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.

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.

Does partial meniscectomy affect anterior cruciate ligament reconstruction results? / A meniscectomia parcial afeta os resultados da reconstrução do ligamento cruzado anterior?

ABSTRACT Objective: To compare the application of partial meniscectomy concomitant with primary ACL reconstruction, using the graft from the patellar tendon with individuals who underwent only ACL reconstruction, in clinical functional criteria and degree of osteoarthritis (OA), after 10 years of the surgical process. Methods: This is a retrospective cross-sectional study with 37 patients who underwent ACL reconstruction with a graft from the patellar tendon, associated or not with partial meniscectomy, divided into 2 groups: with meniscal injury (n = 22) and without meniscal injury (n = 15). Anthropometric data and four outcome measures were used to analyze the results: SF-36 questionnaire, arc of motion assessment, Knee injury and Osteoarthritis Outcome Score (KOOS), and Ahlbäck Radiographic Classification. Results: No differences were found for health-related quality of life, arc of motion, functional condition and knee OA severity/grade in patients who underwent partial or no meniscectomy in conjunction with ACL reconstruction (p > 0.05). Conclusion: Participants who underwent partial meniscectomy in conjunction with primary ACL reconstruction with a graft from the patellar tendon, after 10 years of the surgical process, showed no significant differences in the clinical functional criteria and severity of knee OA, compared to individuals who underwent only ACL reconstruction. Level of Evidence II, Prognostic study.

RESUMO Objetivo: Comparar a realização da meniscectomia parcial concomitante à reconstrução do LCA (RLCA) primária, utilizando o enxerto do tendão patelar, com indivíduos que realizaram apenas a RLCA, em critérios clínico-funcionais e grau de osteoartrite (OA), após 10 anos do processo cirúrgico. Métodos: Trata-se de um estudo retrospectivo transversal, com 37 pacientes que realizaram a RLCA com enxerto do tendão patelar, associada ou não à meniscectomia parcial, divididos em dois grupos: com lesão meniscal (n = 22) e sem lesão meniscal (n = 15). Dados antropométricos e quatro medidas de desfecho foram utilizados para análise dos resultados: questionário SF-36, avaliação do arco de movimento, Knee Injury and Osteoarthritis Outcome Score (KOOS) e Classificação Radiográfica de Ahlbäck. Resultados: Não existem diferenças em termos de qualidade de vida relacionada à saúde, amplitude de movimento, condição funcional e severidade/grau de OA do joelho em pacientes que realizaram ou não meniscectomia parcial em conjunto com a RLCA (p ≥ 0.05). Conclusão: Os participantes que realizaram meniscectomia parcial em conjunto com a RLCA primária com enxerto do tendão patelar, após 10 anos do processo cirúrgico, não demonstraram diferenças significativas nos critérios clínico-funcionais e gravidade da OA do joelho, comparados aos indivíduos que realizaram apenas a RLCA. Nível de Evidência II, Estudos prognósticos.

Artroscopia y fibulectomía parcial simultánea en pacientes con gonartrosis y deformidad en varo / Simultaneous arthroscopc and partial fibulectomy in patients with knee osteoarthritis and varus knee

RESUMEN Fundamento: la gonartrosis es una enfermedad frecuente relacionada con el incremento de la calidad y expectativa de vida de la población, en la evolución de este padecimiento existen factores que aceleran sus manifestaciones entre ellos la deformidad en varo. Objetivo: evaluar los resultados de la técnica quirúrgica combinada de artroscopia, fibulectomía parcial y proximal en pacientes con gonartrosis y deformidad en varo. Métodos: se realizó un estudio cuasi experimental modalidad antes y después sin grupo de control en 25 pacientes con el diagnóstico de gonartrosis primaria asociada a deformidad en varo, en el Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde abril 2016 a agosto de 2019. La investigación tiene un nivel de evidencia II recomendación B. Resultados: predominio del sexo femenino al masculino con una razón de 2,12 a 1. La enfermedad intrarticular más frecuente fue la lesión de meniscos y cartílagos grados III/IV. Se encontró significación entre un antes y después al aplicar las escalas evaluativas. El procedimiento artroscópico más empleado fue la meniscectomía. Conclusiones: la realización simultanea de artroscopia y fibulectomía parcial proximal es una técnica efectiva y sencilla con un mínimo de complicaciones, permite corregir la deformidad angular de la extremidad, al mismo tiempo de tratar lesiones intrarticulares, en especial las de menisco y cartílago.

ABSTRACT Background: gonarthrosis is a frequent entity related to the increase in the quality and life expectancy of the population, in the evolution of this disease there are factors that accelerate its manifestations including varus deformity. Objective: to evaluate the results of the combined surgical technique of arthroscopy, partial and proximal fibulectomy in patients with gonarthrosis and varus deformity. Methods: a quasi-experimental study was performed before and after without a control group in 25 patients with the diagnosis of primary gonarthrosis associated with varus deformity, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from April 2016 to August 2019. The investigation has a level of evidence II recommendation B. Results: female prevailed to male sex with a ratio of 2.12 to 1. The most common intra-articular entity was the meniscus lesion and cartilage grades III/IV. Significance was found between a before and after applying the evaluation scales. The most commonly used arthroscopic procedure was meniscectomy. Conclusions: the simultaneous performance of arthroscopy and proximal partial fibulectomy is an effective and simple technique with a minimum of complications, it allows correcting the angular deformity of the limb, while treating intra-articular lesions, especially those of meniscus and cartilage.

Comportamiento de pacientes con plica sinovial de la rodilla / Behavior of patients with knee plica synovialis

RESUMEN Fundamento: la plica sinovial de la rodilla es una de las causas de dolor anterior, se presenta de forma asilada o combinada a otras afecciones intrarticulares. El tratamiento quirúrgico mediante la vía artroscópica es el más usado en la actualidad. Objetivo: evaluar los resultados del tratamiento artroscópico en pacientes con plica sinovial. Métodos: se realizó un estudio observacional analítico con un nivel de evidencia III recomendación C en 181 pacientes con el diagnóstico clínico, imagenológico y artroscópico de plica sinovial en el Hospital Universitario Manuel Ascunce Domenech desde el 1 de enero de 2012 al 31 de enero de 2018. La población de estudio estuvo dada por todos aquellos enfermos en que se confirmó la presencia de plica sinovial patológica mediante la vía artroscópica, edad de 18 años o más y respuesta limitada o nula al tratamiento conservador ambulatorio por más de seis semanas. Resultados: el promedio de edad de los pacientes estudiados fue de 45,5 años, la razón sexo femenino-masculino fue de 1,9 a 1. Predominó la plica mediopatelar. Las lesiones de cartílago grados III/IV fueron las más encontradas, así como la afección monocompartimental patelofemoral. El desbridamiento y la meniscectomía fueron los procedimientos artroscópicos más realizados después de la sección de la plica. La respuesta clínica de los pacientes a los seis meses fue satisfactoria. Conclusiones: el tratamiento artroscópico de la plica sinovial es efectivo, en especial para pacientes con ausencia de otras lesiones intrarticulares.

ABSTRACT Background: knee plica synovialis is a common cause of anterior knee pain; it could show up isolated or associated to other intra-articular conditions. Nowadays, the surgical arthroscopic treatment is the most used way. Objective: the objective of this study was to evaluate the arthroscopic treatment in patients with plica synovialis of the knee. Methods: an analytic and observational study, with a level of evidence 3, recommendation C was performed in 181 patients with the clinical diagnosis of plica synovialis of the knee according to clinical, imaging and arthroscopic criteria in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 1st, 2012 to January 31th, 2018. The population of the research was the amount of patients who had had the confirmation of having pathologycal plica synovialis through the arthroscopic way, 18 year-old patients and over and also limited or non-response to conservative ambulatory treatment for more than six weeks. Results: the average age was 45,5 years, female-male ratio was 1,9 to 1. The plica synovialis mediopatellaris prevailed. Cartilage lesions levels 3 and 4 were the most found as well as mono-compartiment affecting patellofemoral joint. Debridement and meniscectomy were the most common used arthroscopic procedures after plica section. Clinical results were good at six months. Conclusions: the arthroscopic treatment of plica synovialis is effective, especially in patients with absence of other intrarticular conditions.

A Prospective Study of Comparing Functional Outcome in Case of Meniscal Injury Treated with Arthroscopic Meniscectomy Vs Meniscal Repair

Background: A meniscal tear is the most common injury to theknee, occuring from both athletic events and activities of dailyliving. Generally, the results of repair have been good, withhigh long-term success rates. This study aims to compare thefunctional result of arthroscopic meniscal repair andarthroscopic meniscectomy.Materials & Methods: This study was carried out in theDepartment of Orthopaedics, Mahatma Gandhi MedicalCollege and Hospital, Jaipur for comparing the functionaloutcome of arthroscopic meniscectomy and meniscal repair. 47of Meniscectomy and 35 of Meniscal Repair was done in ourstudy. Statistical analysis was done using SPSS (Statisticalpackage for Social science) 16.0 software. Categoricalvariables are expressed as frequencies and percentages.Results: Our study showed that the mean age for MeniscalRepair was 32.86 vs 29.89 for Meniscectomy. There was nosignificant gender specific difference while comparing bothgroups with a p-value of 1.0. The mean follow-up for both thegroups were same of 1.2 years with a non-significant p-value of0.78. The duration of surgery was 84.5 minute in meniscalrepair as compared to 45.6 minute. There is significantdifference in surgical time required with p-value of 0.0001. Nosignificant differences for Lysholm Score and Tegner activitylevel reduction, hkss, womac and vas scores in such a shortterm follow up.Conclusion: We concluded that more randomized studies withlarger sample sizes and longer follow-up are needed to furthershow the benefits of meniscal repair in terms of patientsperceptions of the outcome and prevention of posttraumaticosteoarthritis.

Surgically induced degenerative changes in the femorotibial joints by total medial meniscectomy in minipigs closely resemble late-stage osteoarthritis / 대한수의학회지

Animal models of osteoarthritis (OA) have played a key role in understanding the etiology of OA and in the development of new therapeutic strategies. Although pigs have an advantage as an animal disease model due to their similarity to humans, there are few studies on the induction of OA in minipigs. Therefore, this study aimed to characterize disease progression of OA in total medial meniscectomy (TMM)-operated skeletally mature minipigs, up to day 180 postoperatively. There were no significant alterations in vital signs or hematological indices throughout the observation period. However, clinical manifestations of OA in the medial femoral condyles of TMM-operated minipigs were progressive, depending on postoperative duration, with respect to osteophytes formation and roughened surfaces on radiological observation, cartilage erosion under macroscopic examination, and severe cartilage defects including fibrillation, vertical fissures, and cartilage denuding on histopathological observation, with the highest score indicating late-stage OA on day 180 and without indicating apparent variation between subjects. In particular, the lateral femoral condyles were also degenerated, possibly due to localization of weight-bearing from both menisci to the lateral meniscus. Therefore, TMM in minipigs is suitable for reproducible induction of degenerative changes in the femorotibial joints that closely resemble late-stage OA, and is suitable for use in further research.

Core Decompression for Post-Arthroscopic Osteonecrosis of the Lateral Tibial Plateau

Post-arthroscopic osteonecrosis is a rare complication that mostly occurs in the over 50s. It most commonly occurs in the medial femoral condyle, followed by the lateral femoral condyle then medial tibial plateau. We report the first case of lateral tibial plateau osteonecrosis in a young patient after arthroscopic lateral meniscectomy. This patient developed progressively deteriorating symptoms after uncomplicated arthroscopy; with a subsequent magnetic resonance imaging (MRI) showing bone oedema and some overlying cartilage damage. Conservative measures were unsuccessful, so core decompression was undertaken. This has resulted in improved symptoms and subsequent follow-up MRI demonstrates resolution of oedema with no progressive cartilage change. This is a rare condition with a poor outcome, usually resulting in arthroplasty. This technique may work in the younger patient. However, since post-arthroscopic osteonecrosis is so rare in this age group, there is limited evidence for its success, and it should be evaluated with further study.

National Trends of Meniscectomy and Meniscus Repair in Korea

BACKGROUND: Meniscus surgeries are frequently performed in orthopaedics. However, their current status is not well known in many countries, including Korea. This study aimed to investigate the national trends of meniscus surgery in Korea. METHODS: Information from the national database was acquired through the Korean Health Insurance Review and Assessment Service from 2010 to 2017. All cases coded as meniscectomy or meniscus repair were included. The total number and incidence of cases of meniscus surgery per 100,000 persons were determined, and the results were stratified by age and gender. The meniscus repair ratio for the total number of meniscus surgeries was evaluated. RESULTS: The total number and incidence of meniscectomy cases were 65,752 and 137, respectively, in 2010, which increased to 74,088 and 154, respectively, in 2017. The number of meniscectomies increased by 12.67% in 8 years. The total number and incidence of meniscus repair cases were 9,055 and 18, respectively, in 2010, which increased to 14,947 and 31 in 2017. The number of meniscus repairs increased by 65.04%. The meniscus repair ratio was 12.1% in 2010, which increased to 16.8% in 2017. The highest peak was noted for patients who underwent meniscus surgeries in their 50s and 60s. Meniscectomy was performed more frequently in women (57%) than in men (43%), whereas repair was performed more frequently in men (54%) than in women (46%) over the study period. CONCLUSION: The total number and incidence of meniscus surgeries increased from 2010 to 2017; the number and incidence of meniscus repair procedures increased more rapidly than those of meniscectomy, with the peak treatment age for both surgeries being in the 50s and 60s. The current study will contribute to understanding the epidemiology of meniscus surgery, its prevention, and cost-saving measures in Korea.

Prevalence and Predictors of Patellofemoral Osteoarthritis after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

BACKGROUND: The present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors. METHODS: Of the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used. RESULTS: Ninety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development. CONCLUSIONS: Significant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.

Discoid Medial Meniscus Tear, with a Literature Review of Treatments

The present study reports our experience of treating four cases of symptomatic discoid medial meniscus, three of which were bilateral. We performed partial meniscectomy with a four-portal technique using a knife leaving a 6 mm peripheral margin after confirmation of magnetic resonance imaging findings. Clinical results were assessed at the end of 2-year follow-up using the Knee Injury and Osteoarthritis Outcome Score and a visual analogue scale. We obtained satisfactory clinical results without recurrence of the symptoms in all cases.

Arthroscopic debridement and meniscectomy in treatment of meniscus injury combined with osteoarthritis / 中国内镜杂志

Objective To investigate the effect of arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage. Methods 156 cases diagnosed with moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage were collected from October 2011 to October 2014. Lysholm knee score and preoperative examinations such as anteroposterior, lateral, axial radiographs, the standing full leg length X-ray film and MRI scan of the knee were recommended to definitively understand the osteoarthritis staging and meniscus injury grading. All patients were treated with arthroscopic debridement and meniscectomy. After operation, physical rehabilitation exercises and regular clinical follow-up were carried out as planned. The Lysholm knee score data from preoperation and terminal follow-up was statistical analyzed. Results No patient experienced any perioperative and postoperative complications. Statistical analysis showed that the Lysholm knee score of postoperation was significantly higher than that of preoperation [(87.3 ± 7.9) vs (67.5 ± 4.9), P < 0.05). Conclusion Arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage, gains beneficial effects for its minimal invasion and quick recovery.

Arthroscopic Meniscectomy for Medial Meniscus Horizontal Cleavage Tears in Patients under Age 45

PURPOSE: The purpose of this study was to evaluate the demographics, clinical features, and outcomes of arthroscopic partial meniscectomy (APM) for isolated medial meniscus horizontal cleavage tears (MMHCTs) in patients under 45 years of age. MATERIALS AND METHODS: We retrospectively reviewed 98 patients (100 knees) under 45 years who underwent APM for MMHCTs. Clinical outcomes were assessed using International Knee Document Committee (IKDC) subjective core, Tegner activity scale, visual analog scale (VAS) pain score, and a question on the symptom relief. RESULTS: 79% were male and 70% had no trauma. The mean symptom duration was 10 months. At arthroscopy, a flap tear was identified in 75%. At a mean of 19-month follow-up, the IKDC subjective score, Tegner activity scale, and VAS pain score were significantly improved compared to the preoperative values (p=0.025, p=0.043, and p=0.032, respectively). While 85% were free of symptoms, 15% had persistent pain. No significant differences in outcomes were observed based on the tear type and the presence of flap tears. No progression or development of radiographic degenerative changes was observed in all knees. CONCLUSIONS: Demographics of MMHCTs under age 45 showed a male dominance and higher frequency of non-traumatic tears. APM was beneficial to symptomatic HCTs in this cohort during the short-term follow-up. Type of HCTs and combined flap tears did not affect clinical outcomes.

Effects of arthroscopic meniscus-plasty on meniscal lesions / 中国基层医药

Objective To analyze the therapeutic effect of arthroscopic meniscus -plasty in the treatment of meniscal lesions.Methods Patients admitted to our hospital′s department of orthopedics were reviewed,and they were divided into two groups according to the surgical methods.The observation group was treated with meniscus -plasty,while the control group was treated with meniscectomy.The Ikeuchievaluation standard was compared at the time of the last follow -up.The Lysholm and IKDC score were compared before and after treatment.Results The excellent -good rates were 86.5% in the observation group,which was significantly higher than that in the control group (62.8%,χ2 =5.768,P =0.016).There was no difference in Lysholm and IKDC score between the two groups before treatment[(63.4 ±10.8)points vs.(61.7 ±9.5 )points,P >0.05;(54.6 ±7.5 )points vs.(55.1 ± 8.3)points,P >0.05].After treatment,the Lysholm[(92.5 ±5.9)points and (90.4 ±6.6)points]and IKDC scores[(85.4 ±9.2)points and (83.6 ±9.8)points]were all significantly increased (t =14.383,16.269,15.784, 14.552,all P 0.05).At the time of the last follow-up,both Lysholm scores[(78.5 ±8.2)points]and IKDC scores[(75.5 ±7.9)points]were decreased in the control group (t =7.413,4.220,all P <0.05),and there were significant difference between the two groups (t =6.165,4.029,all P <0.05).Conclusion Meniscus -plasty and meniscectomy have similar short -term effects on meniscal lesions,but meniscus -plasty may show better effects in the long term.

Clinical Results of Contralateral Arthroscopic Meniscectomy Performed with Unilateral Total Knee Arthroplasty: Minimum 3-year Follow-up

PURPOSE: We assessed the clinical outcome of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: From May 1999 to June 2006, 23 patients underwent unilateral total knee arthroplasty and contralateral arthroscopic meniscectomy at the same time. All patients were women and followed for at least 36 months, except 2 patients who died. For clinical assessment, range of motion of the knee joint, Hospital for Special Surgery (HSS) knee score and the Lysholm knee score were evaluated preoperatively and at the last follow-up. At arthroscopy, meniscal pathology and cartilage changes were recorded and classified according to the Outerbridge scale. Progression of osteoarthritis in the contralateral knee to subsequent TKA was also assessed. RESULTS: The mean age of the 21 patients was 67.1 years and the mean follow-up period was 5.7 years. All of the patients were diagnosed with osteoarthritis and had Outerbridge grade 3 or 4 cartilage changes. Eight of the 21 patients had subsequent TKA at an average of 3.1 years after the index operation. The other 13 patients had no further surgery and clinical results including the HSS knee score and the Lysholm score were improved from 74.5 and 60.6 preoperatively to 90.8 and 82.4 postoperatively, respectively (p<0.001). CONCLUSIONS: Contralateral arthroscopic meniscectomy performed simultaneously with unilateral TKA produces relatively good results regardless of the presence of cartilage degeneration.

Clinical effect of total knee arthroplasty in treatment of patients with valgus knee deformity after lateral meniscectomy / 中国综合临床

Objective To evaluate the clinical efficacy of total knee arthroplasty(TKA)in patients of osteo-arthris with valgus knee deformity after lateral meniscectomy(LMT). Methods Twenty six cases of osteo-arthris with valgus knee deformity after lateral meniscectomy were treated with total knee arthroplasty. Operation evaluations including the range of motion(ROM),the tibial and femur angle(T-F angle),Knee Society Score System(KSS)and the function score were performed as follow-up. Results The median follow-up periods was 22 months and ranged from 5 months to 3 years. The average ROM improved from 96° preoperatively to 116° at postoperatively. The average KSS improved from 22. 5 points preoperatively to 84. 4 points postoperatively. The average function score improved from 25. 5 points preoperatively to 84. 4 points postoperatively,and the average T-F angle was corrected from 22°( 13° - 31°) of valgus preoperatively to 7. 6°( 0° - 9°) of valgus postoperatively. Conclusion The TKA can provide excellent in patients undergoing osteo-arthris with valgus knee deformity after lateral meniscectomy.

Bilaterally Simultaneous Medial and Lateral Discoid Menisci / 대한정형외과학회잡지

Most discoid menisci are lateral and medial discoid meniscus is very rare. Several articles have reported on bilateral lateral discoid menisci as well as bilateral medial discoid menisci, and a few articles have reported simultaneous medial and lateral discoid menisci in the same knee. Only one case of simultaneous medial and lateral discoid menisci, bilaterally, has been reported. We present another case of a male patient with bilaterally simultaneous medial and lateral discoid menisci, diagnosed with magnetic resonance imaging and arthroscopy. The patient was treated by arthroscopic partial meniscetomy.

Correlação entre ruptura de ligamento cruzado cranial e lesão de meniscomedial em cães / Correlation between cranial cruciate ligament rupture and meniscal tears in dogs

O presente trabalho correlacionou o tempo de ruptura do ligamento cruzado cranial (RLCCr) à lesão em menisco medial e ao tipo de lesão observada em cães tratados por estabilização dinâmica (osteotomias) ou estática (sutura fabelo-tibial). Este estudo retrospectivo avaliou os registros de 104 cães (117 joelhos). As osteotomias foram realizadas em 98 articulações, a sutura fabelo-tibial em 15 joelhos e, em 4 joelhos, foi realizada apenas artrotomia exploratória. A média de idade foi 4,5 anos, 41% dos cães eram machos e 59%, fêmeas e a média da massa corporal foi 32,7kg. Os tipos de lesão do menisco medial observados foram: tipo 1, 2, 3, 4, 6, 7 e associações dos tipos 1-4, 1-6 e 1-7. O tipo 1 foi o mais prevalente, sendo responsável por 32,5% dos casos. Não foram encontradas correlações entre a presença ou não de lesão de menisco medial e o tempo de ocorrência da RLCCr e entre o tipo de lesão de menisco medial e o tempo de RLCCr.

The study correlated the time of the cranial cruciate ligament rupture (CCLR) with medial meniscal tears and the type of injury seen in dogs treated with dynamic stabilization (osteotomies) or static (fabellotibial suture). This retrospective study evaluated the records of 104 dogs (117 stifles). The osteotomies were performed in 98 stifles, fabellotibial suture in 15 stifles and exploratory arthrotomy was perform in 4 stifles. The average age was of 4.5 years, 41% of the dogs were male and 59% female and the mean body mass was of 32.7kg. The medial meniscal tears observed were: type1, 2, 3, 4, 6, 7 and associations of types1-4, 1-6 and 1-7. Type 1 was the most prevalent, accounting for 32.5%of cases. No correlation was found between the presence or absence of medial meniscus injury and the time of occurrence of CCLR and between the type of medial meniscal tears and CCLR time.

A New Surgical Technique of Arthroscopic Partial Meniscectomy for Unstable Inferior Leaf of the Anterior Horn in a Horizontal Tear of Lateral Meniscus

We introduce a new arthroscopic partial meniscectomy technique using a three portals and a small skin hook retractor to remove unstable inferior leaf in horizontal meniscal tear that involved the anterior portion of the lateral meniscus. The patient is positioned for a standard knee arthroscopy. After careful estimation of the depth and extent of the cleft and stability of the superior and inferior leaves is done through the standard anteromedial portal, a small skin hook retractor is inserted through the standard anterolateral portal to raise the dominant superior leaf of anterior horn, then the unstable inferior leaf is excised with a 90degrees rotary punch and a motorized shaver through the extreme far anteromedial portal. This technique is useful method to remove unstable inferior leaf of anterior horn of lateral meniscus which is difficult to remove with a standard technique.

Osteonecrosis of the Knee after Arthroscopic Partial Meniscectomy

Osteonecrosis of the femoral condyle is known as an uncommon complication after arthroscopic meniscectomy. The lesion of osteonecrosis can be irreversible, thus early detection of the disease is crucial for treatment. A 50-year-old male patient without known risk factors of osteonecrosis developed increasing knee pain after arthroscopic partial meniscectomy. Magnetic resonance imaging showed rapid progression of osteonecrosis of the medial femoral condyle. Unicompartmental knee arthroplasty was performed after 9 months of conservative therapy. The patient is now free from pain during daily activities. It might be important to remind that if the patient's pain after arthroscopic partial meniscectomy is severe than expected, clinical doctors should pay attention to the possibility of ongoing osteonecrosis of the femoral condyle.