Medial Meniscotibial Ligament of the Knee: A Step by-Step Dissection.

Objective Considerable attention has been paid to meniscotibial ligaments (MTLs), also known as coronary ligaments, especially after the "Save the Meniscus" initiative gained importance among knee surgeons. Technically challenging, the diagnosis and treatment of ramp lesion show the importance of MTLs. These ligaments were discovered long ago, but their contribution to knee stability has only recently been studied and still lacks information. Thus, the aim of the present study was to describe step-by-step an dissection technique of the medial MTL, efficient, reproducible and that may lead to further research. Method Twenty fresh cadaver knees were used, with no preference for sex or age. The knees were dissected using the same technique standardized by our team. Each dissection step was recorded digitally. Results The medial MTL was found in all 20 knees studied using the aforementioned technique. In our sample, the medial MTL exhibited an average length of 70.0 ± 13.4 mm and width of 32.25 ± 3.09 mm, thickness of 35.3 ± 2.7 mm and weight of 0.672 ± 0.134 g. In all the cases, the medial MTL originated proximally and deeply to the deep MTL in the tibia. Conclusion We describe a simple effective and reproducible medial MTL dissection technique that makes it possible to identify the ligament over the entire medial extension of the knee.

Medial Meniscotibial Ligament of the Knee: A Step by-Step Dissection / Ligamento meniscotibial medial do joelho: Uma dissecção passo a passo

Abstract Objective Considerable attention has been paid to meniscotibial ligaments (MTLs), also known as coronary ligaments, especially after the "Save the Meniscus" initiative gained importance among knee surgeons. Technically challenging, the diagnosis and treatment of ramp lesion show the importance of MTLs. These ligaments were discovered long ago, but their contribution to knee stability has only recently been studied and still lacks information. Thus, the aim of the present study was to describe step-by-step an dissection technique of the medial MTL, efficient, reproducible and that may lead to further research. Method Twenty fresh cadaver knees were used, with no preference for sex or age. The knees were dissected using the same technique standardized by our team. Each dissection step was recorded digitally. Results The medial MTL was found in all 20 knees studied using the aforementioned technique. In our sample, the medial MTL exhibited an average length of 70.0 ± 13.4 mm and width of 32.25 ± 3.09 mm, thickness of 35.3 ± 2.7 mm and weight of 0.672 ± 0.134 g. In all the cases, the medial MTL originated proximally and deeply to the deep MTL in the tibia. Conclusion We describe a simple effective and reproducible medial MTL dissection technique that makes it possible to identify the ligament over the entire medial extension of the knee.

Resumo Objetivo Considerável atenção tem sido dada aos ligamentos meniscotibiais (LMT), também conhecidos como ligamentos coronários, especialmente depois que a iniciativa "Salve o Menisco" ganhou importância entre os cirurgiões de joelho. Tecnicamente desafiadores, o diagnóstico e o tratamento da lesão em rampa são importantes nos LMTs. Esses ligamentos foram descobertos há muito tempo, mas sua contribuição para a estabilidade do joelho foi recentemente estudada e ainda carece de informações. Assim, o objetivo deste estudo foi descrever passo a passo uma técnica de dissecção medial do LMT que é eficiente, reprodutível e que possa levar a novas pesquisas. Métodos Foram utilizados 20 joelhos de cadáveres frescos, sem preferência por sexo ou idade. Os joelhos foram dissecados com a mesma técnica padronizada por nossa equipe. Cada etapa da dissecação foi gravada digitalmente. Resultados O LMT medial foi encontrado em todos os 20 joelhos estudados com a técnica supracitada. Em nossa amostra, o LMT medial apresentou comprimento médio de 70,0 ± 13,4 mm e largura de 32,25 ± 3,09 mm, além de espessura de 35,3 ± 2,7 mm e peso de 0,672 ± 0,134 g. Em todos os casos, a origem do LMT medial era proximal e profunda em relação ao LMT profundo na tíbia. Conclusão Descrevemos uma técnica de dissecção simples do LMT medial que é eficaz, reprodutível e permite a identificação do ligamento em toda a extensão medial do joelho.

Ultrashort echo time magnetization transfer imaging of knee cartilage and meniscus after long-distance running.

OBJECTIVE: To assess the detection of changes in knee cartilage and meniscus of amateur marathon runners before and after long-distance running using a 3D ultrashort echo time MRI sequence with magnetization transfer preparation (UTE-MT). METHODS: We recruited 23 amateur marathon runners (46 knees) in this prospective cohort study. MRI scans using UTE-MT and UTE-T2* sequences were performed pre-race, 2 days post-race, and 4 weeks post-race. UTE-MT ratio (UTE-MTR) and UTE-T2* were measured for knee cartilage (eight subregions) and meniscus (four subregions). The sequence reproducibility and inter-rater reliability were also investigated. RESULTS: Both the UTE-MTR and UTE-T2* measurements showed good reproducibility and inter-rater reliability. For most subregions of cartilage and meniscus, the UTE-MTR values decreased 2 days post-race and increased after 4 weeks of rest. Conversely, the UTE-T2* values increased 2 days post-race and decreased after 4 weeks. The UTE-MTR values in lateral tibial plateau, central medial femoral condyle, and medial tibial plateau showed a significant decrease at 2 days post-race compared to the other two time points (p < 0.05). By comparison, no significant UTE-T2* changes were found for any cartilage subregions. For meniscus, the UTE-MTR values in medial posterior horn and lateral posterior horn regions at 2 days post-race were significantly lower than those at pre-race and 4 weeks post-race (p < 0.05). By comparison, only the UTE-T2* values in medial posterior horn showed a significant difference. CONCLUSIONS: UTE-MTR is a promising method for the detection of dynamic changes in knee cartilage and meniscus after long-distance running. KEY POINTS: • Long-distance running causes changes in the knee cartilage and meniscus. • UTE-MT monitors dynamic changes of knee cartilage and meniscal non-invasively. • UTE-MT is superior to UTE-T2* in monitoring dynamic changes in knee cartilage and meniscus.

Arthroscopic, histological and imaging studies of rare abnormal insertion points in the anterior root of the medial meniscus / 中华骨科杂志

Objective:To investigate the characteristics of an abnormal attachment point of the anterior horn of the medial meniscus (AHMM) by methods of arthroscopy, radiological imaging, and pathology.Methods:A total of seven cases of a rare abnormal attachment (anteromedial meniscofemoral ligament, AML) connecting the AHMM and anterior cruciate ligament (ACL) were identified in the more than six thousand arthroscopic procedures from January 2018 to April 2021. During the procedures, subtotal meniscal resection or meniscal repair was performed in all cases. Tissue removed intraoperatively was used for pathologic examination. For this study, the preoperative MRI films of these patients were retrospectively examined.Results:Finally, seven cases with diagnosed meniscal tears were included in this study, including 4 males and 3 females with a mean age of 37.85±7.70 years (range, 27-50 years). The AML, which extends outward and upward and is anterior to the ACL, begins at the AHMM and ends anterior to the femoral attachment of the ACL. The histological staining showed that the AML was a bundle of collagen fibers, whereas the ACL was a bundle of dense fibrous collagen. The AML could be clearly identified in the proton-weighted image of sagittal MRI preoperatively and showed a low signaling similar to the signal intensity of the ACL. AML was easily identified on sagittal MRI but not on axial and coronal MRI. In three patients who underwent bilateral MRI, the AML structure was found in both knees.Conclusion:The incidence of rare anatomic variation between the AHMM and the lateral condyle of the femur is 0.1%, usually occurring in both knees simultaneously. In cases with this variation, there is no bony attachment in the AHMM connected to the ACL via the AML. After transection of the AML, the annular fibrous structure and mechanical properties of the meniscus are damaged, as consequently the AML should be carefully protected in clinical practice.

Medial meniscal ossicles: Associated knee MRI findings in a multicenter case-control study.

PURPOSE: The purpose of this study was to assess and compare the prevalence of meniscal, ligament and cartilage lesions on knee MRI in a series of age- and sex-matched patients with and without medial meniscal ossicle. MATERIALS AND METHODS: Forty-two knee MRI examinations obtained in 42 patients (36 men, 6 women; mean age, 42.5±22.2 [SD] years; range: 19-65years) on which a medial meniscal ossicle was present were compared to 42 knee MRI examinations obtained in 42 age- and sex-matched patients (36 men, 6 women; mean age, 41.8±20.6 [SD] years; range: 19-65years) on which no medial meniscal ossicles were present. Two radiologists (R1, R2) blinded to the presence of meniscal ossicle by reading only the fat-saturated intermediate-weighted MR images separately assessed the presence of meniscal, ligament and cartilage lesions on these 84 knee MRI examinations. Prevalence of meniscal and ligament lesions and degree of cartilage degradation at MRI were compared between knees with and those without medial meniscal ossicle. RESULTS: In knees with medial meniscal ossicle, R1 and R2 detected 33 (79%) and 38 (90%) medial meniscal lesions, respectively that involved the posterior root (n=25/32 for R1/R2), the posterior horn (n=19/14 for R1/R2) or the body (n=8/10 for R1/R2). The prevalence of posterior root tear (60% [25/42]/76% [32/42] for R1/R2) and that of anterior cruciate ligament (ACL) lesions (48% [20/42]/57% [24/42] for R1/R2) as well as the medial cartilage degradation score (3.35±0.87 [SD] for R1 and 3.92±0.78 [SD] for R2) were significantly greater in knees with than in knees without medial meniscal ossicle (root lesions: P<0.01 for both readers; ACL lesions and medial cartilage score: P<0.01 for both readers). CONCLUSION: On MRI examination, knees with a medial meniscal ossicle demonstrate a greater frequency of medial posterior root tear and of ACL lesions and a greater degree of medial femoro-tibial cartilage degradation by comparison with knees without medial ossicle.

Characteristics and risk factor analysis of femoral supracondylar fractures combined with meniscal and?ligamentous knee?injuries / 中华创伤杂志

Objective:To analyze the characteristics and related risk factors of femoral supracondylar fractures combined with meniscus and ligament injuries.Methods:A retrospective case series analysis was performed on clinical data of 100 patients with femoral supracondylar fractures combined with ipsilateral meniscal and?ligamentous knee?injuries?admitted to Tianjin Hospital from January 2016 to December 2020. There were 55 males and 45 females，with age of 22-78 years［（38.5 ± 3.3）years］. Causes of injury included traffic accidents in 45 patients，falls in 45 and others in 10. According to AO classification，type A1 was in 56 patients，A2 in 33 and A3 in 11. Sixty of these patients presented fractures on the left side and forty on the right side. All patients accepted MRI examination to estimate meniscal and ligamentous knee injuries concerning its prevalence，locations and severity. Locations of injury included the medial meniscus（MM），lateral meniscus（LM），anterior cruciate ligament（ACL），posterior cruciate ligament（PCL），medial collateral ligament（MCL）and lateral collateral ligament（LCL）. Meniscal knee injuries were measured using Stoller four-level method，and ligamentous knee injuries by Ruiz three-level method. The patients were subdivided based on age，sex，causes of injury，injury side and fracture AO classification to measure the prevalence of meniscal and?ligamentous injuries，and to identify the factors related to injuries using logistic regression analysis.Results:Seventy-six patients（76.0%）were complicated with meniscal or ligamentous injuries in 151 different parts. Twenty-nine patients（29.0%）had both meniscal and ligamentous injuries. Fifty-six patients had meniscal injuries，including 11 with bilateral meniscus injuries. MM injuries were noted in 32 patients（32.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 12 and grade Ⅲ in 1. LM injuries were found in 35 patients（35.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 14 and grade Ⅲ in 2. Forty-nine patients had ligamentous injuries，among which 22 patients were with single ligamentous injuries，19 with double ligamentous injuries and 8 with triple ligamentous injuries. ACL injuries were found in 33 patients（33.0%），with severity of grade Ⅰ in 22 patients，grade Ⅱ in 10 and grade Ⅲ in 1. PCL injuries occurred in 4 patients（4.0%），with severity of grade Ⅰ in 3 patients and grade Ⅱ in 1. MCL injuries occurred in 28 patients（28.0%），with severity of grade Ⅰ in 18 patients，grade Ⅱ in 9 and grade Ⅲ in 1. LCL injuries occurred in 19 patients，with severity of grade Ⅰ in 12 patients，grade Ⅱ in 5 and grade Ⅲ in 2. There were significant differences in prevalence of meniscal injuries among subgroups of different gender，causes of injury and fracture types（ P < 0.05）.Logistic regression analysis suggested that gender and fracture types showed significant correlation with meniscal injuries，especially factors of males（ P < 0.05）and type A3 fractures（ P < 0.01）. There were significant differences in prevalence of ligamentous injuries among subgroups of different causes of injury and fracture types（ P < 0.05）. Logistic regression analysis showed that causes of injury and fracture types were significantly related to ligamentous injuries，especially factors of traffic accidents（ P < 0.01）and type A3 fractures（ P < 0.01）. Conclusions:Ipsilateral meniscal or ligamentous knee injuries have a high incidence in patients with supracondylar femoral fractures. There exist multiple-site injuries，particularly in ligamentous injuries. Males，type A3 fractures and traffic injuries are risk factors，which needs to be paid much attention in clinical diagnosis and treatment.

[Forensic Analysis of 133 Cases of Knee Injuries].

ABSTRACT: Objective To discuss the types, characteristics, and the evaluation of disability of knee injuries. Methods The data of 133 cases of knee injury from 2017 to 2019 were collected and statistically analyzed according to the region of injury, the degree of disability, etc. Results One hundred and twenty-five cases of injury were compound, and 8 cases were simple. The incidences of ligament injury, meniscus injury and fracture were 88.72%, 75.19% and 57.89%, respectively. Of the cruciate ligament injuries, 12 cases were posterior cruciate ligament injury while 51 cases were anterior cruciate ligament injury, and the differences between the two kinds of injury had statistical significance （P<0.05）; 32 cases were secondary traumatic arthritis. The rates of disability of knee injuries were 38.35% （Grade Ⅸ and Ⅹ）. Conclusion Compound knee injuries are common, and traumatic arthritis has a relatively high rate. Multiple injuries can affect the stability and weight-bearing of the knee joint. It is suggested that in addition to evaluating the range of motion of knee joint, multiple factors should be considered to assess disability.

Work, sport activities and factors associated with medial meniscal tears in nonathletic subjects.

BACKGROUND: It is known that late surgical reconstruction of the anterior cruciate ligament (ACL) is associated with a medial meniscal (MM) tears. However, the association between factors relating to sports and work activities and joint instability, has not been examined in non-athletic subjects. OBJECTIVE: To compare sports and work activities and other factors associated with MM tears, in subjects with ACL rupture. METHOD: A case-control design study, of patients with ACL injury, 140 cases and 140 controls with and without a rupture of MM respectively, were included. Sociodemographic factors, sports and work activities were compared. RESULTS: The independent factors associated with MM ruptures were continuing sports activities after injury (odds ratio [OR]: 3.6; 95% confidence interval [95% CI]: 1.7-7.9), joint instability (OR: 2.2; 95% CI: 1.8-2.6), time between injury and surgical intervention (time of evolution) (OR: 1.003; 95% CI: 1.0-1.01) and age (OR: 1.1; 95% CI: 1.03-1.1). CONCLUSIONS: Intense activities of daily life such as continuing sports activities, after an ACL injury in non-athletic factory workers subjects, without previous training, as well as, age, joint instability and surgical delay are risk factors for rupture of MM.

ANTECEDENTES: Se sabe que la reconstrucción tardía del ligamento cruzado anterior (LCA) se asocia a rotura del menisco medial (MM). Sin embargo, la asociación entre factores referentes a las actividades deportivas, laborales e inestabilidad articular no se ha examinado en sujetos no deportistas. OBJETIVO: Comparar las actividades laborales, deportivas y otros factores asociados a rotura del MM en sujetos con rotura del LCA. MÉTODO: Diseño de casos y controles, de sujetos con rotura del LCA; 140 casos y 140 controles con y sin rotura de MM, respectivamente. Se compararon factores sociodemográficos, actividades deportivas y laborales. RESULTADOS: Los factores independientes asociados a roturas del MM fueron el continuar con actividades deportivas después de la lesión (razón de momios [RM]: 3.6; intervalo de confianza del 95% [IC 95%]: 1.7-7.9), la inestabilidad articular (RM: 2.2; IC 95%: 1.8-2.6), el tiempo de evolución entre la lesión y la reconstrucción (RM: 1.003; IC 95%: 1.0-1.01) y la edad (RM: 1.1; IC 95%: 1.03-1.1). CONCLUSIONES: Actividades intensas de la vida diaria, como continuar con deportes, después de una lesión del LCA en sujetos obreros, no deportistas, sin entrenamiento previo, así como la edad, el retraso en la reconstrucción y la inestabilidad articular, son factores de riesgo para rotura del MM.

Forensic Analysis of 133 Cases of Knee Injuries / 法医学杂志

Objective To discuss the types, characteristics, and the evaluation of disability of knee injuries. Methods The data of 133 cases of knee injury from 2017 to 2019 were collected and statistically analyzed according to the region of injury, the degree of disability, etc. Results One hundred and twenty-five cases of injury were compound, and 8 cases were simple. The incidences of ligament injury, meniscus injury and fracture were 88.72%, 75.19% and 57.89%, respectively. Of the cruciate ligament injuries, 12 cases were posterior cruciate ligament injury while 51 cases were anterior cruciate ligament injury, and the differences between the two kinds of injury had statistical significance （P<0.05）; 32 cases were secondary traumatic arthritis. The rates of disability of knee injuries were 38.35% （Grade Ⅸ and Ⅹ）. Conclusion Compound knee injuries are common, and traumatic arthritis has a relatively high rate. Multiple injuries can affect the stability and weight-bearing of the knee joint. It is suggested that in addition to evaluating the range of motion of knee joint, multiple factors should be considered to assess disability.

The association between high-grade pivot-shift and complete lateral meniscus posterior root tear after anterior cruciate ligament ruptures / 中华骨科杂志

Objective To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.Methods From January 2013 to December 2017,a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively.There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2).The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years).All patients were classified into high-grade pivotshift group (60 patients of IKDC grade Ⅱ-Ⅲ) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions.Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression,involving degree of LMPR tear,integrity of meniscofemoral ligament,width of lateral meniscal extrusion,KT-1000 arthrometer side-to-side difference,age,sex,and BMI.Results The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group.High-grade pivot-shift was associated to complete LMPR tear [OR=4.096,95％CI(1.339,12.371),P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632,95％CI (3.095,29.975),P＜0.001].The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343,95％CI(1.224,56.853),P=0.030].High-grade pivot-shift did not associated with meniscofemoral ligament,lateral meniscal extrusion,age,sex and BMI (P＞0.05).Conclusion In patients with ACL ruptures,complete LMPR tear was an independent risk factor of high-grade pivot-shift,especially for patients with 12 weeks at least duration from injury to surgery.

Short-term clinical outcomes and second-look arthroscopic findings of high tibial osteotomy combined with medial meniscus posterior root repair / 中华骨科杂志

Objective To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy (HTO) combined with medial meniscus posterior root (MMPR) repair.Methods Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed.Biplane HTO combined with MMPR repair was performed on these patients.Arthroscopic transtibial pullout repair was employed to repair the MMPR.The relative degree of the medial meniscus extrusion (MME) were measured.Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy.Clinical outcomes were assessed based on Hospital for Special Surgery (HSS) scores and Lysholm scores.Results The MMPRs were completely healed in 12 cases (48％),partially healed in 9 cases (36％),healed with scarring in 3 cases (12％),and no healed in 1 case (4％).Follow-up duration was 13.04±1.06 months (12-16 months).There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery (x2=0.786,P=0.675).The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88％±t6.44％ preoperatively and 58.68％±17.71％ after operation with significant difference (t=-18.561,P ＜ 0.001).The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation (t=-52.717,P ＜ 0.001).The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation (t=-38.685,P ＜ 0.001).The degree of MME was changed from 51.12％± 13.55％ to 50.48％± 15.15％ without statistical difference (t=0.550,P=0.588).The comparison between different degrees of healing groups revealed no statistical differences in all variables (P ＞ 0.05).The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables (P ＞ 0.05).Conclusion HTO combined with MMPR repair can effectively improve the lower limb alignment and patients' symptoms with a satisfactory healing rate of MMPR.The effects of post-root repair after a short period is not obvious.The longer-term clinical effects is worthy of further observation.

The association between high-grade pivot-shift and complete lateral meniscus posterior root tear after anterior cruciate ligament ruptures / 中华骨科杂志

Objective@#To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.@*Methods@#From January 2013 to December 2017, a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively. There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2). The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years). All patients were classified into high-grade pivot-shift group (60 patients of IKDC grade II-III) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions. Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression, involving degree of LMPR tear, integrity of meniscofemoral ligament, width of lateral meniscal extrusion, KT-1000 arthrometer side-to-side difference, age, sex, and BMI.@*Results@#The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group. High-grade pivot-shift was associated to complete LMPR tear [OR=4.096, 95% CI(1.339, 12.371), P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632, 95% CI (3.095, 29.975), P<0.001]. The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343, 95%CI(1.224, 56.853), P=0.030]. High-grade pivot-shift did not associated with meniscofemoral ligament, lateral meniscal extrusion, age, sex and BMI (P>0.05).@*Conclusion@#In patients with ACL ruptures, complete LMPR tear was an independent risk factor of high-grade pivot-shift, especially for patients with 12 weeks at least duration from injury to surgery.

Short-term clinical outcomes and second-look arthroscopic findings of high tibial osteotomy combined with medial meniscus posterior root repair / 中华骨科杂志

Objective@#To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy (HTO) combined with medial meniscus posterior root (MMPR) repair.@*Methods@#Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed. Biplane HTO combined with MMPR repair was performed on these patients. Arthroscopic transtibial pullout repair was employed to repair the MMPR. The relative degree of the medial meniscus extrusion (MME) were measured. Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy. Clinical outcomes were assessed based on Hospital for Special Surgery (HSS) scores and Lysholm scores.@*Results@#The MMPRs were completely healed in 12 cases (48%), partially healed in 9 cases (36%), healed with scarring in 3 cases (12%), and no healed in 1 case (4%). Follow-up duration was 13.04±1.06 months (12-16 months). There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery (χ2=0.786, P=0.675). The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88%±6.44% preoperatively and 58.68%±7.71% after operation with significant difference (t=-18.561, P<0.001). The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation (t=-52.717, P<0.001). The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation (t=-38.685, P<0.001). The degree of MME was changed from 51.12%±13.55% to 50.48%±15.15% without statistical difference (t=0.550, P=0.588) . The comparison between different degrees of healing groups revealed no statistical differences in all variables (P>0.05). The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables (P>0.05).@*Conclusion@#HTO combined with MMPR repair can effectively improve the lower limb alignment and patients' symptoms with a satisfactory healing rate of MMPR. The effects of post-root repair after a short period is not obvious. The longer-term clinical effects is worthy of further observation.

[Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

OBJECTIVE: To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. METHODS: From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. RESULTS: Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. CONCLUSIONS: MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized.

Anatomical variation in the anterolateral ligament of the knee and a new dissection technique for embalmed cadaveric specimens.

Claes et al. recently documented and described the anterolateral ligament (ALL) of the knee, demonstrating its existence in 97% of their samples. Here, we further examined the anatomy of this ligament, documented its morphological variation, and assessed the feasibility of its dissection in preserved cadaveric specimens. To achieve this, we dissected 53 preserved cadaveric knees and documented their morphological variation in the anterolateral ligament. The originally described dissection technique for identifying and following the ALL requires flexion of the knee, a state which is often not possible in stiff, preserved cadavers. Here, we describe and confirm the feasibility of an alternate dissection technique in which the quadriceps femoris tendon is incised, for use on specimens in which flexion of the undissected knee is not possible. We also identify a novel technique for assessing whether the anterolateral ligament is absent from a specimen or has simply been obliterated or overlooked, using the lateral inferior genicular vasculature. These dissection techniques have great potential for the dissection of preserved cadavers used in gross anatomy laboratories, and we discuss the applications of such an approach in student-led dissections. Our dissections also uncovered noticeable variation in the anterolateral ligament course and position. Most notably, it often inserts significantly more laterally than the classical presentation (30.2%), or originates more proximally with superficial fibers extending superiorly and laterally over the distal femur (7.5%).

Diagnostic value of MRI for posterior root tear of medial and lateral meniscus / 中国骨伤

<p><b>OBJECTIVE</b>To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus.</p><p><b>METHODS</b>From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated.</p><p><b>RESULTS</b>Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72.</p><p><b>CONCLUSIONS</b>MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized.</p>

Meniscectomía artroscópica en 100 pacientes / Arthroscopic meniscectomy in 100 patients

Fundamento: las lesiones del menisco en la articulación de la rodilla son una de las enfermedades más frecuentes debido a causas traumáticas y degenerativas, el cuadro clínico se caracteriza por la presencia de síntomas y signos mecánicos y el tratamiento por lo general es quirúrgico por la vía artroscópica que es de gran utilidad. Objetivo: evaluar la efectividad de la meniscectomía por vía artroscópica en un grupo de pacientes con lesión de menisco. Métodos: se realizó un estudio cuasi experimental modalidad antes y después, en 100 pacientes operados por meniscectomía mediante la vía artroscópica, la investigación tiene un nivel de evidencia III, recomendación B y fue realizada en el hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde febrero de 2013 a enero de 2017. El universo estuvo compuesto por 158 pacientes de los cuales 100 fueron seleccionados para integrar la muestra no probabilística. Resultados: el promedio de edades fue de 46,95 años, predominó el sexo femenino, la rodilla derecha y el menisco medial. El desgarro de tipo degenerativo se observó en el 50 % de los casos, la plica sinovial se detectó en 41 enfermos y las lesiones de cartílago en 78. El dolor en la línea articular y la maniobra de McMurray presentaron el mayor porcentaje de positividad. La meniscectomía parcial fue el procedimiento quirúrgico más empleado. Se observó significación entre un antes y después al emplear las escalas de WOMET y KOOS abreviada. Conclusiones: la meniscectomía artroscópica es un procedimiento quirúrgico efectivo en pacientes con lesiones de menisco, tanto de causa degenerativa como traumática.

Background: meniscal lesions of the knee due to degenerative and traumatic causes are common. Patients usually complain of mechanical symptoms and signs. Treatment is usually surgical by arthroscopy because of several advantages. Objective: the aim of this study was to evaluate the use of arthroscopic meniscectomy in patients with meniscal lesions. Methods: a quasi experimental study before and after modality with a level of evidence III and recommendation grade B in Manuel Ascunce Domenech hospital in Camaguey city from February 2013 to January 2017 was performed in 158 patients diagnosed with meniscal lesions, but 100 of them were selected as a non-probabilistic sample, based on selected criteria. Results: average age was 46,95 years. Female sex, right knee and medial meniscus prevailed. Degenerative tears were detected in 50 % of the cases. Synovial plica and cartilage lesions were found in 41 and 78 patients respectively. Joint line tenderness and McMurray test were positive in a huge number of patients. Partial arthroscopic meniscectomy was the common used surgical procedure. There were significant statistical differences between before and after while using WOMET and short KOOS scales. Conclusions: arthroscopic meniscectomy is an effective surgical procedure in patients with meniscal lesions.

[Observation of curative effects of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease].

OBJECTIVE: To observe the curative effect of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease, and to provide a new method in the treatment of degenerative meniscus disease. METHODS: Seventy-seven patients with degenerative meniscus disease treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2015 to September 2015 were selected, including 30 males and 47 females, aged from 44 to 66 years old, with an average of 57.5 years old. VAS scores, Lysholm scores and distance of meniscal protrusion were analyzed and compared before treatment, 2 weeks and 1 month after treatment. The curative effect was summarized at last. RESULTS: The mean Lysholm scores were 51.63±15.26(before treatment), 77.13±11.82(2 weeks after treatment) and 87.56±8.65(1 month after treatment). The mean VAS scores were 7.080±1.574 (before treatment), 2.630±0.310(2 weeks after treatment) and 0.850±0.177(1 month after treatment). The mean of the distance of meniscal protrusion scores were 0.400±0.156 (before treatment), 0.298±0.140 (2 weeks after treatment) and 0.240±0.110 (1 month after treatment). VAS scores and Lysholm scores were improved significantly compared with preoperative results. The distance of meniscal protrusion showed an obvious improvement after treatment. CONCLUSIONS: The treatment of musculoskeletal ultrasound-guided needle-knife has advantages of high accuracy position and excellent effectiveness for degenerative meniscus disease. The treatment provides safety operation and significantly improves quality of life in patients without any complications.

Observation of curative effects of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease / 中国骨伤

<p><b>OBJECTIVE</b>To observe the curative effect of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease, and to provide a new method in the treatment of degenerative meniscus disease.</p><p><b>METHODS</b>Seventy-seven patients with degenerative meniscus disease treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2015 to September 2015 were selected, including 30 males and 47 females, aged from 44 to 66 years old, with an average of 57.5 years old. VAS scores, Lysholm scores and distance of meniscal protrusion were analyzed and compared before treatment, 2 weeks and 1 month after treatment. The curative effect was summarized at last.</p><p><b>RESULTS</b>The mean Lysholm scores were 51.63±15.26(before treatment), 77.13±11.82(2 weeks after treatment) and 87.56±8.65(1 month after treatment). The mean VAS scores were 7.080±1.574 (before treatment), 2.630±0.310(2 weeks after treatment) and 0.850±0.177(1 month after treatment). The mean of the distance of meniscal protrusion scores were 0.400±0.156 (before treatment), 0.298±0.140 (2 weeks after treatment) and 0.240±0.110 (1 month after treatment). VAS scores and Lysholm scores were improved significantly compared with preoperative results. The distance of meniscal protrusion showed an obvious improvement after treatment.</p><p><b>CONCLUSIONS</b>The treatment of musculoskeletal ultrasound-guided needle-knife has advantages of high accuracy position and excellent effectiveness for degenerative meniscus disease. The treatment provides safety operation and significantly improves quality of life in patients without any complications.</p>

Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis.

OBJECTIVE: To identify predictors of poor exercise adherence in patients with osteoarthritis (OA) and meniscal tear. DESIGN: Secondary analysis of data gathered over the first 12 weeks in the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, a multicenter, randomized controlled trial. SETTING: Seven referral centers. PARTICIPANTS: Most of the patients in the MeTeOR trial (N=325 of 351) were included in the analysis, each of whom was aged ≥45 years and had a meniscal tear and osteoarthritic changes on imaging studies; 26 were excluded because of missing data from which to derive the primary outcome variable. INTERVENTIONS: All patients received a structured, supervised exercise program focused on strengthening, along with prescribed home exercises; half were randomly assigned to also receive arthroscopic partial meniscectomy. MAIN OUTCOME MEASURE: Poor exercise adherence through 12 weeks, defined as performing <50% of prescribed exercise. RESULTS: Thirty-eight percent of the MeTeOR cohort showed poor exercise adherence. In the multivariate model, adjusting for treatment group, those who earned ≤$29,000 per year had 1.64 times the risk of nonadherence (95% confidence interval [CI], 1.10-2.43) than those who earned >$100,000 per year; and those without baseline pain with pivoting and twisting had 1.60 times greater risk of nonadherence than those with these symptoms (95% CI, 1.14-2.25). CONCLUSIONS: Low income was associated with poor exercise adherence among patients aged ≥45 years with OA and a meniscal tear, as was absence of pain with pivoting and twisting. Our findings highlight the need for further research into exercise adherence and for interventions to enhance adherence among those with low incomes.