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.

Long-term clinical and radiological outcomes after arthroscopic partial meniscectomy on stable knees are better for traumatic tears when compared to degenerative lesions: A systematic review.

PURPOSE: An arthroscopic partial meniscectomy (APM) for degenerative meniscus lesions and traumatic meniscus tears are two distinct entities and their long-term outcomes are rarely reported. The aim of this review was to compare the long-term (clinical and radiological) results of APM performed on stable knees for traumatic tears (TT) or degenerative lesions (DL). METHODS: Pubmed, Scopus and Embase databases were searched to identify relevant studies published between 2010 and 2023 using the keywords 'meniscectomy' OR 'meniscectomies' OR 'meniscal resection'. English-language, Levels I-IV evidence studies reporting either radiographic or clinical outcome measures with a minimum of 6 years' follow-up after APM were included. Studies including discoid meniscus, open meniscectomy, unstable knee and combination with other procedures were excluded. To rate the quality of evidence, the methodological index for non-randomized studies was used. RESULTS: Thirty-two studies were included, with follow-up periods ranging from 6 to 22 years. Eleven studies dealt with TT with a mean age of 31.5 ± 6.6 years and a mean follow-up of 11.6 ± 6.9 years. At the last follow-up, radiographic osteoarthritis (OA) ranged from 36% to 76%, with an average rate of 48 ± 19%; functional scores ranged from 71 to 97, with a mean of 90 ± 4 for the Lysholm score, 86 ± 10 for the International Knee Documentation Committee (IKDC) and 94 ± 16 for the knee injury and osteoarthritis outcome (KOOS). Twenty-one studies dealt with DL with a mean age of 49.9 ± 7.2 years and a mean follow-up of 14.9 ± 6.3 years. At the last follow-up, radiographic OA ranged from 23% to 97%, with an average rate of 77 ± 28%; functional scores ranged from 40 to 87, with a mean of 79 ± 10 for the Lysholm score and 71 ± 16 for the IKDC. CONCLUSION: Ten-year clinical outcomes of APM are better for TTs when compared to DLs. Rates of OA are difficult to compare but lower for TTs. LEVEL OF EVIDENCE: Level IV.

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.

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.

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review.

PURPOSE: It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review. METHODS: This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used. RESULTS: Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m2. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate). CONCLUSIONS: The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes. LEVEL OF EVIDENCE: Level I.

Ipsilateral chondral lesions worsen the long-term prognosis following arthroscopic partial medial meniscectomy.

PURPOSE: The effect of knee cartilage defects that are detected during partial meniscectomy remains controversial in terms of the long-term prognosis on knee function. This study aimed to investigate the effect of concurrent medial compartment focal cartilage lesions on the long-term prognosis of knee function in patients who underwent arthroscopic partial medial meniscectomy for traumatic medial meniscal tears. METHODS: This retrospective study analyzed 46 patients who underwent arthroscopic partial medial meniscectomy between 1991 and 2008 by a single surgeon. Twenty-one patients who underwent arthroscopic partial medial meniscectomy due to traumatic meniscal tear had focal chondral lesions only at the medial compartment, and these patients were assigned to group A. Twenty-five patients who had no cartilage lesions in any compartments were assigned to group B. The age, sex, body mass index (BMI), follow-up time, age at the time of surgery, clinical and radiological scores, and perioperative arthroscopy findings were analyzed. RESULTS: The mean follow-up time was 20 ± 3.7 years. No significant difference was found in the demographic data, and the average age of the patients at the time of operation was 35 ± 9.5 years. Both groups had improved Lysholm score at the last follow-up. Although no difference was found between the groups during the preoperative period, group B had a higher Lysholm score at the last follow-up than group A. The mean International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) scores at the last follow-up were significantly higher in group B. The mean Kellgren-Lawrence grades in the operated knees of group A were higher than those of group B. In group A, a negative correlation was found between the BMI and postoperative Lysholm (r = - 0.461, p = 0.03) IKDC (r = - 0.433, p = 0.05) and KOOS (r = - 0.565, p = 0.008) scores. In group B, no correlation was found between BMI and any score. CONCLUSION: Among patients who underwent arthroscopic partial medial meniscectomy with an average follow-up of 20 years, those with concurrent focal cartilage defect in the medial compartment had clinically and radiologically worse outcomes than patients without any cartilage defect. Therefore, orthopedic surgeons should be meticulous before performing any arthroscopic partial medial meniscectomy in case of concurrent cartilage lesion. LEVEL OF EVIDENCE: Level III.

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.

Biomechanical assessment of disease outcome in surgical interventions for medial meniscal posterior root tears: a finite element analysis.

BACKGROUND: The adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly abundant. In this paper, the finite element gait analysis method was used to explore the differences in the biomechanical characteristics of the knee joint under different conditions. METHODS: Based on CT computed tomography and MR images, (I) an intact knee (IK) model with bone, cartilage, meniscus and main ligaments was established. Based on this model, the posterior root of the medial meniscus was resected, and (ii) the partial tear (PT) model, (iii) the entire radial tear (ERT) model, and (iv) the entire oblique tear (EOT) model were established according to the scope and degree of resection. Then, the (v) meniscus repair (MR) model and (vi) partial meniscectomy (PM) model were developed according to the operation method. The differences in stress, displacement and contact area among different models were evaluated under ISO gait loading conditions. RESULTS: Under gait loading, there was no significant difference in the maximum stress of the medial and lateral tibiofemoral joints among the six models. Compared with the medial tibiofemoral joint stress of the IK model, the stress of the PM model increased by 8.3%, while that of the MR model decreased by 18.9%; at the same time, the contact stress of the medial tibiofemoral joint of the ERT and EOT models increased by 17.9 and 25.3%, respectively. The displacement of the medial meniscus in the ERT and EOT models was significantly larger than that in the IK model (P < 0.05), and the tibial and femoral contact areas of these two models were lower than those of the IK model (P < 0.05). CONCLUSIONS: The integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. Partial meniscectomy is not beneficial for improving the tibial-thigh contact situation. Meniscal repair has a positive effect on restoring the normal biomechanical properties of the medial meniscus.

Treatment of post-meniscectomy knee symptoms with medial meniscus replacement results in greater pain reduction and functional improvement than non-surgical care.

PURPOSE: Partial meniscectomy is a common orthopedic procedure intended to improve knee pain and function in patients with irreparable meniscal tears. However, 6-25% of partial meniscectomy patients experience persistent knee pain after surgery. In this randomized controlled trial (RCT) involving subjects with knee pain following partial meniscectomy, it was hypothesized that treatment with a synthetic medial meniscus replacement (MMR) implant provides significantly greater improvements in knee pain and function compared to non-surgical care alone. METHODS: In this prospective, multicenter RCT, subjects with persistent knee pain following one or more previous partial meniscectomies were randomized to receive either MMR or non-surgical care. This analysis evaluated the 1-year outcomes of this 2-year clinical trial. Patient-reported knee pain, function, and quality of life were measured using nine separate patient-reported outcomes. The primary outcomes were the pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the average of all five KOOS subscales (KOOS Overall). Treatment cessation was defined as permanent device removal in the MMR group and any surgical procedure to the index knee in the non-surgical care group. RESULTS: Treated subjects had a median age of 52 years old (range 30-69 years) and one or more previous partial meniscectomies at a median of 34 months (range 5-430 months) before trial entry. Among 127 subjects treated with either MMR (n = 61) or non-surgical care (n = 66), 11 withdrew from the trial or were lost to follow-up (MMR, n = 0; non-surgical care, n = 11). The magnitude of improvement from baseline to 1 year was significantly greater in subjects who received MMR in both primary outcomes of KOOS Pain (P = 0.013) and KOOS Overall (P = 0.027). Treatment cessation was reported in 14.5% of non-surgical care subjects and only 4.9% of MMR subjects (n.s.). CONCLUSION: Treatment with the synthetic MMR implant resulted in significantly greater improvements in knee pain, function, and quality of life at 1 year of follow-up compared to treatment with non-surgical care alone. LEVEL OF EVIDENCE: I.

Do Synovial Inflammation and Meniscal Degeneration Impact Clinical Outcomes of Patients Undergoing Arthroscopic Partial Meniscectomy? A Histological Study.

The menisci exert a prominent role in joint stabilization and in the distribution of mechanical loading. Meniscal damage is associated with increased risk of knee OA. The aim of this study was to characterize the synovial membrane and meniscal tissues in patients undergoing arthroscopic partial meniscectomy for meniscal tear and to evaluate association with clinical outcomes. A total of 109 patients were recruited. Demographic and clinical data were collected. Visual Analogic Scale (VAS) measuring pain and Knee injury and Osteoarthritis Outcome Score (KOOS) were recorded at baseline and at 2-years follow-up. Histological and immunohistochemical characterizations were performed on synovial membranes and meniscal tissues. More than half of the patients demonstrated synovial mononuclear cell infiltration and hyperplasia. Synovial fibrosis was present in most of the patients; marked vascularity and CD68 positivity were observed. Inflammation had an impact on both pain and knee symptoms. Patients with synovial inflammation had higher values of pre-operative VAS and inflammation. Higher pre-operative pain was observed in patients with meniscal MMP-13 production. In conclusion, multivariate analysis showed that synovial inflammation was associated with pre-operative total KOOS scores, knee symptoms, and pain. Moreover, meniscal MMP-13 expression was found to be associated with pre-operative pain in multivariate analysis. Thus, targeting inflammation of the synovial membrane and meniscus might reduce clinical symptoms and dysfunction at the time of surgery.

Arthroscopic Partial Meniscectomy versus Physical Therapy for Degenerative Meniscal Tear: a Systematic Review.

BACKGROUND: Meniscal tears are commonly observed in patients with knee osteoarthritis (OA), however, clinical significance of such lesions detected by magnetic resonance imaging is in many cases unclear. This study aimed to determine the clinical effectiveness of arthroscopic partial meniscectomy (APM) compared with non-operative care in patients with knee OA. METHOD: We used existing systematic reviews with updates of latest studies. Three randomized controlled studies were selected, where two studies compared the effects of APM plus physical therapy (PT) with PT alone and one compared APM alone and PT alone. While 1 study exclusively included OA patients, 2 studies included 21.1 and 12% of patients with no radiographic OA. Patients with knee locking were unanimously excluded. RESULTS: Upon comparison of APM plus PT and PT alone, there was no significant difference observed in knee function, physical activity, or adverse events. Knee pain was observed to be significantly lower in the APM plus PT group at 6 months, but there was no difference between the two groups at 12 and 24 months. With respect to the comparison between APM alone and PT alone, PT was non-inferior based on the criteria for knee function during 24 months; however, knee pain was significantly reduced in the APM alone group. CONCLUSIONS: Our study showed that knee pain was significantly improved in the APM group compared to non-operative care group at 6 months and over 24 months. Our result was based on only 3 randomized controlled trials (RCTs) revealing a significant knowledge gap, hence demanding more high-quality RCTs in OA patients. TRIAL REGISTRATION: PROSPERO Identifier: CRD42020215965.

Intrasubstance degeneration of medial meniscus horizontal cleavage tear in young patients is associated with increased joint line obliquity in the coronal plane of the knee.

PURPOSE: To evaluate the effect of joint line obliquity of the knee on intrasubstance degeneration of isolated medial meniscus horizontal cleavage tear (HCT) in young patients. METHODS: Sixty knees of 50 patients aged < 40 years (mean age, 33.3 ± 5.5 years old), who underwent arthroscopic partial meniscectomy (APM) for HCT, were retrospectively reviewed. The radiologic parameters of alignment, including mechanical hip-knee-ankle (mHKA) angle, posterior tibial slope, and joint line obliquity, were measured on preoperative long-standing whole-leg radiographs. The patients were classified into two groups, simple horizontal type (type 1) and complicated type (type 2), according to the presence of diffuse intrasubstance degeneration of the meniscus on preoperative magnetic resonance imaging. The risk factors for intrasubstance degeneration of HCT were analyzed using multiple logistic regression analysis. Medial joint space width (JSW) on weight-bearing 45° flexion posteroanterior radiographs and the mHKA were measured to evaluate the radiographic outcomes. The clinical outcomes were evaluated using the modified Lysholm score. Among patients followed-up for > 5 years, the clinical and radiologic outcomes were compared between the two groups. RESULTS: The joint line obliquity was significantly greater in the type 2 group than in the type 1 group (2.9 ± 1.3 vs. 0.9 ± 1.4, P < 0.001), and a significant risk factor for diffuse intrasubstance degeneration (P < 0.001; odds ratio, 2.88; 95% confidence interval, 1.27-6.54). The relative changes in the JSW in the type 2 group were greater than those in the type 1 group during the mean follow-up period of 7.9 ± 2.5 years (26% vs 10%, P = 0.045). The modified Lysholm score was not significantly different between the two groups (n.s). CONCLUSION: The diffuse intrasubstance degeneration of medial meniscus HCTs in young patients is associated with increased joint line obliquity of the knee joints. The radiologic outcomes after APM were inferior in the patients with diffuse intrasubstance degeneration. However, the clinical outcomes were not different during the mid-term follow-up. LEVEL OF EVIDENCE: Level III.

Medial Meniscus Posterior Root Tear Does Not Affect the Outcome of Medial Open-Wedge High Tibial Osteotomy.

BACKGROUND: This study aimed to verify whether the presence of medial meniscus posterior root tear (MMPRT) affects the clinical and radiographic outcomes of medial open-wedge high tibial osteotomy (MOWHTO) compared to the patients without MMPRT for over a midterm follow-up. METHODS: One hundred fifty-six knees were retrospectively enrolled that underwent MOWHTO and second-look arthroscopy concomitantly with a minimum 5 years of follow-up. Seventy-four knees with MMPRT (MMPRT group) were identified. Eighty-two knees with intact MMPR were assigned to another group (MMPRI group). All knees with torn medial meniscus with or without MMPRT had an arthroscopic partial meniscectomy during the MOWHTO. Clinical evaluation included range of motion, American Knee Society scores, and Western Ontario and McMaster Universities Osteoarthritis Index scores. Radiologically, the Kellgren-Lawrence grade was assessed preoperatively and at the latest follow-up. Cartilage status was also compared through the 2-stage arthroscopy according to the International Cartilage Repair Society grading. RESULTS: Average age at operation was 55.8 years (range 42-67), and the average follow-up period was 82.2 months (range 60-148). There were no significant differences in clinical outcomes between the groups. Postoperative changes in Kellgren-Lawrence grade and arthroscopic cartilage status showed no significant differences between the groups. Resected MMPR was remodeled in 41.9% (31/74) of the MMPRT group through the second-look arthroscopy. CONCLUSION: MMPRT does not affect the clinical and radiologic outcomes of MOWHTO compared to those patients without MMPRT over a mid-term follow-up.

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).

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study.

OBJECTIVES: To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis-this paper-we examined whether PT is non-inferior to APM. METHODS: We recruited patients aged 45-70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively. RESULTS: We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (-€1803; 95% CI -€3008 to -€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs. CONCLUSIONS: The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears. TRIAL REGISTRATION NUMBERS: NCT01850719 and NTR3908.

Chondral lesions at the medial femoral condyle, meniscal degeneration, anterior cruciate ligament insufficiency, and lateral meniscal tears impair the middle-term results after arthroscopic partial meniscectomy.

PURPOSE: The aim of the present study was to analyse which clinical, radiological and arthroscopic findings are able to predict the postoperative outcome after arthroscopic partial meniscectomy. Furthermore, the present study aimed to investigate the postoperative outcome after partial meniscectomy in patients with degenerative meniscal lesions. METHODS: A total of 91 patients with a follow-up period of 34.7 ± 11.4 months after arthroscopic partial meniscectomy were included in this retrospective study. Clinical, radiological, and arthroscopic data were analysed at the time of follow-up. The multivariable linear regression analysis for postoperative outcome, based on the Western Ontario Meniscal Evaluation Tool (WOMET), included age, gender, body mass index, physical activity, presence of cartilage lesions, leg alignment, grade of radiographic osteoarthritis, location of meniscal lesions, meniscal extrusion, meniscal degeneration, presence of an anterior cruciate ligament tears as well as bone marrow lesions. RESULTS: WOMET and WOMAC scores showed a significant improvement of 45.0 ± 48.1 points (CI 34.9-55.1; p ≤ 0.0001) and 75.1 ± 69.3 points (CI 60.6-89.6; p = 0.001) within the follow-up period. Multivariable linear regression analysis showed that poor preoperative WOMET scores (p = 0.001), presence of cartilage lesions at the medial femoral condylus (p = 0.001), meniscal degeneration (p = 0.008), the presence of an anterior cruciate ligament lesion (p = 0.005), and lateral meniscal tears (p = 0.039) were associated with worse postoperative outcomes. Patients with femoral bone marrow lesions had better outcome (p = 0.038). CONCLUSION: Poor preoperative WOMET scores, presence of cartilage lesions at the medial femoral condylus, meniscal degeneration, concomitant anterior cruciate ligament lesions as well as lateral meniscal tears are correlated with worse postoperative outcomes after arthroscopic partial meniscectomy. Patients with femoral bone marrow lesions femoral are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. Despite justified recent restrictions in indication, arthroscopic partial meniscectomy seems to effectively reduce pain and alleviate symptoms in carefully selected patients with degenerative meniscal tears. LEVEL OF EVIDENCE: III.

Partial meniscectomy provides the favorable outcomes for symptomatic medial meniscus tear with an intact posterior root.

PURPOSE: This study aimed to investigate the long-term outcomes of arthroscopic partial meniscectomy for medial meniscus tear (with intact posterior root) and to analyze the risk factors for treatment failure. METHODS: The records of 165 patients who underwent partial meniscectomy for medial meniscus tear with intact posterior root with a minimum 5-year follow-up were included. Modified Lysholm score and radiologic outcomes were compared between preoperative and latest follow-up periods. The cumulative Outerbridge grade of the medial compartment was defined as follows: 0-4, low chondral wear; 5-6, intermediate wear; or 7-8, high wear. Kaplan-Meier survival and Cox hazard regression analyses were performed to assess the survivorship after partial meniscectomy. Conversion to total knee replacement arthroplasty, high tibial osteotomy or a Lysholm score of < 65 points indicated treatment failure. RESULTS: Mean Lysholm score improved from 66.3 ± 14.2 preoperatively to 81.8 ± 17.9 at the latest follow-up (p = 0.001). The postoperative 10-year survival rate of the low chondral wear group [97% (95% confidence interval (CI) 141.7-152.6 months)] was higher than that of the intermediate [83.1% (95% CI 129.6-147.9 months)] and high wear groups [76.1% (95% CI 115.2-135.0 months)]. A 1 mm joint space width narrowing led to a 37.7% increase in the failure rate [B = - 0.473; hazard ratio, 0.623 (95% CI 0.423-0.917); p = 0.016]. The high chondral wear group showed a higher failure rate compared to the low wear group [B = 1.870; hazard ratio, 6.488 (95% CI 0.853-49.333); p = 0.041]. CONCLUSION: Partial meniscectomy offers pain relief and functional improvement for medial meniscus tear with intact posterior root. Preoperative joint space narrowing and higher chondral wear at surgery were significant risk factors of treatment failure. Partial meniscectomy should be considered as an effective treatment for irreparable medial meniscus tear with intact posterior root without joint space narrowing and chondral wear. LEVEL OF EVIDENCE: Case series, Level IV.

Degenerative medial meniscus posterior root tear and non-root tear do not show differences in joint survival and clinical outcome after partial meniscectomy.

PURPOSE: No comparative studies of outcomes between degenerative medial meniscus posterior root tear (MM PRT) and non-root tear (NRT) have been conducted. This study aimed to compare joint survival and clinical outcome between MM PRT and MM NRT after partial meniscectomy with proper control of confounding factors. METHODS: One hundred and ten patients each in MM PRT and MM NRT groups who underwent arthroscopic partial meniscectomy were retrospectively evaluated through propensity score matching. Joint survival was assessed on the basis of surgical and radiographic failures. Clinical outcomes were assessed using the Lysholm score. RESULTS: The confounding variables were well balanced between the groups, with standardized mean differences of < 0.2 after propensity score matching. Failures occurred in 30 (27.3%) and 35 patients (31.8%) in the MM PRT group and MM NRT group, respectively. The estimated mean survival times were 12.5 years (95% confidence interval [CI] 11.5-13.5) and 11.7 years (10.7-12.7), respectively. There were no significant differences in the overall survival rate and Lysholm score between the two groups (n.s.). CONCLUSION: In middle-aged patients with degenerative MM PRT, joint survival and clinical outcome showed comparable results with those with MM NRT after partial meniscectomy. Arthroscopic partial meniscectomy is one of the effective treatments for MM PRT with consideration of various patient factors. LEVEL OF EVIDENCE: III.

Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy.

PURPOSE: Adductor canal block (ACB) provides postoperative pain relief as effectively as femoral nerve block (FNB) does, and it preserves the strength of the quadriceps femoris. However, its effect on rehabilitation after arthroscopic partial meniscectomy has not been reported. The purpose of this study was to determine the effect of pre-operative ACB and FNB on the quality of rehabilitation after arthroscopic partial meniscectomy. METHODS: A total of 150 patients undergoing arthroscopic partial meniscectomy were randomly allocated to the FNB group (receiving 0.3% ropivacaine 30 ml at the thighroot-femoral nerve), the ACB group (receiving 0.3% ropivacaine 30 ml at mid-thigh adductor canal), or the control group. The primary outcome was the Hospital for Special Surgery (HSS) knee score on the 30th postoperative day. RESULTS: The HSS knee score of the ACB group on the 30th day after the operation was significantly higher than those of the FNB and control groups (88.6 ± 5.3 vs. 85.3 ± 6.9 and 81.2 ± 5.9, respectively; P < 0.05). Both the ACB and FNB groups showed excellent rehabilitation, indicating similar rehabilitation quality for both treatments. CONCLUSION: ACB is similar to FNB concerning the quality of rehabilitation and pain relief after arthroscopic partial meniscectomy, while ACB has little effect on the strength of the quadriceps femoris. LEVEL OF EVIDENCE: I TRIAL REGISTRATAION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INC-16008346).

Distinct degenerative phenotype of articular cartilage from knees with meniscus tear compared to knees with osteoarthritis.

OBJECTIVE: To compare the transcriptome of articular cartilage from knees with meniscus tears to knees with end-stage osteoarthritis (OA). DESIGN: Articular cartilage was collected from the non-weight bearing medial intercondylar notch of knees undergoing arthroscopic partial meniscectomy (APM; N = 10, 49.7 ± 10.8 years, 50% females) for isolated medial meniscus tears and knees undergoing total knee arthroplasty (TKA; N = 10, 66.0 ± 7.6 years, 70% females) due to end-stage OA. Ribonucleic acid (RNA) preparation was subjected to SurePrint G3 human 8 × 60K RNA microarrays to probe differentially expressed transcripts followed by computational exploration of underlying biological processes. Real-time polymerase chain reaction amplification was performed on selected transcripts to validate microarray data. RESULTS: We observed that 81 transcripts were significantly differentially expressed (45 elevated, 36 repressed) between APM and TKA samples (≥ 2 fold) at a false discovery rate of ≤ 0.05. Among these, CFD, CSN1S1, TSPAN11, CSF1R and CD14 were elevated in the TKA group, while CHI3L2, HILPDA, COL3A1, COL27A1 and FGF2 were highly expressed in APM group. A few long intergenic non-coding RNAs (lincRNAs), small nuclear RNAs (snoRNAs) and antisense RNAs were also differentially expressed between the two groups. Transcripts up-regulated in TKA cartilage were enriched for protein localization and activation, chemical stimulus, immune response, and toll-like receptor signaling pathway. Transcripts up-regulated in APM cartilage were enriched for mesenchymal cell apoptosis, epithelial morphogenesis, canonical glycolysis, extracellular matrix organization, cartilage development, and glucose catabolic process. CONCLUSIONS: This study suggests that APM and TKA cartilage express distinct sets of OA transcripts. The gene profile in cartilage from TKA knees represents an end-stage OA whereas in APM knees it is clearly earlier in the degenerative process.