Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores / Medidas de desfechos clínicos na meniscectomia artroscópica: Pontuações de joelho segundo médicos e pacientes

Abstract Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [p< 0.001], Lysholm [p= 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [p< 0.001], but not in the IKDC Examination [p= 0.332]. However, the IKDC Subjective score (p= 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Resumo Objetivo O objetivo do presente estudo foi investigar a diferença entre instrumentos de desfechos preenchidos por médicos e pacientes na detecção de melhora após a meniscectomia artroscópica para tratamento de rupturas de menisco. Métodos Trinta e quatro pacientes com rupturas de menisco foram avaliados de forma prospectiva usando 9 medidas de desfechos clínicos. Os cinco instrumentos de avaliação de joelho respondidos por médicos foram o Escore de Atividade de Tegner, o Escore de Joelho de Lysholm, o Escore de Joelho de Cincinnati, o Escore de Exame do Joelho do International Knee Documentation Committee (IKDC, na sigla em inglês) e o Escore de Classificação do Menisco de Tapper e Hoover. Os quatro instrumentos de avaliação do joelho respondidos por pacientes foram o Escore Subjetivo do Joelho do IKDC, a Pesquisa de Desfecho de Joelho - Escala de Atividades de Vida Diária (KOS-ADLS, na sigla em inglês), o Formulário Curto de Pesquisa em Saúde de 12 Itens (SF-12, na sigla em inglês) e o Escore de Desfecho de Osteoartrite e Lesões no Joelho (KOOS, na sigla em inglês). Vinte e nove dos 34 pacientes foram submetidos a uma meniscectomia artroscópica e reavaliados com todos os 9 instrumentos na sua consulta de acompanhamento. Resultados Uma melhora longitudinal significativa foi observada em 4 dos 5 instrumentos respondidos por médicos (Tegner [p< 0,001], Lysholm [p= 0,004], Cincinnati [p= 0,002] e Tapper e Hoover [p< 0,001], mas não no IKDC [p= 0,332]). Por outro lado, o Escore Subjetivo do Joelho do IKDC (p= 0,021) foi o único instrumento respondido por pacientes a demonstrar melhora pós-operatória significativa. Conclusão De modo geral, os instrumentos respondidos por médicos foram considerados inconsistentes em relação àqueles respondidos por pacientes. O modo de administração dos instrumentos pode ter influência significativa nos resultados, tanto para fins de pesquisa quanto para a prática clínica. A combinação de um instrumento respondido pelo médico com um instrumento respondido pelo paciente pode ser uma abordagem mais equilibrada para a avaliação e a quantificação das rupturas do menisco e do desfecho após a meniscectomia artroscópica.

Does partial meniscectomy affect anterior cruciate ligament reconstruction results? / A meniscectomia parcial afeta os resultados da reconstrução do ligamento cruzado anterior?

ABSTRACT Objective: To compare the application of partial meniscectomy concomitant with primary ACL reconstruction, using the graft from the patellar tendon with individuals who underwent only ACL reconstruction, in clinical functional criteria and degree of osteoarthritis (OA), after 10 years of the surgical process. Methods: This is a retrospective cross-sectional study with 37 patients who underwent ACL reconstruction with a graft from the patellar tendon, associated or not with partial meniscectomy, divided into 2 groups: with meniscal injury (n = 22) and without meniscal injury (n = 15). Anthropometric data and four outcome measures were used to analyze the results: SF-36 questionnaire, arc of motion assessment, Knee injury and Osteoarthritis Outcome Score (KOOS), and Ahlbäck Radiographic Classification. Results: No differences were found for health-related quality of life, arc of motion, functional condition and knee OA severity/grade in patients who underwent partial or no meniscectomy in conjunction with ACL reconstruction (p > 0.05). Conclusion: Participants who underwent partial meniscectomy in conjunction with primary ACL reconstruction with a graft from the patellar tendon, after 10 years of the surgical process, showed no significant differences in the clinical functional criteria and severity of knee OA, compared to individuals who underwent only ACL reconstruction. Level of Evidence II, Prognostic study.

RESUMO Objetivo: Comparar a realização da meniscectomia parcial concomitante à reconstrução do LCA (RLCA) primária, utilizando o enxerto do tendão patelar, com indivíduos que realizaram apenas a RLCA, em critérios clínico-funcionais e grau de osteoartrite (OA), após 10 anos do processo cirúrgico. Métodos: Trata-se de um estudo retrospectivo transversal, com 37 pacientes que realizaram a RLCA com enxerto do tendão patelar, associada ou não à meniscectomia parcial, divididos em dois grupos: com lesão meniscal (n = 22) e sem lesão meniscal (n = 15). Dados antropométricos e quatro medidas de desfecho foram utilizados para análise dos resultados: questionário SF-36, avaliação do arco de movimento, Knee Injury and Osteoarthritis Outcome Score (KOOS) e Classificação Radiográfica de Ahlbäck. Resultados: Não existem diferenças em termos de qualidade de vida relacionada à saúde, amplitude de movimento, condição funcional e severidade/grau de OA do joelho em pacientes que realizaram ou não meniscectomia parcial em conjunto com a RLCA (p ≥ 0.05). Conclusão: Os participantes que realizaram meniscectomia parcial em conjunto com a RLCA primária com enxerto do tendão patelar, após 10 anos do processo cirúrgico, não demonstraram diferenças significativas nos critérios clínico-funcionais e gravidade da OA do joelho, comparados aos indivíduos que realizaram apenas a RLCA. Nível de Evidência II, Estudos prognósticos.

Actualización en Patología Meniscal / Update in Meniscal Pathology

Las lesiones meniscales constituyen una de las patologías más frecuentes localizadas en la rodilla. El estudio y conocimiento de la anatomía y de la función de estas estructuras ha ido evolucionando ampliamente en los últimos años, pasando de ser considerada una estructura vestigial embrionaria sin utilidad a una estructura de gran trascendencia en la distribución de cargas de la rodilla, su lubricación y su congruencia articular. El tratamiento de estas lesiones ha ido evolucionando con diferentes técnicas, partiendo de meniscectomías totales hasta la nueva filosofía de preservación del menisco (“Save the meniscus”), incluyendo diferentes procedimientos de reparación que hoy día siguen renovándose a una velocidad vertiginosa. Todo ello dependerá del mecanismo lesional, naturaleza y edad del paciente. Actualmente es todo un desafío desarrollar nuevas terapias y métodos quirúrgicos que conserven la función meniscal. La gran morbilidad musculoesquelética que comportan sus daños obliga a permanecer actualizado en todo momento al profesional para optimizar los tratamientos de los pacientes. Las lesiones meniscales en la actualidad son motivo de una gran cantidad de estudios, en los que se describen múltiples técnicas e interpretación de las diferentes lesiones.(AU)

Meniscal injuries are one of the most frequent pathologies located in the knee. The study and knowledge of the anatomy and the function of these structures has evolved widely in recent years, going from being considered an unuseless embryonic vestigial structure to a structure of great importance in the distribution of loads on the knee, its lubrication and its articular congruence. The treatment of these lesions has evolved with different techniques, starting from total meniscectomies to the new philosophy of meniscus preservation (“save the meniscus”), including different repair procedures that nowadays are still renewing constantly. These techniques will depend on the injury mechanism, nature and age of the patient. At the present time it is a challenge to develop new therapies and surgical methods that preserve meniscal function. The great musculoskeletal morbidity caused by its damage forces the professional to remain updated everytime to optimize patient treatments.Meniscal injuries are currently the subject of a large number of studies, which describe multiple techniques and interpretation of the different injuries.(AU)

Vuelta a la actividad física en pacientes intervenidos de rotura meniscal en asa de cubo en el Hospital Universitario Reina Sofía / Return to physical activity in patients operated on for bucket handle meniscal tear at the Reina Sofía University Hospital

Objetivos: Comparar la vuelta a la actividad deportiva, según el score de Tegner, en los pacientes tratados con meniscectomía o sutura meniscal, en roturas de menisco en asa de cubo. Material y métodos: Se analizaron retrospectivamente 83 pacientes con diagnóstico de rotura meniscal en asa de cubo tratados en el Hospital Reina Sofía de Córdoba entre los años 2014 y 2019.. Se recogieron los datos a través del sistema informático Diraya y mediante encuesta telefónica, debido a la situación actual de pandemia. Se comparó el score de Tegner de aquellos pacientes intervenidos mediante meniscectomía con los que se intervinieron con sutura meniscal. Resultados: 68 pacientes cumplían los criterios de inclusión, 35 fueron tratados con meniscectomía y 33 mediante sutura meniscal. No se encontraron diferencias estadísticamente significativas entre pacientes tratados con meniscectomía o sutura meniscal, con respecto a la vuelta a la actividad física, con el score de Tegner (P=0,5). El IMC influye en la vuelta a la actividad deportiva, con respecto al score de Tegner, de manera significativa (P=0,005). El tiempo de evolución desde la rotura hasta la intervención no influía de manera significativa, en la vuelta a la actividad deportiva con respecto al score de Tegner (P=0,25). Conclusiones: No hemos encontrado diferencias entre realizar sutura meniscal o meniscectomía en la vuelta a la actividad física de los pacientes intervenidos. Hemos encontrado diferencias en el Tegner postoperatorio en los pacientes intervenidos, en función del IMC.(AU)

Background: Bucket-handle meniscal tear is a common pathology that can cause pain and significant disability and that often requires surgery. Surgical treatment can be mainly divided into meniscectomy or meniscal suture. When it comes to rejoining physical activity, which patients return to sport before? Do these procedures achieve the same level of physical activity prior to surgery? ObjectivesTo compare the level of physical activity and return to sports according to Tegner Activity score, in patients who underwent meniscectomy or meniscal suture, in bucket-handle meniscal tears. Design and Methods: Eighty-three patients diagnosed with bucket-handle meniscal tear treated at the Reina Sofía Hospital in Córdoba between 2014 and 2019 were included in this retrospective analysis. Surgeon chose the procedure intraoperatively Patients who did not want to participate in the study and those who did not exercise or play sports regularly were excluded. Data were collected through Diraya health information system and telephone survey, due to the current pandemic situation. The Tegner Activity score of those patients who underwent meniscectomy was compared with those who underwent meniscal suture. Data were analyzed using the SPSS 23 operating system. A p value <0.05 was considered statistically significant. Results: 68 patients met the inclusion criteria, 35 were treated with meniscectomy and 33 with meniscal suture. The mean age of patients who underwent meniscal suture was 29.03 years ± 11.24, in the meniscectomy group it was 35.54 years ± 11.42. The mean BMI of patients with meniscal suture was 25.92 ± 3.71...(AU)

Symptomatic bilateral medial discoid meniscus treated with arthroscopic meniscal remodeling: clinical case. / Menisco discoideo medial bilateral sintomático tratado con remodelación meniscal artroscópica: caso clínico.

Medial discoid meniscus is a rare entity with a reported incidence of 0.12 to 0.3%, although the real incidence may be greater because not all the patients are symptomatic. Like lateral discoid menisci, medial discoid menisci are prone to degeneration that may prompt the presence of mechanical symptoms at early age. We present the case of a 14 year old male patient with bilateral knee symptoms of insidious onset without a traumatic event. Magnetic resonance revealed bilateral medial discoid menisci. Arthroscopic medial meniscus remodelling was performed in the right knee and, three months later, in the left knee, due to limitating mechanical symptoms. At the latest follow up -6 months for the right knee, 3 months for the left knee-, the patient resumed his sports activities.

Artroscopia y fibulectomía parcial simultánea en pacientes con gonartrosis y deformidad en varo / Simultaneous arthroscopc and partial fibulectomy in patients with knee osteoarthritis and varus knee

RESUMEN Fundamento: la gonartrosis es una enfermedad frecuente relacionada con el incremento de la calidad y expectativa de vida de la población, en la evolución de este padecimiento existen factores que aceleran sus manifestaciones entre ellos la deformidad en varo. Objetivo: evaluar los resultados de la técnica quirúrgica combinada de artroscopia, fibulectomía parcial y proximal en pacientes con gonartrosis y deformidad en varo. Métodos: se realizó un estudio cuasi experimental modalidad antes y después sin grupo de control en 25 pacientes con el diagnóstico de gonartrosis primaria asociada a deformidad en varo, en el Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde abril 2016 a agosto de 2019. La investigación tiene un nivel de evidencia II recomendación B. Resultados: predominio del sexo femenino al masculino con una razón de 2,12 a 1. La enfermedad intrarticular más frecuente fue la lesión de meniscos y cartílagos grados III/IV. Se encontró significación entre un antes y después al aplicar las escalas evaluativas. El procedimiento artroscópico más empleado fue la meniscectomía. Conclusiones: la realización simultanea de artroscopia y fibulectomía parcial proximal es una técnica efectiva y sencilla con un mínimo de complicaciones, permite corregir la deformidad angular de la extremidad, al mismo tiempo de tratar lesiones intrarticulares, en especial las de menisco y cartílago.

ABSTRACT Background: gonarthrosis is a frequent entity related to the increase in the quality and life expectancy of the population, in the evolution of this disease there are factors that accelerate its manifestations including varus deformity. Objective: to evaluate the results of the combined surgical technique of arthroscopy, partial and proximal fibulectomy in patients with gonarthrosis and varus deformity. Methods: a quasi-experimental study was performed before and after without a control group in 25 patients with the diagnosis of primary gonarthrosis associated with varus deformity, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from April 2016 to August 2019. The investigation has a level of evidence II recommendation B. Results: female prevailed to male sex with a ratio of 2.12 to 1. The most common intra-articular entity was the meniscus lesion and cartilage grades III/IV. Significance was found between a before and after applying the evaluation scales. The most commonly used arthroscopic procedure was meniscectomy. Conclusions: the simultaneous performance of arthroscopy and proximal partial fibulectomy is an effective and simple technique with a minimum of complications, it allows correcting the angular deformity of the limb, while treating intra-articular lesions, especially those of meniscus and cartilage.

Comportamiento de pacientes con plica sinovial de la rodilla / Behavior of patients with knee plica synovialis

RESUMEN Fundamento: la plica sinovial de la rodilla es una de las causas de dolor anterior, se presenta de forma asilada o combinada a otras afecciones intrarticulares. El tratamiento quirúrgico mediante la vía artroscópica es el más usado en la actualidad. Objetivo: evaluar los resultados del tratamiento artroscópico en pacientes con plica sinovial. Métodos: se realizó un estudio observacional analítico con un nivel de evidencia III recomendación C en 181 pacientes con el diagnóstico clínico, imagenológico y artroscópico de plica sinovial en el Hospital Universitario Manuel Ascunce Domenech desde el 1 de enero de 2012 al 31 de enero de 2018. La población de estudio estuvo dada por todos aquellos enfermos en que se confirmó la presencia de plica sinovial patológica mediante la vía artroscópica, edad de 18 años o más y respuesta limitada o nula al tratamiento conservador ambulatorio por más de seis semanas. Resultados: el promedio de edad de los pacientes estudiados fue de 45,5 años, la razón sexo femenino-masculino fue de 1,9 a 1. Predominó la plica mediopatelar. Las lesiones de cartílago grados III/IV fueron las más encontradas, así como la afección monocompartimental patelofemoral. El desbridamiento y la meniscectomía fueron los procedimientos artroscópicos más realizados después de la sección de la plica. La respuesta clínica de los pacientes a los seis meses fue satisfactoria. Conclusiones: el tratamiento artroscópico de la plica sinovial es efectivo, en especial para pacientes con ausencia de otras lesiones intrarticulares.

ABSTRACT Background: knee plica synovialis is a common cause of anterior knee pain; it could show up isolated or associated to other intra-articular conditions. Nowadays, the surgical arthroscopic treatment is the most used way. Objective: the objective of this study was to evaluate the arthroscopic treatment in patients with plica synovialis of the knee. Methods: an analytic and observational study, with a level of evidence 3, recommendation C was performed in 181 patients with the clinical diagnosis of plica synovialis of the knee according to clinical, imaging and arthroscopic criteria in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 1st, 2012 to January 31th, 2018. The population of the research was the amount of patients who had had the confirmation of having pathologycal plica synovialis through the arthroscopic way, 18 year-old patients and over and also limited or non-response to conservative ambulatory treatment for more than six weeks. Results: the average age was 45,5 years, female-male ratio was 1,9 to 1. The plica synovialis mediopatellaris prevailed. Cartilage lesions levels 3 and 4 were the most found as well as mono-compartiment affecting patellofemoral joint. Debridement and meniscectomy were the most common used arthroscopic procedures after plica section. Clinical results were good at six months. Conclusions: the arthroscopic treatment of plica synovialis is effective, especially in patients with absence of other intrarticular conditions.

Correlação entre ruptura de ligamento cruzado cranial e lesão de meniscomedial em cães / Correlation between cranial cruciate ligament rupture and meniscal tears in dogs

O presente trabalho correlacionou o tempo de ruptura do ligamento cruzado cranial (RLCCr) à lesão em menisco medial e ao tipo de lesão observada em cães tratados por estabilização dinâmica (osteotomias) ou estática (sutura fabelo-tibial). Este estudo retrospectivo avaliou os registros de 104 cães (117 joelhos). As osteotomias foram realizadas em 98 articulações, a sutura fabelo-tibial em 15 joelhos e, em 4 joelhos, foi realizada apenas artrotomia exploratória. A média de idade foi 4,5 anos, 41% dos cães eram machos e 59%, fêmeas e a média da massa corporal foi 32,7kg. Os tipos de lesão do menisco medial observados foram: tipo 1, 2, 3, 4, 6, 7 e associações dos tipos 1-4, 1-6 e 1-7. O tipo 1 foi o mais prevalente, sendo responsável por 32,5% dos casos. Não foram encontradas correlações entre a presença ou não de lesão de menisco medial e o tempo de ocorrência da RLCCr e entre o tipo de lesão de menisco medial e o tempo de RLCCr.

The study correlated the time of the cranial cruciate ligament rupture (CCLR) with medial meniscal tears and the type of injury seen in dogs treated with dynamic stabilization (osteotomies) or static (fabellotibial suture). This retrospective study evaluated the records of 104 dogs (117 stifles). The osteotomies were performed in 98 stifles, fabellotibial suture in 15 stifles and exploratory arthrotomy was perform in 4 stifles. The average age was of 4.5 years, 41% of the dogs were male and 59% female and the mean body mass was of 32.7kg. The medial meniscal tears observed were: type1, 2, 3, 4, 6, 7 and associations of types1-4, 1-6 and 1-7. Type 1 was the most prevalent, accounting for 32.5%of cases. No correlation was found between the presence or absence of medial meniscus injury and the time of occurrence of CCLR and between the type of medial meniscal tears and CCLR time.

Meniscectomia parcial artroscopica en niños y adolescentes con lesión meniscal aislada: evaluación funcional y radiológica / Partial arthroscopic meniscectomy in children and adolescent with isolated meniscal tears: functional and radiological evaluation

Meniscal tears in skeletally immature patients are usually associated with discoid menisci and knee ligament lesions. We retrospectively evaluated 20 patients, less than 16 years old, with isolated meniscal tears who underwent partial meniscectomies. A traumatic event caused the tear in 14 patients and in 6 patients there was no evident cause. 9 knees had a discoid meniscus. The average follow-up was longer than 3 years. 18 patients had excellent post operative Lysholm scores. We did not observe degenerative signs on radiographic follow up. 3 patients required another surgery: one had a meniscal re-tear and 2 had a symptomatic chondral lesion of the external femoral condyle. These 2 patients had a bad functional result. Partial meniscectomies in patients younger than 16 years old have excellent functional results without degenerative radiological signs at short to mid term follow-up. Bad results were associated with external tears and secondary chondral lesions.

Las roturas meniscales en niños son poco frecuentes, especialmente sin lesiones asociadas. Se estudian retrospectivamente 21 rodillas de 20 pacientes menores de 16 años sometidos a una meniscectomía parcial por una lesión meniscal aislada. De estas rodillas, 9 presentaron un menisco discoídeo roto. En 14 pacientes la rotura meniscal se produjo por un traumatismo y en 6 la sintomatología se inició espontáneamente. Al final de un seguimiento promedio de 37 meses, 18pacientes tuvieron un resultado funcional excelente. Dos pacientes evolucionaron con una lesión condral del cóndilo femoral externo y tuvieron un resultado insatisfactorio. Tres pacientes fueron reintervenidos. No se observaron signos radiográficos degenerativos. La meniscectomía parcial en pacientes menores de 16 años presenta un porcentaje alto de resultados funcionales excelentes y ausencia de signos radiográficos degenerativos a corto plazo. Los resultados insatisfactorios se asociaron a lesiones condrales secundarias luego de una meniscectomía externa.