AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair

@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

Inferior Healing Rate in Isolated Meniscal Repair than that in Meniscal Repair with Concomitant ACL Reconstruction Evaluated with MRI

@#Introduction: Isolated meniscal repair has been suggested as one of the contributing factors in unhealed meniscal repair. The purpose of this study was to compare the healing rate between isolated meniscal repair and meniscal repair with concomitant anterior cruciate ligament reconstruction (ACLR) using a standardised assessment method after propensity score matching. Materials and methods: Accuracy of the Crues' grading system for meniscal healing was validated using second-look arthroscopy as the reference standard in 17 patients. Propensity score matching (one-to-one) was performed between 26 patients who underwent isolated meniscal repair and 98 patients who underwent meniscal repair with concomitant ACLR. Patients were matched for sex, age, side and zone of the meniscal repair, and number of sutures. Healing rates at one year which were evaluated with magnetic resonance imaging (MRI) were compared between the two groups. Results: The sensitivity and specificity of the Crues' grading system on multiple plane MRI for meniscal healing were 100% and 83.3%, respectively. Both the isolated meniscal repair group and the meniscal repair with concomitant ACLR group included 21 patients after propensity score matching. Baseline characteristics did not differ significantly between the two groups. The healing rate was significantly lower in the isolated meniscal repairs group (14.3%) than in the meniscal repair concomitant with ACLR group (47.6%, P=0.04). Conclusion: The healing rate for isolated meniscal repair using a standardised MRI assessment method was inferior to that of meniscal repair with concomitant ACLR after propensity score matching.

Arthroscopic Repair for Medial Meniscus Tear:a Case Report of a 4-year-old Boy / 中国微创外科杂志

[Summary] This paper reported a case of 4-year-old boy suffered with medial meniscus tear treated by arthroscopic repair in our hospital.After the boy injured his knee , plaster was applied for 4 weeks.Without any symptomatic progress , he was hospitalized with the diagnosis of medial meniscus tear .We performed arthroscopic meniscus repair , using 4.0-mm arthroscopy.At 3-month follow-up, the boy could full-bearing walk with no pain or discomfort , with a range of motion of 0°-135°.The post-operational MRI at the fourth month showed preliminary healing of repaired meniscus .We believe that regular arthroscopic instruments can accomplish meniscus repair in young children .

Fibrin Clot Delivery System for Meniscal Repair

As meniscal preservation particularly in younger active individuals with a symptomatic meniscal tear remains the preferred treatment option, various methods have been suggested to increase healing and success rates after meniscal repair. The recent increase in clinical use of platelet rich plasma has contributed to the increased use of fibrin clot, which virtually has the same healing property. However, despite the relative ease of acquisition and preparation of fibrin clots, delivering it to the desired target area arthroscopically is challenging. Therefore, we report with a pertinent literature review a novel method of planting a fibrin clot to the desired area of meniscal tear arthroscopically using our delivery system to enhance healing.

Clinical value of helfet test in the diagnosis of meniscus injury / 中国矫形外科杂志

[Objective]To study the accuracy of Helfet test in the diagnosis of the knee meniscus tear.[Method]From Apr.2007 to Oct.2007,52 cases of the lateral meniscus tear and 23 cases of the medial meniscus tear were checked-up with Helfet test,McMurray test ,KS test,and arthroscope comparatively.[Result]The Helfet Test was positive in most of the lateral meniscus tear cases.The consistency with McMurray test and arthroscope was lateral meniscus tear,especially to bucket-handle and Horizontal tear high respectively.The rate of accuracy to lateral menicus was 81.4%.The rate of accuracy to bucket-handle and Horizontal tear were 89.6% and 87.2% respectively.[Conclusion]The "Helfet" test is sensitive to the knee lateral meniscus tear.It is fast,simple,reliable,reproducible,positive for diagnose of lateral meniscus tear,and is worth of being used widely.

Prevalence of Meniscus Tear in Tibial Plateau Fractures

PURPOSE: To evaluate the pattern of meniscal tear according to the type of the tibial plateau fracture of Schatzker. MATERIALS AND METHODS: Sixty two cases of tibial condyle fracture treated between the period of 1994 and 2003 were evaluated. The fracture type was classified according to Schatzker. The pattern and extent of the meniscus tear were compared with the fracture classification. Statistical analysis was made with the Fisher's exact test. RESULTS: Meniscus tear was noted in 29 cases out of 62 fractures (46.8%). The twenty cases of minimally displaced fractures treated conservatively showed no meniscal tear. Of 18 cases of the most common type I fracture 2 (11.2%) had a meniscus tear. Of 16 type II fractures 12 (75%) had a meniscus tear. The type III fracture showed the highest prevalence of meniscus tear (76.9%, 10/13). There was statistically significant relationtionship between the type of fractures and the rate of meniscus tear (p<0.0001). CONCLUSION: The meniscus tear frequently occurred in tibial plateau fractures in Schatzker type II and III. Associated meniscus tears should be born in mind when those types of fracture are encountered.

Differences of Meniscal Injuries by Age Groups

PURPOSE: We analyzed and classified the patterns of meniscal injuries by age groups and tried to find the statistical meanings. MATERIALS AND METHODS: We reviewed 217 cases with meniscal injuries of 340 patients who received knee arthroscopy from January 1996 to June 2000. We analyzed the statistical significances of them by age groups and classified injury patterns of site, shape and combined injuries. RESULTS: Medial meniscal injuries, especially in posterior horn, were more common, and degenerative tears have higher incidence in elderly groups. In younger groups, longitudinal and flap tears were more common. More prevalent associated injuries were ACL tears in younger groups and loose bodies in elderly groups. CONCLUSION: In knee arthroscopy, to find out the patterns of meniscal injuries by age groups is important to determine the method of treatment and prognosis.

Different Patterns of Meniscal Tears in Recent Anterior Cruciate Ligament ( ACL ) Ruptures and Chronic ACL-deficient Knees / 대한정형외과학회잡지

PURPOSE: We tried to outline the incidence and characteristics of meniscal tears in recent lesions and chronic insufficiency of the ACL. MATERIALS AND METHODS: Through this retrospective study of 103 reconstructions of the anterior cruciate ligament (ACL) performed between Jun 1996 to Sep 1998, according to a more accurate evaluation, ACL-deficient knees can be classified into two different stages (recent, chronic injuries). RESULTS: Overall, there was a significantly increasing incidence of meniscal tears in chronic injuries (P<0.05). A predominance of lateral meniscal tears were demonstrated with recent injuries, whereas the incidence of medial meniscal tears increased significantly with chronic injuries (P<0.05). CONCLUSIONS: This study highlights the increase of lateral meniscal lesion in recent ACL rupture and increase of severe meniscal lesion, especially medial meniscus, with progressive worsening of knee instability after an ACL injury. Although not significant, meniscal tears in the recent injuries were more amenable to repair. The results suggest that maximal meniscal preservation is best achieved with ACL reconstruction shortly after injury.

Meniscus Repair using Meniscus Arrow: Preliminary Report

No abstract available.

A Clinical Study of Arthroscopic Meniscectomy / 대한정형외과학회잡지

Ninety cases of meniscus injury were treated by arthroscopic meniscetomy between March, 1988 and March, 1992. Eighty four cases were treated by arthroscopic partial, 5 cases by subtotal, and 1 case by total meniscectomy. All cases were followed up for more than 1 year. The results were as follows. 1. The ratio of male to female was 57 to 31, and that of right to left was 52 to 38. 2. There were 41 cases of medial meniscus and 49 cases of lateral meniscus. Longitudinal tears were 35 cases (39%), oblique tears were 20 cases (22%), horizontal tears were 15 cases (17%), and radial tears were 9 cases (10%). There was no difference in the shape of tear between medial and lateral meniscus. 4. The most common associated injury was anterior cruciate ligament tear. 5. The Tapper and Hoover scale was used to record the clinical results, and satisfatory results (exellent and good)were in 86% of cases.

Meniscus Tear / 대한정형외과학회잡지

Classification of meniscal tear is necessary only for partial resection. In western countries many reports said that medial meniscal tear is commoner than that of lateral meniscus. Actually the reverse is true in Korea and in some other oriental countries, However there is no plausible explanation concerning this matter. In this report 250 knees of 240 patients were involved. We performed arthroscopic meniscectomy in all cases and we investigated the relationship between the pattern of tear and many possibly related factors. The follow-up period was 1–8 years, the ratio of male-female was 163:77, and the range of age was varied between 7 and 71 tears with the young and middle age groups being predominant. Right and left side ratio was 117:113 and the involvement of both knees was noted in 20 knees of 10 patients. The results were as follows: 1. The medial menisci were torn in 100 knees and was less than 142 lateral meniscal tear, with the ratio being 1:1.4. The tear of lateral meniscus was commoner in the age group of less than 30 years and the tear of medial meniscus was commoner in the age group older than 50 years whereas there was no difference in the age group of inbetween. 2. The commonest pattern of tear was longitudinal one including peripheral tear, that is 135 knees (54.0%), followed by complex tear, 50 knees (20.0%), oblique tear, 40 knees (16.0%), horizontal tear, 21 knees (8.4%) and lastly superior and inferior flap tear, 5 knees (2.0%). 3. The longitudinal tear was most prevalent in the age group of 20–40, whereas the complex tear was most prevalent in the age group of beyond 50 years (p0.05). 5. In the longitudinal tear group, the tear occured most frequently in the midsubstance of posterior portion in the medial menisci without statistical significance (p>0.05) wereas the tear occurred most frequently in the periphery of the anterior portion in case of lateral menisci (p<0.05). 6. There were 37 discoid lateral menisci, with the longitudinal tear being the commonest. 7. Ground sports injuries occurred only in 34 knees (13.6%), with the longitudinal tear being significantly commoner than in the other injuries. From these results it would be suggested that although the discoid lateral meniscus has to be given much weight in the total meniscal injuries another explanation should be given concerning the prevalence of lateral meniscus tear compared to the medial meniscus tear and the prevalence of longitudinal tear.

99mTc Pyrophosphate Knee Scintigraphy as a Diagnostic tool for the Tear of the Meniscus of the Knee / 대한정형외과학회잡지

We tried to evaluate the possibility that the radionuclide imaging of the knee with 99mTc-pyrophosphate be the diagnostic tool for the patients with the suspected tear of the meniscus of the knee. Among the 142 cases in which 99mTc-pyrophosphate scan was performed, both arthrogram and knee scintigraphy were performed in 60 cases, but only 25 cases were done arthroscopy & arthrotomy for identification to intraarticular legion. We observed 4 types of abnormally increased uptake in the scintigraphy from 16 cases of 19 cases that identified to the meniscus tear. These patterns were seen with 1) diffuse increased uptake, 2) focal increased uptake, 3) plate-like increased uptake in or near the joint space, 4) diffuse increased uptake with plate-like accentuation. Among the 25 cases, 18 cases were found to have consistent scintigraphy & operative findings, 3 cases were observed not tear of meniscus but other legions in the knee joint. And only 4 cases were seen differented to findings of arthrotomy & scintigraphy. We could conclude that the knee scintigraphy with 99mTc-pyrophosphate could be used as a helpful method of the initial evaluation of the internal derangement of the knee in the patients with the suspected tear of the meniscus of the knee.

Arthroscopic Partial Meniscectomy: A Study of 95 Knees / 대한정형외과학회잡지

During the period from January 1987 to May 1988, arthroscopic partial meniscectomy had been performed in 95 knees of 94 patients. Of the 94 patients, there were 66 males and 28 females ranging in age from 10 to 49 years(mean, 27.4 years). The mean follow up period was 22.1 months (range, 15 to 32 months). Both medial and lateral menisci were affected in 6 knees, so 101 menisci were removed. In the group studied, there were 35 tears of medial, 29 tears of lateral and 37 tears of discoid meniscus. In the 101 tears of meniscus, 22 cases of longitudinal tear, 37 cases of bucket handle tear, 19 cases of flap tear, 13 cases of transverse tear, 5 cases of horizontal tear and 5 cases of complex tear were observed. Most frequently associated lesion was ACL injury (9 cases), and 4 cases of loose body and 4 cases of synovial plica syndrome were also found. The sensitivity of diagnosis with physical examination only was 63.6% and improved with arthrography to 70.4%, and with arthrography and CT to 80.0%. Satisfactory result including excellent and good was 76.6% and no major complication was accompanied.