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1.
J Orthop Surg (Hong Kong) ; 29(3): 23094990211049569, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34775855

RESUMO

Purpose: Medial meniscus (MM) posterior root (PR) tear leads to severe MM posterior extrusion (PE), resulting in rapid knee cartilage degeneration. MMPR repairs are recommended to reduce MMPE, especially during knee flexion. However, the difference in MMPE between different repair techniques remains unknown. This study aimed to investigate preoperative and postoperative MMPE following several pullout repair techniques. We hypothesized that a technique using two simple stitches (TSS) would be more useful than FasT-Fix-dependent modified Mason-Allen suture (F-MMA) to prevent the progression of MMPE in knee extension. Methods: This retrospective study included 35 patients who underwent MMPR repair. To compare MMPE, patients were divided into two groups according to the use of F-MMA while grasping the posterior capsule and TSS without grasping it. Open magnetic resonance imaging was performed at 10° and 90° knee flexion preoperatively, and at 3 and 12 months postoperatively, and the MMPE of both groups was evaluated. Results: A significant difference was observed between preoperative and 3-month postoperative MMPE at 90° knee flexion in both groups (p < .01). A significant difference was observed in 3- and 12-month postoperative MMPE at 10° knee flexion between both groups (p = .04/.02), whereas no significant difference in the preoperative MMPE at 10° knee flexion was observed between them (p = .45). Conclusions: Both repairs were found to be useful to reduce MMPE in knee flexion. Further, F-MMA repair increased MMPE in knee extension, unlike TSS repair. These findings suggest that TSS might have more advantages for load distribution when standing or walking.

2.
Acta Med Okayama ; 75(4): 423-430, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34511608

RESUMO

The treatment of medial meniscus posterior root tears (MMPRTs) has evolved to include a variety of repair strategies. This study investigated the location of the articular cartilage degeneration during second-look arthroscopy after transtibial pullout repair with a modified Mason-Allen suture using FasT-Fix (F-MMA) in 22 patients with MMPRTs. Second-look arthroscopy was performed approximately 1 year postoperatively to eval-uate the healing status of the medial meniscus (MM). Articular cartilage degeneration was assessed using the International Cartilage Repair Society grade at primary surgery and again at second-look arthroscopy. Articular surfaces of the medial/lateral femoral condyles, the medial/lateral tibial plateaus, the patella and the trochlea were divided into several subcompartments (MF 1-9, LF 1-9, MT 1-5, LT 1-5, P 1-9, T 1-3). Clinical evaluations used the Japanese Knee Injury and Osteoarthritis Outcome, Lysholm, and International Knee Documentation Committee scores. Second-look arthroscopic findings showed complete healing of the MM posterior root in all patients. Significant differences between pullout repair and second-look arthroscopy were observed for MF 2 and 4, LF 7, and P 7. All clinical outcomes were improved. Our results indicate that this technique improves clinical outcomes postoperatively and may prevent the progression of cartilage degenera-tion on the loading surface of the medial knee compartment.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34223925

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of tibial rotation on the postoperative healing status of the medial meniscus (MM) following pullout repair of the MM posterior root tear (MMPRT). METHODS: Ninety-one patients (68 women and 23 men; mean age 63.3 ± 8.8 years) who had undergone transtibial pullout repair of MMPRT were enrolled in the study. The tibial external rotation angle (ERA) in each patient was measured postoperatively using computed tomography in the extended knee position. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period 12 months) using a previously published scoring system (range 0-10). The association between the ERA and the meniscal healing score was investigated using univariate linear regression models. The ERA cut-off for improved meniscal healing score (≥ 7) was determined using receiver-operating characteristic analysis. RESULTS: The ERA and the meniscal healing score were significantly associated, confirming that increased ERAs were correlated with worse meniscal healing status (R = - 0.28; P < 0.001). The optimum ERA cut-off value was 0.5°, with a sensitivity of 68% and a specificity of 63%. The mean meniscal healing scores were 7.3 and 6.2 among patients with ERAs < 0.5° and those with ERAs ≥ 0.5°, respectively (P < 0.001). CONCLUSION: This study demonstrated that the ERA was significantly correlated with the postoperative meniscal healing status. Postoperative tibial rotation could be one of the factors affecting postoperative outcomes of pullout repair of MMPRT. Controlling the tibial rotation may possibly improve meniscal healing. LEVEL OF EVIDENCE: III.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34137941

RESUMO

PURPOSE: Transtibial pullout repairs using two simple stitches (TSS) and a combination of TSS with posteromedial pullout repair (TSS + PMP) using an all-inside meniscal repair device have been reported previously for the treatment of medial meniscus (MM) posterior root tears. This study aimed to investigate the postoperative clinical outcomes of these techniques including MM extrusion (MME). METHODS: Fifty-two patients who underwent transtibial pullout repair were investigated and divided into TSS (n = 27) and TSS + PMP (n = 25) groups. The clinical outcomes were assessed using the Lysholm knee score and Knee Injury and Osteoarthritis Outcome Score 1 year postoperatively and compared between two groups. MME was measured using magnetic resonance imaging at 1 year postoperatively and compared between two groups. RESULTS: A significant improvement in each clinical score was observed in both groups, and no significant difference was seen in clinical outcomes. Moreover, no significant difference in postoperative MME was observed in both groups (TSS and TSS + PMP: 3.5 mm and 3.8 mm, respectively). Though no significant progression of MME was observed in TSS group, a significant progression of it was observed in TSS + PMP group postoperatively. CONCLUSIONS: This study demonstrated that both techniques improved clinical outcomes in the short-term postoperative period. However, MME was progressed significantly in TSS + PMP group 1 year postoperatively, which indicated that PMP might not be a useful additional procedure for reducing the postoperative MME.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33846879

RESUMO

BACKGROUNDS: Medial meniscus (MM) posterior root tear (PRT) results in joint overloading and degenerative changes in the knee, and pullout repair is recommended to prevent subsequent osteoarthritis. Diagnosing MMPRT is sometimes difficult, especially in the case of an incomplete tear. A posterior shiny-corner lesion (PSCL) is reported to be useful for diagnosis, although the association between MMPRT and PSCL is unknown. This study aimed to investigate the properties of PSCL, such as the location, volume, and duration from injury to the time of MRI (duration). We hypothesized that PSCL is observed in the early phase after the MMPRT onset. METHODS: T2-weighted fat-suppression magnetic resonance imaging (MRI) was obtained from 55 patients with MMPRT preoperatively. The prevalence of the PSCL; giraffe neck, cleft, and ghost signs; severe MM extrusion (> 3 mm); and the PSCL volume were evaluated. The PSCL lesion elliptical volume (mm3) was calculated by measuring the anteroposterior, transverse, and craniocaudal dimensions. RESULTS: PSCL was observed in 34 (62%) cases. The mean volume of the PSCL was 102.0 mm3. A significantly shorter duration was observed in the PSCL-positive group (5.6 weeks) than that in the PSCL-negative group (40.9 weeks, P < 0.01), although no significant correlation was observed between the PSCL volume and duration. The sensitivity for the MMPRT was 90.5% when the cut-off duration value was 3 weeks and 81.8% when the cut-off value was 8 weeks. CONCLUSIONS: MRI examination may detect PSCL if it is performed early following MMPRT onset. Detecting PSCL may be useful in diagnosing MMPRT with high sensitivity.

6.
Artigo em Inglês | MEDLINE | ID: mdl-33680859

RESUMO

Background: Medial meniscus (MM) tears are associated with both acute and chronic anterior cruciate ligament (ACL) insufficiency and can lead to degenerative changes in the knee. ACL reconstruction (ACLR) combined with the meniscal repair was reported to result in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term. However, a subtle tear of the MM posterior segment, also known as a ramp lesion, is difficult to detect on conventional magnetic resonance imaging (MRI) and is frequently missed in ACL-deficient knees. However, there are few studies about the associations between bone geometry and ramp lesion of the MM. This study aimed to compare sagittal medial tibial slope (MTS), medial tibial plateau depth (MTPD), and coronal tibial slope (CTS) between ACL-injured knees with and without ramp lesion of the MM. We hypothesised that patients with ramp lesion of the MM and a concomitant ACL injury have a steeper MTS and shallower MTPD than those without ramp lesion of the MM. Methods: Twenty-seven patients who underwent ACLR (group A), and 15 patients with combined MM repair (group AM) were included in the study. Anterior tibial translation (ATT) was measured under general anaesthesia just before surgery using a knee arthrometer. MRI was performed in the 10°-knee-flexed position. The MTS and MTPD were measured on sagittal view, and the CTS was measured on coronal view. These parameters were compared between the groups. Differences in MRI measurements or patient demographics between the groups were evaluated using the Mann-Whitney U test. Results: No significant difference was observed in demographic data and post-operative side-to-side difference in ATT between both groups. Pre-operative ATT was significantly higher in group AM than in group A (P < 0.05), whereas post-operative ATT was similar in both groups. Further, Pre-operative ATT was significantly higher in patients with MTS ≥5.0° than in those with MTS <5.0° (P < 0.05). In groups A and AM, the MTS were 3.6° ± 1.8° and 6.2° ± 2.9°, the MTPD were 2.0 ± 0.5 mm and 2.1 ± 0.6 mm, and the CTS were 2.5° ± 1.8° and 2.4° ± 1.6°, respectively. Patients in group AM had a significantly steeper MTS compared to those in group A (P < 0.01), whereas MTPD and CTS were nearly the same in both groups. When the MTS cut-off value was set at 5.0°, the sensitivity and specificity for ACL injury with concomitant ramp lesion of the MM were 0.73 and 0.76, respectively. Conclusion: A steep posterior slope of the medial tibial plateau is a risk factor for ramp lesion of the MM associated with an ACL injury. Especially in patients with MTS ≥5.0°, an occult MM ramp lesion should be strongly suspected, and surgeons should prepare for MM repair in combination with ACLR.

7.
J Orthop Sci ; 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33581924

RESUMO

BACKGROUND: Medial meniscus (MM) posterior root repairs lead to favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there are few comparative studies in evaluating the superiority among several pullout repair techniques such as modified Mason-Allen suture, simple stitch, and concomitant posteromedial pullout repair. We hypothesized that an additional pullout suture at the MM posteromedial part would have clinical advantages in transtibial pullout repairs of the MMPRTs. The aim of this study was to compare the clinical usefulness among several types of pullout repair techniques in patients with MMPRTs. METHODS: Eighty-three patients who underwent arthroscopic pullout repairs of the MMPRTs were investigated. Patients were divided into three groups using different pullout repair techniques: a modified Mason-Allen suture using FasT-Fix all-inside meniscal repair device (F-MMA, n = 28), two simple stitches (TSS, n = 30), and TSS concomitant with posteromedial pullout repair using all-inside meniscal repair device (TSS-PM, n = 25). Postoperative clinical outcomes and semi-quantitative arthroscopic meniscal healing scores (0-10 points) were evaluated at second-look arthroscopies. RESULTS: No significant differences among the three groups were observed in patient demographics and preoperative clinical scores, except for preoperative Lysholm scores. At second-look arthroscopies, there were no significant differences among the three techniques in postoperative clinical outcomes and meniscal healing scores. CONCLUSIONS: This study demonstrated that the TSS-PM pullout repair technique did not show better scores in postoperative clinical outcomes and meniscal healings compared with the F-MMA and TSS techniques. Our results suggest that the concomitant posteromedial pullout suture may have no clinical advantage in the conventional pullout repairs for the patients with MMPRTs.

8.
Knee Surg Sports Traumatol Arthrosc ; 29(11): 3715-3723, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33388829

RESUMO

PURPOSE: A medial meniscus posterior root tear results in the loss of meniscal circumferential hoop stress and causes a pathological posteromedial extrusion of the medial meniscus. Although creating a tibial tunnel in the anatomic place improves postoperative medial meniscus posterior extrusion, no studies have evaluated the relationship between tibial tunnel position and clinical outcomes. This study aimed to evaluate how tibial tunnel positioning of medial meniscus posterior root pullout repair affects meniscal healing status and clinical outcomes. METHODS: Sixty-two patients with 64 medial meniscus posterior root tears (mean age 62.8 ± 7.9 years) who had undergone pullout repairs and second-look arthroscopies were included. All 62 patients were Lachman test negative. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid to assess the tibial tunnel centre and medial meniscus posterior root attachment centre. Spearman's rank correlation analysis was undertaken to determine displacement distance from the medial meniscus posterior root attachment centre to the tibial tunnel centre and a meniscal healing score, as well as clinical outcomes at 1 year post-repair. RESULTS: Tibial tunnel centres were located more anteriorly and medially than the medial meniscus posterior root attachment centre (mean distance 5.0 ± 2.2 mm). The mean meniscal healing score was 6.7 ± 1.8 of 10 possible points. The 1-year postoperative clinical scores showed significant improvement compared with preoperative scores for all the items. There was a significant negative correlation in the absolute distance between the medial meniscus posterior root attachment centre and the tibial tunnel centre with the meniscal healing score (ρ = - 0.39, p = 0.002). Furthermore, there were significant positive correlations between the distance between the medial meniscus posterior root attachment centre and the tibial tunnel centre in the mediolateral direction and patient-based clinical outcomes (ρ = 0.25-0.43, p < 0.05). CONCLUSION: Accurate placement of a tibial tunnel, especially in the mediolateral direction, significantly improved meniscal healing and clinical outcomes at 1 year following medial meniscus posterior root repair. Surgeons should create a medial meniscus posterior root tibial tunnel at the anatomic attachment with particular attention to the mediolateral position. LEVEL OF EVIDENCE: Level IV.


Assuntos
Artroplastia do Joelho , Lesões do Menisco Tibial , Idoso , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia
9.
Orthop Traumatol Surg Res ; 107(2): 102816, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33484904

RESUMO

BACKGROUND: The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HYPOTHESIS: We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. METHODS: Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. RESULTS: The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DISCUSSION: This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. LEVEL OF EVIDENCE: IV; retrospective cohort study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Estudos Retrospectivos
10.
Knee ; 28: 346-353, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33485164

RESUMO

BACKGROUND: Medial meniscus (MM) translates and extrudes posteriorly during knee flexion in MM posterior root tear (MMPRT) knees, and transtibial pullout repair of MMPRT has been performed to regulate the MM extrusion. This study aimed to calculate each suture translation during knee flexion in transtibial pullout repair of MMPRT, and to investigate the morphologic features of the MM that lead to longer suture translations during knee flexion. METHODS: Thirty patients with MMPRT who met the operative indication of pullout repair were enrolled and investigated prospectively. Pullout repair was performed by using two simple stitches (outer and inner sutures) and an all-inside suture in the posteromedial part of the MM. Each suture's translation from 0° to 90° of knee flexion was measured intraoperatively. The MM morphologic features, including MM medial extrusion (MMME) and MM posterior height (MMPH), were measured using preoperative magnetic resonance imaging, and the correlation between these values and each suture translation was evaluated. RESULTS: The average outer, inner, and all-inside suture translations were 4.8 mm, 3.9 mm, and 1.3 mm, respectively. Significant correlations were observed between the outer suture translation and MMME, and MMPH (p < 0.001 and <0.01, respectively). The thresholds for preoperative MMME and MMPH for longer outer suture translations (≥6 mm) were 2.1 mm and 5.4 mm, respectively. CONCLUSIONS: Preoperative longer MMME and higher MMPH were associated with longer meniscus translations during knee flexion during MMPRT repair.


Assuntos
Articulação do Joelho/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/cirurgia , Amplitude de Movimento Articular/fisiologia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pré-Operatório , Ruptura , Lesões do Menisco Tibial/diagnóstico
12.
Eur J Orthop Surg Traumatol ; 31(6): 1005-1013, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33219860

RESUMO

PURPOSE: Medial meniscus posterior root tears (MMPRTs) can cause severe medial extrusion of the medial meniscus (MMME) and the progression of knee degenerative changes, inducing a high signal intensity of the meniscus on magnetic resonance imaging (MRI). Although MMME and intrameniscal signal intensity (IMSI) reportedly decreased within 3 months after MMPRT repair, no previous studies have reported these changes after a 1-year follow-up. This study aimed to investigate the 1-year postoperative changes in MMME and IMSI on MRI after using different suture techniques. METHODS: Overall, 33 patients with MMPRT were evaluated, 22 underwent FasT-Fix-dependent modified Mason-Allen suture (F-MMA) repair, and 11 underwent two simple stitches (TSS) repair. MRI examinations were performed preoperatively and 1 year postoperatively. MMME and IMSI were determined using MRI. RESULTS: A significant decrease in postoperative MMME was observed in the TSS group (4.1 ± 1.0) relative to that in the F-MMA group (5.1 ± 1.4, P = 0.03). A significant decrease in postoperative IMSI (0.75 ± 0.14) was observed relative to preoperative IMSI in the TSS group (P < 0.01), whereas postoperative IMSI (0.94 ± 0.25) was similar to preoperative IMSI in the F-MMA group (P = 0.06). Furthermore, a significant decrease in postoperative IMSI was observed in the TSS group relative to that in the F-MMA group (P < 0.01). CONCLUSIONS: The most important finding of this study is that TSS repair yielded a greater decrease in MMME and IMSI than F-MMA repair in patients with MMPRT. These results suggest that TSS repair is more useful for restoring loading stress to the posterior horn of the medial meniscus.


Assuntos
Meniscos Tibiais , Lesões do Menisco Tibial , Humanos , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Suturas , Lesões do Menisco Tibial/cirurgia
13.
J Orthop Sci ; 26(6): 1051-1055, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33168401

RESUMO

BACKGROUND: Medial meniscus posterior root tear (MMPRT) causes medial meniscus extrusion (MME) and leads to subchondral insufficiency fracture of the knee (SIFK). However, the progression of SIFK after MMPRT pullout repair remains unknown. This study aimed to investigate the progression of SIFK and compare clinical outcomes in patients with SIFK to those without SIFK after MMPRT pullout repair. We hypothesized that the progression of SIFK would be prevented by MMPRT pullout repair, and clinical outcomes would improve in all patients. METHODS: The SIFK grade (1-4) was evaluated using T2-fat suppression magnetic resonance imaging. Thirty-eight patients without SIFK (n = 22) and with low-grade SIFK (1 and 2; n = 16) who underwent MMPRT pullout repair were included. Preoperative factors, such as the duration from injury to the time of magnetic resonance imaging/surgery (weeks), femorotibial angle (degree), MME (mm), and clinical outcomes were evaluated, as well as the progression of SIFK. RESULTS: SIFK was identified in only 9 patients (grade 1) postoperatively. Significantly improved clinical outcomes were observed in all patients. Preoperative femorotibial angle, MME, and duration from injury to the time of magnetic resonance imaging/surgery were 177.1 ± 1.5°, 3.2 ± 1.6 mm, and 6.4 ± 7.0/10.1 ± 7.5 weeks, respectively. No significant difference in preoperative factors and clinical outcomes was observed between patients with SIFK and those without SIFK. CONCLUSIONS: MMPRT pullout repair prevented the progression of low-grade SIFK and improved clinical outcomes in all patients, although bone contusions (grade 1 SIFK) were not completely healed within 1 year. MMPRT pullout repair could be a good treatment option for optimizing clinical outcomes in patients with low-grade SIFK.


Assuntos
Fraturas de Estresse , Lesões do Menisco Tibial , Artroscopia , Humanos , Articulação do Joelho , Imageamento por Ressonância Magnética , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia
14.
Knee Surg Sports Traumatol Arthrosc ; 29(9): 3001-3009, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112966

RESUMO

PURPOSE: To assess the effects of transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) among patients with early osteoarthritis of the knee as measured by the meniscus healing score and to determine whether the meniscus healing score correlates with the International Cartilage Repair Society (ICRS) grade progression. METHODS: Forty-seven patients with mild osteoarthritic knees (Kellgren-Lawrence grade ≤ 2 and varus alignment < 5°) who underwent transtibial pullout repair less than 3 months after MMPRT onset were assessed. The association between meniscus healing scores at 1 year postoperatively and cartilage damage of the medial compartment (medial femoral condyle [MFC] and medial tibial plateau [MTP]) were evaluated. The MFC was divided into six zones (A to F) and the MTP into two zones (G and H). The mean ICRS grade for each zone was compared between the primary surgery and second-look arthroscopy. The correlation between cartilage damage and meniscus healing status at the time of second-look arthroscopy in each zone was analysed. RESULTS: The mean time interval from injury to surgery was 63 days, and all clinical scores showed significant improvement. There were no significant differences in the extent of cartilage damage in areas B, C, E, or F (n.s.) for MFC or in areas G and H (n.s.) for MTP. The meniscus healing score and cartilage damage were correlated in the loading areas (B, C, E, and H; - 0.53, - 0.45, - 0.33, and - 0.38, respectively; p < 0.05). CONCLUSION: Transtibial pullout repair of MMPRTs among patients with mild osteoarthritic knees improved the clinical outcomes and showed a negative correlation between high meniscus healing scores and ICRS grades in the medial compartment loading area. This study suggests that early surgery should be undertaken for patients with mild osteoarthritic knee who develop MMPRTs. LEVEL OF EVIDENCE: Level IV.


Assuntos
Menisco , Osteoartrite do Joelho , Lesões do Menisco Tibial , Artroscopia , Humanos , Articulação do Joelho , Meniscos Tibiais/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
15.
Knee Surg Sports Traumatol Arthrosc ; 29(1): 44-50, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31243503

RESUMO

PURPOSE: Bone morphological factors are important for menisci. Their association with medial meniscus posterior root tears, however, has not yet been studied. This study aimed to compare sagittal medial tibial slope and medial tibial plateau depth between knees with and without medial meniscus posterior root tears. METHODS: Nine healthy volunteers, 24 patients who underwent anterior cruciate ligament reconstruction, and 36 patients who underwent medial meniscus posterior root pullout repair were included. Magnetic resonance imaging examinations were performed in the 10°-knee-flexed position. The medial tibial slope and medial tibial plateau depth were compared among the groups. RESULTS: In healthy volunteers, the anterior cruciate ligament reconstruction group, and the medial meniscus posterior root tear group, the medial tibial slopes were 3.5° ± 1.4°, 4.0° ± 1.9°, and 7.2° ± 1.9°, respectively, and the medial tibial plateau depths were 2.1 ± 0.7 mm, 2.2 ± 0.6 mm, and 1.2 ± 0.5 mm, respectively. Patients with medial meniscus posterior root tears had a significantly steep medial tibial slope and shallow medial tibial plateau concavity compared to those of healthy volunteers (P < 0.01) and the anterior cruciate ligament group (P < 0.01). In the multivariate logistic regression analysis, body mass index, medial tibial slope, and medial tibial plateau depth were significantly associated with medial meniscus posterior root tears. CONCLUSIONS: A steep posterior slope and a shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tear. LEVEL OF EVIDENCE: Level III: Case-control study.


Assuntos
Traumatismos do Joelho/epidemiologia , Meniscos Tibiais/patologia , Lesões do Menisco Tibial/epidemiologia , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Estudos de Casos e Controles , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ruptura/cirurgia , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia , Adulto Jovem
16.
J Orthop Sci ; 26(2): 237-242, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32284294

RESUMO

BACKGROUND: Medial meniscus (MM) posterior root repairs show favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there is no useful magnetic resonance imaging (MRI) finding to determine a functionally good meniscal healing following MM posterior root repairs. We hypothesized that a characteristic postoperative MRI finding can predict a good meniscal healing following pullout repairs. The aim of this study was to investigate a clinical usefulness of several MRI findings for estimating an actual meniscal healing following MMPRT repairs. METHODS: Fifty eight patients who had a posteromedial painful popping of the injured knee and underwent an arthroscopic pullout repair for the MMPRT were included. Arthroscopic meniscal healing was assessed according to the Furumatsu scoring system at 1 year postoperatively. We evaluated postoperative MRI-based meniscal healing using signal intensity, continuity, suspension bridge-like sign of the MM posterior root, and MM medial extrusion on coronal images. Postoperative clinical outcome evaluations were performed at second-look arthroscopy. RESULTS: Twenty three patients showed good arthroscopic healing scores (≥7 points). Thirty five patients had moderate/poor arthroscopic healing scores (<7 points). At 1-year follow-up period, clinical outcome scores were significantly higher in the good healing group than in the moderate/poor healing group. A characteristic meniscal shape, termed "suspension bridge sign", was highly observed in the good meniscal healing group (83%) compared with in the moderate/poor healing group (26%, P < 0.001). High signal intensity and continuity of the MM posterior root and MM medial extrusion showed no differences between both groups. CONCLUSIONS: Our study demonstrated that the MRI-based suspension bridge sign can predict an arthroscopically favorable meniscal healing following the MM posterior root repair. The suspension bridge-like MRI finding of the MM would be a useful indicator to evaluate the actual meniscal healing in patients who underwent pullout repairs for MMPRTs.


Assuntos
Imageamento por Ressonância Magnética , Meniscos Tibiais , Lesões do Menisco Tibial , Artroscopia , Humanos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia
17.
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
18.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1052-1057, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32488369

RESUMO

PURPOSE: Contralateral medial meniscus posterior root tear (MMPRT) can sometimes occur after primary surgeries for MMPRT and lead to unsatisfactory outcomes. The incidence rate and risk factors for contralateral MMPRT have not been well investigated, despite their clinical importance. Therefore, the incidence and predictors of bilateral MMPRT were aimed to be evaluated. METHODS: Fourteen patients with bilateral MMPRT (group B) and 169 patients with unilateral MMPRT (group U) were enrolled in this study. Sex, age, body mass index, time between injury and surgery, and medial tibial slope angle (MTSA) were compared between the groups. MTSA was measured using lateral radiographs. RESULTS: The incidence rate of bilateral MMPRT was 6.2% among all patients with MMPRTs. Multivariate logistic regression analysis showed that a prolonged time between injury and surgery (odds ratio [OR], 1.0; 95% confidence interval [CI] 1.00-1.01; P < 0.05) and steeper MTSA (OR, 1.85; 95% CI 1.21-2.64; P < 0.01) were significantly associated with the development of bilateral MMPRT. Receiver operating characteristic curve analysis showed that MTSA > 10.0° was associated with bilateral MMPRT, with a sensitivity of 93% and specificity of 69%. CONCLUSION: A longer time between injury and surgery and steeper MTSA were risk factors for the development of bilateral MMPRT. Surgeons need to pay close attention to the contralateral knee in addition to the primary injured knees when treating knees with steep MTSA. Besides, early meniscal repair of primary MMPRT would be important to prevent the events of contralateral MMPRT. LEVEL OF EVIDENCE: III.


Assuntos
Meniscos Tibiais/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Incidência , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Curva ROC , Radiografia/métodos , Estudos Retrospectivos , Fatores de Risco , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Sensibilidade e Especificidade , Tíbia/patologia , Lesões do Menisco Tibial/diagnóstico por imagem
19.
J Orthop Sci ; 26(2): 230-236, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32223991

RESUMO

BACKGROUND: Many histological, mechanical, and clinical studies have been performed on the medial meniscus posterior root attachment, as it often tears in patients with osteoarthritic knee. Medial meniscal root repair is recommended in clinical situations; however, to date, no studies have examined the differences between meniscal root and horn cells. The aim of this study was, therefore, to investigate the morphology, reaction to cyclic tensile strain, and gene expression levels of medial meniscal root and horn cells. METHODS: Meniscal samples were obtained from the medial knee compartments of 10 patients with osteoarthritis who underwent total knee arthroplasty. Root and horn cells were cultured in Dulbecco's modified Eagle's medium without enzymes. The morphology, distribution, and proliferation of medial meniscal root and horn cells, as well as the gene and protein expression levels of Sry-type HMG box 9 and type II collagen, were determined after cyclic tensile strain treatment. RESULTS: Horn cells had a triangular morphology, whereas root cells were fibroblast-like. The number of horn cells positive for Sry-type HMG box 9 and type II collagen was considerably higher than that of root cells. Although root and horn cells showed similar levels of proliferation after 48, 72, or 96 h of culture, more horn cells than root cells were lost following a 2-h treatment with 5% and 10% cyclic tensile. Sry-type HMG box 9 and α1(II) collagen mRNA expression levels were significantly enhanced in both cells after 2- and 4-h cyclic tensile strain (5%) treatment. CONCLUSIONS: Medial meniscal root and horn cells have distinct morphologies, reactions to mechanical stress, and cellular phenotypes. Our results suggest that physiological tensile strain is important to activate extracellular matrix production in horn cells.


Assuntos
Artroplastia do Joelho , Meniscos Tibiais , Lesões do Menisco Tibial , Humanos , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Estresse Mecânico , Lesões do Menisco Tibial/genética , Lesões do Menisco Tibial/cirurgia
20.
Knee ; 27(3): 701-708, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563426

RESUMO

BACKGROUND: Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS: The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS: Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS: The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.


Assuntos
Artroscopia/métodos , Meniscos Tibiais/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Ruptura , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico
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