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Abstract Objective Considerable attention has been paid to meniscotibial ligaments (MTLs), also known as coronary ligaments, especially after the "Save the Meniscus" initiative gained importance among knee surgeons. Technically challenging, the diagnosis and treatment of ramp lesion show the importance of MTLs. These ligaments were discovered long ago, but their contribution to knee stability has only recently been studied and still lacks information. Thus, the aim of the present study was to describe step-by-step an dissection technique of the medial MTL, efficient, reproducible and that may lead to further research. Method Twenty fresh cadaver knees were used, with no preference for sex or age. The knees were dissected using the same technique standardized by our team. Each dissection step was recorded digitally. Results The medial MTL was found in all 20 knees studied using the aforementioned technique. In our sample, the medial MTL exhibited an average length of 70.0 ± 13.4 mm and width of 32.25 ± 3.09 mm, thickness of 35.3 ± 2.7 mm and weight of 0.672 ± 0.134 g. In all the cases, the medial MTL originated proximally and deeply to the deep MTL in the tibia. Conclusion We describe a simple effective and reproducible medial MTL dissection technique that makes it possible to identify the ligament over the entire medial extension of the knee.
Resumo Objetivo Considerável atenção tem sido dada aos ligamentos meniscotibiais (LMT), também conhecidos como ligamentos coronários, especialmente depois que a iniciativa "Salve o Menisco" ganhou importância entre os cirurgiões de joelho. Tecnicamente desafiadores, o diagnóstico e o tratamento da lesão em rampa são importantes nos LMTs. Esses ligamentos foram descobertos há muito tempo, mas sua contribuição para a estabilidade do joelho foi recentemente estudada e ainda carece de informações. Assim, o objetivo deste estudo foi descrever passo a passo uma técnica de dissecção medial do LMT que é eficiente, reprodutível e que possa levar a novas pesquisas. Métodos Foram utilizados 20 joelhos de cadáveres frescos, sem preferência por sexo ou idade. Os joelhos foram dissecados com a mesma técnica padronizada por nossa equipe. Cada etapa da dissecação foi gravada digitalmente. Resultados O LMT medial foi encontrado em todos os 20 joelhos estudados com a técnica supracitada. Em nossa amostra, o LMT medial apresentou comprimento médio de 70,0 ± 13,4 mm e largura de 32,25 ± 3,09 mm, além de espessura de 35,3 ± 2,7 mm e peso de 0,672 ± 0,134 g. Em todos os casos, a origem do LMT medial era proximal e profunda em relação ao LMT profundo na tíbia. Conclusão Descrevemos uma técnica de dissecção simples do LMT medial que é eficaz, reprodutível e permite a identificação do ligamento em toda a extensão medial do joelho.
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Meniscus/surgery , LigamentsABSTRACT
Objective:To investigate the characteristics of an abnormal attachment point of the anterior horn of the medial meniscus (AHMM) by methods of arthroscopy, radiological imaging, and pathology.Methods:A total of seven cases of a rare abnormal attachment (anteromedial meniscofemoral ligament, AML) connecting the AHMM and anterior cruciate ligament (ACL) were identified in the more than six thousand arthroscopic procedures from January 2018 to April 2021. During the procedures, subtotal meniscal resection or meniscal repair was performed in all cases. Tissue removed intraoperatively was used for pathologic examination. For this study, the preoperative MRI films of these patients were retrospectively examined.Results:Finally, seven cases with diagnosed meniscal tears were included in this study, including 4 males and 3 females with a mean age of 37.85±7.70 years (range, 27-50 years). The AML, which extends outward and upward and is anterior to the ACL, begins at the AHMM and ends anterior to the femoral attachment of the ACL. The histological staining showed that the AML was a bundle of collagen fibers, whereas the ACL was a bundle of dense fibrous collagen. The AML could be clearly identified in the proton-weighted image of sagittal MRI preoperatively and showed a low signaling similar to the signal intensity of the ACL. AML was easily identified on sagittal MRI but not on axial and coronal MRI. In three patients who underwent bilateral MRI, the AML structure was found in both knees.Conclusion:The incidence of rare anatomic variation between the AHMM and the lateral condyle of the femur is 0.1%, usually occurring in both knees simultaneously. In cases with this variation, there is no bony attachment in the AHMM connected to the ACL via the AML. After transection of the AML, the annular fibrous structure and mechanical properties of the meniscus are damaged, as consequently the AML should be carefully protected in clinical practice.
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Objective:To analyze the characteristics and related risk factors of femoral supracondylar fractures combined with meniscus and ligament injuries.Methods:A retrospective case series analysis was performed on clinical data of 100 patients with femoral supracondylar fractures combined with ipsilateral meniscal and?ligamentous knee?injuries?admitted to Tianjin Hospital from January 2016 to December 2020. There were 55 males and 45 females，with age of 22-78 years［（38.5 ± 3.3）years］. Causes of injury included traffic accidents in 45 patients，falls in 45 and others in 10. According to AO classification，type A1 was in 56 patients，A2 in 33 and A3 in 11. Sixty of these patients presented fractures on the left side and forty on the right side. All patients accepted MRI examination to estimate meniscal and ligamentous knee injuries concerning its prevalence，locations and severity. Locations of injury included the medial meniscus（MM），lateral meniscus（LM），anterior cruciate ligament（ACL），posterior cruciate ligament（PCL），medial collateral ligament（MCL）and lateral collateral ligament（LCL）. Meniscal knee injuries were measured using Stoller four-level method，and ligamentous knee injuries by Ruiz three-level method. The patients were subdivided based on age，sex，causes of injury，injury side and fracture AO classification to measure the prevalence of meniscal and?ligamentous injuries，and to identify the factors related to injuries using logistic regression analysis.Results:Seventy-six patients（76.0%）were complicated with meniscal or ligamentous injuries in 151 different parts. Twenty-nine patients（29.0%）had both meniscal and ligamentous injuries. Fifty-six patients had meniscal injuries，including 11 with bilateral meniscus injuries. MM injuries were noted in 32 patients（32.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 12 and grade Ⅲ in 1. LM injuries were found in 35 patients（35.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 14 and grade Ⅲ in 2. Forty-nine patients had ligamentous injuries，among which 22 patients were with single ligamentous injuries，19 with double ligamentous injuries and 8 with triple ligamentous injuries. ACL injuries were found in 33 patients（33.0%），with severity of grade Ⅰ in 22 patients，grade Ⅱ in 10 and grade Ⅲ in 1. PCL injuries occurred in 4 patients（4.0%），with severity of grade Ⅰ in 3 patients and grade Ⅱ in 1. MCL injuries occurred in 28 patients（28.0%），with severity of grade Ⅰ in 18 patients，grade Ⅱ in 9 and grade Ⅲ in 1. LCL injuries occurred in 19 patients，with severity of grade Ⅰ in 12 patients，grade Ⅱ in 5 and grade Ⅲ in 2. There were significant differences in prevalence of meniscal injuries among subgroups of different gender，causes of injury and fracture types（ P < 0.05）.Logistic regression analysis suggested that gender and fracture types showed significant correlation with meniscal injuries，especially factors of males（ P < 0.05）and type A3 fractures（ P < 0.01）. There were significant differences in prevalence of ligamentous injuries among subgroups of different causes of injury and fracture types（ P < 0.05）. Logistic regression analysis showed that causes of injury and fracture types were significantly related to ligamentous injuries，especially factors of traffic accidents（ P < 0.01）and type A3 fractures（ P < 0.01）. Conclusions:Ipsilateral meniscal or ligamentous knee injuries have a high incidence in patients with supracondylar femoral fractures. There exist multiple-site injuries，particularly in ligamentous injuries. Males，type A3 fractures and traffic injuries are risk factors，which needs to be paid much attention in clinical diagnosis and treatment.
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Objective To discuss the types, characteristics, and the evaluation of disability of knee injuries. Methods The data of 133 cases of knee injury from 2017 to 2019 were collected and statistically analyzed according to the region of injury, the degree of disability, etc. Results One hundred and twenty-five cases of injury were compound, and 8 cases were simple. The incidences of ligament injury, meniscus injury and fracture were 88.72%, 75.19% and 57.89%, respectively. Of the cruciate ligament injuries, 12 cases were posterior cruciate ligament injury while 51 cases were anterior cruciate ligament injury, and the differences between the two kinds of injury had statistical significance （P<0.05）; 32 cases were secondary traumatic arthritis. The rates of disability of knee injuries were 38.35% （Grade Ⅸ and Ⅹ）. Conclusion Compound knee injuries are common, and traumatic arthritis has a relatively high rate. Multiple injuries can affect the stability and weight-bearing of the knee joint. It is suggested that in addition to evaluating the range of motion of knee joint, multiple factors should be considered to assess disability.
Subject(s)
Humans , Anterior Cruciate Ligament , Anterior Cruciate Ligament Injuries/epidemiology , Knee Injuries/epidemiology , Knee Joint , Posterior Cruciate LigamentABSTRACT
Objective@#To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.@*Methods@#From January 2013 to December 2017, a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively. There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2). The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years). All patients were classified into high-grade pivot-shift group (60 patients of IKDC grade II-III) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions. Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression, involving degree of LMPR tear, integrity of meniscofemoral ligament, width of lateral meniscal extrusion, KT-1000 arthrometer side-to-side difference, age, sex, and BMI.@*Results@#The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group. High-grade pivot-shift was associated to complete LMPR tear [OR=4.096, 95% CI(1.339, 12.371), P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632, 95% CI (3.095, 29.975), P<0.001]. The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343, 95%CI(1.224, 56.853), P=0.030]. High-grade pivot-shift did not associated with meniscofemoral ligament, lateral meniscal extrusion, age, sex and BMI (P>0.05).@*Conclusion@#In patients with ACL ruptures, complete LMPR tear was an independent risk factor of high-grade pivot-shift, especially for patients with 12 weeks at least duration from injury to surgery.
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Objective@#To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy (HTO) combined with medial meniscus posterior root (MMPR) repair.@*Methods@#Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed. Biplane HTO combined with MMPR repair was performed on these patients. Arthroscopic transtibial pullout repair was employed to repair the MMPR. The relative degree of the medial meniscus extrusion (MME) were measured. Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy. Clinical outcomes were assessed based on Hospital for Special Surgery (HSS) scores and Lysholm scores.@*Results@#The MMPRs were completely healed in 12 cases (48%), partially healed in 9 cases (36%), healed with scarring in 3 cases (12%), and no healed in 1 case (4%). Follow-up duration was 13.04±1.06 months (12-16 months). There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery (χ2=0.786, P=0.675). The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88%±6.44% preoperatively and 58.68%±7.71% after operation with significant difference (t=-18.561, P<0.001). The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation (t=-52.717, P<0.001). The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation (t=-38.685, P<0.001). The degree of MME was changed from 51.12%±13.55% to 50.48%±15.15% without statistical difference (t=0.550, P=0.588) . The comparison between different degrees of healing groups revealed no statistical differences in all variables (P>0.05). The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables (P>0.05).@*Conclusion@#HTO combined with MMPR repair can effectively improve the lower limb alignment and patients' symptoms with a satisfactory healing rate of MMPR. The effects of post-root repair after a short period is not obvious. The longer-term clinical effects is worthy of further observation.
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Objective To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.Methods From January 2013 to December 2017,a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively.There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2).The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years).All patients were classified into high-grade pivotshift group (60 patients of IKDC grade Ⅱ-Ⅲ) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions.Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression,involving degree of LMPR tear,integrity of meniscofemoral ligament,width of lateral meniscal extrusion,KT-1000 arthrometer side-to-side difference,age,sex,and BMI.Results The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group.High-grade pivot-shift was associated to complete LMPR tear [OR=4.096,95％CI(1.339,12.371),P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632,95％CI (3.095,29.975),P＜0.001].The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343,95％CI(1.224,56.853),P=0.030].High-grade pivot-shift did not associated with meniscofemoral ligament,lateral meniscal extrusion,age,sex and BMI (P＞0.05).Conclusion In patients with ACL ruptures,complete LMPR tear was an independent risk factor of high-grade pivot-shift,especially for patients with 12 weeks at least duration from injury to surgery.
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Objective To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy (HTO) combined with medial meniscus posterior root (MMPR) repair.Methods Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed.Biplane HTO combined with MMPR repair was performed on these patients.Arthroscopic transtibial pullout repair was employed to repair the MMPR.The relative degree of the medial meniscus extrusion (MME) were measured.Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy.Clinical outcomes were assessed based on Hospital for Special Surgery (HSS) scores and Lysholm scores.Results The MMPRs were completely healed in 12 cases (48％),partially healed in 9 cases (36％),healed with scarring in 3 cases (12％),and no healed in 1 case (4％).Follow-up duration was 13.04±1.06 months (12-16 months).There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery (x2=0.786,P=0.675).The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88％±t6.44％ preoperatively and 58.68％±17.71％ after operation with significant difference (t=-18.561,P ＜ 0.001).The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation (t=-52.717,P ＜ 0.001).The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation (t=-38.685,P ＜ 0.001).The degree of MME was changed from 51.12％± 13.55％ to 50.48％± 15.15％ without statistical difference (t=0.550,P=0.588).The comparison between different degrees of healing groups revealed no statistical differences in all variables (P ＞ 0.05).The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables (P ＞ 0.05).Conclusion HTO combined with MMPR repair can effectively improve the lower limb alignment and patients' symptoms with a satisfactory healing rate of MMPR.The effects of post-root repair after a short period is not obvious.The longer-term clinical effects is worthy of further observation.
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<p><b>OBJECTIVE</b>To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus.</p><p><b>METHODS</b>From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated.</p><p><b>RESULTS</b>Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72.</p><p><b>CONCLUSIONS</b>MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Anterior Cruciate Ligament Injuries , Diagnostic Imaging , Arthroscopy , Knee Injuries , Diagnostic Imaging , Magnetic Resonance Imaging , Menisci, Tibial , Diagnostic Imaging , Retrospective Studies , Sensitivity and Specificity , Tibial Meniscus Injuries , Diagnostic ImagingABSTRACT
Fundamento: las lesiones del menisco en la articulación de la rodilla son una de las enfermedades más frecuentes debido a causas traumáticas y degenerativas, el cuadro clínico se caracteriza por la presencia de síntomas y signos mecánicos y el tratamiento por lo general es quirúrgico por la vía artroscópica que es de gran utilidad. Objetivo: evaluar la efectividad de la meniscectomía por vía artroscópica en un grupo de pacientes con lesión de menisco. Métodos: se realizó un estudio cuasi experimental modalidad antes y después, en 100 pacientes operados por meniscectomía mediante la vía artroscópica, la investigación tiene un nivel de evidencia III, recomendación B y fue realizada en el hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde febrero de 2013 a enero de 2017. El universo estuvo compuesto por 158 pacientes de los cuales 100 fueron seleccionados para integrar la muestra no probabilística. Resultados: el promedio de edades fue de 46,95 años, predominó el sexo femenino, la rodilla derecha y el menisco medial. El desgarro de tipo degenerativo se observó en el 50 % de los casos, la plica sinovial se detectó en 41 enfermos y las lesiones de cartílago en 78. El dolor en la línea articular y la maniobra de McMurray presentaron el mayor porcentaje de positividad. La meniscectomía parcial fue el procedimiento quirúrgico más empleado. Se observó significación entre un antes y después al emplear las escalas de WOMET y KOOS abreviada. Conclusiones: la meniscectomía artroscópica es un procedimiento quirúrgico efectivo en pacientes con lesiones de menisco, tanto de causa degenerativa como traumática.
Background: meniscal lesions of the knee due to degenerative and traumatic causes are common. Patients usually complain of mechanical symptoms and signs. Treatment is usually surgical by arthroscopy because of several advantages. Objective: the aim of this study was to evaluate the use of arthroscopic meniscectomy in patients with meniscal lesions. Methods: a quasi experimental study before and after modality with a level of evidence III and recommendation grade B in Manuel Ascunce Domenech hospital in Camaguey city from February 2013 to January 2017 was performed in 158 patients diagnosed with meniscal lesions, but 100 of them were selected as a non-probabilistic sample, based on selected criteria. Results: average age was 46,95 years. Female sex, right knee and medial meniscus prevailed. Degenerative tears were detected in 50 % of the cases. Synovial plica and cartilage lesions were found in 41 and 78 patients respectively. Joint line tenderness and McMurray test were positive in a huge number of patients. Partial arthroscopic meniscectomy was the common used surgical procedure. There were significant statistical differences between before and after while using WOMET and short KOOS scales. Conclusions: arthroscopic meniscectomy is an effective surgical procedure in patients with meniscal lesions.
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<p><b>OBJECTIVE</b>To observe the curative effect of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease, and to provide a new method in the treatment of degenerative meniscus disease.</p><p><b>METHODS</b>Seventy-seven patients with degenerative meniscus disease treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2015 to September 2015 were selected, including 30 males and 47 females, aged from 44 to 66 years old, with an average of 57.5 years old. VAS scores, Lysholm scores and distance of meniscal protrusion were analyzed and compared before treatment, 2 weeks and 1 month after treatment. The curative effect was summarized at last.</p><p><b>RESULTS</b>The mean Lysholm scores were 51.63±15.26(before treatment), 77.13±11.82(2 weeks after treatment) and 87.56±8.65(1 month after treatment). The mean VAS scores were 7.080±1.574 (before treatment), 2.630±0.310(2 weeks after treatment) and 0.850±0.177(1 month after treatment). The mean of the distance of meniscal protrusion scores were 0.400±0.156 (before treatment), 0.298±0.140 (2 weeks after treatment) and 0.240±0.110 (1 month after treatment). VAS scores and Lysholm scores were improved significantly compared with preoperative results. The distance of meniscal protrusion showed an obvious improvement after treatment.</p><p><b>CONCLUSIONS</b>The treatment of musculoskeletal ultrasound-guided needle-knife has advantages of high accuracy position and excellent effectiveness for degenerative meniscus disease. The treatment provides safety operation and significantly improves quality of life in patients without any complications.</p>
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Fundamento: las fracturas de la meseta tibial pueden ser de bajo o alto grado; las de bajo grado, que se corresponden con los tipos I al III de la clasificación de Schatzker J., pueden ser tratadas mediante reducción asistida por artroscopia. Métodos: se realizó un estudio observacional descriptivo en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2013 al 31 de marzo de 2014. El universo estuvo conformado por 32 pacientes de los cuales 11 reunieron los criterios de selección. Resultados: el promedio de edades fue de 46, 3 años; la razón sexo masculino-femenino fue de 1, 75 a 1. Predominó el tipo de fractura tipo II en el 54, 4 % de los pacientes estudiados. Las lesiones de menisco asociadas predominaron al ser encontradas en el 54, 5 % de los pacientes. Se encontró significación estadística entre las evaluaciones hechas antes de la cirugía y las de 12 meses después, según las escalas de Rasmussen PS y Lysholm J. Conclusiones: la reducción asistida por artroscopia en pacientes con fractura de la meseta tibial de los grados I al III es un método efectivo desde el punto de vista funcional y para aliviar el dolor.
Background: tibial plateau fractures can be of low or high degree. Fractures of low degree, corresponding to types I to III of Schafzker J classification, can be treated by means of reduction assisted by arthroscopy. Methods: an observational, descriptive study was conducted in Manuel Ascunce Domenech Teaching Hospital, Camagüey city from January 1st, 2013 to March 31st, 2014. The universe was composed of 32 patients, 11 of which matched the selection criteria. Results: the average age was of 46, 3 years. The ratio of male to female sex was 1, 75 to 1. Associated lesions of the meniscus predominated being present in the 54, 5 % of the patients. A statistical significance was found between the presurgical evaluations and the ones made 12 months later, according to Rasmussen PS and Lyshol J scales. Conclusion: reduction assisted by arthroscopy in patients with tibial plateau fractures type I to III, is an effective method from the functional point of view and to relieve pain.
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Objective To analyze MRI features of real tears and pseudotears of posterior horn of the lateral meniscus (PHLM) at the insertion site of meniscofemoral ligament(MFL), and to discuss main points of differential diagnosis. Methods MR images of 32 patients with PHLM tears and 30 patients with anterior cruciate ligament tears but without PHLM tears confirmed by arthroscopy were analyzed retrospectively. Another 20 asymptomatic volunteers as controls underwent MR examination and analyzed. The number of consecutive slices displaying longitudinal increased signal in sagittal images and the length in axial images were evaluated. The one?way analysis of variance, χ2 test and ROC curve were used to analyze diagnostic value of different MRI findings. Results Longitudinal line with abnormal increased signal (pseudotear) was found in 82.0% (41/50) normal insertion site of MFLs. The typical MRI finding of real tears was peripheral longitudinal linear high signal in PHLM which reached the margin of articular surface. In sagittal images, longitudinal linear high signal was shown in (5.8 ± 1.2) slices in knees of real tears, which was more than (2.6±1.1) slices and (2.7±1.4) slices in pseudo?tear groups (F=60.9, P<0.01). The area under ROC curve was 0.96 for differentiating real tear from pseudo-tear using the number of consecutive slices displaying longitudinal increased signal in sagittal images. With a threshold of five or more consecutive images with abnormal longitudinal increased signal as the positive standard of continuous?line sign, the overall sensitivity, specificity and accuracy for diagnosing real tear were 90.6%(29/32), 90.2%(37/41) and 90.4%(66/73), respectively. The axial images showed that the length of increased signal line in the outer of PHLM was (16.4±4.9) mm in patients with real tears, which was longer than pseudo?tear groups with length of (8.1 ± 3.2) mm and (6.0 ± 3.1) mm (F=17.0, P<0.01). The area under ROC curve was 0.92 for differentiating real tear from pseudo?tear using the length in axial images. The zip sign was defined when its length was not less than 10 mm. The sensitivity, specificity and accuracy of the zip sign was 84.4%(27/32), 90.2%(37/41) and 87.7%(64/73) respectively. In coronal images, high signal of MFL attachment insertion was shown in 71.9%(23/32), 60.0%(15/25) and 10/16 cases, there was no significant difference (χ2=0.98, P=0.61). Conclusion The continuous?line sign and zip sign are characteristic findings of PHLM tears at the insertion site of MFL attachment, which are valuable for differential diagnosis with pseudotears at the insertion site of MFL.
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Objective:To analyze morphological character of lateral tibial plateau fracture fragment, and its correlation to the presence of a meniscus injury in tibial plateau fractures.Methods:A total of 79 consecutive patients of the simple lateral tibial plateau fractures from July 201 1 to July 2015 were inclu-ded in this study,with 65 males and 14 females with an average age of (34.3 ±7.2)years and 22-61 years.According to Schatzker classification,21 cases were of Type Ⅰ,41 cases Type Ⅱ,and 17 cases Type Ⅲ.The characteristics of lateral tibial plateau fractures were evaluated by plain X-ray and magnetic resonance imaging (MRI ).The type and severity of meniscus injury were diagnosed by MRI scan. Three-dimensional measurements of the lateral fragment width (LFW),the lateral plateau depression (LPD),the coronal angulation of lateral fragment (CALF),and tibial plateau widening (TPW)were measured with Picture Archiving and Communication Systems(PACS)software.The patients with and without meniscus injuries were divided into different groups and analyzed respectively.Comparison of the above measurements between the two groups was analyzed by independent t test.Results:In all the 79 lateral tibial plateau fracture patients,26 cases (32.9%)of meniscus injuries were detected by MRI. Among all the meniscus injury cases,3 were of SchatzkerⅠ,16 SchatzkerⅡ,and 7 SchatzkerⅢ.In meniscus intact group,the average LFW was (22.0 ±2.8)mm while in meniscus injury group it was (21.3 ±3.3)mm (t =-1.008,P =0.317).The average LPD of non meniscus injury group was (5.4 ±2.8)mm,while in meniscus injury group was (8.7 ±2.8)mm (t=4.98,P=0.001).The average CALF of the two groups were 9.1°±6.1°and 10.6°±7.1°,and there was no significant dif-ference between the two groups (t=0.38,P=0.831).The average TPW was (3.0 ±1.1)mm,and (4.8 ±1 .7 )mm of the two groups.There were significant differences between the two groups (t =5.216,P=0.001).Conclusion:There was no obvious correlation between the LFD and meniscus inju-ry.The CALF of lateral tibial plateau fracture had no significant correlation with meniscus injury either. The degree of LPD and TPW may indicate injury of the meniscus in tibial plateau fractures.
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BACKGROUND: The use of tissue engineering technology to build a functional meniscus is a new idea for repair of meniscus injury. OBJECTIVE: To analyze the research progress of seed cells and scaffold materials in tissue-engineered meniscus repair. METHODS: A computer-based search of CNKI and PubMed was performed for articles related to tissue-engineered meniscus repair published from 1996 to 2015. The keywords were meniscal repair, meniscal injury, tissue engineering, tissue-engineered meniscus, biomaterials, stem cells in Chinese and English, respectively. RESULTS AND CONCLUSION: Tissue-engineered meniscus reconstruction is a more viable method for repair of meniscus injury. Mesenchymal stem cells are pluripotent cells that are ideal seed cells for tissue-engineered meniscus reconstruction. Scaffolds are one of important factors for meniscus repair, and natural meniscal scaffolds play an important role. Selection and development of scaffold materials for meniscus tissue engineering have experienced a rapid development period from a single material to composite materials. Composite materials make up a lot of shortcomings and deficiencies that a single material has, and open up new ideas for developing new materials. Meniscal tissues with geometric shapes can be constructed using tissue engineering technology. However, the long-term observation of the biological properties of meniscal tissues is necessary, and from basic to clinic, there is still a lack of reliable data to prove the effect of tissue engineering technology in the meniscus repair.
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BACKGROUND:At present, although the study of three-dimensional finite element biomechanical analysis of knee joint meniscus has been reported and we have a certain understanding of the biomechanical changes of the meniscus, but the dynamic simulation of the knee meniscus in the same load conditions in the process of biomechanical analysis of the knee meniscus is less reported. OBJECTIVE:To analyze the biomechanical characteristics of the knee joint meniscus under different flexion angle by using analogue simulation of finite element method. METHODS:Based on knee MRI data of the normal adult volunteers, the medicine finite element simulation software Mimics10.01 and reverse engineering software Rapidform XOR3 were utilized to reconstruct three-dimensional finite element model of knee joint meniscus. The advanced finite element analysis software Abaqus6.10-1 was utilized for analogue simulation and for analyzing biomechanical changes during flexion under vertical load of 300 N. RESULTS AND CONCLUSION:(1) While the knee joint flexed at 0°, 30°, 60° and 90°, with the increase of angle, maximum stress point moved from the anterior edge of tibia attachment surface of the medial meniscus posterior angle to the posterior edge of tibia attachment surface of the lateral meniscus anterior angle, and the stress range of lateral meniscus was greater than that of the medial meniscus. (2) The maximal displacement point moved from the midpoint of inner edge of the medial meniscus to the front outer-upper edge of the lateral meniscus at knee flexion of 0°, 30°, 60° and 90°. Moreover, the range of displacement of lateral meniscus was bigger than the medial meniscus. (3) These findings suggest that the meniscus is the major bearing structure in the process of knee flexion. The lateral meniscus injury rate is greater than the medial meniscus in process of exercise, which is associated with large stress and displacement.
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Objective To investigate the correlation of medial meniscus extrusion with meniscus injury location, type and genu varum. Methods From March 2014 to March 2015, a total of 97 patients with injury of medial meniscus undergoing ar?throscopy and surgery were selected as subjects, including 40 males and 57 females, aged 32-66 years, with a mean age of 51.2± 10.71 years. Based on the MRI of knee, there were 38 cases with medial meniscus extrusion≥3 mm (extrusion group) and 59 cases without medial meniscus extrusion (non?extrusion group). Genu varus was measured on X?ray (Femur?Tibia?Angle<182°). The me?dial meniscus tear type was observed under arthroscopy (longitudinal tear, horizontal tear, oblique tear, radial tear, complex tear), as well as the meniscus tear location (anterior tear, body tear, posterior tear, root tear). The age, gender, BMI and involved side were compared between two groups. Multifactor unconditioned Logistic regression analysis was employed to analyze risk factors of medial meniscus extrusion. Results Two groups of patient showed no statistically significant difference in age (t=-1.511, P=0.135), gender (χ2=0.208, P=0.648), BMI (t=0.249, P=0.650) and side (χ2=0.052, P=0.820). The incidence of meniscus extru?sion in patients with genu varum was 89% (25/28), and the incidence of meniscus extrusion in patients with meniscus root tear was 78% (18/23). Significant difference could be spotted in the analysis of meniscal root tear (χ2=19.329, P=0.000), complex tear (χ2=5.111, P=0.024), genu varus (χ2=41.481, P=0.000) between patients with medial meniscus extrusion or without medial meniscus extrusion. Meanwhile, meniscus anterior tear (χ2=0.044, P=1.000), body tear (χ2=0.261, P=0.661), posterior tear (χ2=3.722, P=0.086), longitudinal tear (χ2=0.054, P=0.816), horizontal tear (χ2=0.317, P=0.790), oblique tear (χ2=0.198, P=0.819), radial tear (χ2=1.188, P=0.385) no statistical significance. By multifactor analysis, OR values of genu varus and root tear were 101.976 (95%CI:15.973, 651.041, P=0.000) and 35.517 (95%CI:6.804, 185.399, P=0.000), respectively. Conclusion Menis?cal root tear and genu varum were risk factors of medial meniscus extrusion.
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Objective To study the characteristic and manifestations in the middle aged and elderly peoplewith discoid meniscus injury and the outcome of the arthroscopic surgery. Methods Twenty-nine patients with discoid meniscus injury were treated by the arthroscopic surgery from January 2009 to May 2013. According to the injury of discoid meniscus in operation, 6 cases (6 knees , 20.69%) underwent meniscal plasty, 16 cases (16 knees, 55.17%) underwent subtotal meniscectomy, and 7 cases (7 knees, 24.14%) underwent meniscectomy. The Ikeuchi and Lysholm evaluation system was used to assess knee joint function and compared. Results All the postoperative patients were followed up for 12-18 months, and the average was 14 months. According to Ikeuchi knee rating, 5 cases were excellent, 17 cases were good, 4 cases were fair, 4 cases were poor and the rate of excellent and good was 75.86%. Lysholm scores 3, 6 and 12 months after operation were (65.76 ± 5.35), (70.27 ± 4.73) and (77.81 ± 6.24) scores, and before operation was (55.47 ± 3.63) scores. Three, 6 and 12 months after operation, Lysholm scores were significantly higher than those before operation (P<0.05). Conclusions The middle aged and elderly people discoid meniscus injury has its own characteristics compared with adolescent patients in symptoms, signs, and treatments. Arthroscopic surgery is an effective treatment for discoid meniscus with minimal.
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<p><b>OBJECTIVE</b>To observe the clinical result and healing of meniscal suture under arthroscopy for the treatment of the middle aged patients with meniscal injury.</p><p><b>METHODS</b>From March 2014 to January 2015, 40 middle-aged patients included in the standard with injury of meniscus, which were repaired by meniscal suture technique under arthroscopy, involving 24 males and 16 females with an average age of (52.65±3.63) years ranging from 50 to 60 years; 28 cases were on left knee, 12 cases were on right knee. Average flexion angle averaged (117.50±7.16) ° ranging from 110° to 130°. Lysholm knee score averaged 54.30±14.72 ranging from 23 to 71; IKDC score averaged 50.65±15.95 ranging from 18 to 78; the WOMAC score averaged 23.80±19.39 ranging from 2 to 75. All-inside meniscus suture under arthroscopy was performed.</p><p><b>RESULTS</b>All operations were successful without serious complications. Postoperative follow-up was 6 to 12 months, none of the patients lost to follow-up. All patients maintain a category 5 degree muscle strength, normal knee joint mobility, can completely straight and completely buckling. Average flexion angle was (125.00±5.13) ° (110° to 130°) (=3.47,=0.003). Final Lysholm scale, IKDC scores and WOMAC scores averaged 79.50±8.70 (=7.790,=0.000), 79.40±10.40 (=8.431,=0.000), 8.15±6.77 (=3.988,=0.001) separately. Follow-up MRI showed that meniscus healed in 4 cases, partially healed in 22 cases, haven't healed in 14 cases. Failure rate of small lesion was 27.3%(6/22), and failure rate of large lesion was 44.4%(8/18).</p><p><b>CONCLUSIONS</b>Clinical effect of meniscal suture under arthroscopy for the treatment of the middle aged is good. The failing rate was 35% because of healing ability is poor in middle-aged adults. Failure rate of large lesion was higher than that of small lesion.</p>
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Objective To investigate the risk factors of articular cartilage damage secondary to anterior cruciate ligament (ACL) rupture.Methods Clinical data of 490 patients sustaining ACL rupture from July 2008 to July 2014 were collected for a retrospective cohort study.The factors relating to the incidence and degree of the secondary articular carticular damage were analyzed,including gender,age,weight,blood group,places of residence,causes of injury,complication of meniscus tear,damage part and duration of disease.Results Factors associated with the incidence of secondary articular cartilage damage were blood type O (OR =0.605,95％ CI 0.381-0.960,P ＜ 0.05) and complication of meniscus tear(OR =2.241,95％ CI 1.378-3.643,P ＜0.01).Factors associated with the degree of articular cartilage damage were duration of disease (rs =0.168 7,P ＜0.01),damage part (Hc =53.237,P＜0.01),and complication of meniscus tear (x2 =16.944,P＜0.01).Conclusions Meniscus tear is the moderate risk factor for the incidence of secondary articular cartilage damage while blood type O has weak protective effect.Damage part,course of disease,and meniscus tear are factors associated with the degree of secondary articular cartilage damage.