Clinical efficacy of meniscus plasty under arthroscopy in middle-aged and elderly patients with meniscus injury.

Clinical efficacy of meniscal plasty and total meniscectomy under arthroscopy in treating middle-aged and elderly patients with meniscus injury were explored. One hundred and fifteen elderly patients with meniscal injuries treated in the First Peoples Hospital of Wujiang District Suzhou from May 2012 to October 2014 were retrospectively analyzed. They were randomly divided into meniscal plasty group (experimental group) and total meniscectomy group (control group). Length of stay, operation time and VAS between the two groups were compared. Knee function was evaluated before the surgery and at the final follow-up using IKDC 2000 and Lysholm score. The differences of postoperative clinical efficacy and complications in both groups were observed. Postoperative IKDC 2000 and Lysholm score in the experimental group were superior to those of control group (P<0.001). There was no significant difference in the relieving effect of knee pain between the two types of procedures (P>0.05). Shorter operation time was found in control than that of experimental group. We did not observe remarkable differences in length of stay and postoperative complication rate between the two groups (P>0.05). Both meniscal plasty and total meniscectomy under arthroscopy can effectively relieve knee pain in a short time. Meniscal plasty could remarkably alleviate the progression of knee osteoarthritis, maintain knee function and improve daily life of affected population. We considered that meniscal plasty should be served as the preferred approach in treating middle-aged and elderly patients with meniscus injury.

Actifit synthetic meniscal substitute: experience with 18 patients in Brest, France.

BACKGROUND: The management of post-meniscectomy pain is poorly standardised. Allogeneic transplantation may be appropriate in some patients after total meniscectomy. After partial meniscectomy, the synthetic meniscal substitute Actifit may constitute a valid option if the knee is stable or stabilised and aligned or re-aligned. The interconnected pore structure of Actifit promotes tissue regeneration from the meniscal wall. Arthroscopy is used to position the implant, which is then sutured to the remaining native meniscus using horizontal stitches and to the meniscal wall using vertical stitches. However, a burdensome programme of rigorous rehabilitation is required after Actifit implantation. HYPOTHESIS: We hypothesised that implantation of a meniscal substitute effectively alleviated pain without adversely affecting the knee. OBJECTIVES: To assess the intra-articular behaviour of Actifit and the outcomes of Actifit implantation in a prospective case-series of patients monitored using arthroscopy, pathology, and imaging studies, as well as the Lysholm score to assess clinical benefits on daily activities. MATERIALS AND METHODS: Between October 2009 and April 2012, 18 patients underwent Actifit implantation at the military hospital in Brest, France. All procedures were performed by the same surgeon, who had extensive experience with meniscal suturing. There were 13 males and 5 females aged 20 to 46 years. The medial meniscus was involved in 13 patients and the lateral meniscus in 5 patients. Actifit implantation was used alone in 6 patients and in combination with anterior cruciate ligament reconstruction and/or realignment osteotomy in 12 patients. All patients were followed-up for at least 2 years. RESULTS: The mean Lysholm score after 1 year was 92%, indicating excellent outcomes. Magnetic resonance imaging showed no damage to the implant or degeneration of the neighbouring cartilage. Histological examination of meniscal substitute biopsies taken 1 year after implantation showed polymer ingrowth by normal chondrocytes and fibrochondrocytes. The clinical and radiographic outcomes compared favourably with those seen after isolated procedures on bone or ligaments. DISCUSSION: Actifit has no deleterious effects on patients. The implant induces and promotes meniscal regeneration. Actifit constitutes a major addition to our therapeutic armamentarium. We provide convincing evidence that meniscal reconstruction can be highly beneficial in decreasing the risk of progression to knee osteoarthritis. LEVEL OF EVIDENCE: IV.

A Study on the Development of Degenerative Osteoarthritis after Arthroscopic Total Menisectomy / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological incidence of osteoarthritis after a total meniscectomy. MATERIALS AND METHODS: Seventy eight patients, who underwent a total meniscectomy, were evaluated after a minimum follow up of five years. The operations were a medial meniscectomy (group I) in 16 cases, a lateral meniscectomy (group II) in 17 cases, a discoid meniscus (group III) in 29 cases and medial meniscectomy with an anterior cruciate ligament reconstruction (group IV) in 16 cases. The development of degenerative osteoarthritis was analyzed using the Kaplan-Meyer survivorship. RESULTS: At postoperative 5 years and 7 years, degenerative osteoarthritis developed in 17% and 36% of patients, respectively. The incidence ofdegenerative osteoarthritis at postoperative 5 years and 7 years in groups I, II, III and IV was 9% and 18%, 14% and 29%, 25% and 46%, and 28% and 55%, respectively. The difference was statistically significant. CONCLUSION: The meniscus deficient knee joint which varies according to the patterns of a meniscal injury, had a higher incidence of degenerative osteoarthritis. Careful attention should be paid to the treatment of meniscal tears.

Short-term Follow up after Meniscus Allograft Transplantation with Clinical Results and MRI Findings

PURPOSE: We investigated the clinical results and MRI findings follow up after meniscal transplantation using fresh frozen meniscal allograft. MATERIAL AND METHODS: From Dec. 1999 to Dec. 2001, we evaluated 17 patients (12 cases: male, 5 cases: female) after meniscal transplantation using fresh frozen meniscal allograft. The patients performed the lateral meniscal transplantation were 12cases, the medial were 5cases. The average age was 32 years old (ranging from 19 to 50 years old), and was follow up period 18 months (ranging from 12 to 26 months). Among them we studied MRI findings in 16 patients and the postop-period was 16.9 months (ranging from 5 to 26 months). We analyzed the clinical data by applying KASS(knee assessment scoring system) & Lysholm knee score, and rehabilitation ability using of Tegner activity scale. It investigated the retrogressive changes of joint effusion, misfortune degree of meniscal location, intensity, tear and degenerative change which was made from the MRI. RESULTS: The follow up mean KASS score and Lysholm score were 84.3 (ranging from 61 to 94), and 81.1 (ranging from 63 to 90). Among the 17 patients, 15 patients showed good results. But painful swellings were 2 cases and intermitent locking symtom was 1 case. The MRI findings were 14 cases increasing signal intensity, 2 cases peripheral displacement, 2 cases partial meniscal tear and some degree effusions of 13 cases. CONCLUSION: The meniscal transplantation using fresh frozen allogrft came to be thought with the surgical method which improved the function of knee joint after operating it brought a successful result from the MRI.

A new method of arthroscopic total meniscectomy (a report of 169 cases) / 中国微创外科杂志

Objective To research for a new method of arthroscopic total meniscectomy with simple instru- ments. Methods One hundred and sixty nine cases were followed up for short period that had been operated on with a forward knife, a back cutting knife, a punch and a 30?scope from Nov. 1992. to Aug. 1998. Results The av- erage time of operation was 78 minutes. The operations had no injury to cartilage and ligament. It is necessary for only 7 .9 percent of patients to take analgesic intramuscularly after operation. Eight patients had a transient tourniquet paral- ysis. All of them could begin to work and exercise after postoperative 2 weeks. Conclusion As compared with the method introduced by David Sisk ,this method has the advantages of simple instruments, fewer ports and complications and minimal trauma Either lateral meniscus or medial meniscus can be cut off by the same method. This method is a safety and a better way to arthroscopic meniscectomy.

Comparison between Total and Partial Resection with Arthroscope in the Lateral Discoid Meniscus / 대한정형외과학회잡지

In the treatment of meniscal injury of the knee joint, it has been known that the result of partial meniscectomy to prevent degenerative change of the knee joint after meniscectomy. However the result of lateral discoid meniscectomy is controversial between partial and total meniscectomy. In the treatment of lateral discoid meniscal injury, Fujikawa and Dickhaut reported the better results with partial meniscectomy than total resection, but Ikeuchi and Kobayashi reported the better results with total meniscectomy. The purpose of this paper is to compare the results of arthroscopic partial and total meniscectomy. Five hundred ninety-five patients with meniscal injury was treated by meniscectomy between January, 1983 and December, 1994 at the department of orthopaedic surgery, Soonchunhyang Univ. Hospital. 119 patients of all were done lateral discoid meniscectomy had no other combined findings. Wr wrre able to follow up 42 patients(44 cases) of 84 patients with interview and/or questionnaire. WR analysed the 44 cases and summarized the results as follow: 1) A discoid lateral meniscus was presented in 20.0% of all meniscal resection. 2) Postoperative click sound was presented in 7 cases of 25 cases(28.0%) with partial meniscectomy and in 5 cases of 19 cases(26.3%) with total meniscectomy. Giving way was presented in 2 cases(8.0%), 1 case(5.3%) and Locking in 1 case(4.0%), 0case(0.0%) respectively. 3) In the post operative. Pain, no pain and mild pain were presented in 88.0% of partial meniscectomy and in 94.8% of total meniscectomy. 4) In the degree of activity level, “same before symptoms was developed(no symptom)”. was presented in 84.0% of partial meniscectomy and in 84.2% of total meniscectomy. 5) In the return to work, all patients returned to original job with/without limitation. 6) In the knee rating scale of Ikeuch, excellent or good was presented 72.0% of partial meniscectomy and in 89.5% of total meniscectomy. 7) Roentgenologic degenerative changes were more presented after total than partial meniscectomy. We concluded that the total meniscectomy is better than the partial meniscectomy in the symptom and functional results, but long term follow up secondary degenerative change must be followed.