Use of the normalcy index for the assessment of abnormal gait in the anterior cruciate ligament deficiency combined with meniscus injury.

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.

Gender Differences in Surgery for Work-Related Musculoskeletal Injury: A Population-Based Cohort Study.

OBJECTIVE: The objective of this study is to examine if women are less likely than men to receive surgery following work-related musculoskeletal injury in the Canadian province of British Columbia. METHODS: The study included 2,403 workers with work-related knee meniscal tear, thoracic/lumbar disc displacement or rotator cuff tear. Probability of surgery was compared by gender using Kaplan-Meier methods and Cox proportional hazards models. RESULTS: For each injury type, a smaller proportion of women received surgery compared to men (knee: 76% vs. 80%; shoulder: 13% vs. 36%; back: 13% vs. 19%). In adjusted models, compared to men, women were 0.87 (95% confidence interval [CI] [0.69, 1.09]), 0.35 (95% CI [0.25, 0.48]) and 0.54 (95% CI [0.31, 0.95]) times less likely to receive knee, shoulder or back surgery, respectively. CONCLUSIONS: Probability of surgery following work-related musculoskeletal injury was lower for women than for men. Strategies to ensure gender equitable delivery of surgical services by workers' compensation systems may be warranted, although further research is necessary to investigate determinants of the gender difference and the impact of elective orthopaedic surgery on occupational outcomes.

Meniscal Root Injuries.

Meniscal root tears are an increasingly recognized injury leading to notable functional limitations, potential rapid cartilage deterioration of the affected compartment, and subsequent risk of total knee arthroplasty if left untreated. Repair of these tears is advised when articular cartilage remains intact because both medial and lateral meniscus root repairs have demonstrated favorable results. Recent literature demonstrates decreased rates of osteoarthritis and arthroplasty after medial meniscus root repair compared with partial meniscectomy and nonsurgical management. The transtibial pull-out repair technique is most commonly used and provides a biomechanically strong suture construct with standard and familiar knee arthroscopy portals. Furthermore, repair has recently been shown to be economically effective by decreasing overall societal healthcare costs when compared with more conservative management strategies. This review outlines the evaluation, treatment, and documented outcomes of meniscal root repair, which is imperative to the preservation of knee function and maintaining quality of life.

Assessment of Low-Grade Meniscal and Cartilage Damage of the Knee at 7 T: A Comparison to 3 T Imaging With Arthroscopic Correlation.

OBJECTIVES: The aim of this study was to compare the assessment of low-grade meniscal tears and cartilage damage in ultrahigh-field magnetic resonance imaging (MRI) at 7 T to routine clinical MRI at 3 T. MATERIALS AND METHODS: This study was approved by the local ethics committee, and written informed consent was obtained from each patient. Forty-one patients with suspected meniscal damage or mild osteoarthritis (Kellgren-Lawrence score, 0-2) received 7 T as well as routine clinical 3 T consecutively. The imaging protocol at both field strengths consisted of PD-weighted imaging with more than doubled resolution at 7 T. Images were read blinded regarding field strength and patient characteristics by 3 readers with different experience in musculoskeletal MRI (3 years, 6 years, and 10 years) according to a modified whole-organ MRI score of the knee in osteoarthritis and the Score of the International Cartilage Repair Society. Arthroscopic reports as a criterion standard were available for 12 patients. A multifactorial mixed model analysis was performed. RESULTS: The mean cumulated diagnostic score at 7 T was significantly closer to the criterion standard compared with 3 T in patients where criterion standard was available (P < 0.001). In all 41 patients, the damages were rated more severely at 7 T reflected by a mean higher cumulative score in cartilage (P < 0.001) and in the meniscus (P < 0.001). No difference in interreader variability between 3 T and 7 T was observed. Imaging acquisition time was nearly identical. CONCLUSIONS: Morphologic imaging of cartilage and meniscal damage of the knee in ultrahigh-field MRI at 7 T with PD-weighted TSE sequences seemed to have a significantly higher diagnostic accuracy than 3 T and can be performed with equal acquisition times while exploiting higher resolution of 7 T.

Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance.

BACKGROUND: Access to health care services is a critical component of health care reform and may differ among patients with different types of insurance. Hypothesis/Purpose: The purpose was to compare adolescents with private and public insurance undergoing surgery for anterior cruciate ligament (ACL) and/or meniscal tears. We hypothesized that patients with public insurance would have a delayed presentation from the time of injury and therefore would have a higher incidence of chondral injuries and irreparable meniscal tears and lower preoperative International Knee Documentation Committee (IKDC) scores than patients with private insurance. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This was a retrospective study of patients under 21 years of age undergoing ACL reconstruction and/or meniscal repair or debridement from January 2013 to March 2016 at a single pediatric sports medicine center. Patients were identified by a search of Current Procedural Terminology (CPT) codes. A chart review was performed for insurance type; preoperative diagnosis; date of injury, initial office visit, and surgery; preoperative IKDC score; intraoperative findings; and procedures. RESULTS: The study group consisted of 119 patients (mean age, 15.0 ± 1.7 years). Forty-one percent of patients had private insurance, while 59% had public insurance. There were 27 patients with isolated meniscal tears, 59 with combined meniscal and ACL tears, and 33 with isolated ACL tears. The mean time from injury to presentation was 56 days (range, 0-457 days) in patients with private insurance and 136 days (range, 0-1120 days) in patients with public insurance ( P = .02). Surgery occurred, on average, 35 days after the initial office visit in both groups. The mean preoperative IKDC score was 53 in both groups. Patients with meniscal tears with public insurance were more likely to require meniscal debridement than patients with private insurance (risk ratio [RR], 2.3; 95% CI, 1.7-3.1; P = .02). Patients with public insurance were more likely to have chondral injuries of grade 2 or higher (RR, 4.4; 95% CI, 3.9-5.0; P = .02). CONCLUSION: In adolescent patients with ACL or meniscal tears, patients with public insurance had a more delayed presentation than those with private insurance. They also tended to have more moderate-to-severe chondral injuries and meniscal tears, if present, that required debridement rather than repair. More rapid access to care might improve the prognosis of young patients with ACL and meniscal injuries with public insurance.

Systematic review of the prevalence, risk factors, diagnosis and management of meniscal injury in dogs: Part 2.

OBJECTIVE: To systematically evaluate the evidence reporting the diagnosis and management of meniscal injury in dogs with cranial cruciate ligament failure. STUDY DESIGN: Systematic literature review. MATERIALS AND METHODS: Research questions relating to the accuracy of diagnostic techniques for meniscal injury and the effects of meniscal treatment were defined. An electronic database search of PubMed and CAB Abstracts was performed during March 2015. Data were extracted for study participants, design, intervention, outcome measures and results. Studies were evaluated using a validated instrument for assessing methodological quality and assigned a Quality Index score. A level of evidence was then assigned to each study. RESULTS: Eighty-nine studies were identified. The median Quality Index score was 14 out of a possible 26. Twenty-seven studies were prospective case series, 31 retrospective case series, 16 animal research and 15 cadaveric studies. There were no class I or class II studies, 27 class III and 62 class IV studies. CONCLUSIONS: Despite a large number of publications the quality of evidence was generally low. No one study or combination of studies provided high quality evidence to support one diagnostic or surgical intervention over another for meniscal injuries in dogs with cranial cruciate ligament failure.