Assessment of the relationship between smoking and meniscal injury / Avaliação da relação entre tabagismo e lesão meniscal

Abstract Objective: To determine whether being a smoker and the years of smoking correlate with the presence and degree of meniscal injury. Materials and Methods: Individuals who underwent magnetic resonance imaging of the knee were divided into two groups: smokers and nonsmokers. For each smoker, the total smoking history was calculated by multiplying the daily consumption (packs/day) by the years of smoking, and the result is expressed as pack-years. In the evaluation of meniscal injury, the grade of injury was recorded. The thickness of the subcutaneous adipose tissue, as an indicator of obesity, was measured at the medial knee on axial plane images. The relationships that smoking and obesity had with meniscal injury were analyzed statistically. Results: A total of 156 individuals were included in the study. The smoker group consisted of 48 individuals (30.8%), and the nonsmoker group consisted of 108 (69.2%). The meniscus was normal in one (2.1%) of the smokers and in 32 (29.6%) of the nonsmokers (p < 0.0001). The median subcutaneous adipose tissue thickness was 23 mm and 24 mm in the smokers and nonsmokers, respectively (p = 0.900). A moderate but statistically significant correlation was observed between packs/day and injury grade, as well as between pack-years and injury grade (r = 0.462, p = 0.001 and r = 0.523, p = 0.001, respectively). Smoking and age significantly increased the risk of meniscal injury, by 31.221 times (p = 0.001) and 1.076 times (p < 0.001), respectively. Conclusion: Our findings indicate that current smoking and smoking history correlate significantly with meniscal injury grade.

Resumo Objetivo: Determinar a correlação do tabagismo e do tempo de tabagismo com a presença e o grau de lesão do menisco. Materiais e Métodos: Foram incluídos pacientes submetidos a ressonância magnética do joelho e divididos em dois grupos: fumantes e não fumantes. O consumo total de cigarros dos pacientes foi calculado multiplicando-se a quantidade diária de cigarros (maços/dia) pelo tempo de tabagismo (anos). O grau mais alto de lesão foi registrado na avaliação da lesão meniscal. A espessura do tecido adiposo subcutâneo foi medida com base em imagem do joelho em plano axial, como indicador de obesidade. A relação entre tabagismo, obesidade e lesão meniscal foi analisada estatisticamente. Resultados: Foram incluídos no estudo 156 indivíduos. O grupo de fumantes consistiu de 48 (30,8%) indivíduos e o grupo de não fumantes, de 108 (69,2%) indivíduos. O menisco estava normal em um (2,1%) fumante e em 32 (29,6%) não fumantes (p < 0,0001). A espessura média do tecido adiposo subcutâneo em fumantes foi 23 mm e nos não fumantes foi 24 mm, com valor de p = 0,900. Foi observada correlação moderada e estatisticamente significante entre o grau de lesão por pacote/dia (r = 0,462, p = 0,001) e o grau de lesão por pacote × ano (r = 0,523, p = 0,001). O tabagismo e a idade afetaram significativamente o risco de lesão do menisco (31,221 vezes, p = 0,001 e 1,076 vez, p < 0,001, respectivamente). Conclusão: Foi encontrada correlação significativa entre tabagismo/dia e grau de lesão do menisco e pacote de tabagismo × ano e grau de lesão do menisco.

Characteristics of tear meniscus using a spectral domain optical coherence tomography in medically controlled glaucoma

Purpose: To compare the tear meniscus height (TMH) and tear meniscus depth (TMD) between medically controlled glaucoma subjects and age?matched controls. Methods: This prospective, cross?sectional, observational study included 50 patients with medically controlled glaucoma and 50 age?matched controls. Glaucoma subjects using topical medications for the duration of more than 1 year were included. The age?matched controls were participants with no history of glaucoma, dry eye, or any other diseases affecting the ocular surface. All the participants underwent TMH and TMD scan using spectral domain?optical coherence tomography (SD?OCT), which was followed by ocular surface disease index (OSDI) questionnaire administration. Results: The mean ages of glaucoma subjects and age?matched controls were 40 ± 22 and 39 ± 21 years, respectively (P > 0.05). Of them, 40% (n = 22) were on single drug therapy or monotherapy and 60% (n = 28) were on multidrug therapy. TMH and TMD of glaucoma subjects and age?matched controls were 101.27 ± 31.86 versus 230.63 ± 49.82 ?m and 70.60 ± 27.41 versus 167.37 ± 57.06 ?m, respectively. Subjects on multidrug therapy showed a statistically significant reduction in TMH and TMD when compared to age?matched controls. Conclusion: Preservative containing topical glaucoma medications affects the ocular surface, including the tear film. The prolonged duration and multiple combination of this drug usage serve as potential factors for causing reduction in the tear meniscus levels leading to drug?induced dryness

Where is tibial edema located in cases of osteomeniscal impingement? / Onde está o edema ósseo tibial em casos de impacto osteomeniscal?

Abstract Objective: To characterize the location of tibial edema related to meniscal degeneration with a flap displaced into the meniscotibial recess (osteomeniscal impingement) on magnetic resonance imaging (MRI). Materials and Methods: We evaluated 40 MRI examinations of patients submitted to surgery due to inferior displacement of a meniscal flap tear into the meniscotibial recess and peripheral bone edema. Tibial edema was quantified in the coronal and axial planes. Results: On coronal MRI sequences, edema started in the tibial periphery and extended for a mean of 5.6 ± 1.4 mm, or 7.4 ± 2.1% of the tibial plateau. In the craniocaudal direction, the mean extension was 8.8 ± 2.9 mm. The mean ratio between the extent of craniocaudal and mediolateral edema was 1.6 ± 0.6. In the axial plane, the edema started in the medial periphery and extended for a mean of 6.2 ± 2.0 mm, or 8.2 ± 2.9% of the tibial plateau. In the anteroposterior measurement, the mean start and end of the edema was 21.4 ± 5.4 mm and 35.7 ± 5.7 mm, respectively, or 43.4 ± 10.2% and 72.8 ± 11.1% of the tibial plateau. Conclusion: Apparently, tibial edema resulting from osteomeniscal impingement always starts in the periphery of the meniscus. In the coronal plane, it appears to be more extensive in the craniocaudal direction than in the mediolateral direction. In the axial plane, we found it to extend, on average, approximately 6.2 mm in the mediolateral direction and to be most commonly located from the center to the posterior region of the medial tibial plateau.

Resumo Objetivo: Caracterizar a localização do edema ósseo tibial relacionado a lesão meniscal degenerativa com fragmento deslocado no recesso meniscotibial (impacto osteomeniscal) por meio de ressonância magnética (RM). Materiais e Métodos: Quarenta RMs de pacientes submetidos a cirurgia por fragmento deslocado do menisco medial no recesso meniscotibial e edema ósseo periférico foram avaliadas. Edema ósseo tibial foi quantificado nos planos coronal e axial. Resultados: No plano coronal, o edema iniciou-se na periferia tibial e estendeu-se por 5,6 ± 1,4 mm, ou 7,4 ± 2,1% do platô. Na direção craniocaudal, o edema estendeu-se em média 8,8 ± 2,9 mm. A média entre a extensão do edema craniocaudal e mediolateral foi 1,6 ± 0,6. No plano axial, o edema iniciou-se na periferia medial e estendeu-se por 6,2 ± 2,0 mm, ou 8,2 ± 2,9% da medida da tíbia. Na medida anteroposterior, o edema iniciou-se em 21,4 ± 5,4 mm e terminou em 35,7 ± 5,7 mm ou iniciou-se em 43,4 ± 10,2% e terminou em 72,8 ± 11,1% do platô tibial. Conclusão: O edema ósseo tibial relacionado aos casos de impacto osteomeniscal sempre se inicia na periferia do menisco. Ele é mais extenso na direção craniocaudal do que mediolateral no plano coronal. No plano axial, ele estende-se por 6,2 mm de medial a lateral e é mais frequentemente localizado no centro da região posterior do platô medial.

Anatomy of the Medial Meniscotibial Ligament of the Knee: A Systematic Review / Anatomia do ligamento meniscotibial medial do joelho: Uma revisão sistemática

Abstract Objectives To perform a systematic review of the literature on the anatomy of the medial meniscotibial ligaments (MTLs), and to present the most accepted findings, as well as the evolution of the anatomical knowledge on this structure. Materials and Methods An electronic search was conducted in the MEDLINE/PubMed, Google Scholar, EMBASE and Cochrane library databases with no date restrictions. The following index terms were used in the search: anatomy AND meniscotibial AND ligament AND medial. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We included anatomical studies of the knee were included, such as cadaver dissections, histological and/or biological investigations, and/or imaging of the medial MTL anatomy. Results Eight articles that met the inclusion criteria were selected. The first article was published in 1984 and the last, in 2020. The total sample in the 8 articles was of 96 patients. Most studies are purely descriptive in terms of the macroscopic morphological and microscopic histological findings. Two studies evaluated the biomechanical aspects of the MTL, and one, the anatomical correlation with the magnetic resonance imaging examination. Conclusion The main function of the medial MTL, a ligament that originates in the tibia and is inserted in the lower meniscus, is to stabilize and maintain the meniscus in its position on the tibial plateau. However, there is a limited amount of information regarding medial MTLs, primarily in terms of anatomy, especially vascularization and innervation.

Resumo Objetivos Fazer uma revisão sistemática da literatura sobre a anatomia dos ligamentos meniscotibiais (LMTs) mediais, e apresentar os achados mais aceitos e a evolução das informações anatômicas sobre essa estrutura. Materiais e Métodos A busca eletrônica foi realizada nos bancos de dados MEDLINE/PubMed, Google Scholar, EMBASE e Cochrane, sem restrições de data. Os seguintes termos de indexação foram utilizados: anatomy AND meniscotibial AND ligament AND medial. A revisão seguiu as recomendações da declaração de Principais Itens para Relatar Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, em inglês). Foram incluídos estudos anatômicos do joelho, como dissecções de cadáveres, investigações histológicas e/ou biológicas, e/ou imagens da anatomia do LMT medial. Resultados Oito artigos atenderam aos critérios de inclusão e foram selecionados. O primeiro foi publicado em 1984, e o último, em 2020. A amostra total nos 8 artigos foi de 96 pacientes. A maioria dos estudos é puramente descritiva em relação aos achados morfológicos macroscópicos e histológicos microscópicos. Dois estudos avaliaram os aspectos biomecânicos do LMT, e um analisou a correlação anatômica com o exame de ressonância magnética. Conclusão A principal função do LMT medial, ligamento que se origina na tíbia e se insere no menisco inferior, é estabilizar e manter a posição do menisco no platô tibial.

Articulación temporomandibular ¿disco o menisco articular? / Temporomandibular joint, disc or articular meniscus

Los términos disco y menisco se encuentran en Terminologia Anatomica. Sin embargo, ambos términos son utilizados como sinónimos para referirse al cartílago intraarticular presente en la articulación temporomandibular (ATM). Por este motivo, el objetivo de este estudio es exponer las raíces griegas de los términos disco y menisco para evaluar la coherencia entre su relación léxica y su relación morfológica. Ambos términos fueron consultados en el Programa Federativo Internacional de Terminología Anatómica y en diccionarios de idiomas griego, español e inglés. La búsqueda reportó que el término "disco" deriva del latín discus, y este a su vez del griego δίσκος [dískos] que significa "cuerpo cilíndrico cuya base es muy grande respecto a su altura". Por su parte "menisco" proviene del griego mēnískos μηνίσκος [mḗn μήν gr. μείς 'meis', 'luna creciente' + -iskos gr. Sufijo diminutivo 'pequeño'] que significa "luna creciente pequeña" y se define como "cartílago de forma semilunar y de espesor menguante de la periferia al centro; forma parte de la articulación de la rodilla". Por lo tanto, la definición anatómica de disco articular y menisco está determinada por su morfología según la etimología de la palabra. En la ATM se encuentra un disco articular entre los huesos articulares, según su morfología.

SUMMARY: The terms disc and meniscus are found in Terminologia Anatomica. However, both terms are used synonymously to refer to the intra-articular cartilage present in the temporomandibular joint (TMJ). For this reason, this study aims to expose the greek roots of the terms disc and meniscus to evaluate the coherence between their lexical and morphological relationships. Both terms were consulted in the International Federative Program of Anatomical Terminology and in Greek, Spanish and, English dictionaries. The search reported that the term "disc" derives from the Latin discus, and this in turn from the Greek δίσκος [dískos], which means "cylindrical body whose base is very large compared to its height". For its part, "meniscus" comes from the Greek mēnískos μηνίσκος [mḗn μήν gr. μείς 'meis', 'crescent moon' + -iskos Gr. Diminutive suffix 'small'] which means "small crescent moon" and, is defined as "cartilage with a semilunar shape and decreasing thickness from the periphery to the center; It is part of the knee joint. Therefore, the anatomical definition of articular disc and meniscus is determined by its morphology according to the etymology of the word. In the TMJ, an articular disc is found between the articular bones, depending on their morphology.

Relationship of the Cruciate and Meniscofemoral Ligaments with the Knee Osteology. An Anatomical Study / Relação dos ligamentos cruzados e meniscofemorais com a osteologia do joelho: Um estudo anatômico

Abstract Objective To analyze the dimensions of the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), the presence of meniscus-femoral ligaments MFLs in human knees, and the correlation with the dimensions of the knee skeleton. Methods Anatomical study on 29 specimens of human knees in which we measured the length and width of the cruciate and meniscus-femoral ligaments and the dimensions of femoral and tibia condyles and the femoral notch. The ACL length was calculated with different degrees of knee flexion. The relationship between the ligaments and bone dimensions were analyzed. Results The length of the ACL and the PCL were similar. Posterior MFL was more frequent and longer than the anterior MFL. We found the posterior MFL in the 72.41% of the knees and anterior MFL in 20.69%. The ACL presented 30% of its maximum length up to 60°, approximately half of its length between 90° and 120°, reaching its maximum length at 170°. We found a strong correlation between the length of the ACL and that of the PCL (p= 0.001). However, the lengths of the ACL and PCL were not related with the bone dimensions. Conclusion We have found no correlations between the cruciate and MFLs and the anatomical dimensions of the intercondylar notch and the proximal tibia and distal femur. The presence of the posterior MFL was more frequent and longer than that of the anterior ligament.

Resumo Objetivo Analisar as dimensões do ligamento cruzado posterior (LCP), do ligamento cruzado anterior (LCA), a presença de ligamentos meniscofemorais (LMFs) em joelhos humanos e a correlação com as dimensões do esqueleto do joelho. Métodos Estudo anatômico em 29 espécimes de joelhos humanos nos quais medimos o comprimento e a largura dos ligamentos cruzado e meniscofemoral e as dimensões dos côndilos femorais e tibiais e do entalhe femoral. O comprimento do LCA foi calculado com diferentes graus de flexão do joelho. Analisou-se a relação entre os ligamentos e as dimensões ósseas. Resultados O comprimento do LCA e do LCP foram semelhantes, LMF posterior foi mais frequente e mais longo do que o LMF anterior. Foram encontradas LMF posterior em 72,41% dos joelhos e LMF anterior em 20,69%. O LCA apresentou 30% de seu comprimento máximo até 60°, aproximadamente metade de seu comprimento entre 90° e 120°, atingindo seu comprimento máximo com flexão de 170°. Encontramos uma forte correlação entre o comprimento do LCA e do LCP (p= 0,001). No entanto, os comprimentos do LCA e do LCP não estavam relacionados com as dimensões ósseas. Conclusão Não encontramos correlações entre os ligamentos cruzado e meniscofemoral e as dimensões anatômicas do entalhe intercondilar e da tíbia proximal e do fêmur distal. A presença do LMF posterior foi mais frequente e maior que a do ligamento anterior.

Observation of tear film stability in dry eye patients with different lipid layer thickness / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the difference of tear film stability among different lipid layer thickness.METHOD: A total of 194 dry eye patients(384 eyes)admitted to our hospital from June 2020 to December 2021 were enrolled in this study. The tear meniscus height, the first tear film break-up time and lipid layer thickness were measured by corneal topographer. The tear meniscus height and the first tear film break-up time among different lipid layer thickness were compared and the correlation between them was analyzed.RESULTS: The included patients(384 eyes)were divided into lipid rich group(49 eyes), lipid balance group(27 eyes), slight lipid deficiency group(266 eyes)and significant lipid deficiency group(42 eyes)according to the lipid layer thickness. The differences of the tear meniscus height were statistically different(P=0.022), while the differences of the first tear film break-up time were not statistically different(P=0.322). The lipid layer thickness was positively correlated with tear meniscus height(rs=0.143, P=0.006). There was no correlation between lipid layer thickness and the first tear film break-up time(rs=-0.090, P=0.083), nor was there correlation between tear meniscus height and the first tear film break-up time(rs=0.038, P=0.460).CONCLUSION: There was no significant difference in tear film stability in dry eye patients with different lipid layer thickness.

Analysis of Knee Joint Stress During Drop Jump Landing in Females with Generalised Joint Hypermobility / 医用生物力学

Objective To analyze the differences of von Mises stress distribution in knee cartilage and meniscus in female with generalised joint hypermobility (GJH) and healthy female during drop jump landing. Methods The kinematic and ground reaction force (GRF) characteristics of knee joint in female with GJH and healthy female at the moment of peak vertical GRF (VGRF) during loading phase of drop jump landing were collected. The knee joint reaction force was calculated via inverse dynamics, and the combined force of knee joint along long axis of the femur was applied as the load. Based on three-dimensional (3D) finite element model of a female knee joint, numerical simulations were performed separately during drop jump landing of subjects in two groups, and von Mises stresses and stress distribution of knee cartilage and meniscus were calculated. Results At the moment of peak VGRF during drop jump landing, knee flexion and valgus angles in GJH group and control group showed a statistical significance (P<0. 05). Compared with control group, knee flexion angle decreased and valgus angle increased in GJH group. During drop jump landing, GJH group bore larger stress inside the knee joint, and stress distribution in weight-bearing areas of the medial and lateral tibiofemoral compartments was uneven, while the lateral femoral cartilage lateral condyle, the anterior and middle lateral of lateral tibial cartilage, the anterior angle and body lateral margin of lateral meniscus were stress concentration sites. Conclusions For females with GJH, the stability of knee joint decreases and force lines change in jumping events, due to the increased range of motion of knee joint and relaxation of joint capsule, which increases the risk of cartilage and meniscal injury in lateral knee joint. During jumping sports, females with GJH should especially prevent knee joint injury caused by altered force lines in frontal plane of knee joint.

Concerns of Technical Evaluation on Registration of All-inside Meniscus Suture System / 中国医疗器械杂志

OBJECTIVE@#To summarize the product registration declaration ideas and registration technical review of the all-inside meniscal suture system, and to systematically think about of the technical review concerns of the all-inside meniscal suture system products to provide technical guidance for improving the quality of registration and application and regulatory efficiency.@*METHODS@#Consult the public information of such products at home and abroad, and summarize the experience of registration review of such products.@*RESULTS@#The technical review of the all-inside meniscus suture system registration mainly focuses on product basic information, pre-clinical research, clinical evaluation and product technical requirements.@*CONCLUSIONS@#The difficulty of product registration and declaration of the all-inside meniscus suture system lies in the provision of pre-clinical research data of the product, and the applicant needs to strengthen the basic research ability, formulate scientific technical indicators and test methods to ensure the safety and effectiveness of the product, and also provide sufficient supporting data for the registration declaration.

Research progress of knee meniscal repair techniques / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of meniscus repair in recent years, in order to provide help for the clinical decision-making of meniscus injury treatment.@*METHODS@#The domestic and foreign literature related to meniscal repair in recent years was extensively reviewed to summarize the reasons for the prevalence of meniscal repair, surgical indications, various repair methods and long-term effectiveness, the need to deal with mechanical structural abnormalities, biological enhancement repair technology, rehabilitation treatment, and so on.@*RESULTS@#In order to delay the occurrence of osteoarthritis, the best treatment of meniscus has undergone an important change from partial meniscectomy to meniscal repair, and the indications for meniscal repair have been expanding. The mid- and long-term effectiveness of different meniscal repair methods are ideal. During meniscus repair, the abnormality of lower limb force line and meniscus protrusion should be corrected at the same time. There are controversies about the biological enhancement technology to promote meniscus healing and rehabilitation programs, which need further study.@*CONCLUSION@#Meniscal repair can restore the normal mechanical conduction of lower limbs and reduce the incidence of traumatic osteoarthritis, but the poor blood supply and healing ability of meniscal tissue bring difficulties to meniscal repair. Further development of new biological enhanced repair technology and individualized rehabilitation program and verification of its effectiveness will be an important research direction.

A study on repair method of type Ⅱc injury in lateral meniscus popliteal tendon area of porcine knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the repair method of type Ⅱc injury in the lateral meniscus popliteal tendon area based on the porcine knee joint.@*METHODS@#Eighteen commercially available fresh porcine knee joints were randomly divided into 3 groups ( n=6). After preparing a type Ⅱc injury in the lateral meniscus popliteal tendon area, and the anterior (group A), posterior (group B), or anterior and posterior (group C) of the popliteal hiatus (PH) was sutured by vertical mattress. The tension meter was used to apply gradient tensions of 2, 4, 6, 8, and 10 N along the tibial plateau horizontally, respectively, to pull the midpoint of the lateral meniscus popliteal tendon area. The displacement values before modeling, after modeling, and after suture were recorded. The reduction value of lateral meniscus displacement and reduction rate after suture were calculated and compared between groups.@*RESULTS@#There was no significant difference between groups ( P>0.05) in the displacement values before modeling, after modeling, and after suture under different tensions. There was no significant difference between groups A and C ( P>0.05) in the reduction value of lateral meniscus displacement and reduction rate after suture under different tensions. The reduction value of lateral meniscus displacement and reduction rate after suture in group B were lower than those in groups A and C. The reduction value of lateral meniscus displacement under tension of 2 N and the reduction rates under tensions of 2, 4, and 6 N between groups A and B showed significant differences ( P<0.05). The reduction value of lateral meniscus displacement and the reduction rate under tensions of 2, 4, and 6 N between groups B and C showed significant differences ( P<0.05).@*CONCLUSION@#Suturing the anterior area of PH is the key to repairing type Ⅱc injury of lateral meniscus popliteal tendon area.

Meniscus injuries under high-intensity training in cycling athletes / Lesões no menisco sob treinamento de alta intensidade em atletas de ciclismo / Lesiones de menisco bajo entrenamiento de alta intensidad en atletas de ciclismo

ABSTRACT Introduction: Due to the high intensity and speed of cycling, a high technical and tactical level, physical quality, and psychological quality are required of athletes. Meniscal injuries are common in cyclists. In particular, chronic meniscal injuries are usually caused by an accumulation of fatigue or untimely and incomplete treatment of acute sports injuries. Objective: Analyze the protective factors and methods for meniscal injuries in cyclists. Methods: Volunteer male cyclists were selected for a questionnaire that investigated the athletes' meniscal injuries. The data collected were statistically analyzed. Results: There were 6 cases of right knee meniscus injury in athletes; these data accounted for 75% of the injuries. Left meniscus injuries accounted for 2 cases. There was one case of medial injury in both knees. The corresponding preventive measures are presented according to the cause of the injury. Conclusion: Causes of meniscal injuries in cyclists include insufficient knee strength, inadequate training methods, physical fatigue, and long-term localized effort. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Devido à alta intensidade e velocidade do ciclismo, é exigido um alto nível técnico e tático, qualidade física e qualidade psicológica dos atletas. Lesões meniscais são comuns em ciclistas. Em particular, as lesões meniscais crônicas são geralmente causadas por um acúmulo de fadiga ou tratamento inoportuno e incompleto de lesões esportivas agudas. Objetivo: Analisar os fatores e métodos de proteção para lesões meniscais em ciclistas. Métodos: Ciclistas do sexo masculino voluntários foram selecionados para um questionário que investigou as lesões meniscais dos atletas. Os dados coletados foram analisados estatisticamente. Resultados: Houve 6 casos de lesão meniscal do joelho direito em atleta, esses dados são responsáveis por 75% dos danos. Lesões no menisco esquerdo representaram 2 casos. Houve um caso de lesão medial em ambos os joelhos. As medidas preventivas correspondentes são apresentadas de acordo com a causa da lesão. Conclusão: As causas das lesões meniscais em ciclistas incluem força insuficiente no joelho, métodos de treinamento inadequados, fadiga física e esforço localizado a longo prazo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Debido a la alta intensidad y velocidad del ciclismo, se exige a los deportistas un alto nivel técnico y táctico, calidad física y calidad psicológica. Las lesiones de menisco son comunes en los ciclistas. En particular, las lesiones crónicas de menisco suelen ser causadas por una acumulación de fatiga o por un tratamiento inoportuno e incompleto de las lesiones deportivas agudas. Objetivo: Analizar los factores y métodos de protección de las lesiones meniscales en ciclistas. Métodos: Se seleccionaron ciclistas masculinos voluntarios para un cuestionario que investigaba las lesiones meniscales de los atletas. Los datos recogidos se analizaron estadísticamente. Resultados: Hubo 6 casos de lesiones de menisco de la rodilla derecha en atletas, estos datos representaron el 75% de las lesiones. Las lesiones del menisco izquierdo representaron 2 casos. Hubo un caso de lesión medial en ambas rodillas. Las medidas preventivas correspondientes se presentan según la causa de la lesión. Conclusión: Las causas de las lesiones de menisco en los ciclistas incluyen una fuerza insuficiente de la rodilla, métodos de entrenamiento inadecuados, fatiga física y esfuerzos localizados a largo plazo. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Sports rehabilitation in athletes with meniscal lesions based on electroacupuncture associated with sports therapy / Reabilitação esportiva de atletas com lesão meniscal baseada em eletroacupuntura combinada à terapia esportiva / Rehabilitación deportiva de atletas con lesión meniscal basada en electroacupuntura combinada con la terapia deportiva

ABSTRACT Introduction: Meniscal injury is a common condition that can lead to disability due to pain and proprioceptive failure, requiring immediate attention. Combination therapies involve advanced approaches aiming to accelerate rehabilitation in athletes, and electroacupuncture presents therapeutic benefits, although there is still no evidence of its combination with sports therapy. Objective: This paper analyzes the performance of sports rehabilitation in athletes with meniscal lesions using electroacupuncture combined with sports therapy. Methods: The intervention in the control group was based on a traditional range of motion work, muscle strength, proprioceptive training, and other exercise therapies, while the experimental group received a 30 min electro-acupuncture protocol three times a week for four consecutive weeks. The surrogate data (gender, age, disease course, location) are the same. Before treatment, joint activity, muscle strength, total joint scale score of the LYSHOLM questionnaire, and other observational indices were measured during the 6th and 12th week of treatment. The non-parametric statistical method and T-test were used to analyze the changes of each index before and after treatment. After 12 weeks of treatment, the difference between the experimental group and the combination before treatment was significant. Results: The treatment effect of the experimental group was significantly better than the control group. Conclusion: The effect of sports rehabilitation of athletes with meniscus injury based on electroacupuncture combined with sports therapy showed high resolutive application value, indicating an alternative for non-surgical treatment in knee meniscus injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A lesão meniscal é um acometimento comum que pode gerar incapacitação por dor e falha proprioceptiva, exigindo atenção imediata. Terapias combinadas envolvem abordagens avançadas com o objetivo de acelerar a reabilitação nos atletas, e a eletroacupuntura apresenta benefícios terapêuticos, embora ainda não possua evidencias de sua combinação com a terapia esportiva. Objetivo: Analisar o desempenho da reabilitação esportiva em atletas com lesão meniscal utilizando eletroacupuntura combinada à terapia esportiva. Métodos: A intervenção no grupo controle baseou-se no trabalho tradicional de amplitude de movimento, força muscular, treinamento proprioceptivo e outros tipos de terapias de exercício enquanto que ao grupo experimental foi adicionado um protocolo de eletro-acupuntura de 30 minutos de duração, 3 vezes por semana durante 4 semanas consecutivas. Os dados de substituição (sexo, idade, curso de doença, localização) são basicamente os mesmos. Antes do tratamento, a atividade articular, a força muscular, o escore total da escala articular do questionário LYSHOLM e outros índices de observação foram medidos na 6ª e 12ª semana do tratamento. O método estatístico não paramétrico e teste-T foram utilizados para analisar as alterações de cada índice antes e depois do tratamento. Após 12 semanas de tratamento, a diferença entre o grupo experimental e a combinação antes do tratamento foi significativa. Resultados: O efeito de tratamento do grupo experimental foi significativamente melhor do que o grupo controle. Conclusão: O efeito de reabilitação esportiva de atletas com lesão meniscal baseada em eletroacupuntura combinada à terapia esportiva demonstrou alto valor de aplicação resolutiva, indicada como alternativa para o tratamento não cirúrgico em lesões no menisco do joelho. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Resumen Introducción: La lesión meniscal es una lesión común que puede causar incapacidad por dolor y fallo propioceptivo, requiriendo atención inmediata. Las terapias combinadas implican enfoques avanzados con el objetivo de acelerar la rehabilitación en los deportistas, y la electroacupuntura presenta beneficios terapéuticos, aunque todavía no hay pruebas de su combinación con la terapia deportiva. Objetivo: Analizar el rendimiento de la rehabilitación deportiva en atletas con lesión meniscal utilizando electroacupuntura combinada con la terapia deportiva. Métodos: La intervención en el grupo de control se basó en el trabajo tradicional de amplitud de movimiento, fuerza muscular, entrenamiento propioceptivo y otros tipos de terapias de ejercicio, mientras que al grupo experimental se le añadió un protocolo de electroacupuntura de 30 minutos de duración, 3 veces a la semana durante 4 semanas consecutivas. Los datos sustitutivos (sexo, edad, evolución de la enfermedad, localización) son básicamente los mismos. Antes del tratamiento, se midieron la actividad articular, la fuerza muscular, la puntuación total de la escala articular del cuestionario LYSHOLM y otros índices de observación en la 6ª y 12ª semana de tratamiento. Se utilizó el método estadístico no paramétrico y la prueba T para analizar los cambios de cada índice antes y después del tratamiento. Tras 12 semanas de tratamiento, la diferencia entre el grupo experimental y la combinación antes del tratamiento era significativa. Resultados: El efecto del tratamiento del grupo experimental fue significativamente mejor que el del grupo de control. Conclusión: El efecto de la rehabilitación deportiva de atletas con lesión de menisco basada en la electroacupuntura combinada con la terapia deportiva mostró un alto valor de aplicación resolutiva, indicada como alternativa de tratamiento no quirúrgico en las lesiones de menisco de rodilla. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Correlation and consistency of three methods for tear evaluation in the diagnosis of dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the correlation and consistency of three tear assessment methods in the diagnosis of dry eye, which include the Schirmer Ⅰ test(SⅠt), tear meniscus height(TMH)measurement and a new generation of tear detection technology-Strip meniscometry tube(SMTube).METHODS: A diagnostic test study. A total of 183 dry eye outpatients(183 right eyes)in the Dry Eye Center of Henan Eye Hospital were enrolled from May to June 2021. The SⅠt, TMH and SMTube were performed on all patients, and the correlation and consistency of the measurement results were analyzed.RESULTS:The ocular surface disease index(OSDI)of all included patients was 43.75(31.25, 58.33), noninvasive breakup time(NIBUT)was 7.26(4.97, 9.37)s, and the results of SⅠt, TMH and SMTube were 6(2, 12)mm/5min, 0.18(0.14, 0.22)mm and 5(3,8)mm/5s, respectively; The results of correlation analysis: TMH was positively correlated with SMTube(rs=0.751, P<0.001), however, SⅠt had no correlation with TMH(rs=0.139, P=0.060)and SMTube(rs=0.019, P=0.799). The results of consistency analysis: TMH showed good consistency with SMTube(Kappa=0.794, P=0.044), however, SⅠt showed poor consistency with TMH(Kappa=0.271, P=0.074)and SMTube(Kappa=0.193, P=0.070)respectively.CONCLUSION:SMTube is a new, simple and convenient tool for evaluating tear volume. It has a good correlation and consistency with TMH measurement results. Therefore, it can replace TMH measurement, but cannot replace SⅠt in clinical application.

AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair

@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

The Wave Sign Correlates with the Posterior Horn Medial Meniscus (PHMM) Tear in the Anterior Cruciate Ligament (ACL) Deficient Knee

@#Introduction: A posterior horn medial meniscus (PHMM) tear subjects the knee to pathological stresses, especially in the setting of a deficient anterior cruciate ligament (ACL). These PHMM tears have to be surgically addressed, however they remain a diagnostic challenge. Hence, this study aims to evaluate the wave sign as an arthroscopic diagnostic aid for the PHMM tear which may be occult. Materials and methods: This is a retrospective study of 61 consecutive patients (62 ACL-deficient knees) who underwent arthroscopic primary ACL reconstruction between September 2017 and August 2018. We defined PHMM tears as tears located in the posterior one-third of the medial meniscus. Root tears and ramp lesions were included in our analysis. The arthroscopic findings were recorded after a comprehensive arthroscopic survey. Results: In the sample of ACL-deficient knees, 44 (71.0%) had a concomitant medial meniscus tear. The most common location for the tear was in the posterior horn (81.8%). There were seven occult PHMM tears, not described by the radiologist or identified by the operating surgeon on the preoperative magnetic resonance imaging. The wave sign was identified in 10 (16.1%) knees, all confirming the presence of the PHMM tear. A positive correlation was found between the presence of the wave sign and the PHMM tear. Conclusions: The wave sign has a statistically significant but weak positive correlation with the presence of the PHMM. We view the wave sign as a valuable arthroscopic cue to rule-in the presence of the PHMM tear in the ACLdeficient knee.

Inferior Healing Rate in Isolated Meniscal Repair than that in Meniscal Repair with Concomitant ACL Reconstruction Evaluated with MRI

@#Introduction: Isolated meniscal repair has been suggested as one of the contributing factors in unhealed meniscal repair. The purpose of this study was to compare the healing rate between isolated meniscal repair and meniscal repair with concomitant anterior cruciate ligament reconstruction (ACLR) using a standardised assessment method after propensity score matching. Materials and methods: Accuracy of the Crues' grading system for meniscal healing was validated using second-look arthroscopy as the reference standard in 17 patients. Propensity score matching (one-to-one) was performed between 26 patients who underwent isolated meniscal repair and 98 patients who underwent meniscal repair with concomitant ACLR. Patients were matched for sex, age, side and zone of the meniscal repair, and number of sutures. Healing rates at one year which were evaluated with magnetic resonance imaging (MRI) were compared between the two groups. Results: The sensitivity and specificity of the Crues' grading system on multiple plane MRI for meniscal healing were 100% and 83.3%, respectively. Both the isolated meniscal repair group and the meniscal repair with concomitant ACLR group included 21 patients after propensity score matching. Baseline characteristics did not differ significantly between the two groups. The healing rate was significantly lower in the isolated meniscal repairs group (14.3%) than in the meniscal repair concomitant with ACLR group (47.6%, P=0.04). Conclusion: The healing rate for isolated meniscal repair using a standardised MRI assessment method was inferior to that of meniscal repair with concomitant ACLR after propensity score matching.

Functional exercise on patients after sports meniscus injury / Exercício funcional em pacientes após lesão esportiva de menisco / Ejercicio funcional en pacientes tras lesión deportiva de menisco

ABSTRACT Introduction Knee meniscus injury is a common sports injury, and minimally invasive surgery under knee arthroscopy has become an ideal method to treat meniscus injuries. This surgery rehabilitation has been improved, and several studies on the effects of functional exercise in the range of treatment are still inconclusive. Objective Study the functional exercise rehabilitation effects in patients after sports meniscus injury. Methods Twenty patients with meniscus-medial injury being operated on were selected, including eight men and 12 women. They were randomly divided into neuromuscular and strength training groups (11). Signs and symptoms were assessed before and eight weeks after treatment. JOA score indices and gait tests were compared. The impact of rehabilitation differences was evaluated in each group. Results Eight weeks after rehabilitation in both groups, the scores of the strength training group were higher than the neuromuscular group; the difference between the groups was statistically significant (P<0.05). Conclusion Functional exercise accelerates joint recovery, reflected in increased strength of adjacent muscles. The muscle and joint training effects on postoperative meniscus injury are worthy of recognition. The baropodometry revealed distinctions in walking patterns between different rehabilitation methods. From the perspective of this research, rehabilitation methods combined with proprioceptive exercises are complementary. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução Lesão no menisco do joelho é uma lesão esportiva comum e a cirurgia minimamente invasiva sob artroscopia no joelho tornou-se um método ideal para tratar lesões no menisco. A reabilitação dessa cirurgia vem sendo aprimorada e vários estudos sobre os efeitos do exercício funcional no leque de tratamento ainda são inconclusivos. Objetivo Estudar os efeitos da reabilitação com exercício funcional em pacientes após a lesão esportiva do menisco. Métodos Foram selecionados 20 pacientes com lesão menisco-medial a serem operados, incluindo 8 homens e 12 mulheres. Divididos aleatoriamente em 2 grupos: grupo de treinamento neuromuscular e grupo de treinamento força (11). Sinais e sintomas foram avaliados antes do tratamento e 8 semanas após o tratamento, índices de score JOA e teste de marcha foram comparados, as diferenças do impacto da reabilitação em cada grupo foram avaliadas. Resultados Oito semanas após a reabilitação dos dois grupos, os escores do grupo de treinamento de força foram superiores aos do grupo neuromuscular, a diferença entre os grupos foi estatisticamente significante (P<0,05). Conclusão O exercício funcional acelera a recuperação das articulações, refletida no aumento da força dos músculos adjacentes. O efeito do treinamento muscular e articular na lesão do menisco pós-operatório é digno de reconhecimento. A baropodometria revelou distinções no padrão de marcha entre os diferentes métodos de reabilitação. Na perspectiva desta pesquisa, métodos de reabilitação combinados com exercícios proprioceptivos são complementares. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción La lesión de menisco de la rodilla es una lesión deportiva común y la cirugía mínimamente invasiva por artroscopia de rodilla se ha convertido en un método ideal para tratar las lesiones de menisco. La rehabilitación de esta cirugía ha sido mejorada y varios estudios sobre los efectos del ejercicio funcional en el rango de tratamiento aún no son concluyentes. Objetivo Estudiar los efectos de la rehabilitación con ejercicio funcional en pacientes tras una lesión de menisco deportiva. Métodos Se seleccionaron 20 pacientes con lesión de menisco-medial para ser operados, incluyendo 8 hombres y 12 mujeres. Se dividieron aleatoriamente en 2 grupos: grupo de entrenamiento neuromuscular y grupo de entrenamiento de fuerza (11). Se evaluaron los signos y síntomas antes del tratamiento y 8 semanas después del mismo, se compararon los índices de puntuación JOA y la prueba de marcha, y se evaluaron las diferencias del impacto de la rehabilitación en cada grupo. Resultados Ocho semanas después de la rehabilitación para ambos grupos, las puntuaciones del grupo de entrenamiento de fuerza fueron mayores que las del grupo neuromuscular, la diferencia entre los grupos fue estadísticamente significativa (P<0,05). Conclusión El ejercicio funcional acelera la recuperación de la articulación, lo que se refleja en el aumento de la fuerza de los músculos adyacentes. El efecto del entrenamiento muscular y articular en la lesión postoperatoria del menisco es digno de reconocimiento. La baropodometría reveló diferencias en el patrón de la marcha entre los diferentes métodos de rehabilitación. Desde la perspectiva de esta investigación, los métodos de rehabilitación combinados con los ejercicios propioceptivos son complementarios. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores / Medidas de desfechos clínicos na meniscectomia artroscópica: Pontuações de joelho segundo médicos e pacientes

Abstract Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [p< 0.001], Lysholm [p= 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [p< 0.001], but not in the IKDC Examination [p= 0.332]. However, the IKDC Subjective score (p= 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Resumo Objetivo O objetivo do presente estudo foi investigar a diferença entre instrumentos de desfechos preenchidos por médicos e pacientes na detecção de melhora após a meniscectomia artroscópica para tratamento de rupturas de menisco. Métodos Trinta e quatro pacientes com rupturas de menisco foram avaliados de forma prospectiva usando 9 medidas de desfechos clínicos. Os cinco instrumentos de avaliação de joelho respondidos por médicos foram o Escore de Atividade de Tegner, o Escore de Joelho de Lysholm, o Escore de Joelho de Cincinnati, o Escore de Exame do Joelho do International Knee Documentation Committee (IKDC, na sigla em inglês) e o Escore de Classificação do Menisco de Tapper e Hoover. Os quatro instrumentos de avaliação do joelho respondidos por pacientes foram o Escore Subjetivo do Joelho do IKDC, a Pesquisa de Desfecho de Joelho - Escala de Atividades de Vida Diária (KOS-ADLS, na sigla em inglês), o Formulário Curto de Pesquisa em Saúde de 12 Itens (SF-12, na sigla em inglês) e o Escore de Desfecho de Osteoartrite e Lesões no Joelho (KOOS, na sigla em inglês). Vinte e nove dos 34 pacientes foram submetidos a uma meniscectomia artroscópica e reavaliados com todos os 9 instrumentos na sua consulta de acompanhamento. Resultados Uma melhora longitudinal significativa foi observada em 4 dos 5 instrumentos respondidos por médicos (Tegner [p< 0,001], Lysholm [p= 0,004], Cincinnati [p= 0,002] e Tapper e Hoover [p< 0,001], mas não no IKDC [p= 0,332]). Por outro lado, o Escore Subjetivo do Joelho do IKDC (p= 0,021) foi o único instrumento respondido por pacientes a demonstrar melhora pós-operatória significativa. Conclusão De modo geral, os instrumentos respondidos por médicos foram considerados inconsistentes em relação àqueles respondidos por pacientes. O modo de administração dos instrumentos pode ter influência significativa nos resultados, tanto para fins de pesquisa quanto para a prática clínica. A combinação de um instrumento respondido pelo médico com um instrumento respondido pelo paciente pode ser uma abordagem mais equilibrada para a avaliação e a quantificação das rupturas do menisco e do desfecho após a meniscectomia artroscópica.

Retrospective Cross Sectional MRI Study of Morphometry of Menisci of Knee Joint

Introduction: Meniscal tears are commonly encountered in clinical practice and cause significant musculoskeletal morbidity. Most of the data available on Morphometry of menisci in Indian population are through cadaveric studies and very few MRI studies are available to substantiate the available data. Aim of the study: To gather data on the Morphometry of menisci in South Indian population and compare it with the existing literature. Material and Method: 100 MRI images collected retrospectively were used to study menisci. Height and width of MM and LM were measured both in sagittal and coronal planes. Results: It was observed that in both sexes the height of the Anterior horn of Medial meniscus was significantly higher than that of Lateral meniscus. Width of the Anterior horn and body showed significantly higher values in Lateral meniscus whereas width of Posterior horn of Medial meniscus showed significantly higher values in both sexes. Height of Medial meniscus in all the segments was higher in males though the difference was significant only in anterior horn and Posterior horn segments. Height of Lateral meniscus was significantly higher in males in all the segments. Conclusion: Results of this study will add to the existing literature on the Morphometry of menisci and will serve as a database for patients undergoing meniscal allografts.