Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft.

PURPOSE: Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS: This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS: Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS: The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Effect of inside-out meniscal repair on meniscal dimension in meniscal tear patients.

Background: It remains controversial whether meniscal repair causes meniscal extrusion. This study aimed to investigate the effect of inside-out meniscal repair on meniscal dimensions in patients with meniscal tear of the mid-body-posterior horn. Methods: This retrospective study included 75 patients who underwent meniscal repair followed by MRI within 2 weeks after surgery between 2020 and 2022. Patients with a discoid lateral meniscus, pull-out repair, concomitant osteotomy, all-inside repair only, and revision surgery were excluded. Thirty-three meniscal tear treated using an inside-out arthroscopic repair technique were included in the lateral meniscus (LM, n = 19) and medial meniscus (MM, n = 14) tear groups. Thirty-six participants with intact meniscus were included as controls. Meniscal extrusion and posterior shift were measured on coronal and sagittal MRI pre-operatively and within 2 weeks postoperatively. Results: Preoperative coronal extrusion was significantly greater in the LM tear group than in the control group (P = 0.001). Coronal extrusion and posterior shift were significantly smaller postoperatively than preoperatively in the LM tear group (P < 0.001 and, P = 0.008, respectively). Pre- and postoperative coronal extrusion in the MM tear group were not significantly different (P = 0.291). Postoperative coronal extrusion in both LM and MM tear groups were not significantly correlated with the number of sutures required for repair (LM: P = 0.765, R = -0.076, MM: P = 0.1, R = 0.497). Conclusions: The torn meniscus of the mid-body - posterior horn before surgery was extruded and shifted posteriorly in both LM and MM tears, and repair using an inside-out arthroscopic technique was effective in reducing meniscal extrusion and posteriors shift in the LM tear immediately after surgery.

Quadriceps Tendon With Bone Autograft Has Better Stability and Magnetic Resonance Imaging Maturation Than Hamstring Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Patients With Knee Hyperextension.

PURPOSE: To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction between methods using quadriceps tendon with bone (QTB) and hamstring tendon (HT) in patients with hyperextension of the knee. METHODS: The medical records of patients with knee hyperextension greater than 8° who underwent arthroscopic ACL reconstruction between October 2010 and October 2020 with follow-up for at least 2 years (median, 3 years; interquartile range [IQR], 2.0-4.6 years) were retrospectively reviewed. Side-to-side difference in anterior translation, pivot-shift test grade, Lysholm score, and graft intensity using the Howell grade on magnetic resonance imaging at final follow-up were compared between the QTB and HT groups. RESULTS: The HT and QTB groups consisted of 42 patients and 21 patients, respectively. The overall mean age was 21.5 years (range, 14-48 years), and the median Tegner Activity Scale score was 6 (range, 3-9). Postoperatively, the median side-to-side difference in anterior translation was 1.75 mm (IQR, 1-3 mm) in the HT group and 1.0 mm (IQR, 0-1.75 mm) in the QTB group (P = .01). Pivot-shift testing showed grade 0 in 74.7%, grade 1 in 18.7%, and grade 2 in 6.6% of patients in the HT group and grade 0 in 85.7% and grade 1 in 14.3% of those in the QTB group (P = .03). The median postoperative Lysholm score was 99 in both groups. Graft signal intensity showed a significant between-group difference: grade I in 52%, grade II in 36%, and grade III in 12% of patients in the HT group versus grade I in 85.7%, grade II in 9.5%, and grade III in 4.8% of those in the QTB group (P = .03). CONCLUSIONS: In patients who underwent ACL reconstruction for hyperextension of the knee, QTB yielded better clinical outcomes than HT with respect to anterior stability, rotational stability, and graft signal intensity on median 2-year follow-up magnetic resonance imaging. LEVEL OF EVIDENCE: Level III, retrospective case-control study.

Age-based comparison of meniscal dimensions between an asymptomatic complete discoid lateral meniscus and normal meniscus: MRI evaluation.

INTRODUCTION: This study aimed to evaluate the meniscal size of asymptomatic discoid lateral meniscus (DLM) and compare it with that of normal lateral meniscus (LM) and to compare changes in meniscal dimensions with age among patients with asymptomatic DLM and those with normal LM using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed the medical records, including MRI data, of patients with asymptomatic DLM (DLM group) or normal LM (control group). Width and extrusion of both DLM and normal LM and tibial length were measured and compared using mid-coronal and mid-sagittal MR images. Meniscal size and sagittal and coronal meniscal ratio according to age, as well as differences between DLM and normal menisci, were also evaluated. RESULTS: Thirty-four knees were included in the DLM group, whereas the control group comprised of 50 patients. The DLM group showed significantly less meniscal extrusion, greater coronal width, posterior capsule distance, sagittal meniscal length, and sagittal meniscal ratio than the control group (DLM: 0.1 ± 0.3 mm, 23.3 ± 2.2 mm, 5.4 ± 2.4 mm, 25.1 ± 2.8 mm, 61 ± 6%, and control: 0.4 ± 0.4 mm, 9.5 ± 2.3 mm, 2.5 ± 1.2 mm, 30.2 ± 2.6 mm, 71 ± 4%, respectively). The coronal meniscal ratio decreased with age in both the control (p = 0.001) and DLM (p = 0.037) groups. The sagittal meniscal ratio (p = 0.001) and minimum height (p = 0.04) decreased and the anterior capsule distance (p = 0.035), posterior capsule distance (p = 0.026), and entire sagittal length (p = 0.005) increased with age in the DLM group, while the distance between the meniscal inner margins (p = 0.019) increased with age in the control group. CONCLUSIONS: The meniscal ratio in the sagittal plane of the DLM group was significantly lower than that of the control group. The sagittal meniscal ratio of asymptomatic DLM decreased with age, indicating that the size of asymptomatic DLM does not change with age. LEVEL OF EVIDENCE: III: Retrospective comparative study.

Comparative analysis of discoid lateral meniscus size: a distinction between symptomatic and asymptomatic cases.

PURPOSE: This study evaluated the differences in meniscal sizes and occupancy between symptomatic and asymptomatic patients diagnosed with discoid lateral meniscus (DLM) using magnetic resonance imaging (MRI) to understand how these variations relate to the presence of symptoms and the patients' age. METHODS: A retrospective review of 98 patients with DLM was conducted, excluding those with meniscal displacement. Both the width and extrusion of DLM and the percentage of the meniscus to the tibia were measured using mid-coronal and mid-sagittal MRI and compared between symptomatic and asymptomatic DLM groups. The relationships among each parameter, meniscal size, and patient age were evaluated. Symptomatic cases were divided into those with and without horizontal tears on MRI to compare the differences in meniscal morphology. RESULTS: A total of 92 knees from 74 patients were included. Sixty-one knees required surgical intervention for symptomatic DLM, while 31 were asymptomatic and included the contralateral side of symptomatic knees. The symptomatic group exhibited larger morphological variations than the asymptomatic group. Moreover, the sagittal meniscal ratio reduced with age in the asymptomatic group (r = - 0.54, p = 0.002) but remained constant in the symptomatic group. The symptomatic cases with horizontal tears demonstrated larger meniscal dimensions and smaller posterior capsule distances than those without tears. CONCLUSION: Symptomatic patients with DLM had larger knee morphological changes than asymptomatic ones. Age affected the meniscal occupancy in the sagittal plane only in asymptomatic patients. LEVEL OF EVIDENCE: III.

Lateral meniscus autograft transplantation using hamstring tendon with a sandwiched bone marrow - derived fibrin clot: A case report.

INTRODUCTION AND IMPORTANCE: Tendon autograft is a durable solution for the sub/total meniscus; however it is still considered a temporary solution. CASE PRESENTATION: We report the case of a 17-year-old woman with history of subtotal lateral meniscectomy performed 6 years ago. We treated her with lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched bone marrow aspirate (BMA)-derived fibrin clot. T2 relaxation times of the anterior and posterior horns of both menisci and of the cartilage were assessed. CLINICAL DISCUSSION: Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot improved clinical and radiographic outcomes at the 24-month follow-up. These findings suggest that the lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot transformed into a meniscus-like tissue and resulted in preservation of the articular cartilage. CONCLUSION: Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot can function as a meniscal transplant after total or subtotal meniscectomy in young patients.

Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau.

PURPOSE: To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging. METHODS: This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively. RESULTS: A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group. CONCLUSIONS: Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients. LEVEL OF EVIDENCE: Retrospective comparative study; level of evidence, 3.

Postoperative D-dimer levels predict venous thromboembolisms detected with contrast-enhanced computerized tomography in patients undergoing anterior cruciate ligament reconstruction.

BACKGROUND: In the literature, factors associated with postoperative venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) are limited. This study aimed to investigate the incidence of venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) and to identify risk and predictive factors for VTEs. METHODS: This retrospective study included 136 patients who underwent arthroscopic ACLR with mechanical prophylaxis between April 2012 and July 2022. Contrast-enhanced computed tomography (CT) was applied to detect VTEs comprising deep venous thromboses and pulmonary embolisms 7 days after surgery. Data including age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were collected for analyses. The incidence of radiographically confirmed VTEs and the associated risk factors, such as age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were analyzed. RESULTS: The overall incidence of radiographic VTEs was 11.0% (15 cases) in 136 patients. There was one symptomatic patient who had Homan's sign. Multivariable analysis indicated that postoperative D-dimer level was an independent factor related to a radiographic VTE after ACLR, although there was no association between radiographic VTEs and preoperative status or operation status. The optimal cutoff value for postoperative D-dimer level was 2.8 µg/ml according to the receiver operating characteristic curve analysis, with a sensitivity of 80.0% and specificity of 83.5%. CONCLUSION: The incidence of ACLR-associated radiographical VTEs (deep venous thrombosis and pulmonary embolism) under mechanical prophylaxis was 11.0% in this study. An elevated D-dimer level at 7 days after surgery is an independent predictor of VTE in patients undergoing ACLR. The postoperative D-dimer level is a more reliable marker for identifying VTE in patients who underwent ACLR.

Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping.

INTRODUCTION: Discoid lateral meniscus (DLM) is an anatomic knee variant associated with increased tears and degeneration. This study aimed to quantify meniscal status with magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic reshaping surgery for DLM. MATERIALS AND METHODS: We retrospectively reviewed the records of patients undergoing arthroscopic reshaping surgery for symptomatic DLM with ≥ 2-year follow-up. MRI T2 mapping was performed preoperatively and at 12 and 24 months postoperatively. T2 relaxation times of the anterior and posterior horns of both menisci and of the adjacent cartilage were assessed. RESULTS: Thirty-six knees from 32 patients were included. The mean age at surgery was 13.7 years (range 7-24), and the mean follow-up duration was 31.0 months. Saucerization alone was performed on five knees and saucerization with repair on 31 knees. Preoperatively, the T2 relaxation time of the anterior horn of the lateral meniscus was significantly longer than that of the medial meniscus (P < 0.01). T2 relaxation time significantly decreased at 12 and 24 months postoperatively (P < 0.01). Assessments of the posterior horn were comparable. The T2 relaxation time was significantly longer in the tear versus non-tear side at each time point (P < 0.01). There were significant correlations between the T2 relaxation time of the meniscus and that of the corresponding area of the lateral femoral condyle cartilage (anterior horn: r = 0.504, P = 0.002; posterior horn: r = 0.365, P = 0.029). CONCLUSIONS: The T2 relaxation time of symptomatic DLM was significantly longer than that of the medial meniscus preoperatively, and it decreased 24 months after arthroscopic reshaping surgery. The meniscal T2 relaxation time of the tear side was significantly longer than that of the non-tear side. There were significant correlations between the cartilage and meniscal T2 relaxation times at 24 months after surgery.

The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: a retrospective cohort study.

BACKGROUND: In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. METHODS: Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. RESULTS: Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. CONCLUSION: Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.

Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile discoid lateral meniscus with peripheral tear.

INTRODUCTION: We compared subtotal meniscectomy and saucerization with stabilization for osteocartilaginous damage based on injured location and further examined the factors related to osteocartilaginous damage in juvenile discoid lateral meniscus (DLM) with peripheral tear after a follow-up period of at least 5 years. MATERIALS AND METHODS: We retrospectively reviewed juvenile DLM patients with peripheral tear who underwent arthroscopic surgery with more than 5 years of follow-up. Osteocartilaginous damage, which was identified by osteochondritis dissecans (OCD) development and the whole-organ magnetic resonance imaging score (WORMS) of cartilage grade ≥ 3, was compared between subtotal meniscectomy and saucerization with stabilization. A subgroup analysis examining the location of the tear site was performed. Factors for osteocartilaginous damage were analyzed between the damaged and non-damaged groups. RESULTS: Forty-one patients, including 29 who underwent saucerization with stabilization and 12 who underwent subtotal meniscectomy, were included in this study. Seven patients developed OCD lesions; six patients showed cartilage WORMS of more than grade 3. Overall, there was a significant difference in the total cartilage and meniscus WORMS between the two groups at the final follow-up. The subgroup analysis demonstrated more severe osteocartilaginous damage developed in posterior subtotal meniscectomy than in posterior stabilization following saucerization. The damaged group showed significant difference compared to the non-damaged group in terms of age (p = 0.003), sex (p = 0.036), and posterior subtotal meniscectomy (p < 0.001). CONCLUSIONS: Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile DLM with peripheral tear over a minimum follow-up period of 5 years.

Intrameniscal degeneration and meniscotibial ligament loosening are associated factors with meniscal extrusion of symptomatic discoid lateral meniscus.

PURPOSE: This study aimed to compare the amount of extrusion of the discoid lateral meniscus (DLM), which was symptomatic and required surgery, with normal meniscuses and asymptomatic DLMs and examine factors associated with the extrusion of symptomatic DLM. METHODS: Medical records of participants with DLM or normal lateral meniscus (LM) were retrospectively reviewed using magnetic resonance imaging (MRI). DLM cases were divided into symptomatic and asymptomatic groups. The midbody meniscal extrusion was measured using mid-coronal MRI. The association between meniscal extrusion and MRI findings, including the meniscofemoral ligament, meniscotibial ligament (MTL), intrameniscal signal intensity of the peripheral rim, meniscal shift, and skeletal maturity, was evaluated. RESULTS: Eighty-six knees with DLM (63 symptomatic) were included. The control group included 31 patients. The symptomatic group showed significantly greater meniscal extrusion (mean ± standard deviation symptomatic DLM: 1.0 ± 1.1 mm, asymptomatic DLM: 0.1 ± 0.4 mm, and normal LM: 0.3 ± 0.6 mm, P < 0.001) and had a significantly higher incidence of MTL loosening (P = 0.02) and intrameniscal signal (P < 0.001) than the other two groups. In the symptomatic group, multivariable linear regression analysis showed that MTL loosening [ß = 1.45, 95% confidence interval (CI) 1.03-1.86, P < 0.001] and intrameniscal signal (ß = 0.49, 95% CI 0.09-0.90, P = 0.002) were independent associated factors. CONCLUSIONS: LM extrusion was significantly more common in patients with symptomatic DLM than in those with asymptomatic DLM or a normal LM. MTL loosening and intrameniscal high-signal intensity on MRI were independently associated with meniscal extrusion. These findings help explain the pathogenesis and diagnosis of symptomatic DLM. LEVEL OF EVIDENCE: III.

Bone-patellar tendon-bone autograft and female sex are associated with the presence of cyclops lesions and syndrome after anterior cruciate ligament reconstruction.

PURPOSE: Associated risk factors for the development of cyclops lesions have been little. Investigated, because most previous studies have limited their research to cases with symptomatic cyclops lesions (cyclops syndrome). The purpose of this study was to evaluate the presence of cyclops lesions using magnetic resonance image (MRI) at 6 and 12 months after anterior cruciate ligament reconstruction (ACL-R), and to investigate the associated risk factors of cyclops lesions and syndrome. METHODS: A retrospective analysis of patients who underwent ACL-R using bone-patellar tendon-bone (BTPB) or hamstring tendon autograft from 2008 to 2017 was conducted. Predictor variables (age, sex, body mass index [BMI], time from injury to ACL-R, preinjury Tegner activity score, graft, meniscal and cartilage injury, and notch width index on MRI for the presence of cyclops lesions and syndrome were analyzed with multivariate logistic regression. RESULTS: Four hundred and fifty-five patients (225 males and 230 females) were enrolled. One hundred and four patients (22.9%) had cyclops lesions, and all cyclops lesions were detected on MRI at 6 months post-operatively. In addition, 20 patients (4.4%) had cyclops syndrome which means that these were symptomatic cases. The risk factors for presence of cyclops lesions were BPTB autograft (OR = 2.85; 95% CI 1.75-4.63; P < 0.001) and female sex (OR = 2.03; 95% CI 1.27-3.25; P = 0.003). The presence of cyclops syndrome increased with graft (BPTB) (OR = 18.0; 95% CI 3.67-88.3; Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation P < 0.001), female sex (OR = 3.27; 95% CI 1.07-10.0; P = 0.038), and increased BMI (OR = 1.21; 95% CI 1.05-1.39; P = 0.008). CONCLUSIONS: All cyclops lesions were detected 6 months after ACL-R, and the majority of them were asymptomatic. BPTB autograft and female sex were the significant risk factors for the presence of cyclops lesions and syndrome. In addition, increased BMI was associated with a higher risk of developing cyclops syndrome. When BPTB autograft is used for a female patient, full active knee extension should be encouraged in the early period after ACL-R to prevent cyclops lesion formation. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The Potential of Using an Autogenous Tendon Graft by Injecting Bone Marrow Aspirate in a Rabbit Meniscectomy Model.

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects.

Transplantation of Parathyroid Hormone-Treated Achilles Tendon Promotes Meniscal Regeneration in a Rat Meniscal Defect Model.

BACKGROUND: Autologous tendon grafts are used for meniscal reconstruction of surgically removed knee joint meniscus. However, as meniscal reconstruction cannot prevent the progression of cartilage degeneration, additional procedures that confer meniscus-like histological properties to the transplanted tendon are required for improved outcomes. HYPOTHESES: Parathyroid hormone (PTH)(1-34) induces cartilage formation in the rat tendon, and transplantation of PTH-treated tendon promotes meniscal regeneration. STUDY DESIGN: Controlled laboratory study. METHODS: Rat Achilles tendon-derived cells were cultured with or without PTH for 28 days and stained with Alcian blue to determine chondrogenic differentiation. After 14 and 28 days of incubation, gene expression was assessed using quantitative real-time polymerase chain reaction. In an in vivo study, rat Achilles tendon was injected with PTH and then transplanted onto a medial meniscal defect. Macroscopic and histological assessments of the regenerated meniscus and of cartilage degeneration in the tibial plateau were performed at 4 and 8 weeks after surgery. RESULTS: In vitro, PTH-treated cells showed better staining with Alcian blue than the control (normal medium) group. PTH1R, Col2a1, Sox9, and RUNX2 were significantly upregulated in PTH-treated cells (P < .05). Macroscopically, the in vivo results revealed more prominent meniscal coverage and lesser progression of articular cartilage degeneration in the PTH group than in the phosphate-buffered saline-injected group. Histologically, toluidine blue staining revealed metachromasia in the PTH-injected tissue at 4 and 8 weeks. The PTH-treated regenerated meniscus showed positive immunostaining for type II collagen in the area exhibiting metachromasia. Moreover, PTH-treated tendon had an enhanced histological score compared with the untreated group at 4 and 8 weeks (P < .05). CONCLUSION: PTH(1-34) induced cartilage formation in the rat tendon. Transplantation of PTH(1-34)-treated Achilles tendon in a rat meniscal defect model induced meniscal regeneration and preserved knee articular cartilage. Macroscopically, PTH groups showed a greater coverage of the regenerated meniscus. Histologically, the regenerated meniscus had higher cartilaginous matrix content in rats transplanted with PTH-treated tendons. PTH(1-34) stimulated tendon-derived cells to promote chondrogenic differentiation. CLINICAL RELEVANCE: Meniscal transplantation using PTH-injected autologous tendon grafts might promote meniscal regeneration and prevent progression of cartilage degeneration by stimulating chondrogenic differentiation of tendon-derived cells.

Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery.

Background: Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear. Purpose/Hypothesis: To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated. Results: Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively (P < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; P = .024) and postoperative extrusion (odds ratio, 6.18; P = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%). Conclusion: DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.

Comparison of new and old all-inside suture devices in meniscal cyst formation rates after meniscal repair.

PURPOSE: We compared the magnetic resonance imaging (MRI)-confirmed cyst formation rate after meniscal tear repair using a new all-inside suture device (N group) versus the older all-inside suture device (O group). METHODS: Between October 2008 and July 2017, 94 consecutive menisci of 89 patients were diagnosed with meniscal tears and underwent arthroscopic meniscal repair using the all-inside suture device. Five of these patients were lost to follow-up within 12 months and were excluded from the study. The remaining 89 menisci were followed up for at least 12 months and were included in this retrospective cohort study. Older all-inside suture devices (FasT-Fix, Ultra FasT-Fix) were used until December 2012, while the new all-inside suture device (FasT-Fix 360) was used from January 2013 onwards. Meniscal cysts were detected on T2-weighted fat-suppressed MRI at 12 months postoperatively. Multiple logistic regression analysis was used to identify demographic and clinical factors associated with the use of the new all-inside suture device and cyst formation. RESULTS: In total, 36 and 53 menisci were included in the N and O groups, respectively. The incidence of meniscal cysts was significantly greater in the O group (14 out of 53, 26.4%) than in the N group (two out of 36, 5.56%) (P = 0.012). Two patients in the O group had symptomatic cysts that required removal. Multivariate logistic analyses showed that the cyst formation risk significantly decreased after using the new all-inside suture device than the older all-inside suture devices (odds ratio = 0.139; P = 0.04). CONCLUSIONS: The MRI-confirmed cyst formation rate after meniscal tear repair was significantly lower using the new than the older all-inside suture devices, indicating that the use of a low-profile device may decrease the cyst formation rate.

Autologous Platelet-Rich Fibrin Membrane to Augment Healing of Microfracture Has Better Macroscopic and Histologic Grades Compared With Microfracture Alone on Chondral Defects in a Rabbit Model.

PURPOSE: To determine the in vivo effectiveness of a single-stage surgical procedure that combines microfracture and an autologous platelet-rich fibrin (PRF) membrane for cartilage repair in a rabbit model. METHODS: Cartilage defects were created in the trochlear groove of the knees of adult white rabbits. Defects were divided into 2 treatment groups: microfracture only (control group) and microfracture covered by a PRF membrane (PRF group). To evaluate the repair cartilage, assessments were performed at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society (ICRS) macroscopic scoring system and modified Wakitani histologic grading system. RESULTS: The mean ICRS macroscopic scores in the control and PRF groups were 4.1 and 5.8, respectively, at 4 weeks (P = .0623); 6.3 and 9.8, respectively, at 12 weeks (P = .006); and 6.5 and 10.3, respectively, at 24 weeks (P = .010). The mean modified Wakitani scores in the control and PRF groups were 4.0 and 3.9, respectively, at 4 weeks (P > .999); 5.3 and 10.4, respectively, at 12 weeks (P = .006); and 2.6 and 7.4, respectively, at 24 weeks (P = .012). CONCLUSIONS: The ICRS macroscopic scores and modified Wakitani scores showed that a single-stage surgical procedure combining microfracture and a PRF membrane was more effective than surgery with only microfracture for promoting cartilage repair. CLINICAL RELEVANCE: A single-stage surgical procedure combining microfracture and an autologous PRF membrane is a potentially beneficial treatment method for cartilage defects that does not require using any xenocollagen membrane.

Serum Cartilage Oligomeric Matrix Protein Detects Early Osteoarthritis in Patients With Anterior Cruciate Ligament Deficiency.

PURPOSE: To investigate the ability of serum cartilage oligomeric matrix protein (COMP) to detect early osteoarthritis (OA) (International Cartilage Research Society [ICRS] grade 1 or 2 cartilage lesions) in patients with anterior cruciate ligament (ACL)-deficient patients. METHODS: Patients with an ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum samples for COMP measurement were obtained before surgery. The cartilage surfaces of 6 compartments were classified using the ICRS grading system. The patients were divided into groups with and without early OA according to the cartilage findings and diagnostic criteria for early OA. RESULTS: In total, 98 patients (mean age 23.7 years; range 12 to 49) were included, with 30 patients (30.6%) in the early OA group and 68 (69.4%) in the no early OA group. The 2 groups significantly differed in age, body mass index, preoperative Tegner activity scale, and serum COMP level. The cutoff value of serum COMP for the presence of early OA arthroscopic cartilage lesions was 152.0 ng/mL. Multiple logistic regression analysis revealed age (odds ratio 1.09; 95% confidence interval [CI] 1.02 to 1.16; P = .01) and serum COMP (odds ratio 1.02; 95% CI 1.01 to 1.04; P < .001) to be independent factors for the presence of early OA arthroscopic cartilage findings. CONCLUSIONS: The incidence of early OA arthroscopic cartilage findings was ∼30% in patients with ACL deficiency, and serum COMP levels were significantly higher in the early OA group than in the no early OA group. The optimum cutoff value for serum COMP was 152 ng/mL. Serum COMP can be used to detect early cartilage change in patients with ACL deficiency. LEVEL OF EVIDENCE: Ⅲ, retrospective comparative study.