Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM).@*METHODS@#A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7.@*RESULTS@#All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001).@*CONCLUSION@#Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.

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.

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.

Diagnostic value of ultrasound in the discoid lateral meniscus of the knee / 中国骨伤

OBJECTIVE@#Based on the anatomical differences between discoid lateral meniscus(DLM) and normal lateral meniscus (NLM), this study aims to setting up the ultrasound examination parameters to distinguish DLM and NLM and explore the diagnostic value of these parameters on DLM.@*METHODS@#According to the inclusion, exclusion and matching criteria, 66 DLM patients(DLM group) and 132 NLM patients with other knee joint diseases(NLM group), hospitalized from October 2019 to June 2020, were included in this study. There were 18 males and 48 females in the DLM group, ranging in age from 3 to 60 years old, with a mean of (36.9±12.1) years old;36 males and 96 females in the NLM group, ranging in age from 3 to 60 years old, with a mean of (40.0±12.2) years old. Philips high frequency(3.0 to 12.0 MHz) linear array ultrasound probe was used to examine the lateral meniscus of all patients in two groups. Nine parameters including the thickness, width and the included angle of the anterior angle, body and posterior angle respectively in the lateral meniscus were measured. The included angke is formed by the chords of the upper and lower curved surfaces of the meniscus at the free edge. The independent t test was used to analyze the difference of the measured parameters between the DLM group and the NLM group. The receiver operating characteristic(ROC) curve was used to evaluate the cut-off value of each parameter for diagnosing DLM and the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve(AUC).@*RESULTS@#The above 9 ultrasound measurement parameters between the DLM group and the NLM group had significant statistical differences(P<0.001). The ROC curve analysis method evaluated the cut-off value and diagnostic capabilities of these nine ultrasound parameters for DLM. The results showed that the cut-off value of the included angle of anterior part, body and posterior part were 25.85°, 24.85° and 29.15 °, respectively;and the sensitivity, specificity, negative predictive value, positive predictive value and AUC were significantly higher than other parameters, which were 88%, 91%, 79%, 95%, 0.94;89%, 94%, 82%, 97%, 0.96; 92%, 97%, 86%, 98%, 0.97, respectively.@*CONCLUSION@#Ultrasound diagnosis of DLM is feasible and reliable. The diagnostic ability of the included angle of the anterior part, body and posterior part in the lateral meniscus measured by ultrasound to diagnose DLM are significantly better than other ultrasound measurement parameters, and the sensitivity and specificity of those parameters are close to MRI. Therefore, ultrasound can be used as a reliable method for preliminary diagnosis of DLM.

Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears / 北京大学学报(医学版)

OBJECTIVE@#To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries.@*METHODS@#This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears.@*RESULTS@#A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01).@*CONCLUSION@#We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.

Reparación transtibial de la raíz posterior del menisco lateral en lesiones agudas: técnica quirúrgica y seguimiento clínico a corto plazo / Transtibial repair of posterior root of the lateral meniscus in acute lesions: surgical technique and short-term clinical follow-up

Introducción Las lesiones de la raíz posterior del menisco lateral (RPML) afectan la transferencia de la carga axial de la rodilla, lo cual genera una sobrecarga con el posterior deterioro del cartílago articular. Se han descrito numerosas técnicas quirúrgicas en la literatura para su tratamiento, pero aún no se ha demostrado superioridad de alguna, por ende, existen controversias sobre cual técnica es la más indicada para estas lesiones. El objetivo del estudio es describir la técnica quirúrgica y la evolución clínica de pacientes intervenidos con fijación transtibial de la RPML en una clínica especializada, durante el periodo 2016-2017. Materiales & Métodos Se realizó una descripción de la técnica quirúrgica y una serie de casos retrospectiva. Se incluyeron pacientes con lesiones agudas en la RPML, los cuales fueron intervenidos quirúrgicamente utilizando una nueva variación a técnica transtibial. Para determinar la evolución cínica de los pacientes se realizaron las escalas Lysholm e IKDC, antes y después de la cirugía. Resultados Se intervinieron seis pacientes con lesión aguda de la RPML, cuatro de sexo masculino. El tiempo entre el trauma y la cirugía fue en promedio 2,5 meses. Todos los pacientes presentaron lesión concomitante de ligamento cruzado anterior. Al comparar el estado inicial de los pacientes y el postoperatorio mediante las escalas de Lysholm e IKDC, se encontraron diferencias estadísticamente significativas (p<0,05). Asimismo, no se realizaron reintervenciones durante el seguimiento. Discusión La reparación de la RPML con la nueva variación de la fijación transtibial proporciona una mejoría en la función, el dolor y el nivel de actividad de los pacientes, lo que puede ayudar a retrasar la progresión de la osteoartrosis en la rodilla. Igualmente, este procedimiento se puede realizar de forma segura aún en casos de lesiones ligamentarías concomitantes. Nivel de evidencia: IV

Background injuries of posterior lateral meniscus root (PLMR) affect the transfer of the axial load of the knee. Several surgical techniques have been described for it treatment, but still none has demonstrated superiority. Consequently, there are controversies about which technique is most indicated for these injuries. The aim is to describe the a surgical technique and the clinical follow up of patients operated with transtibial fixation of PLMR in a specialized clinic, during the 2016-2017. Methods Retrospective case series and description of the surgical technique. We included patients with acute injuries in the PLMR, who were operated using a new variation to the transtibial technique. For the clinical follow-up, the IKDC and Lysholm scores were performed before and after surgery. Results Six patients with acute lesion in the PLMR were intervened, four were male. The time between trauma and surgery was on average 2.5 months. All the patients presented a concomitant lesion of the anterior cruciate ligament. When comparing the initial state of the patients and the postoperative period, statistically significant differences were found (p <0.05). Likewise, reinterventions were not performed during follow-up. Discussion The repair of PLMR with the new variation of the transtibial fixation provides an improvement in the function, the pain and the level of activity of the patients, which can help to delay the progression of osteoarthrosis in the knee. Likewise, this technique can be performed safely even in cases of concomitant ligament injuries. Level of clinical evidence: Level IV

Menisco lateral hipermóvil: diagnóstico y tratamiento de lesiones de fascículos poplíteo meniscales / Hypermobile lateral meniscus: diagnosis and treatment of popliteomeniscal fasciculi injuries

El Síndrome de Menisco Hipermóvil, caracterizado por bloqueos mecánicos dolorosos de la rodilla, tiene un sustento anatómico basado en los fascículos poplíteo meniscales anteroinferior y posterosuperior, responsables de la estabilidad primaria de la esquina posterolateral meniscal. Con un cuadro clínico característico, usualmente con Resonancia Magnética sin hallazgos sugerentes de patología, la artroscopía juega un rol esencial en casos de alta sospecha, comprobando el diagnóstico al presentar hipermobilidad del cuerno posterior del menisco lateral. MÉTODO: Se presentan 9 casos resueltos, con hiperlaxitud posterolateral meniscal, y presentación clínica caracterizada por bloqueo articular de rodilla sin causa aparente. En todos los casos se realizó reparación de los fascículos poplíteo meniscales con suturas meniscales, con resolución completa de la sintomatología y sin complicaciones post quirúrgicas. CONCLUSIÓN: El manejo del cuadro de menisco hipermóvil está basado por la sospecha clínica y el descarte de otras patologías como causa subyacente de la sintomatología. El manejo quirúrgico con suturas meniscales ha demostrado restaurar la biomecánica normal del compartimento posterolateral de la rodilla, logrando la resolución completa de los síntomas. NIVEL DE EVIDENCIA: IV.

Hypermobile Meniscus Syndrome, characterized by painful mechanical blockages of the knee, has an anatomical support based on the anteroinferior and posterosuperior poplíteomeniscal fascicles, responsible for the primary stability of the posterolateral meniscal corner. With a characteristic clinical presentation, usually with Magnetic Resonance without suggestive findings of pathology, arthroscopy plays an essential role in cases of high suspicion, checking the diagnosis by presenting hypermobility of the posterior horn of the lateral meniscus. METHOD: We present 9 resolved cases, with posterolateral meniscal hypermobility, and clinical presentation characterized by knee articular block without apparent cause. In all cases, poplíteomeniscal fascicles were repaired with meniscal sutures, with complete resolution of the symptoms and without post-surgical complications. CONCLUSION: The management of the hypermobile meniscus syndrome is based on clinical suspicion and the discarding of other pathologies as the underlying cause of the symptomatology. Surgical management with meniscal sutures has been shown to restore the normal biomechanics of the posterolateral compartment of the knee, achieving complete resolution of symptoms. LEVEL OF EVIDENCE: Case series IV.

Shapes Of Menisci Of Knee Joint: A Human Cadaveric Study

Background: The Medial and Lateral Menisci have very important roles in knee joint stability, functioning anddynamic loading and are thus important in maintaining proper joint health and stability.Purpose: To estimate the incidence of various shapes of the Lateral and Medial Menisci which can throw light onits clinical significance on ligament injuries of knee joint.Results: 50% 0f the Medial Menisci were crescent- shaped,37% were sided V-shaped and the remaining 13% weresided U-shaped. 72% of the Lateral Menisci were found to be C-shaped and 26% were crescent-shaped. Onepartial discoid lateral meniscus (2%) was observed.Conclusion: The various morphological variants of Menisci determined in the study revealed that most commonsubgroup of the Medial Meniscus was crescentic type and that of Lateral Menisci was C shaped. A singlespecimen of partial Discoid Lateral Meniscus was observed which is of rare occurrence.Implications: The present study contributes to proper understanding of anatomy of both Medial and LateralMenisci which can be helpful in planning various surgical procedures including meniscal transplantation. Thisknowledge also helps in understanding degenerative diseases affecting knee joint Menisci. Discoid LateralMeniscus, a rare anomaly which was reported in the present study is clinically important because of its higherincidence of meniscal tears.

Influences of Lateral Meniscus Posterior Root Tear with Different Suture Methods on Knee Biomechanics / 医用生物力学

Objective To evaluate the biomechanical effects of lateral meniscus posterior root (LMPR) tears fixed at different suture positions, so as to investigate the optimal suture method for repairing LMPR tears. Methods Eight fresh cadaveric knees were used. Each knee was tested under 6 conditions: intact knee, ruptur of LMPR, suture of LMPR to the center point of root insertion, suture of LMPR posterior, interior and later 5 mm to the center point of root insertion, respectively. The peak contact pressure, the average contact pressure and contact area were evaluated using a Tek-scan sensor positioned between the meniscus and tibial plateau, under 1 kN compressive loading, at 0 degree knee extension. Results In the lateral compartment, the average contact pressure and peak pressure significantly increased under rupture of LMPR compared with the intact state (P0.05). Conclusions The average contact pressure, the peak contact pressure and the contact area between the lateral meniscus and the tibial plateau changed obviously due to the LMPR tears. When the suture position was 5 mm lateral to the center point of root insertion, similar biomechanical function with the intact knee could be obtained.

A study to evaluate the accuracy of MRI in comparison to knee arthroscopy in diagnosing cruciate ligament tear and meniscal tears in organized sports and physical exercise related knee injuries in armed forces personnel

Background: Knee injuries related to organised sports and physical training related activities are a major component of injuries sustained by armed forces personnel. Knee instability caused by meniscal and ligamentous injuries cause varying degree of disabilities to the trained soldier and have a serious implication on the battle preparedness of the armed forces. MRI of the knee being a non-invasive modality is being increasingly used in pre and post op evaluation of patients in such cases.Methods: A prospective observational study comprising of 161 patients of knee injuries sustained due to sports and physical training related activities was carried out. MRI and arthroscopic examination of the knee was done, and various statistical tests were performed to evaluate the accuracy of MRI in comparison to arthroscopy.Results: ACL tears were seen in 122 patients (75.5%), PCL tears were seen in 67 patients (41.6%), while medial and lateral meniscus tears were noted in 93 (57.7%) and 50 (31%) patients respectively. The sensitivity and specificity of MRI in detecting ACL tear, PCL tear and medial meniscus injury ranged from 84% - 90.5% and for lateral meniscus it was 72.92% to 86.73 %. The accuracy of MRI in detecting the tear of ACL, PCL and menisci ranged from 82.61% to 89.97%.Conclusions: The accuracy of MRI in detection of meniscal and ACL tears is very high. Pre-operative MRI in conjunction with adequate history and physical examination can help the clinician to make an accurate diagnosis and can help reduce unnecessary arthrosopic surgeries.

Research progress in diagnosis and treatment of injury of the popliteal meniscal fiber bundle / 中国骨伤

Popliteal meniscal fiber bundle injury is relatively infrequent in clinic, which can be either isolated or associated with anterior cruciate ligament rupture, lateral meniscus injury and so on. Popliteal meniscal fiber bundle injury often leads to instability of lateral meniscus. Because of the lack of specific symptoms and signs of injury, the imaging changes are subtle, and it is easy to miss diagnosis and misdiagnosis in clinical. Timely diagnosis and treatment are essential to prevent the chronic pain and instability of the knee joint. This paper summarizes the anatomical characteristics, biomechanics, injury mechanism, diagnostic points and surgical treatment of the popliteal meniscus fiber bundle injury, in order to guide the diagnosis and treatment of the injury of the popliteal meniscus fiber bundle in the clinical work.

Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

PURPOSE: This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture. MATERIALS AND METHODS: Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed. RESULTS: The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0–20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4–12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2–15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4–9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear. CONCLUSION: LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

The Efficacy of Meniscal Treatment Associated with Lateral Tibial Plateau Fractures

PURPOSE: The purpose of this study was to examine the incidence of lateral meniscal tears associated with lateral tibial plateau fractures and report the clinical outcomes of meniscal treatment with internal fixation of fractures. MATERIALS AND METHODS: All lateral tibial plateau fractures (Schatzker types II and III) in skeletally mature patients treated operatively at our institution between January 2010 and February 2016 were included. All patients underwent open reduction and internal fixation using a buttress plate or cancellous screws. All meniscal tears were initially considered for repair using an all-inside technique. RESULTS: The incidence of lateral meniscal tears with lateral tibial plateau fractures was 64%. Ten patients underwent meniscal repair. In second-look arthroscopy, normal healing was observed in all of the repaired lateral menisci. At the last follow-up, none of the 10 patients had clinical symptoms related to meniscal injuries. One of the 4 patients who had not undergone meniscal treatment although a lateral tear was suspected based on magnetic resonance imaging achieved stable bony union; however, due to the complaint of persisting knee pain, lateral meniscectomy was performed. CONCLUSIONS: Treatment of meniscal lesions associated with lateral tibial plateau fractures showed good clinical and second-look arthroscopic results. Therefore, we believe that recognition and treatment of a meniscal injury at the time of surgical fixation can improve clinical outcome.

Anterolateral Meniscofemoral Ligament of the Lateral Meniscus

Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.

Double-Layered Lateral Meniscus

We report a case of double-layered lateral meniscus, where an accessory proximal hemimeniscus was overlying the body and posterior horn of the lateral meniscus. The double-layered meniscus arises proximal and parallel to the normal lateral meniscus with its periphery dissociated from the capsule and was significantly thinner and more mobile than its underlying true lateral meniscus. The accessory hemimeniscus was resected arthroscopically.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

Intraoperative Templating in Lateral Meniscal Allograft Transplantation

Recently, studies have emphasized the importance of anatomical placement of the lateral meniscal allograft to decrease postoperative extrusion. However, it is infeasible to identify the exact rotation of the allograft during transplantation. We present a patient who underwent a lateral meniscal transplantation using a wire for correct positioning of the allograft. The use of a wire intraoperatively shaped to resemble the contour of the lateral meniscal allograft will aid in more accurate and anatomical graft placement.

Spontaneous Healing of a Displaced Bucket-Handle Tear of the Lateral Meniscus in a Child

Bucket-handle tears less frequently occur in the lateral meniscus than in the medial meniscus. An 11-year-old male patient complained of painful swelling and locking due to a displaced bucket-handle tear of the lateral meniscus. We recommended an arthroscopic surgery; however, the patient left the hospital without surgical treatment. Six weeks afterwards, he returned without any complain of pain and he regained full range of motion. The final follow-up magnetic resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive of a meniscal tear. We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in an 11-year-old patient that healed spontaneously without surgical intervention.

Bilateral Occurrence and Morphologic Analysis of Complete Discoid Lateral Meniscus

PURPOSE: The aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints. MATERIALS AND METHODS: Thirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly. RESULTS: In total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively. CONCLUSION: Based on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.

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.