion within the orthopedic profession and aims to summarize constructive discussions between the National Board of Health and Welfare, the Swedish Orthopedic Association, and the National program board for Musculoskeletal Diseases. The text notes a significant decrease in knee arthroscopies due to knee osteoarthritis and degenerative meniscus injuries over the past decade although 5,000 and 6,000 arthroscopies were performed in 2022 due to knee osteoarthritis or degenerative meniscus rupture. The reasons for the continued performance of the procedure are discussed, including the lack of a precise definition of ¼degenerative meniscus rupture« and interpretation differences within the profession. A recent report from the National Board of Health and Welfare indicates that the profession has largely embraced the recommendations from 2012, but there are significant regional differences in the number of performed arthroscopies. The text emphasizes the need for clearer recommendations, refined data collection, and constructive dialogue to improve the implementation of the National Board of Health and Welfare's recommendations and reduce the use of procedures classified as ¼not recommended.« The authors believe that continuous dialogue and follow-up are necessary to decrease the use of procedures not recommended in the guidelines.

The applied study to improve the treatment of knee sports injuries in ultimate frisbee players based on personalized exercise prescription: a randomized controlled trial.

Objective: Ultimate frisbee can lead to severe sports injuries, especially joint injuries in the lower limbs, such as knee meniscus injuries. This study examines the impact of personalized exercise therapy on knee meniscus injuries in ultimate frisbee players in the Lingnan region of China. Methods: Seventy-six patients with confirmed meniscal injuries participated in the study, divided into an intervention group (n = 38) and a control group (n = 38). The control group received standard treatment, including drug therapy and physical therapy. The intervention group received standard treatment plus a personalized exercise regimen based on FITT-VP (frequency, intensity, time, type, volume, and progression) principles, incorporating strength training, aerobic exercise, flexibility training, neuromuscular training, and aquatic exercise. This program was monitored and adjusted over a six-month period through both online and offline methods. The primary outcomes were joint range of motion (ROM), thigh circumference atrophy index (TCAI), Lysholm Rating Scale (LRS) scores, and visual analog scores (VAS). The secondary outcome was the International Knee Documentation Committee (IKDC) score. Data were collected before the intervention, and at 1 month and 6 months after the intervention. Statistical analysis was conducted using SPSS 24.0 and GraphPad 10.0, with a significance level set at α = 0.05. Results: After 1 month, the intervention group showed significantly better results in ROM (116.67 ± 9.063), LRS score (86.316 ± 3.750), and IKDC score (80.473 ± 5.421) compared to the control group (111.784 ± 4.778, 82.579 ± 3.818, and 77.684 ± 4.430, respectively) (p < 0.05). The TCAI (3.219 ± 1.889) and VAS score (1.921 ± 0.673) in the intervention group were significantly lower than those in the control group (5.228 ± 2.131 and 2.710 ± 1.112, respectively) (p < 0.01). After 6 months, the differences in LRS and VAS scores between the groups were not significant. However, the intervention group continued to show significant improvements in ROM (134.934 ± 3.011), TCAI (1.107 ± 1.158), and IKDC score (93.315 ± 1.847) compared to the control group (125.395 ± 18.554, 4.574 ± 1.109, and 87.789 ± 4.437, respectively) (p < 0.05). Conclusion: Personalized exercise prescriptions offer significant therapeutic and rehabilitative benefits for ultimate frisbee players with knee meniscus injuries. This approach helps to reduce symptoms, alleviate pain, and improve joint function, muscle strength, and athletic performance after sports-related injuries.

Arthroscopic Repair of Medial Meniscus Posterior Root Tear with Adjustable Titanium Plate Fixation.

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected individuals. A posterior root tear disrupts the meniscus's continuous annular structure, compromising its ability to absorb pressure and protect the knee's articular cartilage. If left untreated, this can result in increased stress on the cartilage, leading to conditions such as varus deformity and accelerated joint degeneration. Partial removal (resection) of the medial meniscus further exacerbates these issues, often leading to quicker joint deterioration. Repairing medial meniscus posterior root tears (MMPRTs) plays a crucial role in restoring the meniscus's structural integrity and improving knee biomechanics. Studies have shown that compared to partial medial meniscectomy or conservative treatments, repairing MMPRTs enhances clinical outcomes and significantly delays the onset of arthritis. This article details a surgical procedure that uses a single-suture, double-loop, adjustable titanium plate fixation technique under arthroscopy for effective MMPRT repair.

Arthroscopic Centralization of the Medial Meniscus Reduces Load on a Posterior Root Repair Under Dynamic Varus Loading: A Biomechanical Investigation.

BACKGROUND: In addition to the integrity of the meniscal hoop function, both the anterior and posterior meniscus roots as well as the meniscotibial and meniscofemoral ligaments are crucial in restraining meniscal extrusion. However, the interaction and load sharing between the roots and these peripheral attachments (PAs) are not known. PURPOSES: To investigate the influence of an insufficiency of the PAs on the forces acting on a posterior medial meniscus root repair (PMMRR) in both neutral and varus alignment and to explore whether meniscal centralization reduces these forces. STUDY DESIGN: Controlled laboratory study. METHODS: In 8 fresh-frozen human cadaveric knees, an arthroscopic transosseous root repair (step 1) was performed after sectioning the posterior root of the medial meniscus. The pull-out suture was connected to a load cell to allow measurement of the forces acting on the root repair. A medial closing-wedge distal femoral osteotomy was performed to change the mechanical axis from neutral to 5° of varus alignment. The meniscus was completely released from its PAs (step 2), followed by transosseous arthroscopic centralization (step 3). Each step was tested in both neutral and varus alignment. The specimens were subjected to nondestructive dynamic varus loading under axial compression of 300 N in 0°, 15°, 30°, 45°, and 60° flexion. The changes in force acting on the PMMRR were statistically analyzed using a mixed linear model. RESULTS: Axial loading in neutral alignment led to an increase of the force of root repair of 3.1 ± 3.1 N (in 0° flexion) to 6.3 ± 4.4 N (in 60° flexion). In varus alignment, forces increased significantly from 30° (3.5 N; 95% CI, 1.1-5.8 N; P = .01) to 60° (7.1 N; 95% CI, 2.7-11.5 N; P = .007) flexion, in comparison with neutral alignment. Cutting of the PAs in neutral alignment led to a significant increase of root repair forces in all flexion angles, from 7.0 N (95% CI, 1.0-13.0 N; P = .02) to 9.1 N (95% CI, 4.1-14.1 N; P = .003), in comparison with the intact state. Varus alignment significantly increased the forces in the cut states from 4.8 N (95% CI, 1.0-8.5 N; P = .02) to 11.1 N (95% CI, 4.2-18.0 N; P = .006) from 30° to 60° flexion, in comparison with the neutral alignment. Arthroscopic centralization led to restoration of the native forces in both neutral and varus alignment, with no significant differences between the centralized and intact states. CONCLUSION: An insufficiency of the PAs of the medial meniscus, as well as varus alignment, led to increased forces acting on a PMMRR. These forces were reduced via an arthroscopic meniscal centralization. CLINICAL RELEVANCE: Performing arthroscopic meniscal centralization concomitantly with PMMRR may reduce failure of the repair by reducing the load of the root.

Hypermobile Anterior Horn of the Lateral Meniscus: A Retrospective Case-Series Study of Presentation, Imaging, Treatment, and Outcomes.

Background and Objectives: Hypermobility of the lateral meniscus is typically associated with the posterior part of this structure, with occurrences in the anterior part rarely reported. However, a hypermobile anterior horn of the lateral meniscus can manifest clinical symptoms. This study aimed to increase awareness regarding hypermobility in the anterior horn of the lateral meniscus by presenting its clinical presentations, magnetic resonance imaging (MRI) findings, arthroscopic findings, treatment approaches, postoperative protocols, and clinical outcomes. Materials and Methods: A retrospective case-series involving patients diagnosed as having hypermobile anterior horn of the lateral meniscus through arthroscopy. The clinical presentations, preoperative image findings, arthroscopic findings, treatments, postoperative protocols, and clinical outcomes following meniscal stabilization were all reviewed. Results: A total of 17 patients (17 knees) with a mean age of 45.9 ± 18.4 years were analyzed. The mean follow-up period was 18.2 ± 7.6 months (range, 6-24 months). Primary symptoms included anterior lateral knee pain, tenderness in the lateral joint lines, and a locking sensation in six of the knees. MRI revealed hypodense lesions anterior to the meniscus, fluid accumulation, degenerative changes, and anterior horn deformities. Following meniscal stabilization, the Lysholm Knee Scoring Scale score increased from 65.8 ± 12.7 before surgery to 91.1 ± 9.6 at the final follow-up (p < 0.001). All the analyzed knees achieved a full range of motion by the final follow-up, with no patient experiencing any complication or requiring reoperation. Conclusions: There is no specific sign or test that can be used to detect a hypermobile anterior horn of the lateral meniscus. A thorough arthroscopic examination is essential for diagnosing hypermobility in the anterior horn of the lateral meniscus. Arthroscopic meniscal stabilization yields favorable outcomes.

[High tibial osteotomy on varus knee osteoarthritis with medial meniscus posterior root injury].

OBJECTIVE: To explore clinical effect of distal tibial tubercle-high tibial osteotomy (DTT-HTO) in treating knee osteoarthritis (KOA) with medial meniscus posterior root tear (MMPRT). METHODS: A retrospective analysis was performed on 21 patients with varus KOA with MMPRT from May 2020 to December 2021, including 3 males and 18 females, aged from 49 to 75 years old with an average of (63.81±6.56) years old, the courses of disease ranged from 0.5 to 18.0 years with an average of(5.9±4.2) years, and 4 patients with grade Ⅱ, 14 patients with grade Ⅲ, and 3 patients with grade Ⅳ according to Kellgren-Lawrence;14 patients with type 1 and 7 patients with type 2 according to MMPRT damage classification. The distance of medial meniscusextrusion (MME) and weight-bearing line ratio (WBLR) of lower extremity were compared before and 12 months after operation. Visual analogue scale (VAS), Western Ontarioand and McMaster Universities (WOMAC) osteoarthritis index, and Lysholm knee score were used to evaluate knee pain and functional improvement before operation, 1, 6 and 12 months after operation, respectively. RESULTS: Twenty-one patients were followed up for 12 to 18 months with an average of (13.52±1.72) months. MME distance was improved from (4.99±1.05) mm before operation to (1.87±0.76) mm at 12 months after operation (P<0.05). WBLR was increased from (15.49±7.04)% before operation to (62.71±2.27)% at 12 months after operation (P<0.05). VAS was decreased from (7.00±1.14) before operation to (2.04±0.80), (0.90±0.62) and (0.61±0.50) at 1, 6 and 12 months after operation. WOMAC were decreased from preoperative (147.90±9.88) to postoperative (103.43±8.52), (74.00±9.54) and (47.62±9.53) at 1, 6 and 12 months, and the difference were statistically significant (P<0.05). Lysholm scores were increased from (46.04±7.34) before oepration to (63.19±8.93), (81.10±6.41) and (89.29±3.04) at 1, 6 and 12 months after operation(P<0.05). CONCLUSION: For the treatment of varus KOA with MMPRT, DTT-HTO could reduce medial meniscus protrusion distance, improve the ratio of lower limb force line, and effectively reduce knee pain and improve knee joint function.

Study on the correlation between shear wave elastography and MRI grading of meniscal degeneration.

BACKGROUND: Shear Wave Elastography (SWE) offers quantitative insights into the hardness and elasticity characteristics of tissues. The objective of this study is to investigate the correlation between SWE of the menisci and MRI-assessed degenerative changes in the menisci, with the aim of providing novel reference source for improving non-invasive evaluation of meniscal degenerative alterations. METHODS: The participants in this study were selected from patients who underwent knee joint MRI scans at our hospital from February 2023 to February 2024. The anterior horns of both the medial and lateral menisci were evaluated using SWE technique. The differences in elastic values of meniscus among different MRI grades were compared. The correlation between elastic values and MRI grades, as well as various parameters, was analyzed. Using MRI Grade 3 as the gold standard, the optimal cutoff value for meniscal tear was determined. The intraclass correlation coefficient (ICC) was employed to evaluate the reliability of repeated measurements performed by the same observer. RESULTS: A total of 104 female participants were enrolled in this study, with 152 lateral menisci (LM) and 144 medial menisci (MM) assessed. For the male group, 83 individuals were included, with 147 LM and 145 MM evaluated. The results demonstrated statistically significant differences in the elasticity values of the menisci at the same anatomical sites across different MRI grades (P < 0.001). Within the same grade, the MM had higher elasticity values than the LM, showing a statistically significant difference (P < 0.001). The elasticity values of the menisci were higher in males compared to females. There were statistically significant positive correlations between the elasticity values of the menisci and age, BMI, and MRI grade. The ICC for repeated measurements within the observer demonstrated good reliability (> 0.79). CONCLUSIONS: The meniscal elasticity values measured by SWE exhibit a significant positive correlation with the grades of degeneration assessed by MRI. Furthermore, the elasticity values of the meniscus are found to increase with advancing age and elevated BMI.

Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A Multicenter Study.

BACKGROUND: Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation. PURPOSE: To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test. RESULTS: In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; P = .0004) and anteriorly (9%; P = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure. CONCLUSION: Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.

Patient-reported Outcomes After Medial Meniscus Root Tear Repair Versus Other Medial Meniscus Repairs: An Exploratory Meta-analysis of Single-arm Cohorts.

INTRODUCTION: This study aimed to (1) compare patient-reported outcome measures between patients who underwent medial meniscus root tear (MMRT) repair and those who underwent other types of medial meniscus repair, and (2) identify factors associated with observed differences. METHODS: A literature search identified studies reporting PROMs-knee injury and osteoarthritis outcome score (KOOS) or visual analog scale (VAS) for pain-after repair of the medial meniscus. Studies were excluded if outcomes were not separated by tear type or reported graphically, different or no outcomes reported, no repair or repair with a sutureless method, follow-up greater than 72 months, case report, and systematic review. Patient-reported outcome measures and demographics were summarized as sample-weighted means and compared using t-tests. Mixed model linear regressions were fit predicting postoperative PROMs adjusted for tear type, preoperative PROMs, and follow-up time. F statistics of type III tests of fixed effects were compared. RESULTS: Eighteen articles were included, n = 10 received MMRT repair and n = 8 other tear repairs. Postoperative values for all KOOS scores were less for the MMRT repair group compared with the other tear repair group, VAS pain was not statistically different. Tear type was a stronger predictor for postoperative PROMs than the preoperative score and duration of follow-up for all KOOS scores, but not VAS pain. On average, the MMRT repair group had shorter follow-up, more women, older age, and greater BMI. DISCUSSION: All postoperative PROMs except for VAS pain were worse for patients who underwent MMRT repair compared with patients who underwent other types of medial meniscus repair. Tear type was a better predictor of postoperative PROMs despite intergroup differences in preoperative PROMs and duration of follow-up. Relative risk factors for MMRT compared with other types of medial meniscus tears include older age, greater BMI, and female sex.

A Prospective, Randomized, Double-Blind Clinical Trial to Investigate the Efficacy of Autologous Bone Marrow Aspirate Concentrate During Arthroscopic Meniscectomy in Patients With Early Knee Osteoarthritis.

BACKGROUND: Despite being recognized as a safe procedure with minimal reported complications, injecting autologous bone marrow aspirate concentrate (BMAC) as an adjuvant to arthroscopic partial meniscectomy (APM) for symptomatic patients with meniscal tears and concomitant knee osteoarthritis (OA) has not been studied in randomized controlled trials. PURPOSE: To compare patient-reported outcome measure (PROM) scores and radiographic outcomes in symptomatic patients with meniscal tears and concomitant mild knee OA who underwent APM with and without an autologous BMAC injection administered at the time of surgery. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Enrolled patients aged ≥18 years determined to have a symptomatic meniscal tear with concomitant mild knee OA suitable for APM and meeting inclusion and exclusion criteria were randomized into 2 groups: BMAC and control (no BMAC). The primary endpoint of the study was the International Knee Documentation Committee (IKDC) score at 1 year postoperatively. Secondary endpoints included radiographic outcomes (Kellgren-Lawrence grade) at 1 year postoperatively and various PROM scores, including those for the IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale, and Veterans RAND 12-Item Health Survey, at 3 months, 6 months, 1 year, and 2 years after meniscectomy. RESULTS: Of the 95 enrolled patients, 83 (87.4%) were included for final analysis. No significant differences were found between the groups with regard to patient characteristics, intraoperative variables, concomitant procedures, preoperative PROM scores, or preoperative radiographic findings. At 1 year postoperatively, the BMAC group failed to demonstrate significantly better IKDC scores (P = .687) or radiographic outcomes (P > .05 for all radiographic measures) compared with the control group. Secondary PROM scores also did not significantly differ between the groups (P > .05 for all PROMs). However, there were higher achievement rates of the minimal clinically important difference for the KOOS Sport (100.0% vs 80.0%, respectively; P = .023) and KOOS Symptoms (92.3% vs 68.0%, respectively; P = .038) at 1 year postoperatively in the BMAC group than in the control group. All PROMs, excluding the VR-12 mental score, showed significant improvements compared with baseline at all postoperative time points for both the BMAC and control groups. CONCLUSION: The addition of an autologous BMAC injection during APM did not result in significant changes in IKDC scores or radiographic outcomes at the 1-year postoperative mark. Secondary PROM scores were generally comparable between the 2 groups, but there was higher minimal clinically important difference achievement for the KOOS Sport and KOOS Symptoms at 1 year postoperatively in the BMAC group. In patients with symptoms consistent with a meniscal tear who had concomitant mild OA, the addition of BMAC to arthroscopic debridement did not affect the outcome. REGISTRATION: NCT02582489 (ClinicalTrials.gov).

Meniscus Injuries in Soccer.

Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players.

Evaluation of the relationship between Knee Osteoarthritis and Meniscus Pathologies.

Background: Knee osteoarthritis is a common, degenerative joint disease that causes chronic pain that affects daily life. Our study aims to evaluate geriatric patients aged 65 and over with knee pain in terms of osteoarthritis with radiography and magnetic resonance imaging and to investigate its relationship with meniscal pathologies. Methods: Radiography and magnetic resonance imaging of patients aged 65-88 years with knee pain were evaluated in terms of knee osteoarthritis and staging was performed. Meniscal pathologies were evaluated in magnetic resonance imaging, and the prevalence of different meniscal lesion types was calculated. In addition, the relationship between knee osteoarthritis and meniscal pathologies was analyzed. Results: Radiographic evidence of knee osteoarthritis was found in 182 (84.2%) of the 216 cases in our study group. A strong correlation was found between the degrees of knee osteoarthritis on magnetic resonance imaging and radiography. At least one meniscus pathology was observed in all 182 radiography cases with knee osteoarthritis findings. At least one meniscus pathology was observed in 29 (85.3%) of those without osteoarthritis signs. It was determined that meniscus degeneration, tear, and extrusion were observed more frequently in patients with knee osteoarthritis than in patients without osteoarthritis. Meniscal extrusion and complex and horizontaltype tears were the most common lesions. Conclusions: Osteoarthritis was found to be common in geriatric patients with knee pain. A correlation was found between radiography and magnetic resonance imaging regarding knee osteoarthritis. It was observed that meniscal pathologies were detected more frequently in patients with knee osteoarthritis.

A larger radius of the medial femoral posterior condyle is a risk factor for medial meniscus posterior root tears.

BACKGROUND: Studies have shown an association between medial meniscus posterior root tears (MMPRT) and morphologic characteristics of the bone. However, the association between distal femoral bone morphology and MMPRT, particularly the medial femoral posterior condyle, is poorly understood. Our study aimed to determine the association between the morphologic characteristics of the medial posterior femoral condyle and MMPRT. METHODS: A retrospective case-control study was performed from January 2021 to January 2022. After screening based on the inclusion and exclusion criteria, two matched groups were analyzed: the MMPRT group and the isolated lateral meniscus tears group. The hip-knee-ankle angle (HKA) and Kellgren-Lawrence grade (KLG) were measured on radiographs; the medial tibial slope angle (MTSA), medial tibial plateau depth (MTPD), and radius of the medial femoral posterior condyle (RMFPC) were measured on magnetic resonance imaging (MRI) in both groups. The area under the curve (AUC) and the best cutoff value for predicting MMPRT were calculated by using receiver operating characteristic (ROC) curve analysis. RESULTS: The final analysis included a total of 174 patients (87 MMPRT patients and 87 controls). Significant differences were shown in the RMFPC (17.6 ± 1.0 vs. 16.2 ± 1.0, p < 0.01) and MTSA (6.4 ± 2.0 vs. 4.0 ± 1.3, p < 0.01), which were larger than those of the control group. The MTPD (1.8 ± 0.6 vs. 2.9 ± 0.7, p < 0.01) and HKA (175.4 ± 2.2 vs. 179.0 ± 2.7, p < 0.01) of the injury group were significantly different from the control group, and both were lower than the control group. However, between the MMPRT and control groups on the KLG (2.3 ± 0.6 vs. 2.2 ± 0.6, p = 0.209), there was no statistically significant difference. Among them, the RMFPC cutoff value was calculated to be 16.8 mm by ROC curve analysis, and the sensitivity and specificity were both 81.61%. CONCLUSIONS: This study demonstrated that larger RMFPC, MTSA, smaller MTPD, and HKA were all associated with MMPRT, and RMFPC ≥ 16.8 mm was considered as a significant risk factor for MMPRT.

Evaluation of orthobiological ozonized platelet-rich plasma therapy post-arthroscopic suturing and lone partial meniscectomy in the treatment of meniscal tears within degenerative knee osteoarthritis.

BACKGROUND: Knee joint osteoarthritis (OA)-related meniscal tears are still sometimes treated in centers by arthroscopic partial meniscectomy (APM), which is then followed by a solitary physical therapy regimen. OBJECTIVE: The present study was conducted to compare the efficacy of intra-articular injection of ozonized platelet-rich plasma (PRP) and hyaluronic acid following arthroscopic suturing, and APM to treat meniscal tear degenerative type. METHODS: In a randomized trial of prospective comparative research, 104 patients, all of whom had meniscal tears due to OA of the knee, were randomly divided into two groups. The participants in Group A (55 patients) were given intra-articular ozonized PRP and hyaluronate therapeutics, following arthroscopic suturing of meniscal tear treatment (ASMT) of degenerative knee joint OA. Group B (49 patients) was prepared for APM alone. Both groups were followed by physical therapy and a follow up visit throughout 12, 24, and 36 months. The WOMAC and Lequesne scores were evaluated. RESULTS: At every follow up visit for 6, 12, and 24, months, there was a significant decline in the mean of WOMAC and Lequesne scores in Groups A and B relative to baseline. Additionally, Group A significantly (P<0.0001) outperformed Group B at 12, 24, and 36 months for both Lequesne's and WOMAC scores. There were infection, stiffness, and widespread OA knee degeneration detected in Group B while no serious adverse effects were observed in Group A. CONCLUSION: The study's findings demonstrated that physical and intra-articular orthobiological ozonized PRP and hyaluronate therapies were more effective than APM in treating degenerative knee joint OA.

In the Acute Phase of Anterior Cruciate Ligament Rupture: Quantitative Assessment of Matrix Changes and Correlation between Different States of Meniscus and Adjacent Cartilage.

OBJECTIVE: Cartilage and meniscus are important structures that maintain the health of the knee joint. Early detection of changes in the internal components of cartilage and meniscus before morphological changes occur is essential to prevent and delay the development of osteoarthritis (OA). This study was designed to determine the changes in the matrix composition of morphologically intact cartilage and meniscus during the acute phase of an anterior cruciate ligament (ACL) rupture, as well as the effect of different states of meniscus (intact or tear) on adjacent cartilage during the acute phase. METHODS: This cross-sectional study compared and analyzed 50 patients in the acute phase of ACL rupture who underwent surgical treatment and 66 age-, weight- and height-matched healthy volunteers from May 2022 to May 2023 at our institution. Mean T2 relaxation times and effect sizes in different regions of tibiofemoral articular cartilage and meniscus were compared between the two groups using the Mann-Whitney nonparametric t-test, and correlations between different meniscal states and adjacent cartilage were analyzed. RESULTS: Both in the lateral and medial compartments of the knee, T2 relaxation times were significantly higher in all subregions of cartilage and meniscus in the ACL rupture group (p < 0.05), and the site of injury was predominantly centered in the medial compartment (femur, p = 0.000; tibia, p = 0.000; anterior horn, p = 0.000). In the respective compartments, the posterior horn of the lateral meniscus showed a significant positive correlation with the mid-cartilage of the femoral and tibial (r = 0.566, p = 0.035; r = 0.611, p = 0.02); and the posterior horn of the medial meniscus showed a significant positive correlation with the posterior tibial cartilage (r = 0.668, p = 0.018). CONCLUSION: During the acute phase of ACL rupture, the internal composition of the cartilage and meniscus undergoes significant changes, even if the morphology is intact. More importantly, the state of the meniscus significantly affects the internal composition of the adjacent cartilage. This is an early warning sign of OA, which should be closely monitored and carefully managed in clinical practice.