The presence of a deep lateral femoral notch sign in ACL-injured patients is associated with a 2.7° steeper posterior tibial slope and a 19% higher frequency of lateral meniscal injuries.

PURPOSE: The purpose of this study was to study the relationship between the presence of a deep lateral femoral notch sign (DLFNS) in anterior cruciate ligament (ACL)-injured patients and a higher posterior lateral tibial slope (LPTS), a reduced meniscal bone angle (MBA), a higher LPTS/MBA ratio and a higher incidence of concomitant injuries in primary ACL tears. METHODS: A retrospective case-control study was performed in patients submitted to primary ACL reconstruction with an available preoperative magnetic resonance imaging (MRI) scan. Patients with ACL tears and a femoral impactation with a depth ≥2 mm were assorted to the DLFNS group and patients with ACL tear and without a DLFNS to the control group. LPTS and MBA were measured in MRI. The presence of concomitant injuries (meniscal, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament and bone injuries) was assessed in MRI. Quantitative data are presented in the median ± interquartile range (IQR). RESULTS: There were 206 patients included in the study, with 46 patients assorted to the DLFNS group and 160 patients to the control group. In the DLFNS group, the median LPTS was 6.7° (IQR: 4.0-8.2) versus 4.0° in the control group (IQR: 2.2-6.5) (p = 0.003). The LPTS/MBA ratio was significantly higher in the DLFNS group, with a median of 0.32 (IQR: 0.19-0.44), in comparison to the control group, with a median of 0.19 (IQR: 0.11-0.31) (p < 0.001). The multivariable logistic regression analysis showed that the LPTS is an independent risk factor to having a DLFNS (odds ratio [OR] = 1.161; 95% confidence interval [CI]: 1.042-1.293, p = 0.007). There was a higher incidence of concomitant lateral meniscal injuries in the DLFNS group (67% vs. 48%, p = 0.017). CONCLUSIONS: In patients with ACL tears, the presence of a DLFNS is associated with a steeper lateral posterior tibial slope, as well as a higher incidence of concomitant lateral meniscal injuries. LEVEL OF EVIDENCE: Level III.

Medial meniscus extrusion is associated with meniscus tears in US and MRI: A case control study.

OBJECTIVES: To study the medial meniscus extrusion (MME) in subjects with and without medial meniscal tears on magnetic resonance imaging (MRI), supine ultrasound (US), and weight-bearing US. METHODS: Forty-seven cases (mean age 43.7 years) with medial meniscus tears and 53 healthy controls (mean age 36.6 years) were assessed. Two experienced sonographers performed the US evaluations, and a fellowship-trained musculoskeletal radiologist assessed the menisci on MRI. Independent and paired T-tests and ICC were used for statistical analyses. RESULTS: On supine US, the mean MME was 3.9 mm for the cases and 2.3 mm for the controls (p < 0.001). On weight-bearing US, the values were 4.2 and 2.8 mm (p < 0.001), and on MRI 3.0 and 2.0 mm (p < 0.001), respectively. The mean difference between supine and weight-bearing US extrusion was 0.38 mm for the cases and 0.49 mm for the controls (p = 0.291). Correlation between supine US and MRI MME measurements was good (ICC = 0.660, CIs [0.533-0.758]). CONCLUSIONS: MME can be assessed using US with good correlation to MRI. US-observed extrusion was significantly increased in supine and standing positions for medial meniscus tears. The mean difference between examination positions was reduced with medial meniscus tears although this result was statistically insignificant.

Epidemiology of Knee Injuries in Baseball Players from the State of São Paulo.

Objective This study aimed to identify the main knee complaints and injuries associated with baseball and their prevalence in the state of São Paulo, Brazil. Methods This epidemiological study analyzed data from an online questionnaire sent to baseball athletes from the state of São Paulo, Brazil, from 2019 to 2022. Results Ninety-eight athletes participated in the study. Their average age was 24.3 years, and 85.72% of the subjects were men. The most prevalent ethnicities were yellow (50%) and white (42.86%). Most athletes had incomplete or complete higher education (75.5%). Most (88.77%) have been training for over 1 year, and 40.82% played in more than 1 position. More than half also practiced another sport. Most (66.32%) athletes present knee complaints or symptoms, and 37.75% had suffered a knee injury playing baseball, with several mechanisms (contact with the ground, contact with another player, or no contact). More than half (59.45%) of the athletes required time away from baseball due to complaints, symptoms, or injuries. Conclusion Among the athletes interviewed, 66.32% had a knee complaint, and 37.75% had already had a knee injury, especially meniscal and ligament injuries. The injury rate was highest in the first year of practice.

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

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

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

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

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

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

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

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

Preoperative Meniscus: Pitfalls and Traps to Avoid.

To accurately interpret knee MRI, it is important not only to know the basic meniscal anatomy but also to distinguish it from that under pathological conditions. Thus, it would be helpful to know the normal meniscus variants (false positives) that could be mistaken for meniscal tears, and tears that could easily be missed and incorrectly diagnosed as normal (false negatives). False positives include synovial recesses, meniscal flounce, the relationship between the popliteus tendon and lateral meniscus, transverse ligament, the anterior root of the meniscus, and meniscofemoral ligament. False negatives include focal radial tears, flap tears, posterior root tears, meniscocapsular separation, and discoid meniscal tears. In this pictorial essay, we reviewed the imaging data obtained in the aforementioned cases.

Microinvasive Meniscal Suture with Disposable Needle.

The first meniscal suture was performed in 1885 and took about a century to become popular. Currently, all-inside meniscal repair devices are widely used. However, this technique presents the disadvantage of being a method dependent on specific devices, presenting a higher cost than other techniques. This high cost limits the use of such a technique in many locations. The objective of the present technical note is to describe a microinvasive meniscal suture technique as a modification of the all-inside technique, using a disposable 40 × 12 mm procedure needle. The authors believe that the proposed modification to the technique can make it more popular, enabling the use of the microinvasive technique in places with limited resources.

[Recent research on relationship of lower limb alignment and repairment of medial meniscus injury].

Meniscus and lower limb alignment play an important role in load transfer of knee joint and has internal relationship between them. At present, different scholars have different views on the choice of surgical methods for patients with medial meniscus injury with knee varus. In recent years, many scholars have shown that choice of operation and abnormal lower limb alignment are related to repair and healing of medial meniscus injury and clinical effect. Therefore, evaluation of lower limb alignment should pay attention on diagnosis and treatment for patient with medial meniscus injury. This paper summarizes biomechanical function and internal relationship between meniscus and lower limb alignment, and expounds the interaction between medial meniscus posterior root injury, degenerative injury, acute tear and lower limb alignment, respectively. It shows that osteotomy plays an important role in repairing medial meniscus injury and the occurrence and development of knee osteoarthritis in patients with abnormal lower limb alignment and medial meniscus injury. It is expected to provide theoretical guidance for the clinical treatment of patients with medial meniscus injury with abnormal lower limb alignment.

Microinvasive Meniscal Suture with Disposable Needle / Sutura meniscal microinvasiva com agulha descartável

Abstract The first meniscal suture was performed in 1885 and took about a century to become popular. Currently, all-inside meniscal repair devices are widely used. However, this technique presents the disadvantage of being a method dependent on specific devices, presenting a higher cost than other techniques. This high cost limits the use of such a technique in many locations. The objective of the present technical note is to describe a microinvasive meniscal suture technique as a modification of the all-inside technique, using a disposable 40 x 12 mm procedure needle. The authors believe that the proposed modification to the technique can make it more popular, enabling the use of the microinvasive technique in places with limited resources.

Resumo A primeira sutura meniscal foi realizada em 1885 e levou cerca de um século para tornar-se popular. Atualmente, os dispositivos de reparo meniscal all-inside são amplamente utilizados. Contudo, esta técnica apresenta a desvantagem de ser um método dependente de dispositivos específicos, apresentando um custo superior aos de outras técnicas. Este valor elevado limita o uso de tal técnica em muitos locais. O objetivo da presente nota técnica é descrever uma técnica de sutura meniscal microinvasiva, como uma modificação da técnica all-inside, utilizando uma agulha descartável de procedimento de 40 x 12 mm. Os autores acreditam que a modificação proposta para a técnica pode torná-la mais popular, possibilitando o uso da técnica microinvasiva em locais com recursos limitados.

Analysis of the types of lateral meniscal injury in Schatzker type II tibial plateau fractures and its correlation with CT features of lateral plateau / 中华骨科杂志

Objective:To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods:The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed, including 132 males and 81 females, aged from 29 to 61 years, with an average of 44.9 years. All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation (ORIF). According to the actual situation during the operation, the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group. By measuring lateral plateau depression (LPD) and lateral plateau widening (LPW) of the lateral tibial plateau on CT images, the correlation of which and lateral meniscus injury was analyzed. The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic (ROC) curves.Results:The meniscus injury group (109 patients) mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.2%, 107/109) and LPD was 13.1±3.2 mm; while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference ( t=3.98, P<0.001). The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm, respectively, and the difference was statistically significant ( t=2.68, P=0.011). The optimal predictive critical point of LPD and LPW was 7.6 mm (sensitivity 90.3%, specificity 64.7%, area under the curve 0.834) and 7.3 mm (sensitivity 80.5%, specificity 58.8%, area under the curve 0.722). Conclusion:Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation, rupture and longitudinal fracture. The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD> 7.6 mm and/or LPW> 7.3 mm on coronal CT images.

Application of fracture liaison service-based intervention in elderly patients with meniscus injury / 中国实用护理杂志

Objective:To investigate the intervention effects of fracture liaison service (FLS)-based intervention in elderly patients with meniscus injury, to provide reference for clinical rehabilitation.Methods:A total of 86 elderly patients with meniscus injury from February 2018 to October 2019 in the Second Affiliated Hospital of Xi ′an Jiaotong University were divided into experimental group and control group according to random number table method. There were 43 cases in each group.The control group was given routine nursing, and the experimental group implemented FLS-based nursing intervention on the basis of the control group. The clinical effects were compared between the two groups by using knee function, knee joint mobility and degree of frailty. Results:Finally, 38 cases were included in the experimental group and 41 cases in the control group. There was no significant difference in knee function, knee joint mobility and degree of frailty between the two groups at discharge ( P>0.05). At 1, 3 months after discharge, the knee scores and knee joint mobility were (75.37 ± 4.68) points, (90.34 ± 3.02) points and (96.68 ± 8.11)°, (119.11 ± 7.92)° in the experimental group, higher than those in the control group (73.17 ± 3.92) points, (87.76 ± 2.93) points and (91.76 ± 7.75)°, (108.61 ± 7.72)°, the differences were statistically significant ( t values were 2.26-5.96, all P<0.05). The knee function scores and knee joint mobility of the two groups changed with time ( F=264.33, 279.54, both P<0.05). There were interaction effects between groups and time in the knee joint mobility of the two groups ( F=6.12, P<0.05). At 1, 3, 6 months after discharge, the physiological dimension scores and frailty total scores were 5.08 ± 1.34, 4.74 ± 1.10, 4.13 ± 0.88 and 8.32 ± 1.50, 7.82 ± 1.31, 6.82 ± 0.95 in the experimental group, lower than those in the control group 5.68 ± 1.15, 5.22 ± 0.85, 5.02 ± 0.76, 9.05 ± 1.28, 8.40 ± 0.89, 8.18 ± 0.90, the differences were statistically significant ( t values were 2.15-6.57, all P<0.05). At 6 months after discharge, the psychological and cognitive dimension scores were 0.98 ± 0.30 and 0.45 ± 0.24 in the experimental group, lower than those in the control group 1.32 ± 0.37 and 0.59 ± 0.22, the differences were statistically significant ( t=4.49, 2.82, both P<0.05). The physiological and cognitive dimension scores and total scores of the two groups changed with time ( F=30.61, 31.72, 38.50, all P<0.05). There were interaction effects between groups and time in the physiological demension scores and the frailty total scores of the two groups ( F=2.86, 4.03, both P<0.05). Conclusions:FLS-based intervention can promote the rehabilitation of knee joint function and alleviate the degree of frailty of elderly patients with meniscus injury.

[Arthroscopic surgery combined with platelet-rich plasma for meniscus injury:a Meta analysis].

OBJECTIVE: To evaluate clinical efficacy of arthroscopic with platelet-rich plasma (PRP) in treating meniscus injury. METHODS: From January 2015 to December 2019, clinical control study on repair meniscus injury by arthroscopic with PRP between arthroscopic were searched by PubMed, Science Direct, Cochrane library, Chinese Journal Full-text Database, Wanfang and VIP database. Literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria. Visual analogue scale(VAS) of knee joint and Lysholm score at 1, 6 and 12 months after opertaion between two groups were compared, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at 3, 6 and 12 months after opertaion between twogroups were also compared. RESULTS: Totally 9 literatures and 329 patients with meniscal injuries were screened, include 146 patients treated by arthroscopic with PRP and 183 patients treated by arthroscopic. There were no statistical differences in VAS between two groups at 1, 6 and 12 months after opertaion. There were differences in Lysholm score at 1 and 6 months after operation between two groups [MD=3.85, 95%CI (1.25, 6.44), P<0.05], [MD=2.88, 95%CI (0.13, 5.63), P<0.05];while there was no difference at 12 months[MD=5.88, 95%CI(-8.72, 20.48), P=0.43]. There were differneces in WOMAC score at 3 and 6 months after operation between two groups[MD=-8.07, 95%CI(-11.17, -4.89), P<0.000 01], [MD=-7.96, 95%CI(-11.44, -4.48), P<0.000 01];and no difference at 12 months after operation[MD=-6.61, 95%CI (-16.64, 3.41), P>0.05]. CONCLUSION: Arthroscopic with PRP for repair meniscus injury has short term efficacy of knee function and delay arthritis, while has similar effect in long term clinical efficacy and relieve pain.

[Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus].

OBJECTIVE: To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique. METHODS: Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed. RESULTS: All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group Ultrabraid suture group >FiberWire suture group, and had statistical differences among groups (P<0.05);the results showed the suture strength in Ethibond was the best, Ultrabraid suture took the second place, and FiberWire suture was the worst. (2)As for different suture sites, comparison of the maximum failure load, yield load and stiffness showed that red zone fixation group >red-white region fixation group, and had statistical difference between two groups(P< 0.05);comparison of cyclic displacement at 100, 500 and 1 000 cycles showed that red zone fixation group

Arthroscopic Saucerization of a Symptomatic Posterior Horn Tear in a Discoid Medial Meniscus.

Background: Discoid medial meniscus is an extremely rare congenital anatomic variant with an estimated incidence of 0.12%. Arthroscopic meniscal saucerization and repair are reserved for symptomatic tears only. We present a case of discoid medial meniscus tear, outline the surgical arthroscopic technique used for treatment, and compare several surgical approaches. Case Report: An 18-year-old male presented with left knee pain and mechanical symptoms present for 2 years. Physical examination showed stability to both varus and valgus stresses with absence of locking or catching on McMurray testing. Magnetic resonance imaging confirmed discoid medial meniscus with a horizontal oblique tear of the posterior horn. The patient underwent saucerization of the left discoid medial meniscus and medial meniscus repair. Conclusion: Discoid medial meniscus predisposes individuals to meniscal tears that often require operative management. Careful consideration of surgical approach can help to optimize patient outcomes while minimizing the risk of iatrogenic injury.

"You'd be better off to do the keyhole and make a good job of it" a qualitative study of the beliefs and treatment expectations of patients attending secondary care with degenerative meniscal tears.

BACKGROUND: Current clinical practice guidelines for degenerative meniscal tears recommend conservative management yet patients are frequently referred to the consultant orthopaedic surgeon despite a lack of evidence for the use of arthroscopy. OBJECTIVES: To explore the beliefs about their condition and treatment expectations of patients referred to a secondary care orthopaedic clinic with a degenerative meniscal tear. DESIGN AND METHODS: Design and MethodsThis qualitative study involved ten patients who participated in semi-structured telephone interviews. Data were subjected to thematic analysis and findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. RESULTS: Analysis identified five themes. Participants described beliefs, strongly influenced by magnetic resonance imaging (MRI) results, that damaged structures were causing their knee problems ("The meniscus is busted"), and expected their knee problems to inevitably worsen over time ("It's only going to get worse"). Participants were hopeful the orthopaedic consultation would clarify their problem and lead to a subsequent definitive intervention ("Hopefully they will give me answers"). Most participants viewed surgery as "the quick and straightforward solution" necessary to repair faulty cartilage. Exercise was not seen as compatible with the recovery process by most ("Would I make it worse?"). CONCLUSIONS: How participants understand their knee problem contributes to surgical expectations and perceptions that it is not amenable to conservative management. Findings suggest a need to educate both patients and primary care clinicians about the safety and efficacy of exercise as first-line therapy for degenerative meniscal tears. The negative role of MRI in promoting surgical expectations needs further consideration.

Arthroscopic surgery combined with platelet-rich plasma for meniscus injury:a Meta analysis / 中国骨伤

OBJECTIVE@#To evaluate clinical efficacy of arthroscopic with platelet-rich plasma (PRP) in treating meniscus injury.@*METHODS@#From January 2015 to December 2019, clinical control study on repair meniscus injury by arthroscopic with PRP between arthroscopic were searched by PubMed, Science Direct, Cochrane library, Chinese Journal Full-text Database, Wanfang and VIP database. Literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria. Visual analogue scale(VAS) of knee joint and Lysholm score at 1, 6 and 12 months after opertaion between two groups were compared, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at 3, 6 and 12 months after opertaion between twogroups were also compared.@*RESULTS@#Totally 9 literatures and 329 patients with meniscal injuries were screened, include 146 patients treated by arthroscopic with PRP and 183 patients treated by arthroscopic. There were no statistical differences in VAS between two groups at 1, 6 and 12 months after opertaion. There were differences in Lysholm score at 1 and 6 months after operation between two groups [@*CONCLUSION@#Arthroscopic with PRP for repair meniscus injury has short term efficacy of knee function and delay arthritis, while has similar effect in long term clinical efficacy and relieve pain.

Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus / 中国骨伤

OBJECTIVE@#To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique.@*METHODS@#Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed.@*RESULTS@#All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group

Fijación externa en la fractura de meseta tibial tipo VI de Schatzker / External fixation in Schatzker J´s type VI tibial plateau fracture

RESUMEN Fundamento: las fracturas de la meseta tibial son lesiones traumáticas frecuentes por lo general son provocadas por mecanismos de compresión vertical en varo o valgo, de allí la incidencia de fracturas abiertas con pérdida de piel no son frecuentes, ya que estas responden por lo general a mecanismos directos. Objetivo: presentar el caso de una paciente con fractura abierta de la meseta tibial tipo VI de Schatzker J. Presentación del caso: paciente de 61 años de edad, mestiza, femenina sin antecedentes mórbidos de salud, la cual sufre accidente del tránsito al proyectarse contra un camión y es traída al servicio de urgencias de Ortopedia y Traumatología por presentar dolor e inflamación a nivel de la rodilla y pierna izquierda, que le impide la marcha y los movimientos, además de presentar herida avulsiva de base distal que se comunicaba con el foco de fractura. El examen radiográfico simple de la rodilla izquierda en proyecciones anteroposterior y lateral mostró solución de continuidad del tejido óseo a nivel de la zona metafiso-epifisaria de la tibia proximal izquierda. El tratamiento definitivo de la paciente consistió en la colocación de tornillo canulado y fijación externa tipo Hoffman 1® mediante dos anclajes en el fémur y tibia. Conclusiones: las fracturas de la meseta tibial tipo VI de Schatzker J, son lesiones traumáticas de difícil tratamiento debido a su asociación a complicaciones como: comunicación con el exterior y pérdida de piel. La fijación externa es un método de osteosíntesis útil y de fácil aplicación, que permite el tratamiento de estas lesiones complicadas.

ABSTRACT Background: tibial plateau fractures are common traumatic lesions due to vertical compression in varus and valgus. That is why open fractures associated to skin loss are not so frequent, because they are caused by direct mechanisms. Objetive: to present the case of a patient with an open fracture of the tibial plateau type VI by Schatzker J. Case report: a 61 year old mixed race, woman without health morbid antecedents, who after having a traffic accident was taken to emergency room of Orthopedics and Traumatology complaining of pain, swelling and limitation of movement of the left knee and leg. Simple imaging examination in antero-posterior and lateral views showed a structural break in the continuity of bone at epiphysis and metaphysis in the left proximal tibia. Definite treatment consisted of an osteosynthesis with cannulated screw and fixation by an external device type Hoffmann 1 with two pins in femur and tibia respectively. Conclusions: tibial plateau fractures type VI according to Schatzker J classification system are difficult to treat because of associated lesions and complications as open fractures and skin loss. External fixation is a useful and easy method to fix complex fractures as tibial plateau fractures.

[Research progress on the application of lower limb alignment in discoid meniscus injury].

Discoid meniscus injury is a kind of common sports injury. Its treatment methods include arthroscopic discoid meniscus plasty, discoid meniscus subtotal resection, discoid meniscus total resection and so on. Although the short-term clinical effect is good, the long-term clinical effect is not ideal. At present, different scholars have different views on the choice of surgical methods for discoid meniscus injury. In recent years, many scholars have shown that the choice of operation and the change of lower limb force line are related to the therapeutic effect of discoid meniscus injury. This paper mainly summarizes the current situation of the treatment of discoid meniscus injury and the changes of the force line of the lower limbs after operation, and expounds therole of the evaluation of the force line of the lower limbs in the treatment of discoid meniscus, so as to provide the basis for the clinical individualized treatment of discoid meniscus injury.

Deep convolutional neural network-based detection of meniscus tears: comparison with radiologists and surgery as standard of reference.

OBJECTIVE: To clinically validate a fully automated deep convolutional neural network (DCNN) for detection of surgically proven meniscus tears. MATERIALS AND METHODS: One hundred consecutive patients were retrospectively included, who underwent knee MRI and knee arthroscopy in our institution. All MRI were evaluated for medial and lateral meniscus tears by two musculoskeletal radiologists independently and by DCNN. Included patients were not part of the training set of the DCNN. Surgical reports served as the standard of reference. Statistics included sensitivity, specificity, accuracy, ROC curve analysis, and kappa statistics. RESULTS: Fifty-seven percent (57/100) of patients had a tear of the medial and 24% (24/100) of the lateral meniscus, including 12% (12/100) with a tear of both menisci. For medial meniscus tear detection, sensitivity, specificity, and accuracy were for reader 1: 93%, 91%, and 92%, for reader 2: 96%, 86%, and 92%, and for the DCNN: 84%, 88%, and 86%. For lateral meniscus tear detection, sensitivity, specificity, and accuracy were for reader 1: 71%, 95%, and 89%, for reader 2: 67%, 99%, and 91%, and for the DCNN: 58%, 92%, and 84%. Sensitivity for medial meniscus tears was significantly different between reader 2 and the DCNN (p = 0.039), and no significant differences existed for all other comparisons (all p ≥ 0.092). The AUC-ROC of the DCNN was 0.882, 0.781, and 0.961 for detection of medial, lateral, and overall meniscus tear. Inter-reader agreement was very good for the medial (kappa = 0.876) and good for the lateral meniscus (kappa = 0.741). CONCLUSION: DCNN-based meniscus tear detection can be performed in a fully automated manner with a similar specificity but a lower sensitivity in comparison with musculoskeletal radiologists.