Predictors of Postoperative Outcomes after Arthroscopic Partial Meniscectomy: A Retrospective Analysis.

OBJECTIVE: Arthroscopic partial meniscectomy is a widely used surgical technique for treating meniscus injuries, while individual differences in postoperative outcomes remain a significant concern. This retrospective study aimed to identify the factors influencing clinical outcomes following arthroscopic partial meniscectomy. METHODS: We retrospectively examined the clinical data of 52 patients who underwent arthroscopic partial meniscectomy at our institution from January to May 2022. Observation indicators, including gender, age, type of medical insurance, various surgeons, the self-pay portion of hospital costs, and total hospital costs, were systematically recorded. Subjective symptoms were evaluated with ΔTenger, ΔLysholm, and International Knee Documentation Committee (IKDC) scores during follow-up. The trends of the above questionnaires and potential predictors were statistically evaluated through regression analysis. RESULTS: Binary logistic analysis revealed that female patients (OR: 32.42; 95% confidence interval [CI]: 2.22, 473.86) and higher preoperative visual analog scale (VAS) (odds ratio [OR]: 3.58; 95% CI: 1.55, 8.28) were significantly associated with FP Lysholm score. Similarly, patients with elevated preoperative VAS (OR: 1.47; 95% CI: 1.01, 2.15) were significantly more likely to have FP IKDC scores. Multiple linear regression analysis revealed that traumatic meniscus tear (ß = -0.324; 95% CI: -0.948, -0.036; p = 0.035) emerged as a negative independent predictor of ΔTegner, while higher preoperative VAS scores (ß = 0.330; 95% CI: 0.013, 0.217; p = 0.028) were identified as positive independent predictors of ΔTegner. The duration of symptoms (ß = -0.327; 95% CI: -0.010, -0.001; p = 0.023) had a negative impact on the ΔLysholm scores. Factors such as body mass index (BMI) (ß = -0.250; 95% CI: -1.000, -0.020; p = 0.042), duration of symptoms (ß = -0.302; 95% CI: -0.009, -0.001; p = 0.014), and preoperative VAS (ß = -0.332; 95% CI: -1.813, -0.250; p = 0.011) were negatively associated with ΔIKDC scores. CONCLUSION: The study offers insights into multiple factors for patient outcomes after arthroscopic partial meniscectomy. Orthopedic surgeons need to consider variables such as gender, BMI, duration of symptoms, preoperative VAS, and the traumatic/degenerative types of meniscal tears to optimize postoperative outcomes.

[Arthroscopic surgery for injuries to the popliteal tendon area of the lateral meniscus].

OBJECTIVE: To investigate the mid-term effect and complications of arthroscopic popliteal tendon suture in the treatment of lateral meniscus injury. METHODS: From January 2016 to December 2020, the data of 57 patients with lateral meniscus popliteal tendon injury treated by arthroscopic popliteal tendon suture fixation were retrospectively analyzed, including 35 males and 22 females, aged from 18 to 47 years old with an average of (32.9±7.9) years old. Knee function was evaluated using the International Knee Documentation Committee (IKDC) and Lysholm scores both before the operation and at the final follow-up. Meniscus healing was evaluated according to the postoperative Barrett standard. Wound healing complications, such as vascular injury, nerve injury, and lower extremity venous thrombosis, were recorded. RESULTS: All 57 patients were followed up for 12 to 58 months with an average of (38.1±14.9) months.The incisions of the patients after the operation were all Grade A healing without infection, popliteal tendon injury, blood vessel injury, nerve injury and lower extremity venous thrombosis.The IKDC score increased from (49.7±3.6) points preoperatively to (88.5±4.4) points in the final follow-up (P<0.05). The Lysholm score increased from (48.8±4.9) points preoperatively to (91.9±3.9) points at the final follow-up (P<0.05). At 3, 6 months and 1 year after operation, according to Barrett's criteria, 54 cases were clinically healed, the healing rate was 94.7% (54/57). CONCLUSION: This study preliminarily confirmed that arthroscopic suture technique can result in clinical stability through suture and fixation of the meniscus in the injured lateral popliteal tendon area. No adverse effects on knee joint function were found in the mid-term follow-up after the operation.

Novel Meniscus Transfer Technique: A Case Report.

The meniscus is an essential component of the knee joint, acting as a shock absorber as well as assisting in the transmission of forces. Due to the meniscus importance of the knee, much of the current literature focuses on treatment techniques that can spare and repair the meniscus when it is torn. The unique vasculature of the meniscus often makes repair difficult or, in many cases, impossible. A current focus within orthopedics has been on meniscal allograft transplantation to fill this gap. The lack of a universal surgical technique for graft fixation, along with the current failure rates, demonstrates the need for further improvements. The senior author proposes a novel technique for meniscal allograft transplantation that has shown decreased blood loss and surgical time, while also reducing intra-operative trauma to the knee. This case reports a 16-year-old patient who underwent a right lateral meniscal allograft transplant following a large segmental defect tear of the lateral meniscus. The patient initially underwent arthroscopy and meniscectomy with screw fixation of the lateral femoral condyle lesion. After physical therapy, the patient experienced increased pain and swelling, with magnetic resonance imaging (MRI) demonstrating a meniscal defect unamenable to repair. The patient met indications for meniscal allograft transplantation given the failed meniscectomy, absence of cartilage loss and significant osteoarthritis, and the patient's age of less than 50 years old.

Meniscal Lesions in Multi-Ligament Knee Injuries.

Introduction: Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries. Objective: The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available. Materials and methods: Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered. Results: Seventy patients with MLKIs were included, with a mean age of 30.69 years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89-26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%. Conclusion: The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns. It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs.

Extracorporeal shockwave therapy for degenerative meniscal tears results in a decreased T2 relaxation time and pain relief: An exploratory randomized clinical trial.

PURPOSE: The optimal management of degenerative meniscal tears remains controversial. Extracorporeal shockwave therapy (ESWT) has been shown to promote tissue repair in both preclinical and clinical studies; however, its effect on degenerative meniscal tears remains unknown. This study aimed to examine whether ESWT improves meniscal degeneration. METHODS: This randomized trial was conducted between 2020 and 2022 and involved patients with degenerative medial meniscal tears. Patients were allocated to receive either focused ESWT (0.25 mJ/mm2, 2000 impulses, 3 sessions with a 1-week interval) or sham treatment. Patients were evaluated using magnetic resonance imaging (MRI) before treatment and at 12 months after treatment. The primary endpoint was improvement in meniscal degeneration, as assessed by the change in T2 relaxation time from baseline on MRI T2 mapping. Knee pain and clinical outcomes were also examined at the same time. RESULTS: Of 29 randomized patients, 27 patients (mean age 63.9 ± 8.7 years; females 37%; ESWT group 14 patients; control group 13 patients) were included in the final analysis. At 12 months postintervention, patients in the ESWT group showed a greater decrease in the T2 relaxation time (ESWT group -2.9 ± 1.7 ms vs. control group 1.0 ± 1.9 ms; p < 0.001) and had less knee pain (p = 0.04). The clinical outcomes at 12 months post-treatment were not statistically significant. No adverse events were reported. CONCLUSION: ESWT decreased the T2 relaxation time in the meniscus at 12 months post-treatment. ESWT also provided pain relief, but no differences were observed in clinical outcomes. LEVEL OF EVIDENCE: Level II.

Repair of bucket handle meniscus tears improves patient outcomes versus partial meniscectomy at the time of ACL reconstruction.

Purpose: The aim of this study was to examine demographic and surgical factors that influence patient-reported knee function in patients who undergo anterior crucial ligament reconstruction (ACLR) with concurrent bucket-handle meniscal tear (BHMT) procedures. We hypothesized that repair of BHMT in the setting of concomitant ACLR and shorter time from injury to surgery would lead to improved patient-reported outcomes. Methods: Forty-one patients (mean age: 28.0 ± 9.8 years, 72% male) with BHMT at the time of ACLR completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) via online survey at an average of 15.2 months postop. Patient demographics and surgical characteristics, including time from injury to surgery, were compared between repair (n = 22) and meniscectomy (n = 19) groups using one-way analysis of variances; distributions of sex, graft source, BHMT compartment and zone were compared between groups using χ 2 tests. The association between IKDC-SKF score, demographics and surgical characteristics was evaluated using multivariable linear regression. A priori alpha level was p < 0.05. Results: Meniscal repair and meniscectomy groups differed based on graft source and BHMT zone but not IKDC-SKF score (p = 0.085). Patients undergoing ACLR with autograft (p = 0.003) and with red-red zone BHMT (p < 0.001) more often underwent meniscal repair. The regression model demonstrated longer time from injury to surgery (p = 0.049), red-red tear zone (p = 0.04) and meniscectomy (p = 0.008); these were predictive of poorer IKDC-SKF scores. Conclusion: BHMT repair was more likely performed in ACL autograft and on red-red zone tears. Longer time from injury to surgery is an indicator of poorer IKDC-SKF score, as this may increase the risk of concomitant pathologies. White-white zone BHMTs are associated with better IKDC-SKF scores than red-red zone BHMTs, which may be due to the smaller volume of tissue removed during meniscectomy of white-white zone tears and the avoidance of iatrogenic complications of meniscal repair. Level of Evidence: Level III, therapeutic study.

Failure rate of isolated medial meniscus repair in the stable knee: Systematic review and meta-analysis.

PURPOSE: The present meta-analysis aims to determine the outcomes and failure rates for medial meniscus repairs in patients with stable knees. METHODS: A literature search was conducted using PubMed and Scopus with the terms '(medial meniscus OR medial meniscal) AND (repair)'. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included 93 articles assessed for eligibility. The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analyses and case reports. RESULTS: In total, 10 studies with 595 patients were included. Degenerative tears or studies reporting meniscus repair outcomes on root repairs, revision or primary anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. All studies included revision surgery and/or clinical symptoms as failure definitions. The overall medial meniscal repair failure rate was 26% with a 95% confidence interval (CI) [15%-37%]. The mean time to failure from isolated medial meniscus repair surgery was 27.7 months with 95% CI [18.5-36.9 months]. The postoperative Lysholm and IKDC scores were reported in three articles. At the final follow-up, the mean postoperative Lysholm and IKDC scores were 92.3 with 95% CI [84.5-100] and 88.6 with 95% CI [83.5-93.8], respectively. CONCLUSION: The current meta-analysis revealed an overall failure rate of 26% in the case of medial meniscus repair in a stable knee. For these reasons, the patient should be aware of the substantial risk of revision surgery (one out of four cases). Medial meniscus repair in a stable knee yielded good clinical results. LEVEL OF EVIDENCE: II.

Achieving high accuracy in meniscus tear detection using advanced deep learning models with a relatively small data set.

PURPOSE: This study aims to evaluate the effectiveness of advanced deep learning models, specifically YOLOv8 and EfficientNetV2, in detecting meniscal tears on magnetic resonance imaging (MRI) using a relatively small data set. METHOD: Our data set consisted of MRI studies from 642 knees-two orthopaedic surgeons labelled and annotated the MR images. The training pipeline included MRI scans of these knees. It was divided into two stages: initially, a deep learning algorithm called YOLO was employed to identify the meniscus location, and subsequently, the EfficientNetV2 deep learning architecture was utilized to detect meniscal tears. A concise report indicating the location and detection of a torn meniscus is provided at the end. RESULT: The YOLOv8 model achieved mean average precision at 50% threshold (mAP@50) scores of 0.98 in the sagittal view and 0.985 in the coronal view. Similarly, the EfficientNetV2 model obtained area under the curve scores of 0.97 and 0.98 in the sagittal and coronal views, respectively. These outstanding results demonstrate exceptional performance in meniscus localization and tear detection. CONCLUSION: Despite a relatively small data set, state-of-the-art models like YOLOv8 and EfficientNetV2 yielded promising results. This artificial intelligence system enhances meniscal injury diagnosis by generating instant structured reports, facilitating faster image interpretation and reducing physician workload. LEVEL OF EVIDENCE: Level III.

Excellent accuracy of magnetic resonance imaging for diagnosis of discoid meniscus tears: A systematic review and meta-analysis.

Purpose: The discoid meniscus (DM) is distinguished by its thickened, disc-shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis escalates if a DM tear remains undiagnosed and untreated. While DM tears can be diagnosed through arthroscopy, the high cost, invasive nature and limited availability of this procedure highlight the need for a better diagnostic modality. This study aims to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing DM tears. Methods: A systematic review was conducted to gather articles with at least 10 cases on the comparison of MRI and arthroscopy as the gold standard for DM tear diagnosis. Stata and MetaDisc were used to conduct the statistical analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: Five diagnostic performance studies, derived from four original research papers involving 305 patients, were evaluated. Based on the pooled data, the sensitivity, specificity, diagnostic odds ratio, positive limit of detection and negative limit of detection were found to be 0.87 (95% confidence interval [CI], 0.82-0.91) and 0.84 (95% CI, 0.75-0.90), 32.88 (95% CI, 5.81-186.02), 5.22 (95% CI, 1.71-15.92) and 0.18 (95% CI, 0.09-0.38), respectively. A hierarchical summary receiver operating characteristic curve with an area under the curve of 0.92 was generated. Conclusion: This meta-analysis demonstrates that MRI has excellent sensitivity and specificity for diagnosing DM tears. Despite its lower accuracy compared to arthroscopy, MRI can be used in symptomatic patients as a viable alternative to arthroscopy due to its inherent advantages. Level of Evidence: Level IV.

A Comprehensive Evaluation of Deep Learning Models on Knee MRIs for the Diagnosis and Classification of Meniscal Tears: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study delves into the cutting-edge field of deep learning techniques, particularly deep convolutional neural networks (DCNNs), which have demonstrated unprecedented potential in assisting radiologists and orthopedic surgeons in precisely identifying meniscal tears. This research aims to evaluate the effectiveness of deep learning models in recognizing, localizing, describing, and categorizing meniscal tears in magnetic resonance images (MRIs). MATERIALS AND METHODS: This systematic review was rigorously conducted, strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extensive searches were conducted on MEDLINE (PubMed), Web of Science, Cochrane Library, and Google Scholar. All identified articles underwent a comprehensive risk of bias analysis. Predictive performance values were either extracted or calculated for quantitative analysis, including sensitivity and specificity. The meta-analysis was performed for all prediction models that identified the presence and location of meniscus tears. RESULTS: This study's findings underscore that a range of deep learning models exhibit robust performance in detecting and classifying meniscal tears, in one case surpassing the expertise of musculoskeletal radiologists. Most studies in this review concentrated on identifying tears in the medial or lateral meniscus and even precisely locating tears-whether in the anterior or posterior horn-with exceptional accuracy, as demonstrated by AUC values ranging from 0.83 to 0.94. CONCLUSIONS: Based on these findings, deep learning models have showcased significant potential in analyzing knee MR images by learning intricate details within images. They offer precise outcomes across diverse tasks, including segmenting specific anatomical structures and identifying pathological regions. Contributions: This study focused exclusively on DL models for identifying and localizing meniscus tears. It presents a meta-analysis that includes eight studies for detecting the presence of a torn meniscus and a meta-analysis of three studies with low heterogeneity that localize and classify the menisci. Another novelty is the analysis of arthroscopic surgery as ground truth. The quality of the studies was assessed against the CLAIM checklist, and the risk of bias was determined using the QUADAS-2 tool.

The Usefulness of Posterior Shiny Corner Lesions in the Early Diagnosis of Medial Meniscus Posterior Root Tears.

INTRODUCTION:  Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients. However, the usefulness of PSCLs in outpatients, particularly regarding the optimal timing of magnetic resonance imaging (MRI) examinations after injury, remains unknown. We hypothesized that PSCLs would normally be observed in patients with MMPRTs within one month of injury. MATERIALS AND METHODS:  This study included 144 patients with knee pain who visited our hospital between January 2021 and May 2023. MRI findings within and after one month were examined. Fisher's exact test was performed for PSCLs, cleft signs, ghost signs, radial tear signs, bone cysts, and medial meniscus extrusion (MME), which are findings used for the diagnosis of MMPRTs. Time-dependent receiver operating characteristic (ROC) curve analysis was performed for each MRI finding. A binomial logistic regression analysis was performed for age, sex, PSCL, ghost sign, and MME. RESULTS: PSCLs were observed on 82.6% of the MRI scans within one month, but the positivity rate decreased after one month. After one month, a high percentage of patients had cleft signs and ghost signs. The results of a time-dependent ROC curve analysis showed that the PSCL had better diagnostic ability than the cleft sign, ghost sign, radial tear sign, and MME at a relatively early stage. Additionally, the area under the curve (AUC) of PSCL peaks around 35 days and then declines, reaching 0.8 or less around 40 days. On the other hand, the AUC of the cleft sign and ghost sign began to increase around 30 days after injury, and it exceeded 0.8 after approximately 100 days. The results of the binomial logistic regression analysis revealed significant PSCLs and ghost signs. Independent associations between the PSCL, or ghost sign, and the MMPRT were demonstrated. CONCLUSION:  This study suggests that PSCLs have a superior diagnostic capability for MMPRT during the early stages of injury compared with other MRI findings in outpatients. In particular, PSCLs have a high positivity rate within one month after injury and a high diagnostic capacity up to 40 days after injury.

Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury.

PURPOSE OF REVIEW: The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. RECENT FINDINGS: Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.

Secondary restraints in ACL reconstruction: State-of-the-art.

At-risk patients continue to experience a high likelihood of graft rupture after anterior cruciate ligament (ACL) reconstruction (ACLR). This narrative review seeks to provide the reader with an evidence-based synopsis of state-of-the-art concepts related to secondary restraint lesions, and how addressing them surgically might result in improved outcomes of ACLR.

Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis.

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.

The Impact of Bone Marrow Venting Augmentation on Knee Functions in the Repair of Vertical/Longitudinal Meniscus Tears: A Triple Comparison.

Objective: Preserving and restoring meniscus function is crucial for maintaining knee biomechanics and overall functionality. To enhance the healing process after meniscus repair, various biological techniques have been introduced. In this study, three treatment approaches examined were bone marrow venting with stem cells (BMVP), anterior cruciate ligament reconstruction (ACLR) with meniscus repair, and isolated meniscus repair. Materials and Methods: From 2015 to 2019, we retrospectively analyzed data from 83 patients who presented with complaints of knee pain or pain in addition to instability, were diagnosed with vertical/longitudinal meniscus tears, and underwent arthroscopic repair (30 with isolated repair, 28 with ACLR repair, and 25 with BMVP) at our University Hospital. Among the 28 patients with anterior cruciate ligament rupture, pain and instability were the predominant complaints, whereas 55 patients with meniscus tear primarily complained pain. Clinical and functional conditions were assessed using Lysholm, WOMAC, IKDC, and VAS scores before and 18 months after surgery. Surgical success was evaluated based on Barrett's criteria. Causes of failure were analyzed considering demographic data, smoking status, injury time, tear location, shape, zone, and suture type and number. Results: Of the participants, 58 were male, 25 were female, 61 had medial meniscus lesions, and 22 had lateral meniscus lesions. The tear types included 51 simple longitudinal tears, 18 bucket handle tears, and 14 complex tears. A significant improvement was observed in the postoperative 18 month Lysholm, WOMAC, and IKDC values in all three groups (p: 0.001). At the 18 month mark, clinical and functional outcomes were comparable between BMVP and ACLR repair groups (Lysholm p: 0.951, WOMAC p: 0.241, IKDC p: 0.984). Both of these procedures yielded better results compared to isolated meniscus repair (Lysholm p: 0.001, WOMAC p: 0.027, IKDC p: 0.001). Conclusion: The superior clinical and functional outcomes observed after meniscus repair with BMVP and ACLR, compared to isolated meniscus repair, indicate positive effects of bone marrow stem cells, blood components, and tissue healing factors on meniscus repair and knee function.

The mediating role of synovitis in meniscus pathology and knee osteoarthritis radiographic progression.

Meniscus pathologies (damage, extrusion) and synovitis are associated with knee osteoarthritis (KOA); however, whether synovitis mediates the relationship between meniscus pathologies and KOA radiographic progression remains unclear. We conducted an observational study in the Osteoarthritis Initiative (OAI) cohort, with a 48-month follow-up. Meniscus pathology and synovitis were measured by MRI osteoarthritis knee score (MOAKS) at baseline and 24 months, and a comprehensive synovitis score was calculated using effusion and Hoffa synovitis scores. The knee osteoarthritis radiographic progression was considered that Kellgren-Lawrence (KL) grade and joint space narrowing (JSN) grade at 48 months were increased compared to those at baseline. This study included a total of 589 participants, with KL grades mainly being KL1 (26.5%), KL2 (34.1%), and KL3 (30.2%) at baseline, while JSN grades were mostly 0 at baseline. A logistic regression model was used to analyze the relationship between meniscus pathology, synovitis, and KOA progression. Mediation analysis was used to evaluate the mediation effect of synovitis. The average age of the participants was 61 years old, 62% of which were female. The medial meniscus extrusion was longitudinally correlated with the progression of KL (odds ratio [OR]: 2.271, 95% confidence interval [CI]: 1.412-3.694) and medial JSN (OR: 3.211, 95% CI: 2.040-5.054). Additionally, the longitudinal correlation between medial meniscus damage and progression of KOA (OR: 1.853, 95% CI: 1.177-2.941) and medial JSN (OR: 1.655, 95% CI: 1.053-2.602) was significant. Synovitis was found to mediate the relationship between medial meniscus extrusion and KL and medial JSN progression at baseline (ß: 0.029, 95% CI: 0.010-0.053; ß: 0.022, 95% CI: 0.005-0.046) and beyond 24 months (ß: 0.039, 95% CI: 0.016-0.068; ß: 0.047, 95% CI: 0.020-0.078). However, we did not find evidence of synovitis mediating the relationship between meniscal damage and KOA progression. Synovitis mediates the relationship between medial meniscus extrusion (rather than meniscus damage) and KOA progression.

A Rare Case of Arthroscopic Lateral Segmental Meniscal Allograft Transplantation (SMALT) and Osteochondral Allograft Transplantation (OCA) of the Lateral Femoral Condyle Augmented With Bone Marrow Aspirate Concentrate (BMAC).

The meniscus of the knee serves as a crucial load-bearing structure, and its damage can significantly impact weight distribution. In addressing focal meniscal defects, segmental meniscal allograft transplantation (SMALT) emerges as an innovative solution. Here, we detail a case involving a young, active female who underwent SMALT augmented with osteochondral allograft transplantation (OCA) and bone marrow aspirate concentration (BMAC). The patient, a 40-year-old former Division I volleyball player, previously underwent arthroscopic procedures and presented with knee pain alongside complex lateral meniscus tear evident in magnetic resonance imaging (MRI) findings. Initial arthroscopy revealed multiple tears, including segmental deficiency at the posterior horn-body junction and a horizontal cleavage tear. Despite failed attempts at repair due to the meniscal gap, a second-stage lateral SMALT was performed, with the allograft soaked in the patient's BMAC, supplemented with OCA to the lateral femoral condyle. Rehabilitation protocols tailored to both SMALT and OCA were implemented. This represents the first documented instance of lateral SMALT, extending the scope of viable solutions for segmental meniscal deficiencies, and marking a significant milestone in orthopedic practice.

Decay-Accelerating Factor Differentially Associates With Complement-Mediated Damage in Synovium After Meniscus Tear as Compared to Anterior Cruciate Ligament Injury.

We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus tear (MT) and proposed this as a mechanism for a greater post-injury prevalence of post traumatic osteoarthritis (PTOA). To explore additional roles of complement proteins and regulators, we determined the presence of decay-accelerating factor (DAF), C5b, and membrane attack complexes (MACs, C5b-9) in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy, osteoarthritis (OA)-related knee replacement surgery and normal controls. Multiplexed immunohistochemistry was used to detect and quantify complement proteins. To explore the involvement of body mass index (BMI), after these 2 injuries, we examined correlations among DAF, C5b, MAC and BMI. Using these approaches, we found that synovial cells after ACL injury expressed a significantly lower level of DAF as compared to MT (p<0.049). In contrast, C5b staining synovial cells were significantly higher after ACL injury (p<0.0009) and in OA DSST (p<0.039) compared to MT. Interestingly, there were significantly positive correlations between DAF & C5b (r=0.75, p<0.018) and DAF & C5b (r=0.64 p<0.022) after ACL injury and MT, respectively. The data support that DAF, which should normally dampen C5b deposition due to its regulatory activities on C3/C5 convertases, does not appear to exhibit that function in inflamed synovia following either ACL injury or MT. Ineffective DAF regulation may be an additional mechanism by which relatively uncontrolled complement activation damages tissue in these injury states.

Ramp-like lateral meniscus tear. Description of an infrequent lesion.

Numerous studies on meniscal tears have been published, a pathology that continues to evolve in terms of treatment and patient outcomes. As our understanding of anatomy and biomechanics improves, new entities have emerged. The lateral meniscus, especially its posterior attachment, tends to be overlooked due to its greater mobility compared to the medial meniscus. Evaluating the instability of the posterior horn poses a challenge, even during arthroscopy, therefore, it is crucial to understand the posterior menisco-synovial detachment lesions, which are indeed real and, to date, haven't received enough attention in the existing literature. The aim is to describe a new entity affecting the posterior synovial attachment of the lateral meniscus, without injury to the posterior horn of the lateral meniscus (PHLM). We also aim to present a case report detailing the intraoperative diagnosis and management of a 20-year-old patient with a sports trauma that led to a combined anterior cruciate ligament (ACL) and lateral meniscus tear managed with arthroscopic ACL reconstruction and all-inside meniscal suture. Through conventional arthroscopic evaluation of the posterior capsule anatomy and dissections, we have identified a distinct lesion of the PHLM at the menisco-synovial junction. Further research is necessary in this field to understand the biomechanical repercussions and determine the ideal surgical management.

Medial Meniscus Posterior Root Reconstruction and Open-Wedge High-Tibial Osteotomy for Medial Meniscus Posterior Root Tear With Varus Knee Alignment: A Retrospective Study on Short-Term Outcomes.

PURPOSE: We describe 13 cases of medial meniscus posterior root tear (MMPRT) with varus knee alignment treated with medial meniscus posterior root reconstruction (MMPR-R) and open-wedge high-tibial osteotomy (OWHTO) to identify an optimal MMPRT treatment. METHODS: We retrospectively reviewed 13 patients (mean age: 66.3 ± 8.0 years) who underwent MMPR-R and OWHTO. The Knee Injury and Osteoarthritis Outcome Score (KOOS), femorotibial angle (FTA), percentage mechanical axis (%MA) on radiography, and medial meniscus extrusion (MME) on magnetic resonance imaging (MRI) between the preoperative period and last follow-up were compared. Moreover, meniscus healing status and the International Cartilage Repair Society (ICRS) classification of the medial femoral condyle and medial tibial plateau on arthroscopy between the initial surgery and second-look arthroscopy were compared. RESULTS: The mean follow-up duration was 12.8 ± 2.2 months. At the last follow-up, the KOOS significantly improved (P < 0.01). Based on the FTA and %MA, the varus alignment was predominantly corrected at the last follow-up (P < 0.01). The MME was increased in nine (62.9%) patients, and the mean MME significantly increased at the last follow-up (P = 0.04). Second-look arthroscopy revealed improvements in the ICRS grade for the medial femoral condyle and medial tibial plateau in six (46.2%) patients. However, the results did not significantly differ. Regarding meniscus healing, four (30.8%) patients presented with complete healing, eight (57.1%) with partial healing, and one (7.7%) with failed healing. CONCLUSIONS: The MMPRT with varus knee alignment significantly improved with MMPR-R and OWHTO. However, the MME and meniscus healing were unsatisfactory.