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1.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1025-1034, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32451621

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of tibial tunnel position in pullout repair for a medial meniscus (MM) posterior root tear (MMPRT) on postoperative MM extrusion. METHODS: Thirty patients (median age 63 years, range 35-72 years) who underwent transtibial pullout repairs for MMPRTs were included. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid for assessment of tibial tunnel position and MM posterior root attachment. Preoperative and postoperative MM medial extrusion (MMME) and posterior extrusion (MMPE) at 10° and 90° knee flexion were measured using open magnetic resonance imaging. RESULTS: Tibial tunnel centers were located more anteriorly and more medially than the anatomic center (median distance 5.8 mm, range 0-9.3 mm). The postoperative MMPE at 90° knee flexion was significantly reduced after pullout repair, although there was no significant reduction in MMME or MMPE at 10° knee flexion after surgery. In the correlation analysis of the displacement between the anatomic center to the tibial tunnel center and improvements in MMME, and MMPE at 10° and 90° knee flexion, there was a significant positive correlation between percentage distance and improvement of MMPE at 90° knee flexion. CONCLUSION: This study demonstrated that the nearer the tibial tunnel position to the anatomic attachment of the MM posterior root, the more effective the reduction in MMPE at 90° knee flexion. Our results emphasize that an anatomic tibial tunnel should be created in the MM posterior root to improve the postoperative MMPE and protect the articular cartilage in a knee flexion position. Placement of an anatomic tibial tunnel significantly improves the MMPE at 90° of knee flexion after MM posterior root pullout repair. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Ruptura/cirurgia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
2.
Connect Tissue Res ; 61(6): 546-553, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31181971

RESUMO

Purpose/Aim of the study: Posterior root injury of the medial meniscus often leads to articular cartilage degeneration due to altered biomechanics. To avoid dysfunction, the attachment must be repaired using the transtibial pullout technique. To guide appropriate placement of the tibial tunnel, additional details on the normal anatomy of the meniscus insertion are needed. Therefore, we performed a histological analysis of a tibial bone slice with the medial meniscus posterior insertion obtained during total knee arthroplasty surgery. Materials and methods: Horizontal slices of the proximal tibia were obtained from 7 patients with osteoarthritis who underwent total knee arthroplasty. After decalcification, the region of the posterior horn was cut out and segmented into four pieces (2.0 mm thickness; medial to lateral). Sagittal sections were evaluated by safranin O staining or immunohistochemistry with anti-type collagen antibody. Results: Safranin O staining showed that the insertion of the posterior root consisted primarily of fibrocartilaginous layers in segment 2. Anatomically, segment 2 corresponded to the sagittal plane passing through the peak of the medial intercondylar tubercle. In this section, safranin O staining and immunohistochemistry revealed that the anterior one-third of the posterior root insertion was richer in proteoglycans and type II collagen than the central and posterior one-third. Conclusions: Anatomical insertion of the posterior root of the medial meniscus was located at the sagittal plane passing through the peak of the medial intercondylar tubercle. The structure of the medial meniscus posterior insertion was mainly localized in the anterior one-third.


Assuntos
Meniscos Tibiais/patologia , Tíbia/patologia , Idoso , Idoso de 80 Anos ou mais , Colágeno Tipo II/metabolismo , Feminino , Humanos , Masculino , Meniscos Tibiais/metabolismo , Coloração e Rotulagem , Tíbia/metabolismo
3.
Acta Med Okayama ; 73(6): 503-510, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871332

RESUMO

Clinical studies have demonstrated that transtibial pullout repair led to favorable midterm outcomes in patients with medial meniscus posterior root tears (MMPRTs) although medial meniscal extrusion (MME) continued to be present. It has been unclear whether these residual postoperative MMEs existed after the pullout repair or had progressed at the very short-term evaluation after surgery. We sought to determine which characteristics of patients with MMPRTs influence the incidence of postoperative MME. The cases of 23 patients whose date of injury was known were analyzed. All patients underwent MMPRT pullout fixation. Preoperative and 3-month postoperative magnetic resonance imaging (MRI) examinations were performed. MME was retrospectively assessed on the mid-coronal plane of MRI scans. The preoperative and postoperative MME values were 4.2±1.2 mm and 4.3±1.5 mm, respectively (p=0.559). Pullout repair surgery was performed significantly earlier after the MMPRT-specific injury in patients whose postoperative MME improved compared to the patients whose MME did not improve (p<0.001). Our findings demonstrated that an early transtibial pullout repair of an MMPRT was more effective in reducing MME than a late repair. Surgeons should not miss the optimal timing for the pullout repair of an MMPRT, considering the period from the injury and the preoperative MME.


Assuntos
Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
4.
Eur J Orthop Surg Traumatol ; 29(8): 1737-1741, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31359180

RESUMO

INTRODUCTION: The effect of tranexamic acid (TXA) on the incidence of venous thromboembolic events (VTEs) in total knee arthroplasty (TKA) as assessed by contrast-enhanced computed tomography (CT) is unclear. Thus, we investigated the efficacy and safety profiles of TXA administration during TKA. We hypothesised that intra-articular 1 g TXA administration would have a sufficient effect on the reduction of blood loss and transfusion rates without increasing VTE risk. MATERIALS AND METHODS: We retrospectively analysed 86 patients who underwent primary TKA from January 2014 to September 2017. The study comprised control (n = 45) and TXA (n = 41) groups. All patients underwent navigation-assisted TKA via the medial parapatellar approach. In those who received TXA, 1 g of intra-articular TXA was injected via a drain immediately following wound closure. The drain was clamped for 2 h and then reopened. Contrast-enhanced CT was performed 5-6 days after surgery to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). Blood loss was calculated using the haemoglobin balance method. RESULTS: The mean postoperative volume of blood loss was 900 ± 296 mL vs 1216 ± 445 mL in the TXA vs control group (p < 0.01). Allogeneic blood transfusion was required for 0 (0%) vs 6 (13.3%) patients in the TXA vs control group (p = 0.013). There were no significant inter-group differences regarding DVT and PE incidence (p > 0.05). No case of symptomatic PE occurred. CONCLUSIONS: This study demonstrated that intra-articular 1 g TXA administration during TKA is safe and effective for reducing blood loss and blood transfusion without increasing VTE risk.


Assuntos
Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/efeitos adversos , Idoso , Artroplastia do Joelho , Transfusão de Sangue , Volume Sanguíneo , Meios de Contraste , Feminino , Hemoglobinas/metabolismo , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Embolia Pulmonar/induzido quimicamente , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Trombose Venosa/induzido quimicamente , Trombose Venosa/diagnóstico por imagem
5.
Knee Surg Sports Traumatol Arthrosc ; 27(2): 361-368, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30251100

RESUMO

PURPOSE: The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after meniscal repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. METHODS: This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. RESULTS: On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p < 0.001). All parameters did not differ between the three groups on postoperative MRI. In addition, the posterior width and extrusion of the medial meniscus were decreased significantly after meniscal repair concurrent with ACL reconstruction. CONCLUSIONS: This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial meniscal repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following meniscal repair combined with ACL reconstruction. LEVEL OF EVIDENCE: III.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Articulação do Joelho/diagnóstico por imagem , Meniscos Tibiais/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Adolescente , Adulto , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Lesões do Menisco Tibial/fisiopatologia , Adulto Jovem
6.
Orthop Traumatol Surg Res ; 105(1): 107-111, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30442555

RESUMO

INTRODUCTION: Medial meniscus posterior root tear (MMPRT) can occur in middle-aged patients who have a posteromedial painful popping during light activities. MMPRTs are more common in patients with increased age, female gender, sedentary lifestyle, obesity, and varus knee alignment. However, injury mechanisms of minor traumatic MMPRTs are still unclear. We hypothesized that high flexion activities are the major cause of MMPRTs. The aim of this study was to clarify injury patterns of MMPRTs. MATERIALS AND METHODS: One hundred patients were diagnosed having MMPRTs after posteromedial painful popping episodes. Details of posteromedial painful popping episode, situation of injury, and position of injured leg were obtained from the patients by careful interviews. Injury patterns were divided into 8 groups: descending knee motion, walking, squatting, standing up action, falling down, twisting, light exercise, and minor automobile accident. RESULTS: A descending knee motion was the most common cause of MMPRTs (38%) followed by a walking injury pattern (18%) and a squatting action related to high flexion activities of the knee (13%). The other injury patterns were less than 10%. DISCUSSION: Descending knee motions associated with descending stairs, step, and downhill slope are the most common injury pattern of MMPRTs. High flexion activities of the knee are not the greatest cause of MMPRTs. Our results suggest that the descending action with a low knee flexion angle may trigger minor traumatic MMPRTs. LEVEL OF EVIDENCE: IV, retrospective cohort study.


Assuntos
Acidentes por Quedas , Acidentes de Trânsito , Postura , Lesões do Menisco Tibial/etiologia , Caminhada , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Lesões do Menisco Tibial/diagnóstico por imagem
7.
Orthop Traumatol Surg Res ; 105(1): 113-117, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30482466

RESUMO

BACKGROUND: Medial meniscus posterior root tear (MMPRT) results in joint overloading and degenerative changes in the knee. Favorable clinical outcomes have been reported after transtibial pullout repair of MMPRT. To date, however, in vivo tibial rotational changes before and after root repair remain poorly understood. The purpose of this study was to investigate postoperative changes in tibial rotation following MMPRT pullout repair. HYPOTHESIS: Pathological external rotation of the tibia in the knee-flexed position is caused by MMPRT and is reduced after transtibial pullout repair. PATIENTS AND METHODS: Fifteen patients who underwent MMPRT pullout repair and 7 healthy volunteers were included. Magnetic resonance imaging examinations were performed in the 10° and 90° knee-flexed positions. The angles between the surgical epicondylar axis and a line between the medial border of the patellar tendon and the apex of the medial tibial spine were measured. Baseline was defined as a line lying at a right angle to the other, and a value was positive and negative when the tibia rotated internally and externally, respectively. RESULTS: In the volunteer's normal knees, tibial internal rotation was +1.00°±3.27° at 10° flexion and +4.14°±3.46° at 90° flexion. In the MMPRT preoperative knees, tibial internal rotation was +1.07°±3.01° at 10° flexion and +1.27°±2.96° at 90° flexion. In the postoperative knees, tibial internal rotation was +1.60°±2.85° at 10° flexion and +4.33°±2.89° at 90° flexion. DISCUSSION: This study demonstrates discontinuity of the MM posterior root may induce a pathological external rotation of the tibia during knee flexion and that MMPRT pullout repair reduces the pathological external rotation of the tibia in the knee-flexed position. LEVEL OF EVIDENCE: III, comparative retrospective study.


Assuntos
Articulação do Joelho/fisiopatologia , Rotação , Tíbia/fisiopatologia , Lesões do Menisco Tibial/fisiopatologia , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ligamento Patelar/diagnóstico por imagem , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ruptura/diagnóstico por imagem , Ruptura/fisiopatologia , Ruptura/cirurgia , Tíbia/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico por imagem , Adulto Jovem
8.
Knee Surg Relat Res ; 30(4): 348-355, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30466255

RESUMO

Purpose: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. Materials and Methods: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. Results: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. Conclusions: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

9.
BMC Musculoskelet Disord ; 19(1): 367, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30309341

RESUMO

BACKGROUND: Cyclops nodule formation is a serious complication after anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to investigate whether an increase in thymol turbidity test (TTT) values is involved in the development of cyclops nodule formation or cyclopoid scar formation following ACL reconstruction. METHODS: Between 2011 and 2014, 120 cases underwent outside-in ACL reconstruction. Forty-seven patients who had high TTT values were individually matched for age, sex, body mass index, and meniscus injury to a low TTT value group of 47 patients. The primary outcome was the occurrence of cyclops nodule formation or cyclopoid scar formation. All 94 patients were divided into 3 groups using surgical records and intra-operative video to enable a sub-analysis. The groups were a no-cyclops group, a cyclopoid group, and a cyclops group. Blood examinations, including TTT, and knee range of motion evaluations were performed before surgery, 3 months after surgery, and 1 year after surgery. RESULTS: There were no differences in preoperative demographic data between the two groups. TTT values did not significantly influence cyclopoid scar formation (OR, 1.67; 95% CI, 0.62 to 4.66; p = 0.362). However, patients with cyclops nodule formation showed significantly higher TTT values than the control patients. (OR, 9.34; 95% CI, 1.94 to 90.3; p = 0.002). Knee extension loss was observed in the cyclopoid and cyclops groups 3 months after reconstruction. In the cyclops group, arthroscopic resection of the cyclops nodule was performed 3 months after reconstruction. Eventually, almost full range of motion was restored in all patients. CONCLUSIONS: High TTT values before ACL reconstruction were an indicator of cyclops nodule formation. Furthermore, cyclopoid scar formations may not be the result of an individual's immune reaction but that of extension loss in the early post-reconstruction phase.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Imunoglobulina M/sangue , Articulação do Joelho/cirurgia , Nefelometria e Turbidimetria , Complicações Pós-Operatórias/etiologia , Timol , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/imunologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Biomarcadores/sangue , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Valor Preditivo dos Testes , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
10.
Acta Med Okayama ; 72(5): 493-498, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30369606

RESUMO

Medial meniscus (MM) posterior root tear (PRT) results in joint overloading and degenerative changes in the knee. MM root repair is recommended to prevent subsequent cartilage degeneration following MMPRT. Favorable clinical outcomes have been reported after transtibial pullout repair of MMPRT. However, it is unclear whether pullout repair can cause compositional change in the MM posterior segment. We examined this question in 14 patients who underwent MMPRT pullout repair. Magnetic resonance imaging examinations were performed preoperatively and 3 months postoperatively at 10° knee flexion. The region-of-interest was marked along the MM posterior segment edge. Intra-meniscal signal intensity (IMSI) was expressed as the signal intensity ratio of the repaired MM to the intact lateral meniscus, which was used as a control. MMPRT pullout repair reduced IMSI from 1 to 0.915±0.096 (range, 0.760-1.074) 3 months postoperatively (p=0.006, power=0.90). Meniscal degeneration causes high proton density-weighted imaging signal intensity of the meniscal body. In our study, MMPRT pullout repair reduced IMSI contrary to other tears. This technique may decrease the MM posterior segment signal intensity by restoring the hoop tension mechanism. Measuring IMSI may be useful to assess the effect of MMPRT pullout repair on meniscal healing.


Assuntos
Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prótons
11.
J Orthop Res ; 36(7): 1894-1900, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29369416

RESUMO

This study aimed to evaluate the relationship between preoperative lateral meniscal extrusion (LME) and arthroscopic findings of lateral meniscus posterior root tear (LMPRT) in knees with anterior cruciate ligament (ACL) tear. Thirty-five knees that had LMPRTs with concomitant ACL tears on arthroscopy were evaluated. Patients were divided into two groups, partial and complete root tears, via arthroscopic findings at the time of ACL reconstruction. For comparison, we added two groups, using the same database; 20 normal knees (normal group) and 20 ACL-injured knees without LM injury (intact LM group). We retrospectively measured preoperative LMEs using magnetic resonance imaging (MRI). Twenty-three knees had partial LMPRTs. Complete LMPRTs were observed in 12 knees. The average LME was -0.1 ± 0.4 mm in the normal group, 0.2 ± 0.5 mm in the intact LM group, 0.4 ± 0.8 mm in the partial LMPRT group, and 2.0 ± 0.6 mm in the complete LMPRT group. A significant difference in preoperative LMEs was observed between the complete LMPRT group and the other groups (p < 0.001). The receiver operating curve analysis, which distinguishes a partial tear from a complete tear, identified an optimal cut-off point of 1.1 mm for preoperative LME. This LME cut-off had a sensitivity of 100% and specificity of 83% for complete LMPRT. We found that preoperative LMEs were larger in complete LMPRTs associated with ACL injuries than in partial LMPRTs. Our results suggest that preoperative MRI-detected LME may be a useful indicator for estimating LMPRT severity in ACL-injured knees. LEVEL OF EVIDENCE: Retrospective comparative study level IV. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1894-1900, 2018.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/patologia , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/complicações , Adolescente , Adulto , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Feminino , Humanos , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
12.
Knee Surg Relat Res ; 29(4): 295-301, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29172390

RESUMO

Purpose: Medial meniscus posterior root tears (MMPRT) induce medial meniscus extrusion (MME). However, the time-dependent extent of MME in patients suffering from the MMPRT remains unclear. This study evaluated the extent of MME after painful popping events that occurred at the onset of the MMPRT. Materials and Methods: Thirty-five patients who had an episode of posteromedial painful popping were investigated. All the patients were diagnosed as having an MMPRT by magnetic resonance imaging (MRI) within 12 months after painful popping. Medial meniscus body width (MMBW), absolute MME, and relative MME (100×absolute MME/MMBW) were assessed among three groups divided according to the time after painful popping events: early period (〈1 month), subacute period (1-3 months), and chronic period (4-12 months). Results: In the early period, absolute and relative MMEs were 3.0 mm and 32.7%, respectively. Absolute MME increased up to 4.2 mm and 5.8 mm during the subacute and chronic periods, respectively. Relative MME also progressed to 49.2% and 60.3% in the subacute and chronic periods, respectively. Conclusions: This study demonstrated that absolute and relative MMEs increased progressively within the short period after the onset of symptomatic MMPRT. Our results suggest that early diagnosis of an MMPRT may be important to prevent progression of MME following the MMPRT.

13.
Acta Med Okayama ; 71(5): 413-418, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29042699

RESUMO

Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Here we evaluated the effects of arthroscopic all-inside MM repair on MME and the clinical outcomes in patients with radially oriented MM tears and mildly osteoarthritic knees. Twenty patients with a symptomatic radial or oblique tear of the MM posterior segment, MME ≥2.5 mm, and mildly osteoarthritic knees were treated using FasT-Fix 360 All-inside Meniscal Suture devices. We used magnetic resonance imaging (MRI) to measure the patients' MM body width (MMBW), absolute MME, and relative MME. The Japanese Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, IKDC Subjective Knee Evaluation, and Visual Analogue Scale scores were obtained. Arthroscopic all-inside MM repair prevented increases of absolute and relative MME. The preoperative and 3- and 12-month MRI-based MMBW values were similar. Over a 24-month follow-up after the MM repairs, the clinical scores showed significant improvements. Our results suggest that all-inside meniscal repairs would be useful in preventing the progression of MME in patients suffering from symptomatic MM radial/oblique tears associated with mildly osteoarthritic knees.


Assuntos
Artroscopia/métodos , Osteoartrite/patologia , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Ruptura
14.
J Orthop Sci ; 22(6): 1084-1088, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28823532

RESUMO

BACKGROUND: To compare the plain knee radiograph finding of tibial eminence width between knees with complete discoid lateral meniscus, incomplete discoid lateral meniscus, and normal lateral meniscus. MATERIALS AND METHODS: The study included 27 knees with discoid lateral meniscus, including 13 knees with complete discoid lateral meniscus and 14 knees with incomplete discoid lateral meniscus. A control group of 14 knees with normal lateral meniscus was also included. Tibial eminence width and the lateral slope angle of the medial tibial eminence were assessed using plain frontal knee radiographs. Individual differences in knee size were corrected by dividing tibial eminence width by tibial width to obtain the tibial eminence width percentage. RESULTS: Mean tibial eminence width and tibial eminence width percentage in the complete discoid lateral meniscus group was significant larger than other groups. Mean lateral slope angle in the complete discoid lateral meniscus group was significantly smaller than other groups. A tibial eminence width cut-off of 13.9 mm showed a sensitivity and specificity of 100% and 83%, respectively. A tibial eminence width percentage cut-off of 18.8% showed a sensitivity and specificity of 100% and 90%, respectively. A lateral slope angle cut-off of 27.1° showed a sensitivity and specificity of 71% and 83%, respectively. CONCLUSION: There were clear differences in tibial eminence width, tibial eminence width percentage, and lateral slope angle between the complete discoid lateral meniscus group and the other groups. The plain radiographic parameters identified by this study could be useful for complete discoid lateral meniscus screening. STUDY DESIGN: Clinical.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/fisiopatologia , Radiografia/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Valor Preditivo dos Testes , Valores de Referência
15.
Int Orthop ; 41(10): 2113-2118, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28707050

RESUMO

PURPOSE: The purpose of this study was to compare the load-to-failure of different common suturing techniques with a new technique for the medial meniscus posterior root tear (MMPRT). METHODS: Thirty porcine medial menisci were randomly assigned to three suturing techniques used for transtibial pullout repair of the MMPRT (n = 10 per group). Three different meniscal suture configurations were studied: the two simple suture (TSS) technique, the conventional modified Mason-Allen suture (MMA) technique, and the new MMA technique using the FasT-Fix combined with the Ultrabraid (F-MMA). The ultimate failure load was tested using a tensile testing machine. RESULTS: The MMA and F-MMA groups demonstrated significantly higher failure loads than the TSS group (P = 0.0003 and P = 0.0005, respectively). No significant differences were observed between the MMA and F-MMA groups (P = 0.734). CONCLUSIONS: The ultimate failure load was significantly greater in the F-MMA than the TSS group and similar to the conventional MMA technique.


Assuntos
Meniscos Tibiais/cirurgia , Técnicas de Sutura/efeitos adversos , Resistência à Tração/fisiologia , Lesões do Menisco Tibial/cirurgia , Animais , Fenômenos Biomecânicos , Feminino , Traumatismos do Joelho/cirurgia , Suturas/efeitos adversos , Suínos
16.
Skeletal Radiol ; 46(8): 1041-1045, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28314900

RESUMO

OBJECTIVES: (1) To reveal the prevalence of the bony recess (posterior dimple) and (2) to determine the position of the posterior dimple on the tibial plateau using three-dimensional computed tomography (3DCT). MATERIALS AND METHODS: In this study, a retrospective review of 112 patients was performed to identify the posterior dimple and to evaluate its position on 3DCT. Magnetic resonance images (MRIs) were also used to determine the positional relationship among the posterior cruciate ligament (PCL), medial meniscus posterior insertion (MMPI), and posterior dimple. RESULTS: The posterior dimple was observed in 100 of 112 knees (89.3%) on 3DCT. The center of the posterior dimple was 13.6 ± 0.8 mm from the medial tibial eminence apex. MRI showed that the posterior dimple separated the tibial attachment of the PCL and MMPI. CONCLUSION: This is the first study to discuss the prevalence and position of the bony recess in the posterior intercondylar fossa.


Assuntos
Articulação do Joelho/anatomia & histologia , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/anatomia & histologia , Meniscos Tibiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Imageamento Tridimensional , Masculino , Ligamento Cruzado Posterior/anatomia & histologia , Ligamento Cruzado Posterior/diagnóstico por imagem , Estudos Retrospectivos
17.
Eur J Orthop Surg Traumatol ; 27(4): 559-562, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28265760

RESUMO

Medial meniscus posterior root has an important role in the maintenance of knee articular cartilage. Although pullout repair of the medial meniscus posterior root tear has become a gold standard, it has several difficulties for suturing. We have developed a modified Mason-Allen suture technique using the FasT-Fix all-inside suture device combined with Ultrabraid. The present suture technique allows a strong grasping of the medial meniscus posterior horn for arthroscopic pullout repair.


Assuntos
Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Técnicas de Sutura , Lesões do Menisco Tibial/cirurgia , Seguimentos , Humanos , Imobilização/métodos , Traumatismos do Joelho/diagnóstico por imagem , Posicionamento do Paciente , Cuidados Pós-Operatórios/métodos , Suturas , Lesões do Menisco Tibial/diagnóstico por imagem , Resultado do Tratamento , Suporte de Carga/fisiologia
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