RESUMO
OBJECTIVE: The purpose of this systematic review was to summarize the results of original research studies evaluating the characteristics and performance of deep learning models for detection of knee ligament and meniscus tears on MRI. MATERIALS AND METHODS: We searched PubMed for studies published as of February 2, 2022 for original studies evaluating development and evaluation of deep learning models for MRI diagnosis of knee ligament or meniscus tears. We summarized study details according to multiple criteria including baseline article details, model creation, deep learning details, and model evaluation. RESULTS: 19 studies were included with radiology departments leading the publications in deep learning development and implementation for detecting knee injuries via MRI. Among the studies, there was a lack of standard reporting and inconsistently described development details. However, all included studies reported consistently high model performance that significantly supplemented human reader performance. CONCLUSION: From our review, we found radiology departments have been leading deep learning development for injury detection on knee MRIs. Although studies inconsistently described DL model development details, all reported high model performance, indicating great promise for DL in knee MRI analysis.
Assuntos
Lesões do Ligamento Cruzado Anterior , Inteligência Artificial , Ligamentos Articulares , Menisco , Humanos , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Imageamento por Ressonância Magnética/métodos , Menisco/diagnóstico por imagem , Menisco/lesõesRESUMO
OBJECTIVE: To evaluate the change in minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) from 3 to 12 months following arthroscopic meniscus surgery. DESIGN: Retrospective cohort study. METHODS: We included patients from the Knee Arthroscopy Cohort Southern Denmark who had meniscus surgery between 2013 and 2015. We calculated the interpretation threshold values for MIC, PASS, and TF using an anchor-based adjusted predictive modeling method. Thresholds at 3 and 12 months postoperatively were compared to evaluate changes over time. RESULTS: The proportions of people who reported a clinically relevant improvement, or their symptoms being acceptable, increased by 10% to 15% points from 3 to 12 months after surgery. MIC thresholds for the 5 KOOS subscales remained stable from 3 to 12 months with statistically nonsignificant differences (95% confidence intervals) ranging from -0.3 (-3.0, 2.6) to -2.4 (-6.1, 1.3). All PASS thresholds except for quality of life (QOL) decreased by -6.5 (-11.8, -1.5) to -3.7 (-7.1, -0.4) points, indicating that higher symptom levels were accepted at 12 months. In contrast, the proportion reporting their treatment to have failed remained stable over time (19% and 17%). For QOL, a 7.4 (2.0, 13.2) higher TF threshold at 12 months suggested that improved QOL was required to not consider that the treatment had failed. CONCLUSION: More patients reported being improved at 1 year compared to at 3 months following meniscus surgery. The KOOS MIC thresholds were stable over time, whereas time-specific PASS values should be applied after meniscus surgery. J Orthop Sports Phys Ther 2023;53(11):685-702. Epub 3 October 2023. doi:10.2519/jospt.2023.11993.
Assuntos
Traumatismos do Joelho , Menisco , Osteoartrite do Joelho , Humanos , Qualidade de Vida , Estudos Retrospectivos , Artroscopia/métodos , Menisco/lesões , Menisco/cirurgia , Traumatismos do Joelho/cirurgia , Medidas de Resultados Relatados pelo PacienteRESUMO
BACKGROUND: To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing. METHODS: This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. INCLUSION CRITERIA: (1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described. EXCLUSION CRITERIA: (1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1. RESULTS: Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)]. CONCLUSION: In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing. TRIAL REGISTRATION: The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).
Assuntos
Artroscopia , Traumatismos do Joelho , Menisco , Artroscopia/métodos , Estudos de Coortes , Traumatismos do Joelho/cirurgia , Menisco/lesões , Menisco/cirurgia , Suturas , HumanosRESUMO
OBJECTIVE: The efficacy and safety of arthroscopic surgery combined with hyaluronic acid in the treatment of meniscal injuries were evaluated by Meta-analysis to provide an evidence-based basis for the selection of clinical treatment options. METHODS: PubMed, Cochrane Library, EMBASE, Scopus, Web of Science English databases, and Chinese databases of China National Knowledge Infrastructure, WAN FANG, VIP, and China SinoMed had been searched up to June 2021. Quality evaluation was performed concerning the Cochrane Systematic Evaluation Tool. The obtained data were analyzed using the statistical software Review Manager 5.3. RESULTS: Eleven randomized controlled trials with a total of 955 patients were eventually included, 473 in the arthroscopic combined with hyaluronic acid group (combined treatment group) and 482 in the arthroscopy alone group (surgery group). The results of the study revealed that the excellent treatment [OR = 3.44, 95% CI (2.10, 5.65), p < .00,001], the VAS score [MD = -0.99, 95% CI (-1.50, -0.48), p = .0002], the Lysholm score [MD = 9.70, 95% CI (6.41, 12.99), p < .00,001] and the joint mobility [MD = 6.31, 95% CI (0.84, 11.78), p = .02] of the combined treatment group were significantly better than the surgery group, the difference was statistically significant. The complications rate was comparable in both groups [OR = 0.86, 95% CI (0.29, 2.53), p = .78], with no statistically significant difference. CONCLUSION: Arthroscopic surgery combined with hyaluronic acid for meniscal injury can improve the efficiency of treatment compared with arthroscopic surgery alone, as well as the efficacy in relieving joint pain and improving joint function and mobility, without increasing the incidence of complications. Arthroscopic surgery combined with hyaluronic acid administration has good effectiveness and safety profile. Therefore, hyaluronic acid supplementation is recommended after arthroscopic surgery when treating meniscal injuries.
Assuntos
Artroscopia , Ácido Hialurônico , Menisco , Humanos , Terapia Combinada , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Menisco/lesõesRESUMO
PURPOSE OF REVIEW: Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS: Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.
Assuntos
Artroplastia do Joelho , Cartilagem Articular , Menisco , Osteoartrite , Humanos , Osteoartrite/etiologia , Osteoartrite/metabolismo , Menisco/lesões , Citocinas/metabolismo , Artroplastia do Joelho/efeitos adversos , Cartilagem Articular/metabolismoRESUMO
Concomitant cruciate and meniscus injuries of the knee are generally associated with acute trauma and commonly treated with surgical intervention. Comorbidities (simultaneous presence of two or more medical conditions) may be acquired from changes in activity levels and lifestyle after an injury and/or treatment. This study aimed to compare differences in comorbidity proportions between surgical and nonsurgical approaches in Military Health System beneficiaries who had concurrent cruciate and meniscus injuries. The retrospective case control design included 36-month data that were analyzed to reflect 12 months prior to injury/surgery and 24 months after injury/surgery. A comparison of differences within and between groups in surgical and nonsurgical approaches was calculated and logistic regression was used to determine if surgery increased or decreased the odds of comorbidities at 24 months. In our sample of 2,438 individuals with concurrent meniscus and cruciate injury, 79.1% (n = 1,927) received surgical intervention and 20.9% (n = 511) elected for nonoperative management. All comorbidities demonstrated significant within-group differences from pre- to postsurgery for those with a surgical intervention; approximately, half the comorbidities increased (i.e., concussion or traumatic brain injury, insomnia, other sleep disorders, anxiety, posttraumatic stress disorder, and tobacco abuse disorder), whereas the other half decreased (i.e., chronic pain, apnea, cardiovascular disease, metabolic syndrome, mental health other, depression, and substance abuse disorders). The odds of acquiring a comorbid diagnosis after surgery reflected the bivariate comparisons with half increasing and half decreasing in odds. To our knowledge, this is the first study to explore comorbidity changes with a control group for individuals with concurrent meniscus and cruciate injuries.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Menisco/lesões , Estudos de Casos e Controles , Comorbidade , Humanos , Modelos Logísticos , Menisco/cirurgia , Militares , Estudos Retrospectivos , Estados UnidosRESUMO
Introducción: La subluxación del menisco externo indemne, por desinserción meniscocapsular posterior, es una causa de dolor y bloqueo articular poco frecuente y con escasa bibliografía reportada hasta la fecha.Materiales y métodos: presentamos una serie de doce pacientes a los que se diagnosticó por clínica y examen físico: referían bloqueo articular y dolor recurrente. En todos los casos, la resonancia magnética fue informada como normal. En todos los casos, además, se realizó sutura meniscal con sistema todo-adentro asociado a puntos verticales de afuera-adentro.Resultados: el seguimiento promedio fue de cuatro años y dos meses (rango de 7 a 2 años). Al año de la cirugía los pacientes fueron citados para realizarles examen físico y completar las escalas de Lysholm y Tegner para la reinserción deportiva; todos los pacientes refirieron remisión de la sintomatología, sin complicaciones. El promedio de la escala de Lysholm fue de 97.5 puntos (mín. 90 máx. 100) y el promedio en la escala de Tegner para reinserción deportiva fue de 7.6 (mín. 7 máx. 9).Conclusión: se debe sospechar la desinserción meniscocapsular del menisco externo en pacientes que presentan antecedentes de bloqueos o pseudobloqueos de rodilla (meniscales), con resonancia informada como normal, o sin lesión meniscal cuantificada, y que no respondan al tratamiento médico. Ante la alta sospecha de esta patología, y como se observa en nuestra serie, su reparación, a corto plazo, muestra excelentes resultados. Nivel de Evidencia: IV
Introduction: Subluxation of a healthy lateral meniscus, due to posterior meniscal capsular disinsertion, is an uncommon cause of pain and locking knee. Literature reported so far is scarce.Materials and methods: we present a case series of twelve patients, in which the diagnosis was made by clinical presentation and physical examination: locking knee episodes and recurrent pain. In all cases, the MRI did not show any abnormalities. Meniscal fixation was made in all patients, using a combination of all-inside and vertical outside-in sutures, achieving a stable meniscus.Results: one year after surgery, patients were given an appointment to perform a physical examination, complete the Lysholm score and Tegner activity scale. Average follow-up was four years and two months (range 2 to 7 years). One year after surgery, all patients reported remission of symptoms without complications. Average of the Lysholm score was 97.5 points (min. 90 max. 100) and Tegner activity scale for sports reintegration was 7.6 (min. 7 max. 9).Conclusion: posterior capsular meniscal disinsertion of the lateral meniscus should be suspected in patients with a history of locking knee (meniscal), with MRI reported as normal or without quantified meniscal injury, and who do not respond to medical treatment. Given the high suspicion of this pathology and as observed in our series, in the short term, their repair shows excellent results. Level of Evidence: IV
Assuntos
Criança , Adolescente , Adulto , Dor , Menisco/lesões , Instabilidade Articular , Articulação do JoelhoRESUMO
PURPOSE: To report of efficacy repair treatment for meniscus posterior root tears repair. METHODS: We systematically searched databases including PubMed, Embase, and Cochrane Library for relevant articles. Coleman Methodology Score was used for a quality assessment of the included studies. A meta-analysis was performed to analyze for efficacy of MMPRTs repair. RESULTS: Twenty-two studies, 14 level III and 8 level IV, were included in this systematic review, with a total of 926 cases. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower progression of Kellgrene-Lawrence grade with meniscal repair. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. As treatment efficacy, the Lysholm score increased 28.87 (P < 0.001), IKDC score increased 31.73. The overall pooled event rates of progression of K-L grade is 0.200. Difference of Lysholm score and IKDC score between repair and meniscectomy were 8.72 and 9.67. CONCLUSIONS: The clinical subjective score after MMPRT repair was significantly improved compared with the preoperative status. Considering the progression of joint K-L grade, it can prevent the progression of arthrosis to some extent, but not completely. Decreased meniscus extrusion is beneficial to the prognosis of patients undergoing MMPRTs repair. Based on these results, MMPRTs repair cloud result favorable outcomes.
Assuntos
Artropatias/cirurgia , Menisco/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Artroscopia/estatística & dados numéricos , Humanos , Artropatias/diagnóstico , Artropatias/epidemiologia , Meniscectomia/efeitos adversos , Meniscectomia/métodos , Meniscectomia/estatística & dados numéricos , Menisco/lesões , Menisco/patologia , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Osteoartrite/cirurgia , Prognóstico , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia , Resultado do TratamentoRESUMO
Abstract Medial arthrosis of the knee is an evolutionary pathology that occurs due to progressive muscle imbalance. The muscles of the knee region have a large imbalance caused by the difference of power and lever arm. With the progression of life, this imbalance manifests itself more importantly, especially due to the loss of muscle strength due to aging. Pathological postures begin to occur and determine areas of support and pressure harmful to the joint. Meniscal injury is typical in the evolution of this pathology, as well as cartilage injury. The recognition of this pathology enables good results with less aggressive treatments, such as correction of muscle imbalance and consequent reeducation of joint support. Economic and partial meniscectomy brings good results in the early stages of the degenerative process. Progressive evolution leads to knee degeneration and the consequent need for broader surgeries.
Resumo A artrose medial do joelho é uma patologia evolutiva que ocorre em decorrência de desequilíbrio muscular progressivo. Os músculos da região do joelho têm um grande desequilíbrio, provocado pela diferença de potência e braço de alavanca. Com a progressão da vida, este desequilíbrio se manifesta de forma mais importante, especialmente em decorrência da perda de força muscular em função do envelhecimento. Posturas patológicas passam a ocorrer e determinar zonas de apoio e pressão lesivas para a articulação. A lesão meniscal é típica na evolução desta patologia, assim como a lesão da cartilagem. O reconhecimento desta patologia possibilita resultados bons com tratamentos menos agressivos, como a correção do desequilíbrio muscular e consequente reeducação do apoio da articulação. A meniscectomia econômica e parcial traz bons resultados nas fases iniciais do processo degenerativo. A evolução progressiva leva à degeneração do joelho e à consequente necessidade de cirurgias mais amplas.
Assuntos
Osteoartrite/diagnóstico , Osteoartrite/terapia , Osteonecrose , Menisco/lesõesRESUMO
PURPOSE: This study aimed to investigate how fibroblastic and chondrocytic properties of human meniscal fibrochondrocytes are affected in culture conditions according to the type of meniscal pathology and localization, and to provide basic information for tissue-engineering studies. METHODS: Primary fibrochondrocyte cultures were prepared from meniscus samples of patients who had either traumatic tear or degeneration due to osteoarthritis. Cultures were compared in terms of mRNA expression levels of COL1A1, COL2A1, COMP1, HIF1A, HIF2A, and SOX9 and secreted total collagen and sulfated sGAG levels according to the type of meniscal pathology, anatomical localization, and the number of subcultures. RESULTS: mRNA expression levels of COL1A1, COMP1, HIF1A, HIF2A, and SOX9 were found to be increased in subsequent subcultures in all specimens. COL1A1 mRNA expression levels of both lateral and medial menisci of patients with traumatic tear were significantly higher than in patients with degenerative pathology, indicating a more fibroblastic character. P1 subculture of lateral and P3 or further subculture of medial meniscus showed more fibroblastic characteristics in patients with degenerative pathology. Furthermore, in patients with degenerative pathology, the subcultures of the lateral meniscus (especially on the inner part) presented more chondrocytic characteristics than did those of medial meniscus. CONCLUSIONS: The mRNA expression levels of the cultures showed significant differences according to the anatomical localization and pathology of the meniscus, indicating distinct chondrocytic and fibroblastic features. This fundamental knowledge would help researchers to choose more efficient cell sources for cell-seeding of a meniscus scaffold, and to generate a construct resembling the original meniscus tissue.
Assuntos
Fibrocartilagem , Articulações/lesões , Menisco , Osteoartrite/patologia , Transcriptoma , Adolescente , Adulto , Idoso , Células Cultivadas , Condrócitos/citologia , Condrócitos/metabolismo , Condrócitos/patologia , Feminino , Fibrocartilagem/citologia , Fibrocartilagem/metabolismo , Fibrocartilagem/patologia , Perfilação da Expressão Gênica , Humanos , Articulações/metabolismo , Articulações/patologia , Masculino , Menisco/citologia , Menisco/lesões , Menisco/metabolismo , Menisco/patologia , Pessoa de Meia-Idade , Osteoartrite/genética , Osteoartrite/metabolismo , Cultura Primária de Células/métodos , Ruptura/genética , Ruptura/metabolismo , Ruptura/patologia , Adulto JovemRESUMO
RATIONALE: The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery. PATIENT CONCERNS: The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing. DIAGNOSIS: On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins. INTERVENTIONS: After 3âdays of low-molecular-weight heparin 1âmg/kg every 12âhours, treatment was changed to an oral drug, dabigatran, for 6âmonths. OUTCOMES: There were no PTE or DVT findings on computed tomography at 6âmonths postoperative. The patient did not complain of symptoms related to PTE or DVT at 6âmonths after the operation, has returned to work, and is living without discomfort. LESSIONS: The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of â¼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
Assuntos
Artroscopia/efeitos adversos , Menisco/lesões , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Adulto , Anticoagulantes/administração & dosagem , Dabigatrana/administração & dosagem , Eletrocardiografia , Veia Femoral/diagnóstico por imagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Menisco/cirurgia , Veia Poplítea/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológicoRESUMO
Osteoarthritis, a highly prevalent degenerative joint disorder, is characterized by joint pain and disability. Available treatments fail to modify osteoarthritis progression and decrease joint pain effectively. Here, we show that intermittent parathyroid hormone (iPTH) attenuates osteoarthritis pain by inhibiting subchondral sensory innervation, subchondral bone deterioration, and articular cartilage degeneration in a destabilized medial meniscus (DMM) mouse model. We found that subchondral sensory innervation for osteoarthritis pain was significantly decreased in PTH-treated DMM mice compared with vehicle-treated DMM mice. In parallel, deterioration of subchondral bone microarchitecture in DMM mice was attenuated by iPTH treatment. Increased level of prostaglandin E2 in subchondral bone of DMM mice was reduced by iPTH treatment. Furthermore, uncoupled subchondral bone remodeling caused by increased transforming growth factor ß signaling was regulated by PTH-induced endocytosis of the PTH type 1 receptor-transforming growth factor ß type 2 receptor complex. Notably, iPTH improved subchondral bone microarchitecture and decreased level of prostaglandin E2 and sensory innervation of subchondral bone in DMM mice by acting specifically through PTH type 1 receptor in Nestin+ mesenchymal stromal cells. Thus, iPTH could be a potential disease-modifying therapy for osteoarthritis.
Over time the cartilage between our bones gets worn down, and this can lead to a painful joint disorder known as osteoarthritis. Nearly 40 million people with osteoarthritis in the United States experience chronic pain. Although there are a number of drugs available for these patients, none of them provide sustained pain relief, and some have substantial side effects when ingested over a long period of time. Bone tissue is continuously broken down into minerals, such as calcium, that can be reabsorbed into the blood. In 2013, a group of researchers found that the tissue in the layer of bone below the cartilage known as the subchondral bone is reabsorbed and replaced incorrectly in patients with osteoarthritis. This irregular 'remodeling' stimulates nerve cells to grow into the subchondral layer, leading to increased sensitivity in the joint. A protein called parathyroid hormone, or PTH for short, plays an important role in the loss and formation of bone. A drug containing PTH is used to treat patients with another bone condition called osteoporosis, and could potentially work as a treatment for osteoarthritis pain. To investigate this, Sun et al. including some of the researchers involved in the 2013 study tested this drug on a mouse model that mimics the symptoms of osteoarthritis. This revealed that PTH significantly decreases the number of nerves present in the subchondral bone, which caused the mice to experience less pain. PTH also slowed down the progression of osteoarthritis, by preventing the cartilage on the subchondral layer from deteriorating as quickly. Sun et al. found that the subchondral bones of treated mice also had a more stable structure and reduced levels of a protein involved in the reabsorption of bone. The results suggest that PTH is able to correct the errors in bone remodeling caused by osteoarthritis, and that this drug could potentially alleviate patients' chronic pain. This drug has already been approved by the US Food and Drug Administration (FDA), and could be used in clinical trials to see if PTH has the same beneficial effects on patients with osteoarthritis.
Assuntos
Remodelação Óssea/efeitos dos fármacos , Osteoartrite/tratamento farmacológico , Dor/tratamento farmacológico , Hormônio Paratireóideo/farmacologia , Animais , Osso e Ossos/inervação , Osso e Ossos/patologia , Dinoprostona , Modelos Animais de Doenças , Membro Posterior , Masculino , Menisco/lesões , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Hormônio Paratireóideo/administração & dosagemRESUMO
OBJECTIVE: To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone. METHODS: PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched. RESULTS: We investigated six RCTs (total n = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1). CONCLUSION: There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.
Assuntos
Traumatismos do Joelho/terapia , Menisco/lesões , Manejo da Dor/métodos , Adulto , Humanos , Metanálise em Rede , Medição da Dor/métodosRESUMO
Introducción: El objetivo del siguiente trabajo es mostrar los resultados de reparaciones meniscales en asa de balde con un seguimiento mínimo a dos años, describir la técnica quirúrgica utilizada y analizar los resultados funcionales, complicaciones y causas de falla. Materiales y métodos: evaluamos retrospectivamente pacientes intervenidos quirúrgicamente por nuestro equipo a los que se les realizó reparación de lesión en asa de balde meniscal, con cinco o más suturas, asociada, o no, a lesión del LCA. Se excluyeron los pacientes a los que se les realizaron cuatro o menos suturas y aquellos con cirugías previas y seguimiento menor a dos años. Resultados: cuarenta pacientes con edad promedio de veintiséis años (rango 8-60). Seguimiento promedio de cuarenta y ocho meses (rango 24-60). El promedio de suturas utilizadas fue de seis (rango 5-9 puntos). Cuatro pacientes presentaron fallas aisladas de la sutura meniscal por eventos traumáticos. Hasta la fecha, los pacientes con lesión asociada del LCA no presentaron fallas. Los scores de Lysholm, Tegner e IKDC mostraron gran mejoría en el postoperatorio. Conclusión: en la serie estudiada encontramos muy buenos resultados funcionales con la reparación meniscal, con un índice de falla del 10%. Es por esto que, para este tipo de lesiones, estimulamos al cirujano artroscopista a intentar la sutura meniscal por sobre la meniscectomía, aunque la primera sea, técnicamente, más demandante. Nivel de Evidencia: IV
Introduction: our aim is to show the results of bucket handle meniscal repairs with a minimum follow-up of two years, describing the surgical technique used and analyzing the functional results, complications and causes of failure. Materials and methods: we retrospectively reviewed those patients who were treated by our surgical team who experienced a bucket-handle meniscus tear that were isolated or with concomitant ACL injury. We excluded patients with four sutures or less, previous surgeries and follow up less than two years.Results: forty patients were included between 8 and 60 years old (average of 26 years). Average follow up of 48 months (range 24 to 60 months). The number of sutures varies from five up to nine (average: 6). Four patients (10%) were defined as failure, due to a new sport traumatic event. None of these had an ACL concomitant surgery. Lysholm, Tegner and IKDC post-operative score show promising results. Conclusions: we found encouraging outcomes and functional results with meniscal repair, with a failure rate of 10%. This is why, for this type of injury, we encourage the surgeon to always try meniscal repair over meniscectomy, although the former is technically more demanding. Level of Evidence: IV
Assuntos
Artroscopia/métodos , Resultado do Tratamento , Menisco/lesões , Traumatismos do JoelhoRESUMO
BACKGROUND: We provide a meta-analysis for clinicians and researchers regarding the psychometric properties of the WOMET as a patient-reported outcome measure (PROM) for patients with meniscal pathologies. METHODS: A comprehensive literature search identified 6 eligible papers evaluating WOMET measurement properties in patients with different meniscal injuries and meniscal treatments following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The quality of the included studies was evaluated using the four-point Consensus-based Standard for the selection of health Measurement Instruments (COSMIN) Checklist for good measurement properties. The checklist was specifically developed for studies on health-related PROMs. RESULTS: Our meta-analysis suggests that the WOMET can be used to evaluate patients with different meniscal injuries and meniscal treatments, especially acute or chronic meniscal injuries and traumatic or degenerative meniscal injuries treated operatively or conservatively. The WOMET shows satisfactory internal consistency, test-retest reliability, and construct validity. Due to limitations in both sample sizes and methodologies of the included studies, no conclusions can be drawn regarding the WOMET's content validity, structure validity, cross-cultural validity, measurement error, or responsiveness. A further limitation of the studies included in this meta-analysis is the lack of cross-cultural validation, although recommended by the COSMIN Standards. CONCLUSIONS: The first meta-analysis on measurement properties of the WOMET demonstrates satisfactory internal consistency, test-retest reliability, and construct validity. Further studies are needed, focusing on the methodological deficiencies highlighted in this meta-analysis. To ensure that the WOMET adequately reflects the symptoms, functions, and quality of life of patients with meniscal tears based on COSMIN criteria, it is necessary to assess the structural validity and content validity of this PROM.
Assuntos
Traumatismos do Joelho/terapia , Menisco/lesões , Menisco/cirurgia , Medidas de Resultados Relatados pelo Paciente , Psicometria/métodos , Tratamento Conservador , Humanos , Procedimentos Ortopédicos , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
There is a noticeable increase in the unnecessary ordering of Magnetic Resonance Imaging (MRI) of the knee in older patients. This quality improvement study assessed the frequency of unnecessary pre-consultation knee MRIs and investigated the effect on the outcome of the patients' consultation with the orthopedic surgeon. 650 medical charts of patients aged 55 years or older referred to an orthopedic clinic with knee complaints were reviewed. Patients arriving with a pre-consultation MRI were identified, and the usefulness of the MRI was evaluated using the appropriateness criteria developed to support this study. Of the 650 patient charts reviewed, 225 patients presented with a pre-consultation MRI, 76% of which were not useful for the orthopedic surgeon. The ordered knee MRI scans were considered not useful because they were requested for confirmed meniscal tear for patients ≥55 years, suspected degenerative disorder and ligament/tendon injury, or for patients with severe osteoarthritis without locking or extension. These MRI scans were done despite the absence of signs of effusion, tenderness, soft tissue swelling, decreased range of motion, or difficulty of weight-bearing, a lack of persistent knee joint pain at the time of assessment, or with no x-ray before ordering MRI. Half of the patients with a pre-consult MRI did not present with plain radiographs of their knee, however, 35% of those still required an x-ray to be ordered at the time of the surgical consult. A logistic regression analysis on post-consult disposition found that patients with pre-consult MRI were less likely to be considered for total knee arthroplasty (TKA) (OR 0.424, CI 0.258-0.698, p = 0.001). Patients assessed by an advanced practice physiotherapist prior to referral for surgical consult were 4.47 more likely to have TKA (CI 2.844-7.039, p< 0.000). Most of the pre-consult knee MRIs were deemed as unnecessary for the orthopedic surgeon's clinical decision-making. This study highlights the potential benefits of following a comprehensive model of care within the referral process to reduce the unnecessary high orders of pre-consult MRI scans.
Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Osteoartrite/diagnóstico por imagem , Procedimentos Desnecessários/normas , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/normas , Tomada de Decisão Clínica/métodos , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Joelho/cirurgia , Traumatismos do Joelho/cirurgia , Masculino , Menisco/diagnóstico por imagem , Menisco/lesões , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Amplitude de Movimento Articular , Encaminhamento e Consulta/normas , Suporte de CargaRESUMO
BACKGROUND: Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients' return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. METHODS: This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. RESULTS: High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. CONCLUSIONS: Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Menisco/lesões , Menisco/cirurgia , Qualidade de Vida , Volta ao Esporte , Técnicas de Sutura , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia , Fatores de Tempo , Falha de Tratamento , Adulto JovemRESUMO
The normalcy index (NI) has been implemented by several studies as a simple index for quantitatively analyzing diffident gait abnormalities, such as children with cerebral palsy and idiopathic toe-walkers. However, whether the NI can be used in anterior cruciate ligament (ACL) deficiency with different types of meniscus injuries or not, has not been reported yet. In this study, 25 patients who combined different types of ACL and meniscus injuries were evaluated by the NI analysis. 12 healthy subjects were used to define the normal range of NI. The result showed that NI values of patients were significantly larger than the control group (P < 0.05). Meanwhile, the tendency of increasing NI values associated with increasing pathology were significant with only 5 subjects in the smallest group (Jonkheere-Terpsta test: P < 0.001). These results indicated that the NI was a concise yet effective tool to evaluate combined ACL and meniscus injury patients. Increasing severity degree of meniscus tears in ACL rupture patients is corresponded to increasing NI values. It also demonstrates that the proposed NI can be applied as a robustness factor to detect the discrepancy between healthy and patient subjects clinically, and has the potential in the quantitative evaluation of pre- or post-surgery and rehabilitation.
Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/fisiopatologia , Marcha/fisiologia , Menisco/lesões , Menisco/fisiopatologia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Análise de Componente PrincipalRESUMO
BACKGROUND: Knee pain is a common symptom in the community. There is a wide range of conditions that can cause pain. Identifying the type and severity of the condition is important for effective management. There are several guidelines for the appropriate imaging of patients presenting with knee pain. Presentation is generally divided into a post-traumatic group and those without known trauma (including arthritis). OBJECTIVE: The aim of this article is to discuss the approach to imaging of the knee with reference to Diagnostic Imaging Pathways and illustrate some of the conditions that may be encountered. DISCUSSION: The initial workup is typically done in general practice to determine which patients require referral for specialist management and which patients can be cared for in the community. Most cases presented in this article are patients referred from primary care to a metropolitan radiology practice during a six-month period, and they represent examples of some of the more common pathologies.
Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Joelho/diagnóstico por imagem , Medicina Geral/instrumentação , Medicina Geral/métodos , Medicina Geral/tendências , Humanos , Traumatismos do Joelho/fisiopatologia , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Ligamentos/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Menisco/diagnóstico por imagem , Menisco/lesões , Menisco/fisiopatologia , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/lesões , Articulação Patelofemoral/fisiopatologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: This study aimed to investigate the effect of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) on the healing of vertical medial meniscal tears in a rabbit model. METHODS: The study was conducted on 72 New Zealand mature rabbits aged more than 6 months. Rabbits were randomly assigned to six groups: control (C) group, meniscal repair (MR) group, PRP group, PRFM group, MR+PRP group, and MR+PRFM group, with 12 rabbits in each group. A 5-mm full-thickness vertical tear was created in the avascular zone of the medial meniscus corpus in the right knee of all rabbits. The respective treatment for each group was given to the meniscal tear in each rabbit. Histological evaluation of healing was performed 6 and 12 weeks after surgery. RESULTS: Defect filling and collagen formation remained low in the C group. However, in all other groups, there was no significant difference in the 6th week. In the 12th week, similar results as those obtained in the 6th week were obtained. In the C group, there was a difference in defect filling and cell type. This difference was that the defect filling and collagen formation remained low in the 12th week. No significant difference was observed between MR, MR + PRP and MR + PRFM groups. The MR group significantly differed from the other groups in the defect-filling rate and cell type; however, the use of PRP and PRFM did not provide an obvious benefit. CONCLUSION: The contradictory results obtained in previous studies emphasize the need for further research on the use of PRP in meniscal recovery and repair. We believe that if surgery is indicated, repair is absolutely necessary to improve the healing of the tissue in meniscal tears. Studies using human meniscal tissue for meniscal injury and those that evaluate clinical applications of PRP are warranted.