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1.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 206-212, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196342

RESUMO

INTRODUCCIÓN: El tratamiento tradicional del menisco discoide sintomático inestable ha sido la meniscectomía total o subtotal. Sin embargo, estudios a largo plazo demuestran que los resultados son pobres. El objetivo de este estudio fue evaluar los resultados clínicos y supervivencia de la remodelación artroscópica combinada con la reparación periférica para el tratamiento del menisco discoide sintomático en niños. MÉTODOS: Se analizaron todos los pacientes≤18 años con menisco discoide y una lesión periférica tratados entre enero 2012 y enero 2018. Las reparaciones se llevaron a cabo con una combinación de técnicas de dentro-fuera y fuera-dentro según lo dictado por la configuración de la lesión. Los resultados clínicos se evaluaron utilizando las escalas de Ikeuchi, Pedi-IKDC y Lysholm. El análisis de supervivencia se realizó con el método de Kaplan-Meier. RESULTADOS: En el período evaluado se trataron 18 pacientes (18 rodillas). El promedio de edad al momento de la cirugía fue 11,1±3,8 años. El promedio de seguimiento fue 40,4±21,2 meses. Se utilizó un promedio de 3,4±1 suturas (rango, 2-6). Dieciséis pacientes pudieron ser evaluados funcionalmente (2 pérdidas de seguimiento). Cuatro pacientes presentaron síntomas mecánicos. Uno fue tratado de manera conservadora con fisioterapia que alivió los síntomas y 3 (18,8%) requirieron una nueva cirugía (meniscectomía subtotal). De acuerdo a la escala de Ikeuchi, 12 (75%) tuvieron resultados excelentes, uno (6,2%) bueno y 3 (18,8%) malos (falla de la reparación). Las puntuaciones promedio Pedi-IKDC y Lysholm fueron 98,3±2 y 98,7±2,9 respectivamente al último seguimiento. Las probabilidades generales de supervivencia de Kaplan-Meier después de la reparación fueron del 93,7% a un año y del 85,9% a los 2 años. CONCLUSIONES: Los resultados a mediano plazo de la saucerización asociada a la reparación periférica son alentadores en niños y adolescentes con menisco discoide inestable sintomático


INTRODUCTION: The traditional treatment of unstable symptomatic discoid meniscus has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children. METHODS: Patients≤18 years with discoid meniscus and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method. RESULTS: Eighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1±3.8 years. The average follow-up was 40.4±21.2 months. An average of 3.4±1 meniscal sutures (range, 2 to 6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and 3 (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, one (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3±2 and 98.7±2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at one year, and 85.9% at 2 years. CONCLUSIONS: Mid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Artropatias/cirurgia , Meniscectomia/métodos , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Análise de Sobrevida , Meniscos Tibiais/fisiopatologia , Artroscopia , Modalidades de Fisioterapia
2.
Comput Methods Biomech Biomed Engin ; 23(4): 127-137, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31931606

RESUMO

We established an effective finite element model of knee joint for observation of stress and displacement of meniscus related changes after medial meniscus injury. Different types of medial meniscus injury can lead to varied meniscus stress and displacement changes. Stress and displacement concentration were found in fissure tip of meniscus tear compared to normal meniscus. The posterior horn injury of medial meniscus may initiate combined injury of medial meniscus posterior horn (MMPH) and that of medial meniscus body, and combined injury of MMPH and that of lateral meniscus anterior horn; fissure expansions regarding horizontal fissure, longitudinal fissure and grip-shaped fissure of MMPH were spotted.


Assuntos
Análise de Elementos Finitos , Meniscos Tibiais/patologia , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/fisiopatologia , Adulto , Fenômenos Biomecânicos , Humanos , Masculino , Modelos Biológicos , Estresse Mecânico
3.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 2000-2008, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31595339

RESUMO

PURPOSE: (1) To investigate whether an increased lateral meniscal slope measured on magnetic resonance image (MRI) would be associated with greater risk of bone contusions in noncontact anterior cruciate ligament injury, and (2) to measure the relationship between the occurrence of bone contusions and associated findings observed in ACL deficient knees such as cartilage damage, anterolateral complex injury and concomitant meniscal tears. METHOD: Patients who underwent ACL reconstruction surgery between 2013 and 2018 were retrospectively reviewed. Sixty-three patients were included in the study group (ACL + bone contusions group), 56 participants were in the control group (isolated ACL group). The presence and severity of bone contusions were determined from preoperative MRIs. The lateral meniscal slope and lateral posterior tibial slope were measured on the MRIs in a blinded fashion. The predictors of lateral bone contusions including age, sex, body mass index, lateral meniscal slope and lateral posterior tibial slope were examined by multivariable logistic regression. Associated findings including concomitant meniscal lesions, intra-articular cartilage damage and anterolateral complex injury, which were also calculated by multivariable logistic regression. RESULTS: The mean lateral meniscal slope in the study group was 6.5° ± 3.5°, which was significantly larger than that in the control group (3.8° ± 2.7°; P < 0.01). In addition, increased lateral meniscal slope was significantly associated with lateral bone contusions in noncontact ACL injury (Lateral femoral condyle (LFC): AOR 16.5; 95% CI 5.40-50.20; P < 0.01; Lateral tibial plateau (LTP): AOR 31.8; 95% CI 8.68-116.7; P < 0.01). However, lateral posterior tibial slope was not significantly associated with bone contusions. Moreover, the presence of lateral bone contusions was associated with concomitant lateral meniscal tears (OR 12.4; 95% CI 3.30-46.30) and cartilage damage (OR 2.9; 95% CI 1.04-8.18). CONCLUSION: An increased lateral meniscal slope was associated with increased risk of lateral bone contusions in noncontact ACL injury. In addition, the presence of lateral bone contusions was associated with intra-articular cartilage damage, anterolateral complex injury and concomitant meniscal tears. Hence, additional information was provided for counseling patients who have increased LMS on the greater risk of knee rotational instability and identify patients undergoing ACL reconstruction who may benefit from extra-articular tenodesis. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Cartilagem Articular/diagnóstico por imagem , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/diagnóstico por imagem , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Cartilagem Articular/cirurgia , Estudos de Casos e Controles , Contusões/diagnóstico por imagem , Contusões/etiologia , Epífises/cirurgia , Feminino , Fêmur/cirurgia , Humanos , Incidência , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia
5.
J Knee Surg ; 33(3): 314-318, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31683351

RESUMO

One of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58-78 years], five males, six females; DVL group: mean age 67.4 years [range, 59-77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann-Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p < 0.05). No significant difference was found between groups regarding ultimate load to failure measurements (p > 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.


Assuntos
Meniscos Tibiais/cirurgia , Técnicas de Sutura , Lesões do Menisco Tibial/cirurgia , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Meniscos Tibiais/fisiopatologia , Pessoa de Meia-Idade , Suturas , Lesões do Menisco Tibial/fisiopatologia
6.
Arch Orthop Trauma Surg ; 140(3): 365-372, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31838547

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the healing rate of repaired meniscus and functional outcomes of patients who received all-inside meniscal repair using sutures or devices with concomitant arthroscopic anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Among the patients who have ACL tear and posterior horn tear of medial or lateral meniscus, 61 knees who received all-inside repair using sutures (suture group, n = 28) or meniscal fixation devices (device group, n = 33) with concomitant ACL reconstruction during the period from January 2012 to December 2015, followed by second-look arthroscopy, were retrospectively reviewed. Healing status of the repair site was assessed by second-look arthroscopy. Through the clinical assessment, clinical success (negative medial joint line tenderness, no history of locking or recurrent effusion, and negative McMurray test) rate of the repaired meniscus and functional outcomes (International Knee Documentation Committee subjective score and Lysholm knee score) was evaluated. RESULTS: In a comparison of healing status of repaired meniscus evaluated by second-look arthroscopy, suture group had 23 cases of complete healing (82.1%), 4 cases of incomplete healing (14.3%), and 1 case of failure (3.6%). Device group had 18 cases of complete healing (54.5%), 4 cases of incomplete healing (24.2%), and 7 cases of failure (21.2%) (p = 0.048). Clinical success rate of the meniscal repair was 89.3% (25 cases) and 81.8% (27 cases) in suture group and device group, respectively (p = 0.488). No significant difference of functional outcomes was observed between the two groups (p > 0.05, both parameters). CONCLUSIONS: Among the patients who received meniscal repair with concomitant ACL reconstruction, suture group showed better healing status of repaired meniscus based on the second-look arthroscopy than device group. However, no significant between-group difference of clinical success rate and functional outcomes was observed.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Meniscos Tibiais , Cirurgia de Second-Look , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Meniscos Tibiais/fisiopatologia , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Suturas , Resultado do Tratamento , Cicatrização
7.
Free Radic Biol Med ; 145: 146-160, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31550528

RESUMO

Osteoarthritis (OA) is a progressive joint disorder that is primarily characterized by the degeneration and destruction of the articular cartilage. Cartilage matrix degradation, production of proinflammatory mediators, chondrocyte apoptosis and activation of macrophages in the synovial are involved in OA pathogenesis. Current non-surgical therapies for OA mainly aim at relieving pain but can barely alleviate the progression of OA. Quercetin, a naturally occurring flavonoid has shown potent anti-inflammatory effects, however, its effects and underlying mechanisms on OA have seldom been systematically illuminated. In this study, we explored the protective effects of quercetin on repairing OA-induced cartilage injuries and its possible mechanisms. In vitro, quercetin remarkably suppressed the expression of matrix degrading proteases and inflammatory mediators, meantime promoted the production of cartilage anabolic factors in interleukin-1ß-induced (IL-1ß) rat chondrocytes. In addition, quercetin exhibited anti-apoptotic effects by decreasing intracellular reactive oxygen species (ROS), restoring mitochondrial membrane potential (MMP) and inhibiting the Caspase-3 pathway in apoptotic rat chondrocytes. Moreover, quercetin induced M2 polarization of macrophages and upregulated the expression of transforming growth factor ß (TGF-ß) and insulin-like growth factor (IGF), which in turn created a pro-chondrogenic microenvironment for chondrocytes and promoted the synthesis of glycosaminoglycan (GAG) in chondrocytes. In vivo, intra-articular injection of quercetin alleviated the degradation of the cartilage and the apoptosis of chondrocytes in a rat OA model. Moreover, the expression of TGF-ß1 and TGF-ß2 in the synovial fluid and the ratio of M2 macrophages in the synovial membrane were elevated. In summary, our study proves that quercetin exerts chondroprotective effects by inhibiting inflammation and apoptosis of chondrocytes, modulating synovial macrophages polarization to M2 macrophages and creating a pro-chondrogenic environment for chondrocytes to enhance cartilage repair under OA environment. It is suggested that quercetin may serve as a potential drug for OA treatment.


Assuntos
Inflamação/tratamento farmacológico , Macrófagos/efeitos dos fármacos , Osteoartrite/tratamento farmacológico , Quercetina/farmacologia , Animais , Apoptose/efeitos dos fármacos , Polaridade Celular/efeitos dos fármacos , Polaridade Celular/genética , Condrócitos/efeitos dos fármacos , Modelos Animais de Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Inflamação/genética , Inflamação/fisiopatologia , Fator de Crescimento Insulin-Like I/genética , Macrófagos/patologia , Meniscos Tibiais/fisiopatologia , Meniscos Tibiais/cirurgia , Osteoartrite/genética , Osteoartrite/fisiopatologia , Ratos , Espécies Reativas de Oxigênio/metabolismo , Líquido Sinovial/efeitos dos fármacos , Líquido Sinovial/metabolismo , Fator de Crescimento Transformador beta1/genética , Fator de Crescimento Transformador beta2/genética
8.
Am J Sports Med ; 47(12): 2960-2965, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31454255

RESUMO

BACKGROUND: It is controversial whether soft tissue fixation only and bone-plug techniques for medial meniscal allograft transplantation provide equivalent fixation and restoration of load distribution. Prior studies on this topic did not re-create the clinical situation with use of size-, side-, and compartment-matched meniscal transplants. HYPOTHESIS: Both techniques will provide equivalent fixation of the meniscal transplant and restore load distribution and contact pressures similar to those of the native knee. STUDY DESIGN: Controlled laboratory study. METHODS: Nine fresh-frozen human cadaveric knees underwent mean contact pressure, mean contact area, and peak contact pressure evaluation in 4 medial meniscal testing conditions (native, total meniscectomy, bone-plug fixation, and soft tissue fixation) at 3 flexion angles (0°, 30°, and 60°) using Tekscan sensors under a 700-N axial load. RESULTS: Medial meniscectomy resulted in significantly decreased contact area and increased contact pressure compared with the native condition at all flexion angles (P < .0001). Compared with the native state, soft tissue fixation demonstrated significantly higher mean contact pressure and lower mean contact area at 0° and 30° of flexion (P < .05), while bone-plug fixation showed no significant difference. There was no significant difference in peak contact pressure between study conditions. CONCLUSION: Total medial meniscectomy leads to significantly worsened load distribution within the knee. Medial meniscal allograft transplantation can restore load parameters close to those of the native condition. The bone-plug technique demonstrated improved tibiofemoral contact pressures compared with soft tissue fixation. CLINICAL RELEVANCE: Medial meniscal allograft transplantation with bone-plug fixation is a viable option to restore biomechanics in patients with meniscal deficiency.


Assuntos
Articulação do Joelho/fisiologia , Meniscectomia/métodos , Meniscos Tibiais/transplante , Fenômenos Biomecânicos , Cimentos para Ossos , Cadáver , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Transplante Homólogo
9.
Am J Sports Med ; 47(7): 1591-1600, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31091129

RESUMO

BACKGROUND: Although posterior medial meniscal root (PMMR) repairs are often successful, postoperative meniscal extrusion after a root repair has been identified as a potential clinical problem. PURPOSE/HYPOTHESIS: The purpose was to quantitatively evaluate the tibiofemoral contact mechanics and extent of meniscal extrusion after a PMMR repair. It was hypothesized that the addition of a centralization suture (into the posterior medial tibial plateau) would help restore normal joint load-bearing characteristics and restore the native amount of meniscal extrusion after a root tear. Furthermore, we hypothesized that the amount of meniscal extrusion would be greatest in loaded and flexed knees when measured at the posterior border of the medial collateral ligament (MCL). STUDY DESIGN: Controlled laboratory study. METHODS: Meniscal extrusion and tibiofemoral contact mechanics were measured using 3-dimensional digitization and pressure sensors in 10 nonpaired, human cadaveric knees. The PMMR of each knee was tested under 6 states: (1) intact; (2) type 2A PMMR tear; (3) anatomic transtibial pull-out root repair; (4) anatomic transtibial pull-out repair with centralization; (5) nonanatomic transtibial pull-out repair; and (6) nonanatomic transtibial pull-out repair with centralization, with randomization of the order of conditions 3 and 4, and 5 and 6. The testing protocol loaded knees with a 1000-N axial compressive force at 4 flexion angles (0°, 30°, 60°, 90°) in each state. Meniscal extrusion was measured with a 3-dimensional coordinate digitizer at 0° and 90° in both the loaded and unloaded states and calculated from the difference from the articular margin of the tibia to the periphery of the meniscus. Peak contact pressure, contact area, and total contact pressure were also recorded for all states at all flexion angles. Statistical analysis investigated the independent effects of flexion, state, and loading using 3 distinct 2-factor models. RESULTS: Differences in the contact mechanics between repair techniques were most notable at higher flexion angles, demonstrating significantly higher average and peak contact pressures for nonanatomic repair states when compared with anatomic repairs with and without centralization (all P < .05). In unloaded knees at full extension, the magnitude of medial meniscal extrusion was significantly higher at the posterior border of the MCL compared with the posterior medial tibia ( P < .001) and adjacent to the root attachment on the tibia locations ( P < .001). Both anatomic repair states had no significant difference in the degree of extrusion when compared with the intact state. CONCLUSION: The anatomic transtibial pull-out root repair and the anatomic transtibial pull-out root repair with centralization techniques best restored contact mechanics of the knee and meniscal extrusion when compared with root tear and nonanatomic repair states at time zero. There were no significant differences in contact pressure or magnitude of extrusion between the anatomic repair state and the anatomic repair with centralization state. We found that extrusion is best measured in the coronal plane at the posterior border of the MCL for unloaded knees. However, the degree of extrusion increased as the knee was loaded and flexed to 90°. CLINICAL RELEVANCE: When there are concerns about meniscal extrusion with a medial meniscal root repair, the addition of a centralization suture may be beneficial for patients in reducing pathologic meniscal extrusion and restoring joint contact mechanics.


Assuntos
Meniscos Tibiais/cirurgia , Suturas , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Artroplastia do Joelho , Fenômenos Biomecânicos/fisiologia , Cadáver , Humanos , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/fisiopatologia , Pessoa de Meia-Idade , Pressão , Amplitude de Movimento Articular/fisiologia , Técnicas de Sutura , Tíbia/cirurgia , Lesões do Menisco Tibial/fisiopatologia , Suporte de Carga/fisiologia
10.
Biomed Res Int ; 2019: 5689613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931327

RESUMO

Sinapic acid (SA) modulates the nuclear factor-erythroid 2-related factor 2 (Nrf2) signaling pathway in chondrocytes. In order to test the hypothesis that SA is protective against the development of osteoarthritis (OA), primary mouse chondrocytes were treated in vitro with SA and the promoter transactivation activity of heme oxygenase 1 (HO-1), nuclear translocation of Nrf2, and protein expression of HO-1 were assayed. To test the hypothesis in vivo, a destabilization of the medial meniscus (DMM) model was used to induce OA in the knees of mice and SA was delivered orally to the experimental group. The chondrocytes were harvested for further analysis. The expression of HO-1 was similarly upregulated in cartilage from both the experimental mice and human chondrocytes from osteoarthritic knees. SA was found to enhance the promoter transactivation activity of heme oxygenase 1 (HO-1) and increase the expression of Nrf2 and HO-1 in primary chondrocytes. Histopathologic scores showed that the damage induced by the DMM model was significantly lower in the SA treatment group. The addition of a HO-1 inhibitor with SA did not show additional benefit over SA alone in terms of cartilage degradation or histopathologic scores. The expression of TNF-α, IL-1ß, IL-6, MMP-1, MMP-3, MMP-13, ADAMTS4, and ADAMTS5 was significantly reduced both in vitro and in vivo by the presence of SA. Protein expressions of HO-1 and Nrf2 were substantially increased in knee cartilage of mice that received oral SA. Our results suggest that SA should be further explored as a preventative treatment for OA.


Assuntos
Ácidos Cumáricos/administração & dosagem , Heme Oxigenase-1/genética , Fator 2 Relacionado a NF-E2/genética , Osteoartrite do Joelho/tratamento farmacológico , Administração Oral , Idoso , Animais , Cartilagem/efeitos dos fármacos , Cartilagem/patologia , Condrócitos/efeitos dos fármacos , Condrócitos/patologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Meniscos Tibiais/efeitos dos fármacos , Meniscos Tibiais/fisiopatologia , Camundongos , Osteoartrite do Joelho/genética , Osteoartrite do Joelho/patologia , Regiões Promotoras Genéticas/efeitos dos fármacos
11.
Arthroscopy ; 35(7): 2189-2206.e2, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30979628

RESUMO

PURPOSE: To systematically review the literature regarding the biomechanical properties of various meniscal root repair techniques. METHODS: A systematic review of multiple databases was performed. The inclusion criteria included English language, studies relevant to meniscal root repairs, studies comparing 2 or more different discrete techniques, posterior root repairs, controlled laboratory studies, and human cadaveric or animal studies. Abstracts, case reports, cohort studies, case-control studies, systematic reviews and meta-analyses, and studies of meniscal body repairs were excluded. RESULTS: Seventeen controlled laboratory studies were included for final analysis. There is no consensus on biomechanical superiority between transtibial pullout repair (TPR) and suture anchor repair. For TPR, there is no significant difference between 1 and 2 tibial tunnels. Nonanatomic repairs result in significantly lower joint surface contact areas and higher contact pressures, but suture placement farther from the root results in higher maximum load to failure. Two-suture repair has a greater maximum load to failure than 1-suture repair. Use of more than 2 sutures has diminishing returns. The modified Mason-Allen suture configuration is superior to a simple suture configuration, but there is no consensus regarding the superiority or feasibility of more complex sutures. There is no consensus on the superiority of a single suture material or shape. CONCLUSIONS: Anatomic meniscal root repairs with either TPR or suture anchor repair have better joint surface contact pressures and contact surface areas than nonanatomic repairs. The use of 2 sutures results in better fixation than 1 suture. There is evidence that the modified Mason-Allen suture configuration is superior to a simple suture configuration in a TPR, although the benefits of more complicated configurations are unclear. CLINICAL RELEVANCE: This study suggests that, in general, more complex sutures exhibit higher maximum loads. Increasing the number of sutures to up to 2 of the same configuration also increases the maximum load.


Assuntos
Artroscopia/métodos , Meniscos Tibiais/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Animais , Fenômenos Biomecânicos , Humanos , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/fisiopatologia
12.
PLoS One ; 14(4): e0213734, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973882

RESUMO

Osteoarthritis (OA) is the most common cause of disability in ageing societies, with no effective therapies available to date. Two preclinical models are widely used to validate novel OA interventions (MCL-MM and DMM). Our aim is to discern disease dynamics in these models to provide a clear timeline in which various pathological changes occur. OA was surgically induced in mice by destabilisation of the medial meniscus. Analysis of OA progression revealed that the intensity and duration of chondrocyte loss and cartilage lesion formation were significantly different in MCL-MM vs DMM. Firstly, apoptosis was seen prior to week two and was narrowly restricted to the weight bearing area. Four weeks post injury the magnitude of apoptosis led to a 40-60% reduction of chondrocytes in the non-calcified zone. Secondly, the progression of cell loss preceded the structural changes of the cartilage spatio-temporally. Lastly, while proteoglycan loss was similar in both models, collagen type II degradation only occurred more prominently in MCL-MM. Dynamics of chondrocyte loss and lesion formation in preclinical models has important implications for validating new therapeutic strategies. Our work could be helpful in assessing the feasibility and expected response of the DMM- and the MCL-MM models to chondrocyte mediated therapies.


Assuntos
Cartilagem Articular/fisiopatologia , Condrócitos/patologia , Meniscos Tibiais/fisiopatologia , Osteoartrite/fisiopatologia , Animais , Apoptose/genética , Cartilagem Articular/metabolismo , Condrócitos/metabolismo , Colágeno Tipo II/metabolismo , Modelos Animais de Doenças , Humanos , Meniscos Tibiais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Osteoartrite/genética , Osteoartrite/cirurgia , Proteoglicanas/genética , Proteoglicanas/metabolismo , Proteólise , Suporte de Carga/fisiologia
13.
Am J Sports Med ; 47(3): 651-658, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30624953

RESUMO

BACKGROUND: Historically, radial meniscal tears were treated with partial or near-total meniscectomy, which usually resulted in poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. PURPOSE/HYPOTHESIS: The purpose was to compare 3 repair techniques for radial tears of the medial meniscus: the 2-tunnel, hybrid, and hybrid tunnel techniques. It was hypothesized that there would be no differences among the 3 groups in regard to gapping and ultimate failure strength. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty human male cadaver knees (10 matched pairs, n = 20; 10 unpaired, n = 10) were used to compare the 2-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal material testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull to failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. RESULTS: After 1000 cycles of cyclic loading, there were no significant differences in displacement among the 2-tunnel repair (3.0 ± 1.7 mm), hybrid repair (3.0 ± 0.9 mm), and hybrid tunnel repair (2.3 ± 1.0 mm; P = .4042). On pull-to-failure testing, there were also no significant differences in ultimate failure strength among the 2-tunnel repair (259 ± 103 N), hybrid repair (349 ± 149 N), and hybrid tunnel repair (365 ± 146 N; P = .26). However, the addition of vertical mattress sutures to act as a "rip stop" significantly reduced the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4 of 16, 25%) as compared with the 2-tunnel repair (7 of 9, 78%; P = .017). CONCLUSION: The results showed equivalent biomechanical testing with regard to gap distance and pull-to-failure strength among the 3 repairs. The addition of the vertical mattress sutures to act as a rip stop was effective in preventing meniscal cutout through the meniscus. CLINICAL RELEVANCE: Effective healing of radial meniscal tears after repair is paramount to prevent joint deterioration and symptom development. Each tested repair showed a biomechanically equivalent and stable construct to use to repair radial meniscal tears. The authors recommend that rip stop vertical mattress sutures be used, especially in poor-quality meniscal tissue, to prevent suture cutout.


Assuntos
Procedimentos Ortopédicos/métodos , Técnicas de Sutura , Lesões do Menisco Tibial/fisiopatologia , Lesões do Menisco Tibial/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Lacerações/cirurgia , Masculino , Meniscos Tibiais/fisiopatologia , Meniscos Tibiais/cirurgia , Resistência à Tração
14.
Biosci Rep ; 39(1)2019 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-30626725

RESUMO

The morphology and histology changes in the medial meniscus after posterior cruciate ligament (PCL) rupture are poorly understood. Forty-eight rabbits were divided into matched mode pairs; each rabbit had an experimental side, in which the PCL was transacted, and a control side. At the 4, 8, 16 and 24 weeks after the PCL transection, each of the 12 rabbits was killed. Histology was performed to detect the expression of the tissue inhibitors of metalloproteinases-1 (TIMP-1), matrix metalloproteinase (MMP)-1 and MMP-13 in the medial meniscus. We found that medial meniscus displayed significant degenerative characteristics in morphology. The histological evaluation of the degeneration found that the expression levels of TIMP-1, MMP-1 and MMP-13 in the medial meniscus were higher in the experiment side than those in the control side (P<0.05). The expression of both TIMP-1 and MMP-13 was initially elevated and then decreased. The MMP-1 expression reached its peak swiftly and then maintained a relatively high level. There were clear time-dependent degenerative changes in the histology of the medial meniscus after PCL rupture. The high expression of TIMP-1, MMP-1 and MMP-13 in the cartilage may be responsible for the degeneration, and PCL rupture may trigger meniscus degradation and ultimately osteoarthritis.


Assuntos
Metaloproteinase 13 da Matriz/genética , Metaloproteinase 1 da Matriz/genética , Osteoartrite/genética , Ligamento Cruzado Posterior/metabolismo , Inibidor Tecidual de Metaloproteinase-1/genética , Animais , Modelos Animais de Doenças , Regulação da Expressão Gênica/genética , Humanos , Traumatismos do Joelho/genética , Traumatismos do Joelho/fisiopatologia , Meniscos Tibiais/metabolismo , Meniscos Tibiais/fisiopatologia , Osteoartrite/fisiopatologia , Ligamento Cruzado Posterior/fisiopatologia , Coelhos
15.
Acta Orthop Belg ; 85(4): 477-483, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32374238

RESUMO

The purpose of this study was to assess the factors associated with high fibular head in symptomatic discoid lateral meniscus (DLM). Eighty-seven patients with complete DLM (discoid group) and 80 normal subjects (control group) were included prospectively. Plain X-rays and MRI were analyzed for level and angle of the fibular head and thickness and type of Wrisberg ligament. Multivariate regression analysis was performed to find the factors associated with levels of the fibular head and DLM. The angle of the fibular head was the only factor associated with level of the fibula in the discoid group (odds ratio : 3.0, p=0.007). The 13.6mm cut off value for fibular level had 70.5% sensitivity and 77.0% specificity for diagnosis of DLM. A high fibular head was associated with larger angle and type of fibular head. Level of evidence : Level II.


Assuntos
Fíbula/diagnóstico por imagem , Fíbula/fisiopatologia , Ligamentos/diagnóstico por imagem , Ligamentos/fisiopatologia , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/fisiopatologia , Adulto , Artroscopia , Feminino , Fíbula/cirurgia , Humanos , Ligamentos/cirurgia , Imagem por Ressonância Magnética , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia
16.
Prosthet Orthot Int ; 43(2): 132-139, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30200814

RESUMO

BACKGROUND:: A medial meniscal tear is a common knee injury, especially following an anterior cruciate ligament injury. Decreasing the compressive force on the medial meniscus during dynamic activities using an unloader knee brace could reduce meniscal strain, effectively reducing injury risk and/or severity. OBJECTIVES:: To investigate the efficacy of two unloader knee braces on medial meniscus strain during dynamic activities in intact & deficient anterior cruciate ligament states. STUDY DESIGN:: Combined in vivo/in vitro study. METHODS:: In vivo knee kinematics and muscle force profiles from a healthy individual performing single/doubleleg squats and walking motions were simulated on 10 cadaveric specimens using a dynamic knee simulator system. Simulations were performed on knees in unbraced and braced scenarios, with and without the anterior cruciate ligament. Anterior and posterior medial meniscal strains were measured. RESULTS:: Two different braces each showed a significant reduction in the posteromedial meniscal strain ( p ⩽ 0.01) in an intact anterior cruciate ligament state. Neither brace mirrored this result for the anteromedial strain ( p > 0.05). In the deficient anterior cruciate ligament state, the braces had no significant effect on strain ( p > 0.05). CONCLUSION:: Two unloader knee braces effectively reduced strain in the medial meniscus with an intact anterior cruciate ligament during dynamic activities. Neither brace made a significant reduction in strain for anterior cruciate ligament-deficient knees. CLINICAL RELEVANCE: Unloader knee braces could be used to reduce the medial meniscus strain following meniscal surgery and during rehabilitation in patients with an isolated medial meniscus injury. However, these braces cannot be recommended for this purpose in patients with an anterior cruciate ligament deficiency.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Braquetes , Traumatismos do Joelho/reabilitação , Meniscos Tibiais/fisiopatologia , Entorses e Distensões/prevenção & controle , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Desenho de Equipamento , Feminino , Humanos , Traumatismos do Joelho/diagnóstico , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Estresse Mecânico
17.
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 , Imagem por Ressonância Magnética , Masculino , Meniscos Tibiais/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Lesões do Menisco Tibial/fisiopatologia , Adulto Jovem
18.
Knee Surg Sports Traumatol Arthrosc ; 27(1): 206-214, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30097687

RESUMO

PURPOSE: To analyse the stress distribution through longitudinal and radial meniscal tears in three tear locations in weight-bearing conditions and use it to ascertain the impact of tear location and type on the potential for healing of meniscal tears. METHODS: Subject-specific finite-element models of a healthy knee under static loading at 0°, 20°, and 30° knee flexion were developed from unloaded magnetic resonance images and weight-bearing, contrast-enhanced computed tomography images. Simulations were then run after introducing tears into the anterior, posterior, and midsections of the menisci. RESULTS: Absolute differences between the displacements of anterior and posterior segments modelled in the intact state and those quantified from in vivo weight-bearing images were less than 0.5 mm. There were tear-location-dependent differences between hoop stress distributions along the inner and outer surfaces of longitudinal tears; the longitudinal tear surfaces were compressed together to the greatest degree in the lateral meniscus and were most consistently in compression on the midsections of both menisci. Radial tears resulted in an increase in stress at the tear apex and in a consistent small compression of the tear surfaces throughout the flexion range when in the posterior segment of the lateral meniscus. CONCLUSIONS: Both the type of meniscal tear and its location within the meniscus influenced the stresses on the tear surfaces under weight bearing. Results agree with clinical observations and suggest reasons for the inverse correlation between longitudinal tear length and healing, the inferior healing ability of medial compared with lateral menisci, and the superior healing ability of radial tears in the posterior segment of the lateral meniscus compared with other radial tears. This study has shown that meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci. This may be used in decision making regarding conservative or surgical management.


Assuntos
Análise de Elementos Finitos , Articulação do Joelho/fisiologia , Meniscos Tibiais/fisiopatologia , Modelos Biológicos , Lesões do Menisco Tibial/fisiopatologia , Adulto , Artroscopia , Humanos , Joelho , Traumatismos do Joelho , Imagem por Ressonância Magnética , Masculino , Pressão , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Suporte de Carga , Cicatrização
19.
Knee Surg Sports Traumatol Arthrosc ; 27(2): 354-360, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30099570

RESUMO

PURPOSE: To report the outcomes (subjective function, return to play, complications and reoperations) of arthroscopic all-inside meniscal fixation in a large sample of soccer players with hypermobile lateral meniscus. METHODS: Between 2010 and 2015, 55 patients undergoing surgical treatment for hypermobile lateral meniscus at Mutualidad Catalana de Futbolistas (Barcelona, Spain) were identified. Patients with open physes, associated injuries, discoid meniscus, or clinical follow-up less than 6 months were excluded. Once identified, all patients were contacted over the phone to collect cross-sectional data on International Knee Documentation Committee (IKDC) score, postoperative Tegner score, and postoperative visual analogue scale (VAS) for pain. In addition, complications and reoperations were retrospectively collected. RESULTS: Forty-six cases (in 45 patients) with a mean (SD) age of 26.3 (9.5) years and mean (SD; range) follow-up of 43 (19.5; 8-73) months were included. The pre- and post-operative median (range) Tegner score was 9 (6-9) and 8 (0-9), respectively. Compared to the preoperative period, the postoperative Tegner score was equal in 27/46 (59%) cases and lower in 16/46 (35%) cases (3 missing values). Return to play was possible in 38/46 (82%) cases, from which 27/46 (59%) corresponded to the same pre-injury activity level. Postoperatively, the median (range) VAS for pain was 1 (0-9), and the mean (SD) subjective IKDC was 86.2 (16.7). Three of the 46 cases (6.5%) required a reoperation because of pain in one patient (meniscal suture failure) and meniscal tear in two patients. CONCLUSIONS: All-inside meniscal fixation is a successful treatment for hypermobile lateral meniscus, which allows acceptable return to play and good function in soccer players at a low reoperation rate. However, according to the present cross-sectional case series, players should be advised that return to the same pre-injury activity level is achieved in only 27 of 46 (59%) of the cases. Surgeons facing with the difficult problem of hypermobile lateral meniscus in soccer players should consider meniscus fixation as an easy and successful option. LEVEL OF EVIDENCE: Level IV-Therapeutic Case Series.


Assuntos
Atletas , Meniscos Tibiais/fisiopatologia , Meniscos Tibiais/cirurgia , Dispositivos de Fixação Ortopédica , Futebol/fisiologia , Adulto , Artroscopia , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Avaliação de Resultados da Assistência ao Paciente , Reoperação , Estudos Retrospectivos , Volta ao Esporte , Técnicas de Sutura , Escala Visual Analógica
20.
Int Orthop ; 43(5): 1239-1245, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30069591

RESUMO

PURPOSE: Medial meniscus posterior root tear (MMPRT) leads to a rapid degradation of articular cartilage. In the treatment of MMPRT, transtibial pullout repair demonstrates a high clinical survival rate. However, there is no reliable method to evaluate the meniscal healing after surgery. We propose an arthroscopic scoring system for evaluating the meniscal healing status. The aim of this study was to investigate the correlations between second-look arthroscopic scores and clinical outcomes after transtibial pullout repair. METHODS: Twenty patients who had MMPRTs underwent transtibial pullout repairs. Clinical outcomes were assessed using the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain score evaluated by visual analogue scale at preoperatively and 1 year postoperatively. The healing status of repaired MM was assessed at one year post-operatively using a semi-quantitative arthroscopic scoring system (total, 10 points) composed of three evaluation criteria: (i) anteroposterior width of bridging tissues, (ii) stability of the MM posterior root, and (iii) synovial coverage of the sutures. Linear regression analysis was used to assess the correlation between second-look arthroscopic scores and clinical outcomes. RESULTS: Transtibial pullout repairs of MMPRTs significantly improved clinical evaluation scores at one year post-operatively. A median of second-look arthroscopic scores was 6.5 (5.75-8). A good correlation was observed between the arthroscopic score and KOOS quality of life (QOL) subscale. A moderate negative correlation between the arthroscopic score and pain score was observed. CONCLUSIONS: This study demonstrated that our semi-quantitative scoring system of meniscal healing correlated with the KOOS QOL subscale following MMPRT transtibial pullout repair. Our results suggest that the second-look arthroscopic score using this system may be a useful scale to determine and compare the healing status of the MM posterior root.


Assuntos
Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia , Idoso , Artroscopia , Feminino , Humanos , Masculino , Meniscos Tibiais/fisiopatologia , Pessoa de Meia-Idade , Qualidade de Vida , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Cirurgia de Second-Look , Índice de Gravidade de Doença , Lesões do Menisco Tibial/fisiopatologia , Resultado do Tratamento , Cicatrização
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