Effects of demineralized bone matrix on tendon-bone healing: an in vivo, experimental study on rabbits.

OBJECTIVE: The aim of this study was to investigate the effects of demineralized bone matrix (DBM) on tendon-bone healing. METHODS: The extensor digitorum longus tendon was fixed with pegged suture technique in a tunnel at the proximal tibia in both legs of 12 New Zealand rabbits. Rabbit DBM was applied in the tunnel on the right limbs before fixation (study group), while the fixation was performed without DBM in the left legs (control group). Randomly, four rabbits were sacrificed at the 3rd, four rabbits at the 6th and the remaining four rabbits at the 9th week with an intravenous high dose (200 mg/kg) pentothal and both legs were collected for histological analysis. Each specimen was blindly and independently examined to assess fibrocartilage formation, new bone formation, tendon graft bonding to adjacent tissue and Sharpey's fiber formation. A scoring system was used for quantification of histopathological analysis. RESULTS: The DBM group showed higher number of Sharpey's fibers, slightly increased fibrocartilage formation and new bone formation scores than the control group in the 3rd week. All histological scores were similar in both groups in the 6th and 9th weeks (p>0.05). CONCLUSION: DBM increased new bone formation and the number of Sharpey's fibers in a bone tunnel animal model within the first three weeks of tendon-bone healing process.

Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport.

The purposes of this multi-center study were: (a) to document the location and type of meniscal and chondral lesions that accompany anterior cruciate ligament (ACL) tears, and (b) to test for possible relationships between these lesions and patient age, time from initial injury (TFI), and sports level (i.e., recreation, amateur, professional, and national). The cases of 764 patients with ACL tears who underwent arthroscopy for the first time were retrospectively analyzed. The group included 684 males and 80 females of mean age 27 years (range 14-59 years). The mean TFI was 19.8 months (range 0.2-360 months). Eighty-seven percent of the group engaged in regular sporting activity. Thirty-seven percent had medial meniscal tears, 16% had lateral meniscal tears, and 20% had tears of both menisci. The most common tear types were longitudinal tears in the posterior and middle horns of both menisci. Tears of the lateral meniscus were more centrally located than those of the medial meniscus. Incomplete tears and radial tears were significantly more common in the lateral meniscus. Nineteen percent of the knees had one or more chondral lesions. Sixty percent of the chondral lesions were located in the medial tibio-femoral compartment. Patient age was statistically associated with presence of a medial meniscal tear, presence of a grade 3 or 4 chondral lesion, and presence of a complex tear of the medial meniscus. Sports level was not statistically related to any of the parameters studied. The odds of having a medial meniscal tear at 2 to 5 years TFI were 2.2 times higher than the odds in the first year post-injury, and the odds at >5 years were 5.9 times higher than at 0 to 12 months TFI. The frequency of lateral meniscal tear remained fairly constant at 2 years TFI. The odds of having a grade 3 or 4 chondral lesion were 2.7 times greater at 2 to 5 years TFI than they were at 1 year post-injury, and these odds increased to 4.7 when patients at >5 years TFI were compared to those in the 2 to 5 years category. Multivariate analysis demonstrated that TFI and age were equally important predictors of lateral meniscal tears and of grade 3 or 4 chondral lesions; however, TFI was the better predictor of medial meniscal tear.

Discoid lateral meniscus: diagnosis and results of arthroscopic treatment.

We evaluated the results of arthroscopic meniscectomy in patients with discoid lateral menisci of the knee. Discoid lateral menisci were detected in 308 patients, of whom 197 (124 males, 73 females; mean age 34.5 years, range 6-67) were clinically, radiologically, and arthroscopically found to be symptomatic and underwent partial meniscectomy. The average period between injury and operation was 13.2 months (range 6-52). The results were evaluated according to the Ikeuchi and Lysholm criteria. The mean follow-up was 57.8 months (range 24-138). The most common complaints were pain (66%) and joint line tenderness (61%). Widening of lateral joint space was the most common radiological finding (25%). The confirmation of diagnosis by magnetic resonance imaging was not congruent with arthroscopic results for some patients (31%). According to the Ikeuchi criteria, the results were excellent in 110 patients (56%), good in 53 (27%), fair in 26 (13%), and poor in 8 (4%). On the other hand, according to the Lysholm scale, the results were excellent in 119 patients (60%), good in 57 patients (29%), fair in 16 (8%), and poor in five (3%) patients. Clinical and radiological findings were not congruent with arthroscopic results for all patients. Therefore arthroscopic evaluation has more value for discoid lateral meniscus. Moreover, tear pattern and degenerative changes in lateral compartment may effect outcomes without relation to the type of surgery. We concluded that arthroscopic partial meniscectomy should be the preferred method for the surgical treatment for discoid lateral menisci, due to it's minimal traumatic effects, possibilities of early mobilization, a lower complication rate, and easy and short rehabilitation period.

[Arthroscopic meniscal repair with the use of conventional suturing materials]. / Konvansiyonel sütür materyalleri ile yapilan artroskopik menisküs tamirleri.

OBJECTIVES: We evaluated the mid-term clinical results of patients who underwent arthroscopic meniscal repair. METHODS: Sixty-one patients (43 males, 18 females; mean age 26.9 years; range 17 to 42 years) underwent meniscal repair using conventional suture techniques for unstable vertical longitudinal meniscal tears in the peripheral vascular zone, measuring more than 1 cm. All patients had an adequate follow-up. The involved side was right in 34 patients, and left in 27 patients. The localization was medial in 36 tears, and lateral in 25 tears. Arthroscopic meniscal repair technique was inside-out in 47 cases, and outside-in in 14 cases. Associated lesions were anterior cruciate ligament tears in 24 patients, and tibial plateau fractures in five patients, all of which were treated simultaneously. The patients were evaluated with the use of a modified Marshall knee scoring system. The mean follow-up was 44 months (range 12 to 72 months). RESULTS: The results were excellent in 41 patients, good in 14 patients, fair in three patients, and poor in three patients. Limited range of motion seen in four knees postoperatively was successfully treated by arthroscopic release and an intense rehabilitation program. All patients returned to sports activities within a mean of six months. Second-look arthroscopy performed in 20 patients after a mean of six months postoperatively showed complete healing of the involved menisci in 17 patients. CONCLUSION: Meniscal tears occurring in the peripheral vascular zone without any injury to the meniscal body can be successfully repaired using conventional suture techniques.