جستجوی مقالات مرتبط با کلیدواژه « Meniscus » در نشریات گروه « پزشکی »

Discoid lateral meniscus (DLM) is the most frequent congenital variant of the lateral meniscus, which is prone to degeneration and tears, and frequently causes knee osteoarthritis. The purpose of this article has been to analyze the publications made during 2023 on DLM. The main conclusions of the analysis were as follows: MRI assessment might be helpful to diagnose DLM and detect the presence of instability: two main factors in the decision to perform surgery. Arthroscopic assessment should be utilized in conjunction with MRI findings for complete DLM diagnosis. Restoring the normal shape, retaining adequate width and thickness, and ensuring the stability of the remnant DLM is essential to sustaining the physiological function of the meniscus and preserving the knee. Partial meniscectomy with or without repair should be the first-line treatment when feasible, given that the clinical and radiological long-run results of total or subtotal meniscectomy are worse. Level of evidence: III

Blood supply to the meniscus determines its recovery and is a reference for treatment planning. This study aimed to apply tissue clearing and three-dimensional (3D) imaging in exploring the quantitative distribution of blood vessels in the mouse meniscus.

In this experimental study, tissue clearing was performed to treat the bilateral knee joints of transgenic mice with fluorescent vascular endothelial cells. Images were acquired using a light sheet microscope and the vascular endothelial cells in the meniscus was analysed using 3D imaging. Quantitative methods were employed to further analyse the blood vessel distribution in the mouse meniscus.

The traditional three-equal-width division of the meniscus is as follows: the outer one-third is the red-red zone (RR), the inner one-third is the white-white zone (WW), and the transition area is the red-white zone (RW). The division revealed significant signal differences between the RW and WW (P<0.05) zones, but no significant differences between the RR and RW zones, which indicated that the division might not accurately reflect the blood supply of the meniscus. According to the modified division (4:2:1) in which significant differences were ensured between the adjacent zones, we observed that the width ratio of each zone was 38 ± 1% (RR), 24 ± 1% (RW), and 38 ± 2% (WW). Furthermore, the blood supply to each region was verified. The anterior region had the most abundant blood supply. The fluorescence count in the anterior region was significantly higher than in the central and posterior regions (P<0.05). The blood supply of the medial meniscus was superior to the lateral meniscus (P<0.05).

Analysis of the blood supply to the mouse meniscus under tissue clearing and 3D imaging reflect quantitative blood vessel distribution, which would facilitate future evaluations of the human meniscus and provide more anatomical references for clinicians.

A foundational knowledge of the anatomy and biomechanics of meniscal root tears is warranted for proper repair of meniscal root tears and for preventing some of their commonly described iatrogenic causes. Meniscal root tears are defined as either a radial tear occurring within one cm of the root attachment site of the meniscus or a complete bony or soft tissue avulsion of the root attachment altogether. Meniscal root tears disrupt the protective biomechanical function of the native meniscus. Biomechanical analyses of the current techniques for meniscal root repair highlight the importance of restoring menisci to their correct anatomic orientation, thereby restoring their biomechanical function. A comprehensive understanding of the clinical and radiographic presentations of these injuries is critical to preventing their underdiagnosis. The poor long-term outcomes associated with conservative treatment measures, namely, ipsilateral compartment osteoarthritis, warrants the surgical repair of meniscal root tears whenever possible. While excellent patient-reported outcomes exist for the various surgical repair techniques, adherence to stringent post-operative rehabilitation protocols is critical for patients to avoid damaging the integrity of a repaired root. This review will focus on current concepts pertaining to the anatomy, biomechanics, diagnosis, treatment, and postoperative rehabilitation for meniscal root tears.

Rugby is a contact sport, and the frequency of injuries is high. In our clinical experience with patients diagnosed arthroscopically with lateral meniscus tears in the middle segment, rugby players are more prevalent than players of other sports. We hypothesized that a meniscus tear in the middle segment is a common injury in rugby players and is associated with specific positions in rugby.

This study aimed to describe a series of lateral meniscus tears in rugby players.

We retrospectively reviewed the medical charts of cases with an arthroscopically confirmed isolated lateral meniscus tear in the middle segment associated with rugby players in our center between 2006 and 2020. We investigated the epidemiology of injury, including the player position and phase of play, the symptoms; as well as imaging and arthroscopic findings.

Of 4452 cases (4666 knees) diagnosed arthroscopically with meniscus tears, 27 cases (28 knees) were isolated radial lateral meniscus tears in the middle segment, 26 of which were sports-associated, including 11 cases related to rugby. Among the 11 rugby players, 10 were forwards, 5 of whom were in the front row. The injury was associated with a tackle in 4 patients, while the phase of play of injury was unknown in 6 patients. In the clinical manual examination, tenderness and a positive hyperextension test had a relatively high sensitivity. In imaging examination, MRI depicted a characteristic image of a partial meniscal defect in the sagittal view. All patients underwent arthroscopic partial meniscectomy. The postoperative course was favorable. All patients returned to play rugby at the pre-injury competition level.

In this study, radial lateral meniscus tears involving the middle segment frequently occurred in rugby players, mostly in forward positions. Arthroscopic partial meniscectomy achieved a return to play in all players.

Meniscus tear is a common finding in patients with anterior cruciate ligament (ACL) injury and may affectthe natural history of the injury and the outcomes of treatment. In the current study, the characteristics of meniscus tearsin patients who underwent arthroscopic ACL reconstruction were investigated.

The hospital records of 1022 patients were reviewed. The measured variables included the presence ofmeniscus tear, ramp and root injury, the zone of injury based on the Cooper classification, and the type of tear. The ACLtears with delay more than 3 months for ACLR were recorded as chronic injuries.

The incidence of meniscus tear was 44.4%; among whom, bucket-handle injury was the most common type(30.4%) and the ramp lesion was found in 20.5%. The meniscus was repaired in 56.6%. The incidence of medialmeniscus injury was significantly higher in chronic ACL tears and vice versa (P<0.001). The incidence of ramp lesion(9.1% Vs 20.5%) and root tear (1.3% Vs 2.9%) were significantly higher in the chronic and acute tears, respectively(P<0.001).

Delay more than 3 months in ACLR was associated with the increased incidence of meniscal injury,specially the medial meniscus, and ramp lesion. It seems that early ACLR may be more helpful for the patients.Level of evidence: IV

Meniscus plays an important role in weight‑bearing and energy absorption. Moreover, its function is optimal to maintain joint stability and congruous. Treatments for meniscus damage or meniscus tear include open or arthroscopic repair and meniscectomy. One of the most important factors that influence patients’ recovery outcome is restoration technique. The purpose of this study was to compare the strength of recently new method of meniscus repair, submeniscal horizontal sutures, and single vertical loop suturing techniques in meniscus repair.

An experimental study was conducted to study 12 ruptured medial meniscuses of bulls, which were divided into two groups of six meniscuses equally. In this study, submeniscal horizontal and vertical loop suturing techniques were compared based on their resistance to tensile forces and the stability of repaired gaps.

In this study, submeniscal horizontal and vertical loop knots were 104.3 ± 12.5 N and 110.7 ± 16.4 N, respectively. No significant difference was found between the two groups. To measure the stability of the gap, 95.4 ± 8.7 N tensile force was applied to submeniscal and 124.6 ± 11.7 N to vertical loop techniques. There was significantly different in gap stability between horizontal and vertical loop techniques in meniscal repair (P = 0.02).

The results of this study indicate that knot resistance in submeniscal horizontal is similar to vertical loop resistance. The stability of the restored gap in vertical loop technique is more than submeniscal horizontal techniques. Vertical loop causes greater stability against tensile force.

Nowadays open meniscal repair approach is completely replaced by arthroscopic meniscal repair.
The current study aimed at assessing the results of arthroscopic meniscal repair using the outside-in technique.
Patients diagnosed with meniscal tearing from 2008 to 2014 fulfilling the inclusion criteria were entered to the current cohort study. Outcomes of arthroscopic meniscal repair were assessed by 2 known questionnaires, IKDC (international knee documentation committee) and KOOS (knee injury and osteoarthritis outcome score), as well as magnetic resonance imaging (MRI) of knee.
A total of 63 patients were assessed. The mean age and follow-up period were 28.8 ± 4.8 years and 44.3 ± 20.3 months, respectively; 82% of the subjects were male and 60.3% had injuries in both meniscus and anterior cruciate ligament (ACL); 76% of the patients had medial meniscal injury; 67% had posterior horn tear, and 56% had longitudinal meniscal tear. There was no significant association between age, gender, grade of tear, number of sutures, anatomic site of tear, and type of tear with the level of patient’s satisfaction. Patients with simultaneous reconstruction of ACL had significant difference compared with the ones with isolated meniscal injury. Grading of tear in MRI had no association with the better outcomes according to the questionnaires.
Arthroscopic meniscal repair using the outside-in technique yielded acceptable results.

Diagnosis of knee injuries following trauma to the lower extremity is very important and needs to be carefully examined. This study aimed at comparing the diagnostic precision of clinical examination (CE) and MRI with findings from arthroscopy in traumatic knee injuries with femur or tibia shaft fracture. A cross-sectional study was conducted on 164 patients with traumatic knee injuries with femur or tibia shaft fracture who had been referred to Imam Hossein Hospital, Shahroud, between March 2014 and February 2015. We compared CE and MRI with arthroscopic findings (gold standard) to determine the concordance, accuracy, sensitivity, and specificity of injuries to the meniscus and knee ligaments. The results showed that internal mucus rupture was the most common trauma, noted in 83 cases (50.6%), followed by anterior corrosion rupture, noted in 65 cases (39.6%). CE sensitivity was 68.4% and specificity was 96.2% for medial meniscal (MM) injuries, while sensitivity was 53.6% and specificity was 96.4% for lateral meniscal (LM) injuries. For anterior cruciate ligament (ACL) injuries, CE showed sensitivity of 77.2% and specificity of 91.8%. For posterior cruciate ligament (PCL) injuries, CE showed sensitivity of 52.6% and specificity of 98.6%. For MM injuries, MRI showed sensitivity of 92.5% and specificity of 86.5%, while for LM injuries, it showed sensitivity of 85.00% and specificity of 98.6%. For ACL injuries, MRI showed sensitivity of 86.7% and specificity of 93.8%, and for PCL injuries, MRI showed sensitivity of 84.5% and specificity of 98.8. For ACL injuries, the best concordance was with CE, while for MM and LM injuries, it was with MRI (P Meniscal and ligament injuries in traumatic knee injury can be diagnosed through careful clinical examination, while requests for MRI can be reserved for complex or doubtful cases. CE and MRI used together have high sensitivity for ACL, PCL, and MM lesions, while for LM lesions, the specificity is higher.

Parts of the implants placed over the meniscus during meniscal repair can wear down the cartilage in the contact zones and cause chronic synovitis. Placing horizontal sutures under the meniscus may overcome this potential hazard. The purpose of this prospective study was to evaluate the midterm results of arthroscopic meniscal repair using submeniscally placed out-in horizontal sutures. One hundred and three meniscal repairs with submeniscal horizontal out-in technique in 103 patients were performed between 2009 and 2012. Our indications for meniscal repair were all longitudinal tear in red-red and redwhite zone with acceptable tissue quality. Clinical evaluation included the Tegner and Lysholm knee scores and clinical success was defined as absence of joint-line tenderness, locking, swelling, and a negative McMurray test. The average follow-up was 19 months (range, 14 to 40 months). The time interval from injury to meniscal repair ranged from 2 days to 390 days (median, 96 days). At the end of follow-up, the clinical success rate was 86.5%. Fourteen of 103 repaired menisci (13.5%) were considered failures according to Barrett’s criteria. The mean Lysholm score significantly improved from 39.6 preoperatively to 84.5 postoperatively (P˂0.001). Eighty five patients (82.5%) had an excellent or good result according to Lysholm knee score. Tegner activity score improved significantly (P˂0.01) from an average of 3.4 (range, 2-6) preoperatively to 5.9 (range, 5-8) postoperatively. Statistical analysis showed that age, simultaneous anterior cruciate ligament reconstruction, chronicity of injury did not affect the clinical outcome. Our results showed that acceptable midterm results are expected from submeniscal horizontal out-in repair technique. This technique is cheap, safe and has the advantage of avoiding chondral abrasion caused by solid implants and suture materials placed over the meniscus.

Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “modified outside-in technique” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with eniscal injuries by our new technique were evaluated. The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients’ satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months. Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients’ satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.