INFLUENCE OF CRYOTHERAPY WITH PULSE COMPRESSION ON THE FUNCTIONAL CONDITION OF THE KNEE JOINT AFTER PARTIAL MENISCECTOMY.

OBJECTIVE: The aim: To study the effect of cryotherapy with adjustable pulse compression in patients after arthroscopic partial meniscectomy on the functional state of the knee joint in the early period of rehabilitation. PATIENTS AND METHODS: Materials and methods: A total of 63 patients took part in the research: the experimental group included 32 patients (23 men and 9 women), and the control group - 31 patients (21 men and 10 women). In order to determine the effect on the functional state of the knee joint after arthroscopic partial meniscectomy in the experimental group, cryotherapy with adjustable pulse compression was used with the help of «GIOCO CRYO - 2¼ system; ice bags were used in the control group. In the research process, the following methods were used: visual analogue point scale, sonography, goniometry and myotonometry. RESULTS: Results: It was found that in the experimental group, under the influence of cryotherapy with adjustable pulse compression, there was a progressive decrease in the intensity of the pain syndrome, the accumulation of reactive synovial fluid, a dynamic increase in the amplitude of movements of the operated joint, and an improvement in the muscle tone of the quadriceps femoris (p<0,05-0,001). CONCLUSION: Conclusions: Thus, cryotherapy with adjustable pulse compression has shown a positive effect on the functional state of the knee joint in the early period of patients' rehabilitation, after partial meniscectomy and can be recommended for use in clinical practice.

Total Knee Replacement After Arthroscopic Meniscectomy in Knee Osteoarthritis: A Nationwide Population-Based Cohort Study.

BACKGROUND: Recent studies raise concerns that arthroscopic meniscectomy (AM) for degenerative tear may be detrimental to the maintenance of the joint structure. This study was performed to examine the rate of total knee replacement (TKR) among patients with knee osteoarthritis (OA) who underwent AM for meniscal tears and compare this rate with those who did not. METHODS: A retrospective cohort study was conducted using the National Health Insurance Database of South Korea. Among knee OA patients aged 50-79, those who were treated with AM due to meniscal damage from 2007 to 2009 were selected as the AM group while those not treated with AM despite the presence of meniscal damage were selected as control group. Both were matched based on a propensity score and followed-up until the earliest occurrence of: TKR, death, or 10 years. Cox proportional hazards models were used to compare the outcome. RESULTS: A total of 36,974 patients were included in AM groups and non-AM group after 1:1 matching. TKR occurred in 9.62% and 7.64% in AM and non-AM groups with the average duration after meniscectomy of 5.88 ± 2.77 and 5.50 ± 2.94 years, respectively. After adjustment for baseline confounders, the TKR rate in the AM group was calculated to be 25% higher than that in the non-AM group (subdistribution hazard ratio, 1.25; 95% confidence interval, 1.16-1.34). The mortality rate was 5.20%, which did not significantly differ between groups. CONCLUSION: OA patients who underwent AM for the meniscal injury had higher incidence of TKR up to 10 years of follow-up than the non-operated group. The greater TKR utilization observed in patients undergoing AM merits caution when treating OA patients with meniscal injury.

The value of reducing arthroscopic partial meniscectomy in the treatment of degenerative meniscus tears: a budget impact analysis.

AIMS: Numerous studies have shown that arthroscopic partial meniscectomy (APM) is not (cost-) effective in patients with symptoms attributed to a degenerative meniscus tear. We aimed to assess the budget impact of reducing APM in routine clinical practice in this population. MATERIALS AND METHODS: A patient-level state transition model was developed to simulate patients recently diagnosed with a degenerative meniscus tear. Three strategies were compared: "current guideline" (i.e., postpone surgery to at least 3 months after diagnosis), "APM at any time" (i.e., APM available directly after diagnosis), and "nonsurgical" (i.e., APM no longer performed). Total societal costs over 5 years were calculated to determine the budget impact. Probabilistic and deterministic sensitivity analyses were conducted to address uncertainty. RESULTS: The average cost per patient over 5 years were EUR 5,077, EUR 4,577, and EUR 4,218, for the "APM at any time," "current guideline," and "nonsurgical" strategy, respectively. Removing APM from the treatment mix (i.e., 30,000 patients per year) in the Netherlands, resulted in a reduction in health care expenditures of EUR 54 million (95 percent confidence interval [CI] EUR 38 million-EUR 70 million) compared to the "current guideline strategy" and EUR 129 million (95 percent CI EUR 102 million-EUR 156 million) compared to the "APM at any time" strategy. Sensitivity analyses showed that uncertainty did not alter our conclusions. CONCLUSIONS: Substantial costs can be saved when APM is no longer performed to treat symptoms attributed to degenerative meniscus tears in the Netherlands. It is therefore recommended to further reduce the use of APM to treat degenerative meniscus tears.

Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review.

OBJECTIVE: The objective of this study is to establish which patient and lesion characteristics are related to the clinical outcome after microfracture of cartilage defects in the knee. STUDY DESIGN: Systematic review. METHODS: After preregistration, PubMed, Embase, and Cochrane were searched for studies that analyzed prognostic factors for the outcome of microfracture treatment in the knee. The criteria for inclusion were outcome measured using Patient-Reported Outcome Measures (PROMs), a clinical study with ≥10 participants receiving microfracture, and a minimal follow-up period of 1 year. RESULTS: For none of the investigated prognostic factors, effect size reporting was sufficiently homogeneous to conduct a meta-analysis. However, a majority of the included studies identified higher age, larger lesion size, longer preoperative symptom duration, and previous surgery on the ipsilateral knee, especially meniscectomy and anterior cruciate ligament reconstruction, as factors that are reported to be correlated to a less favorable outcome. A lesion location that does not include the trochlea or the patellofemoral joint and is not weightbearing, a nondegenerative mechanism of injury, and a single lesion were reported as factors that predict a favorable outcome. As to gender, body mass index, preoperative activity level, smoking, and concomitant knee surgery, the included articles were inconclusive or no effect was reported. CONCLUSIONS: Several factors correlated with the clinical result after microfracture treatment. However, the information on the effect sizes of the influence on clinical outcome is incomplete due to poor reporting. Large-scale registries or pooling of homogeneous, well-reported data is needed to work toward prognostic models. That would be an important step toward personalized treatment.

Editorial Commentary: We Should Be Cautious About Using Catching and Locking as an Indication for Knee Arthroscopy: Mechanical Symptoms May Be Multifactorial in Their Causes.

Knee arthroscopy may be offered as a treatment for mechanical (catching/locking, grinding/clicking) and meniscal (pain with twisting/pivoting) symptoms. Recent studies have found that mechanical symptoms, particularly catching/locking, may be multifactorial in their causes (chondral lesions, meniscal tears, loose bodies) and less responsive to arthroscopic meniscectomy. Surgeons should be aware of this evidence and adjust their surgical indications appropriately.

Does laterality matter? a systematic review and meta-analysis of clinical and survival outcomes of medial versus lateral meniscal scaffolds.

PURPOSE: Meniscal scaffold implants have gained interestas a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aimsto assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants. METHODS: The study was performedaccording to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcomedata specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data. RESULTS: Ten studies comprising 568 patients (mean age 29.2-40 years, follow up duration 1-14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51-3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain,Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores. CONCLUSION: Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.

Objective laxity and subjective outcomes are more influenced by meniscal treatment than anterior cruciate ligament reconstruction technique at minimum2 years of follow-up.

OBJECTIVE: The purposes of this study were: (1) to compare three different surgical techniques for anterior cruciate ligament (ACL) reconstruction at a minimum 2 years of follow-up in terms of objective laxity and patient-reported outcomes; (2) to inspect the role of meniscal tears and treatment alongside with ACL reconstruction. METHODS: 59 patients were randomly assigned to one of the three reconstruction groups according to the ACL reconstruction technique: Double Bundle, Single Bundle, Single Bundle with Lateral Plasty. Autologous hamstring tendons were used in all the ACL reconstruction techniques. Objective laxity tests and KOOS were collected before surgery as a baseline and at a minimum of 2 years of follow-up and compared through a Repeated measure ANOVA. Secondary analysis to evaluate the effect of meniscal treatment on laxity reduction and scores improvement was also conducted using ANOVA. Three laxity evaluations were performed: anterior/posterior displacement at 30° of knee flexion (AP 30), anterior/posterior displacement at 90° of knee flexion (AP 90), and pivot-shift test. RESULTS: Objective laxity and KOOS showed statistically significant improvement at follow-up in all three groups (p < 0.0001) without differences among the techniques. A higher AP 30 (mean difference 2.4 mm, p = 0.0333, ES = 0.66) was found at baseline for the patients with irreparable medial meniscal tear compared to the patients with isolated ACL tear; a statistically significant difference in pain score at two-year follow-up was found between patients who underwent lateral meniscectomy and patients with either meniscal repair (mean difference 6.9 ± 12.5) or isolated ACL tear (mean difference 6.8 ± 16.1); patients with reparable meniscal tear had a statistically significant pain score improvement compared to the patients who underwent medial and lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2 respectively). CONCLUSION: Comparable objective laxity and subjective outcomes were found among the three ACL reconstruction techniques at a minimum of 2 years of follow-up. The presence of irreparable medial meniscal tear increased pre-operative laxity (AP 30, mean difference 2.4 ± 3.6 mm). Patients with meniscal repair presented higher pain relief between baseline and follow-up compared with patients undergoing medial or lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2, respectively).

Editorial Commentary: Meniscal Repair, When Possible, Is Better for Patients Than Meniscectomy.

Patients do not do as well after meniscectomy as after repair. Although saving the meniscus is not always easy and the success rate of repair is not 100%, repair-when possible-remains the best option for patients in the long run. Meniscal repair rates are on the rise, especially in younger patients, but are not high enough. Recent research has shown that more than 95% of meniscal procedures are partial meniscectomies. Improved surgical techniques and instrumentation, as well as a continued increase in understanding the importance of repair, are leading to an increase in meniscal repair rates. Preserve as much meniscus as possible and as often as possible.

The Potential of Using an Autogenous Tendon Graft by Injecting Bone Marrow Aspirate in a Rabbit Meniscectomy Model.

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects.

In degenerative meniscal tears, PT was noninferior to arthroscopic partial meniscectomy for knee function at 5 y.

SOURCE CITATION: Noorduyn JCA, van de Graaf VA, Willigenburg NW, et al. Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial. JAMA Netw Open. 2022;5:e2220394. 35802374.

Variation in Patient-Reported Outcomes in Young and Old Patients Up to 4 to 6 Years After Arthroscopic Partial Meniscectomy.

OBJECTIVE: To assess the variation in changes in patient-reported outcomes 4 to 6 years after arthroscopic partial meniscectomy (APM). DESIGN: Prospective cohort study. SETTING: Orthopedic departments at public hospitals. PATIENTS: Patients (n = 447) from the Knee Arthroscopy Cohort Southern Denmark undergoing APM. INTERVENTIONS: All patients underwent APM. MAIN OUTCOME MEASURES: Change in KOOS4 scores from baseline before surgery to ∼5 years (range 4-6 years) after surgery. KOOS4 is the average aggregated score of 4 of 5 of the Knee injury and Osteoarthritis Outcome Score (KOOS) excluding the activities of daily living subscale (minimal clinical important improvement ∼10 points). A mixed linear model adjusted for sex and body mass index was used to assess change from baseline to ∼5-year follow-up. Change in KOOS4 was divided into 5 categories based on change from baseline to ∼5-year follow-up: <0 points, 0 to 9 points, 10 to 19 points, 20 to 29 points, and ≥30 points. RESULTS: On average, patient-reported outcomes continued to improve from baseline to ∼5-year follow-up (mean KOOS4 change: 26, 95% CI, 24-28). Proportions in the different response groups were <0 points (12%), 0 to 9 points (13%), 10 to 19 points (16%), 20 to 29 points (19%), and ≥30 points (40%), with no difference between younger (≤40 years, n = 75) and older (>40 years, n = 337) patients (P = 0.898). CONCLUSIONS: Patient-reported outcomes on average improved up to ∼5 years after APM; however, large variability was observed. The similar variability in younger and older patients questions the assumption that younger patients with traumatic injuries experience larger benefits from APM.

Kinematics-Based Lower Limb Rehabilitation Monitoring Following Partial Knee Meniscectomy: Case Study.

Physiotherapy includes treatment to restore and optimize mobility after surgery, injury, disease, and/or degeneration. Based on assessments throughout the recovery process from visual observations of movement, exercises are prescribed to perform at home between clinic sessions. Although technical advances have facilitated remote communication between therapists and patients, accurate assessment of at-home exercises is challenged by a lack of direct observation. The current study advances remote assessment tools to assess key lower body exercises prescribed in a case study following recovery from arthroscopic partial meniscectomy (APM). Using Vicon motion capture, recovery metrics related to range of motion, strength, and gait function were extracted. Peak knee flexion angle on the operated leg during heel slide increased from 91.61° ± 4.17° to 127.42° ± 2.35° (p<0.05), although significant differences were found compared to the non-operated leg at Day 6 (138.19° ± 5.44°, p<0.05). Repetition times in heel slide and leg raise exercises on the affected leg decreased from Day 2 (2.74s) to Day 6 (1.07s), indicating strength recovery. Step length asymmetry decreased by 61.22% and step width asymmetry decreased by 41.75% from Day 2 to Day 6 post surgery, demonstrating improved gait function. This work presents a sample of automated recovery metrics that can be used for therapists to assess rehabilitation and inform the recovery process. Implications of the study findings on remote assessment using wearables are discussed. This work presents kinematics based quantifiable lower limb rehabilitation metrics to assess recovery objectives (e.g., knee flexion angle to assess knee range of motion) used by clinicians to inform recovery remotely.

Participation of patients during arthroscopic partial meniscectomy is conducive to postoperative rehabilitation and satisfaction: a single-center retrospective study.

PURPOSE: To evaluate the effect of patient participation in arthroscopic partial meniscectomy (APM) on rehabilitation and patient satisfaction. METHODS: A total of 86 patients of traumatic longitudinal vertical meniscus tears, between January 2017 and December 2020 at the First Affiliated Hospital of Zhejiang Chinese Medical University, met the inclusion and exclusion criteria. The patients in the intraoperative participation group (n = 33) were awake and could watch the screen during APM and communicate with the surgeon in the surgery; patients who underwent APM in the traditional mode were classified as the traditional group(n = 53). The differences in exercise adherence, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and satisfaction at follow-up were compared. In the intraoperative participation group, the mean age of the patients was 26.97 ± 5.63 years and the follow-up time was 25.12 ± 6.23 months. In the traditional group, the mean age of the patients was 29.21 ± 5.29 years and the follow-up time was 25.08 ± 6.70 months. RESULTS: The intraoperative participation group reported a better result in exercise adherence (78.79% VS 50.94%, p = 0.012). As secondary outcomes, Patients in the intraoperative participation group demonstrated better scores on the KOOS domains of pain (79.80 ± 6.38 VS 76.26 ± 5.33, p = 0.007), Symptoms (59.41 ± 5.27 VS 56.74 ± 5.97, p = 0.038), and QOL (65.91 ± 10.72 VS 60.26 ± 9.34, p = 0.012), as compared to these in the traditional group. There were no significant differences in the KOOS domains of Sport (72.88 ± 8.20 VS 72.64 ± 7.70, P = 0.892), and ADL (89.47 ± 3.50 VS 87.87 ± 4.50 p = 0.085). what's more, in the intraoperative participation group, the results of satisfaction (96.97% VS 81.13%, p = 0.025) were also significantly better. CONCLUSION: The mode of participation of patients during APM can improve patients' exercise adherence, reduce pain, improve symptoms and improve patients' satisfaction as well as the quality of life. More work is needed to develop this mode further.

The role of patient characteristics and the effects of angiogenic therapies on the microvasculature of the meniscus: A systematic review.

BACKGROUND: Considerable interindividual variation in meniscal microvascularization has been reported. The purpose of this review was to identify which patient characteristics affect meniscal microvascularization and provide a structured overview of angiogenic therapies that influence meniscal neovascularization. METHODS: A systematic literature search was undertaken using PubMed, Embase, Web of Science, Cochrane library and Emcare from inception to November 2021. Studies reporting on (1) Patient characteristics that affect meniscal microvascularization, or (2) Therapies that induce neovascularization in meniscal tissue were included. Studies were graded in quality using the Anatomical Quality Assessment (AQUA) tool. The study was registered with PROSPERO(ID:CRD42021242479). RESULTS: Thirteen studies reported on patient characteristics and eleven on angiogenic therapies. The influence of Age, Degenerative knee, Gender, and Race was reported. Age is the most studied factor. The entire meniscus is vascularized around birth. With increasing age, vascularization decreases from the inner to the peripheral margin. Around 11 years, blood vessels are primarily located in the peripheral third of the menisci. There seems to be a further decrease in vascularization with increasing age in adults, yet conflicting literature exists. Degenerative changes of the knee also seem to influence meniscal vascularization, but evidence is limited. Angiogenic therapies to improve meniscal vascularization have only been studied in preclinical setting. The use of synovial flap transplantation, stem cell therapy, vascular endothelial growth factor, and angiogenin has shown promising results. CONCLUSION: To decrease failure rates of meniscal repair, a better understanding of patient-specific vascular anatomy is essential. Translational clinical research is needed to investigate the clinical value of angiogenic therapies.

The State of Meniscal Allograft Transplantation in New York Over the Last Decade.

BACKGROUND: The purpose of this study was to evaluate for changes in the incidence of arthroscopic meniscal procedures, especially meniscal allograft transplantation (MAT) in New York State (NYS) between 2005 to 2014. METHODS: The New York Statewide Planning and Research Cooperative Systems (SPARCS) database was queried from 2005 through 2014 to identify patients undergoing meniscetomies, meniscal repairs, and MAT. Patients were followed longitudinally to determine the incidence of subsequent ipsilateral knee procedures. The impact of patient demographics and surgeon volume on reoperation was explored. RESULTS: From 2005 through 2014, there were 524,737 arthroscopic meniscal procedures. Of these, there were 510,406 meniscectomies, 14,214 meniscal repairs, and 117 MATs. The number of MATs increased 15.5% per year, with the largest increase being between 2013 to 2014 (an increase of 86.5%). Average MAT patient age was 29.8 ± 11.1 years; 65.0% of patients were male; 66% were Caucasian; 84% were privately-insured; and 23% of surgeons met the criteria for high-volume (five or more MATs in a year). A total of 25.6% (30/117) patients underwent subsequent surgery; 26 patients underwent knee procedures at mean of 18.9 ± 18.3 months after initial MAT, the most common of which were ipsilateral meniscectomies (19/26). Four patients underwent total knee arthroplasty (TKA) at a mean of 21.0 ± 9.2 months after initial MAT. Patients undergoing TKA after MAT were significantly older (42.0 ± 15.0 years vs, 29.3 ± 10.7 years; p = 0.0242) than patients who did not. Neither demographics nor surgeon volume were statistically significant factors for undergoing subsequent surgery (p > 0.05). CONCLUSION: Meniscal allograft transplantation, though relatively uncommon, is being performed with greater frequency in NYS. Surgeons should counsel patients regarding the likelihood of requiring subsequent knee surgery after MAT, with repeat arthroscopic partial meniscectomy being the most commonly performed procedure.

The meniscal tear outcome (METRO) review: A systematic review summarising the clinical course and outcomes of patients with a meniscal tear.

BACKGROUND: Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes. METHOD: A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints. RESULTS: 35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant. CONCLUSIONS: Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.

Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression.

OBJECTIVE: To perform conventional, morphological, and T2 mapping compositional MRI imaging to assess the cartilage degeneration and osteoarthritic progression in patients with medial meniscus posterior root tears (MMPRTs) who underwent trans-posterior cruciate ligament (PCL) all-inside repair or partial meniscectomy. DESIGN: Patients with MMPRTs after trans-PCL all-inside repair (group AR) or partial meniscectomy (group PM) between 2015 and 2018 were retrospectively identified. Preoperative and postoperative conventional MRI were collected to assess medial meniscus extrusion (MME) and the whole-organ magnetic resonance imaging score (WORMS). Postoperative morphological MRI and T2 mapping compositional MRI were collected to evaluate the quantitative cartilage thickness/volume and cartilage composition. RESULTS: The final cohort consisted of 21 patients in group AR and 22 patients in group PM, with no differences in demographic data and baseline patient characteristics between the 2 groups. Group AR demonstrated less progression of articular cartilage wear (P < 0.05) and decreased meniscal extrusion (P = 0.008) than group PM at the final follow-up. In addition, group AR demonstrated less extracellular matrix degeneration in the cartilage subregion of the medial compartment (P < 0.05) than group PM with lower T2 relaxation times in the superficial layer of the articular cartilage. CONCLUSION: Trans-PCL all-inside repair of MMPRTs could delay the initial cartilage deterioration and morphological cartilage degeneration compared with partial meniscectomy. However, the amount of residual meniscal extrusion is clinically important, and an improved root repair fixation method should be investigated.

Finite element study of a partial meniscectomy of a complete discoid lateral meniscus in adults.

BACKGROUND: Incidence of osteoarthritis and genu valgus is higher after partial meniscectomy of the discoid lateral meniscus. We aimed to provide a biomechanical reference for slowing the development of osteoarthritis and genu valgus after complete discoid lateral meniscus (CDLM) surgery. METHODS: Computed tomography and magnetic resonance images of the knee were used to establish a finite element model of the knee. The discoid lateral meniscus model was cut at 2-mm intervals to obtain 10 lateral meniscus models of different widths (2-20 mm). The instantaneous stress peak and knee valgus angle were obtained by finite element analysis under the same coaxial load. FINDINGS: When the residual width of the lateral meniscus was greater than 12 mm, the peak stress of the knee joint and angle of genu valgus did not significantly change from preoperative levels. The contact stress peak increased slightly as the width decreased from 12 to 8 mm. When the width was reduced from 8 to 0 mm, the contact stress peak increased significantly. INTERPRETATION: For partial meniscectomy in CDLM patients, meniscus width of 8-10 mm provides a better biomechanical environment. This may reduce risk of early knee degeneration and valgus from excessive meniscectomy in conventional surgery.