Post-traumatic and OA-related lesions in the knee at baseline and 2 years after traumatic meniscal injury: Secondary analysis of a randomized controlled trial.

OBJECTIVE: To assess the presence of early degenerative changes on Magnetic Resonance Imaging (MRI) 24 months after a traumatic meniscal tear and to compare these changes in patients treated with arthroscopic partial meniscectomy or physical therapy plus optional delayed arthroscopic partial meniscectomy. DESIGN: We included patients aged 18-45 years with a recent onset, traumatic, MRI verified, isolated meniscal tear without radiographic osteoarthritis. Patients were randomized to arthroscopic partial meniscectomy or standardized physical therapy with optional delayed arthroscopic partial meniscectomy. MRIs at baseline and 24 months were scored using the MRI Osteoarthritis Knee Score (MOAKS). We compared baseline MRIs to healthy controls aged 18-40 years. The outcome was the progression of bone marrow lesions (BMLs), cartilage defects and osteophytes after 24 months in patients. RESULTS: We included 99 patients and 50 controls. At baseline, grade 2 and 3 BMLs were present in 26% of the patients (n = 26), compared to 2% of the controls (n = 1) (between group difference 24% (95% CI 15% to 34%)). In patients, 35% (n = 35) had one or more cartilage defects grade 1 or higher, compared to 2% of controls (n = 1) (between group difference 33% (95% CI 23% to 44%)). At 24 months MRI was available for 40 patients randomized to arthroscopic partial meniscectomy and 41 patients randomized to physical therapy. At 24 months 30% (n = 12) of the patients randomized to arthroscopic partial meniscectomy showed BML worsening, compared to 22% (n = 9) of the patients randomized to physical therapy (between group difference 8% (95% CI -11% to 27%)). Worsening of cartilage defects was present in 40% (n = 16) of the arthroscopic partial meniscectomy group, compared to 22% (n = 9) of the physical therapy group (between group difference 18% (95% CI -2% to 38%)). Of the patients who had no cartilage defect at baseline, 33% of the arthroscopic partial meniscectomy group had a new cartilage defect at follow-up compared to 14% of the physical therapy group. Osteophyte worsening was present in 18% (n = 7) of the arthroscopic partial meniscectomy group and 15% (n = 6) of the physical therapy group (between group difference 3% (95% CI -13% to 19%)). CONCLUSIONS: Our results might suggest more worsening of BMLs and cartilage defects with arthroscopic partial meniscectomy compared to physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up in young patients with isolated traumatic meniscal tears without radiographic OA.

Centralization reduces meniscal extrusion, improves joint mechanics and functional outcomes in patients undergoing meniscus surgery: A systematic review and meta-analysis.

PURPOSE: To perform a systematic review and meta-analysis of the existing literature on meniscal centralisation procedures, analysing its impact on meniscal extrusion, joint biomechanics and clinical and radiological outcome measures. METHODS: The Cochrane Controlled Register of Trials, PubMed (MEDLINE) and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Biomechanical studies on healthy animal or human cadaveric knee joints that assessed meniscal extrusion or tibiofemoral contact mechanics (contact area and pressure) following centralization for meniscal pathologies were included. For clinical studies, those that prospectively or retrospectively assessed patient-reported outcome measures (PROMs), postoperative knee motion, complications and radiological extrusion following centralization for meniscal pathologies were included. RESULTS: Fifteen studies were included in the analysis, comprising eight biomechanical, six clinical and one both. There were 92 knee specimens for biomechanical testing, of which 40 were human cadaveric and 52 porcine models. Biomechanical data revealed centralization to be commonly performed for posterior meniscal root tears and significantly reduced extrusion and contact pressure whilst improving contact area following a tear (p < 0.00001). Centralization restored extrusion to that of the native knee at all flexion angles described (0-90°, p = 0.25) and, compared to the torn state, brought tibiofemoral contact mechanics 3.2-5.0 times closer to the native state. Clinical data showed that 158 patients underwent centralization for extrusion. It improved postoperative Knee Injury and Osteoarthritis Outcome score (KOOS) (p = 0.006) and Lysholm scores (p < 0.00001) at 25.0 months, maintained extrusion reduction at 17.1 months (p < 0.00001) and preserved knee motion. CONCLUSION: Centralisation for various meniscal injuries associated with extrusion can reduce meniscal extrusion and improve joint biomechanics, along with clinical and radiological outcomes. Existing evidence is still scarce and exhibits a notable amount of methodological heterogeneity. LEVEL OF EVIDENCE: Systematic review of Level IV evidence.

Arthroscopy with partial meniscectomy for degenerative tear does not increase the risk of total knee arthroplasty at five year follow up; however, this population undergoes total knee arthroplasty with a lower threshold of osteoarthritis.

PURPOSE: Degenerative meniscus tears can cause discomfort in some patients, and when medical treatments fail to provide relief, arthroscopy may be considered before resorting to knee prosthesis. However, the benefits of arthroscopy over nonsurgical treatments in patients over 60 years old are limited, and the evidence regarding its overall efficiency and drawbacks remains scarce. Furthermore, there has been no investigation into whether those patients treated with partial meniscectomy, undergo the knee operation at an earlier stage of osteoarthritis. METHODS: This study focused on data from a single Belgian hospital, involving patients over 60 years old with internal meniscal tears. The participants were categorized into two groups based on the treatment they received: arthroscopic partial meniscectomy (APM) or conservative management. The primary outcome assessed was the occurrence of knee arthroplasty within a five year period. Secondary outcomes included evaluating the ICRS cartilage grade and the time taken until total knee arthroplasty (TKA). RESULTS: A total of 194 patients with internal meniscal tears were included in the study. At the 5-year mark, the overall rate of knee arthroplasty was found to be 16.5%, with 11.9% of cases occurring within two years. After the 5-year follow-up, it was observed that 19.2% (24 patients) of the APM group and 11.6% (8 patients) of the conservative management group underwent knee arthroplasty. Notably, patients over 70 years old who underwent APM had a higher risk of eventually requiring TKA compared to those who received conservative management. Additionally, patients who underwent meniscectomy and later underwent TKA showed less wear in the internal compartment of the knee compared to patients in the conservative treatment group who underwent TKA. CONCLUSION: The study suggests that patients who underwent arthroscopy faced a similar risk of knee arthroplasty compared to those who underwent conservative management, excepted for patients over 70 years old. Despite this similar risk of arthroplasty for the whole population, they exhibited lower osteoarthritis severity when compared to the conservative group.

Meniscal repair failure following concurrent primary anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry.

PURPOSE: This study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction. METHODS: Prospective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included. Repair failure was defined as a subsequent reoperation involving meniscectomy of the repaired meniscus. Multivariate survival analysis was performed to identify the risk factors for failure. RESULTS: A total of 3,024 meniscal repairs were analysed with an overall failure rate of 6.6% (n = 201) at a mean follow-up of 2.9 years (SD 1.5). The risk of medial meniscal repair failure was higher with hamstring tendon autografts (adjusted HR [aHR] = 2.20, 95% CI 1.36-3.56, p = 0.001), patients aged 21-30 years (aHR = 1.60, 95% CI 1.30-2.48, p = 0.037) and in patients with cartilage injury in the medial compartment (aHR = 1.75, 95% CI 1.23-2.48, p = 0.002). The risk of lateral meniscal repair failure was higher in patients aged ≤ 20 years (aHR = 2.79, 95% CI 1.17-6.67, p = 0.021), when the procedure was performed by a low case volume surgeon (aHR = 1.84, 95% CI 1.08-3.13, p = 0.026) and when a transtibial technique was used to drill the femoral graft tunnel (aHR = 2.30, 95% CI 1.03-5.15, p = 0.042). CONCLUSION: The use of a hamstring tendon autograft, younger age and the presence of medial compartment cartilage injury are risk factors for medial meniscal repair failure, whereas younger age, low surgeon volume and a transtibial drilling technique are risk factors for lateral meniscal repair failure. LEVEL OF EVIDENCE: Level II.

Update on imaging of the discoid meniscus.

Discoid menisci represent a range of morphological meniscal variants, most commonly involving the lateral meniscus. Clinical presentation ranges from an asymptomatic incidental finding to snapping, pain, swelling and reduced range of knee movement. Symptomatic presentation of discoid menisci is usually due to meniscal tears and instability resulting from abnormal meniscal morphology and ultrastructure, with absent peri-meniscal ligamentous and meniscocapsular attachments characteristic of the Wrisberg sub-type. This article reviews the current classification systems of discoid menisci, gross morphological characteristics of each sub-type and ultrastructure. Clinical presentation, arthroscopic findings and indirect radiological diagnostic criteria are described, as are the MRI findings of normal and pathological discoid menisci. Current concepts of surgical management and outcomes of the discoid meniscus are also briefly discussed.

Posterior knee arthroscopy facilitates the safe and effective all-inside repair of locked bucket-handle medial meniscal tear using a suture hook technique.

PURPOSE: This study reported the outcomes of locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction. METHODS: Between 2011 and 2014, 48 patients with BHMMTs and ACL tears who met the eligibility criteria were enrolled in the present study. BHMMTs were assessed using a posterolateral transseptal portal and repaired using a posteromedial portal. Transportal ACL reconstruction was performed using hamstrings autograft. Patients were assessed based on their IKDC and Lysholm scores and Tegner activity level. Meniscal healing was clinically evaluated based on the absence of swelling, joint line tenderness, locking, and catching; McMurray test results; and the need for meniscectomy. RESULTS: According to follow-up assessments, the average IKDC and Lysholm scores improved significantly after 3-5 years (P < 0.001) CONCLUSION:  Excellent clinical outcomes were obtained when locked BHMMTs were repaired using an all-inside suture technique that employed posteromedial and posterolateral transseptal portals. LEVEL OF EVIDENCE: IV.

Patient beliefs and perceptions play a crucial role in the decision-making process when managing a meniscal tear. A qualitative systematic review of the literature.

INTRODUCTION: There has been an increase in research on the effectiveness of treatment options for the management of meniscal tears. However, there is very little evidence about the patient experiences of meniscal tears. AIM: To summarise the available qualitative evidence on patients' experiences and expectations of meniscal tears. METHOD: A search of EMBASE, Medline, Sociofile and Web of Science up to November 2020 was performed to identify studies reporting patient experiences of meniscal tears. Studies were critically appraised using the CASP (Critical Appraisal Skills Program) checklist, and a meta-synthesis was performed to generate third-order constructs (new themes). RESULTS: Two studies reporting semi-structured interviews from 34 participants (24 male; 10 female) were included. The mean interview length ranged from 16 to 45 min. Five themes were generated: (1) the imaging (MRI) results are a key driver in the decision-making process, (2) surgery is perceived to be the definitive and quicker approach, (3) physiotherapy and exercise is a slower approach which brought success over time, (4) patient perceptions and preferences are important in the clinical decision-making process and, (5) the impact on patient lives is a huge driver in seeking care and treatment decisions. CONCLUSION: This is the first study to summarise the qualitative evidence on patient experiences with meniscal tears. The themes generated demonstrate the importance of patient perceptions of MRI findings and timing of treatment success as important factors in the decision-making process. This study demonstrates the need to strengthen our understanding of patients' experiences of meniscal tears.

The influence of the steep medial posterior tibial slope on medial meniscus tears in adolescent patients: a retrospective case-control study.

BACKGROUND: Several studies have demonstrated a relationship between the posterior tibial slope (PTS) and meniscal tears in adults. However, little is known about the association between the PTS of the adolescents and medial meniscal tears (MMT). The purpose of this study was to evaluate the association between the PTS and MMT in adolescents, and to determine the optimal cut-off values of PTS for discriminating between the MMT and the control groups. METHODS: Between January 2018 and January 2020, a retrospective case-control study was performed. In this study, isolated MMT adolescent patients with no ligamentous injuries were matched by age and sex to a control group of radiologically normal images. The PTS was defined as the angle between the perpendicular line to proximal tibial cortex (PTC) and the tangent line along the tibial plateau. Then, both the medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS) were measured by plain radiographs on the lateral views. In addition, the optimal cut-off values of PTS were determined by the receiver operating characteristic (ROC) curve analysis. RESULTS: A total of seventy-two patients who met the inclusion criteria were enrolled in the final analysis (36 patients with isolated MMT, 36 controls). The MPTS was greater in the knees with isolated MMT (10.7° ± 2.1°) than that of the control group (8.8° ± 1.7°), showing significant difference (P<0.001). However, there was no significant difference regarding the LPTS between the isolated MMT and controls (11.5 ± 3.4 vs 10.9 ± 2.6, p>0.05). In the ROC curve analysis, the calculated cutoff value of the MPTS discriminating between the groups was 10.3°, with a sensitivity of 73.3% and specificity of 78.9%. CONCLUSIONS: This study demonstrated that steep MPTS is associated with MMT, and MPTS≥10.3° was identified to be a risk factor for MMT in adolescents.

Meniscal tears are more common than previously identified, however, less than a quarter of people with a tear undergo arthroscopy.

PURPOSE: The management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust. METHODS: Radiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy. RESULTS: 1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s]. CONCLUSION: Meniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery. LEVEL OF EVIDENCE: III.

Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial.

OBJECTIVE: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. DESIGN: Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. RESULTS: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. CONCLUSION: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01002794).

Prediction of reparability of meniscal tears in athletes using magnetic resonance.

Meniscal tears account for approximately 15% of all knee injuries and almost 25% of them require surgical procedures. Magnetic Resonance Imaging (MRI) is widely used for noninvasive assessment of the knee joint and is considered reliable and a powerful tool for the detection of soft tissue injuries of the knee. The aim of the study was to evaluate the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) to predict the meniscal tears repair in sports practitioners. 104 incoming consecutive patients who underwent knee joint ligament reconstruction and/or arthroscopy for the treatment of meniscal injury at knee joint were imaged using a 1.5-T MRI scanner prior to arthroscopy. MRI images were evaluated for anterior cruciate ligament (ACL), articular cartilage, and meniscal injury. Images were correlated with arthroscopic findings, used as the gold standard. The sensitivity, specificity, and accuracy of MRI in predicting meniscal repair were 61.1%, 65.94%, and 64.58%, respectively. The agreement between MRI and arthroscopy yielded a kappa index of 0.236, indicating fair agreement. When the menisci were evaluated separately, 65.85% sensitivity, 45.45% specificity, and 54.16% accuracy were found for the medial meniscus, while 46.15%, 79.51%, and 75.0% for the lateral meniscus, respectively. The accuracy was 62.09% in whose patients that arthroscopy was performed up to 3 months after MRI and 67.18% in those that this time frame was more than 3 months before surgery. The 54 meniscal injuries occurred more frequently in the posterior horn; most injuries had a longitudinal pattern and were located in the red-red (vascular) zone. We suggest that magnetic resonance imaging is only moderately accurate for the prediction of meniscus reparability.

Widening is a predictive factor of bucket handle tear in tibial plateau fractures.

BACKGROUND: It is well known that tibial plateau fractures have an association with soft tissue injuries. However, as far as the authors are aware, there has been no literature specifically on the incidence of bucket handle meniscal tears in patients with tibial plateau fractures. Bucket handle tears are often symptomatic and amenable to repair if detected early. Our objective was therefore to determine the incidence of bucket handle tears specifically in tibial plateau fractures and identify radiographic features which are suggestive of bucket handle tears. METHOD: Data for 88 consecutive patients with tibial plateau fractures in a major trauma centre over a two-year period were analysed. Clinical records were reviewed to identify injuries with an associated bucket handle tear. Pre-operative computerised tomography was reviewed. Monovariant and multivariant analyses were conducted to identify radiographic predictive features. RESULTS: The results showed a 20% incidence of soft tissue injuries in concurrence with the existing literature. In addition, there was found to be a 10% incidence of meniscal bucket handle tears. Articular widening of > 8 mm was found to be a unique significant predictor of bucket handle tears. CONCLUSION: It is essential to bear in mind the association with soft tissue injuries in tibial plateau fractures and the incidence of bucket handle tears in particular. The radiographic feature of articular widening should alert the clinician to the possibility of this injury. This will enable appropriate investigations and surgical planning to be carried out in order to improve patient management and outcomes.

Meniscus-Targeted Injections for Chronic Knee Pain Due to Meniscal Tears or Degenerative Fraying: A Retrospective Study.

OBJECTIVES: Meniscal tears caused by acute trauma or degenerative fraying affect a wide array of individuals. An effective, long-lasting treatment has widely been sought after. Intra-articular corticosteroid injections have been among the methods of controlling pain for more than 60 years. However, such injections tend to produce short-lasting results, with profound effects lasting an average of up to 4 weeks. The purpose of this study was to determine the average duration and magnitude of pain relief after meniscal-targeted injections. METHODS: The electronic medical records of 135 patients were accessed for this retrospective chart review. Patients who had meniscal tears or degenerative fraying and were treated with meniscal-targeted injections were selected. Patients' visual analog scale (VAS) pain scores (before and after treatment) were recorded, along with the percentage of pain relief and duration of pain relief. RESULTS: Ultrasound-guided meniscus-targeted corticosteroid injections for meniscal tears or degenerative fraying produced 5.68 (SD, 5.28) weeks of pain relief on average, with a decrease in pain from initial to follow-up visits of 2.14 (P < .0001) as per the visual analog scale score, and an Integral of Pain Relief score of 3.98. CONCLUSIONS: Our findings indicate a substantial benefit from 20- or 40-mg meniscus-targeted triamcinolone injections, granted the limitations of chart review research and no control group comparison. Results highlight the need for future prospective research comparing meniscus-targeted injections with intra-articular injections to identify a better modality for treating patients with chronic knee pain caused by meniscal tears or degenerative fraying.

Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction.

PURPOSE: To determine demographic, anatomic, and surgical factors associated with static and dynamic Anterior Tibial Translation (ATT) following ACL reconstruction. The hypothesis was that both static and dynamic ATT would be greater in knees with high tibial slope or that required meniscectomy. METHODS: The authors prospectively enrolled 280 consecutive patients that had primary ACL reconstruction using hamstring autografts at one center for which preoperative tear type, meniscal tears, and medial tibial slope were documented. A total of 137 were excluded due to concomitant extra-articular tenodesis or surgical antecedents on either knee, and 18 were lost to follow-up, leaving 125 that were evaluated at a minimum of 6 months including: static ATT on monopodal weight-bearing radiographs, and dynamic ATT on differential stress radiographs using the Telos™ device. RESULTS: Both postoperative static and dynamic ATT were strongly associated with preoperative static and dynamic ATT (respectively, ß = 0.068 and ß = 0.50, p < 0.001). Multivariable regression confirmed that postoperative static ATT increased with tibial slope (ß = 0.24; CI 0.01-0.47; p = 0.042) and in knees that had partial medial meniscectomy (ß = 2.05; CI 0.25-3.84; p = 0.025), while dynamic ATT decreased with age (ß = - 0.11; CI - 0.16 to - 0.05; p < 0.001), and increased with tibial slope (ß = 0.27; CI 0.04-0.49; p = 0.019) and in knees that had partial medial meniscectomy (ß = 2.20; CI 0.35-4.05; p = 0.019). CONCLUSION: Both static and dynamic ATT following ACL reconstruction increased with tibial slope and in knees that had partial medial meniscectomy. These findings could help surgeons tailor their techniques and 'à la carte' rehabilitation protocols, by preserving the menisci and sometimes delaying full weight-bearing and return to sport in patients at risk, and hence improve outcomes and prevent graft failures. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: V.

Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears.

PURPOSE: The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. METHODS: The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test. RESULTS: Multivariable regression showed that static ATT increases only with tibial slope (ß = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (ß = 0.19; p = 0.041), medial meniscal tears (ß = 1.27; p = 0.007), complete ACL tears (ß = 2.06; p < 0.001), and to decrease with age (ß = - 0.09; p < 0.001). Multivariable regression also indicated that high-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010). CONCLUSION: Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors. LEVEL OF EVIDENCE: Cohort study, Level IV.

The 6-m timed hop test is a prognostic factor for outcomes in patients with meniscal tears treated with exercise therapy or arthroscopic partial meniscectomy: a secondary, exploratory analysis of the Odense-Oslo meniscectomy versus exercise (OMEX) trial.

PURPOSE: To identify the prognostic factors for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears treated with exercise therapy (ET) or arthroscopic partial meniscectomy (APM). METHODS: One hundred and seven patients, with mean age 49.6 (SD 6.2) years and BMI 25.7 (SD 3.7), were included in this analysis of data from the OMEX trial ( http://www.clinicaltrials.gov NCT01002794). Linear and Poisson regression models were built to explore the associations between potential prognostic factors (patient characteristics, knee function-related and disease-related factors) and 2-year patient-reported outcomes: the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Pain, Symptoms, ADL, Sport/Rec, QoL and 5-point Global Rating of Change scales for knee pain (GRC Pain) and function (GRC Function). Analyses were performed for the whole cohort and for the two treatment groups (n = 55 and 52) with adjustments for age, sex, BMI and baseline KOOS. RESULTS: For the whole cohort, a 1-s better baseline 6-m timed hop test result was associated with 3.1-7.1 points better 2-year scores for all KOOS subscales (95% CIs 1.1-5.2 to 4.1-10.1 points). A 1.61-2.80 s better test was associated with scores equivalent to previously calculated clinical relevant differences for each KOOS subscale. For the groups of patients treated with ET and APM, respectively, 2.09-3.60 s and 0.63-1.99 s better tests were associated with clinical relevant differences. For the whole cohort, a 1-s better test was associated with 26% (95% CI 15-38%) and 22% (95% CI 11-34%) higher possibility for better or much better GRC Pain and Function scores. Patients treated with ET had 17% (95% CI 2-33%) increased possibility for better or much better GRC Pain score, and patients treated with APM had 65% (95% CI 32-108%) and 70% (95% CI 38-109%) increased possibility for better or much better GRC Pain and Function scores. CONCLUSIONS: The 6-m timed hop test result was a significant prognostic factor for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears, especially in those treated with APM. LEVEL OF EVIDENCE: II.

Change in patient-reported outcomes in patients with and without mechanical symptoms undergoing arthroscopic meniscal surgery: A prospective cohort study.

OBJECTIVE: Patients with degenerative or traumatic meniscal tears are at high risk of developing knee osteoarthritis. We investigated if younger (≤40 years) and older (>40 years) patients with preoperative mechanical symptoms (MS) improved more in patient-reported outcomes after meniscal surgery than those without MS. DESIGN: Patients from Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing arthroscopic surgery for a meniscal tear completed online questionnaires before surgery, and at 12 and 52 weeks follow-up. Questionnaires included self-reported presence of MS (i.e., sensation of catching and/or locking) and the Knee injury and Osteoarthritis Outcome Score (KOOS). We analyzed between-group differences in change in KOOS4 from baseline to 52 weeks, using an adjusted mixed linear model. RESULTS: 150 younger patients (mean age 31 (SD 7), 67% men) and 491 older patients (mean age 54 (SD 9), 53% men) constituted the baseline cohorts. Patients with MS generally had worse self-reported outcomes before surgery. At 52 weeks follow-up, younger patients with preoperative MS had improved more in KOOS4 scores than younger patients without preoperative MS (adjusted mean difference 10.5, 95% CI: 4.3, 16.6), but did not exceed the absolute postoperative KOOS4 scores observed for those without MS. No difference in improvement was observed between older patients with or without MS (adjusted mean difference 0.7, 95% CI: -2.6, 3.9). CONCLUSIONS: Younger patients (≤40 years) with preoperative MS experienced greater improvements after arthroscopic surgery compared to younger patients without MS. Our observational study result needs to be confirmed in randomized trials.

Association of weight change with progression of meniscal intrasubstance degeneration over 48 months: Data from the Osteoarthritis Initiative.

OBJECTIVES: To investigate the association of weight change over 48 months with progression of meniscal intrasubstance degeneration (MID). METHODS: We studied 487 subjects with MID at baseline and after 48 months using 3-T MRI with the same protocol (FSE sequences with and without fat suppression). These participants lost weight (≥3%, n = 141), had moderate weight gain (3-10%, n = 77), substantial weight gain (>10%, n = 15) or maintained stable weight (n = 254). Progression of MID to a meniscal tear was assessed using the WORMS grading system and compared among weight change groups using logistic regression. ANOVA and chi-square tests were used to study the differences in subjects' characteristics. RESULTS: Progression of MID increased from weight loss to substantial weight gain (p < 0.001) and was significantly more likely with both moderate weight gain (odds ratio [OR], 4.9; 95% confidence interval [CI] 2.4-8.9) and substantial weight gain (OR, 9.5; 95% CI 3.2-28.5) compared to stable weight. Results were similar in both menisci for moderate weight gain (medial: OR, 6.8; 95% CI 3.5-11.3; lateral: OR, 2.6; 95% CI 1.1-6.6) and substantial weight gain (medial: OR, 21.0; 95% CI 5.1-80.7; lateral: OR, 9.7; 95% CI 0.95-100.2). CONCLUSION: Weight gain is associated with an increased likelihood that meniscal intrasubstance degeneration will progress with the risk increasing with greater weight gain. KEY POINTS: • Subjects who gained weight were more likely to develop meniscal tears. • Greater amount of weight gain was associated with an increasing likelihood of progression. • Prevention of weight gain has health benefits for the meniscus.

Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept 'squeeze' technique.

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) 'squeeze' technique compared to a sham technique in participants with a clinically diagnosed meniscal tear.Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics.Results: All participants in the MC 'squeeze' group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC 'squeeze' technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74).Discussion: The results indicate the MC 'squeeze' technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC 'squeeze' technique is warranted.

Recovery of lower extremity muscle strength and functional performance in middle-aged patients undergoing arthroscopic partial meniscectomy.

PURPOSE: To investigate lower extremity muscle strength and functional performance before and after arthroscopic partial meniscectomy in middle-aged patients with degenerative meniscal tears. We hypothesized that patients would experience deficiencies in the affected leg at 3 months post-surgery, and that this deficiency would be normalized at 12 months following surgery. METHODS: Twenty-three patients (46 ± 6.5 years) meniscectomized in 2012 and 2013 were examined for knee extension, knee flexion, and hip abduction maximal isometric muscle strength (iMVC), rate of force development (RFD200), and knee function (single-leg hop for distance and single-leg knee bends in 30 s.) before surgery, 3 and 12 months after surgery. RESULTS: Functional performance, knee extension iMVC and RFD200 were impaired in the affected leg compared to the contralateral leg (p < 0.05) prior to surgery. A significant (Knee extension RFD200, p = 0.033) or borderline significant improvement was observed in the affected leg compared to the contralateral leg from before to 12 months after surgery in most variables (leg × time interaction, n.s.). CONCLUSION: Middle-aged patients undergoing surgery for degenerative medial meniscal tears show significant reductions in muscle strength, rapid force production, and functional performance in the leg undergoing surgery compared to the contralateral leg prior to surgery. These deficits in muscle strength and knee function were still present at 3 months post-surgery but were no longer observed at 12 months following surgery. LEVEL OF EVIDENCE: III.