Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

Meniscus Repair in Children and Adolescents: A Systematic Review of Treatment Approaches, Meniscal Healing, and Outcomes

2018 ◽  
Vol 32 (06) ◽  
pp. 490-498 ◽  
Author(s):  
Márcio Balbinotti Ferrari ◽  
Colin P. Murphy ◽  
João Luiz Ellera Gomes
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Meniscal Repair ◽  
Cochrane Central Register ◽  
Meniscal Tears ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
Meniscal Healing ◽  
Anterior Cruciate

AbstractAlthough the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young population. Better evidence regarding the outcomes following traumatic meniscal tears in children would improve our understanding of this increasing pathology and help define important factors in deciding the best treatment option. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines using the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, and MEDLINE PubMed databases. Inclusion criteria were as follows: studies reporting the outcomes of meniscal repair in patients 18 years old or younger, with a minimum mean follow-up of 12 months, Portuguese, Spanish, or English languages, and human studies including 10 or more patients. Our search identified 2,534 individual titles. After application of the inclusion and exclusion criteria, 8 studies were included, evaluating 287 patients with repaired meniscal tears. All eight studies were classified as level of evidence IV. The mean methodological index for nonrandomized studies score was 8.6 ± 1.4. Meniscal repair included all meniscal zones and tear patterns. Anterior cruciate ligament tear was the most common associated injury. The all-inside and inside-out techniques were predominantly reported. The majority of the patients reported good to excellent outcomes and had clinical signals of meniscal healing; meniscectomies following meniscal repair were performed in just 44 cases. In conclusion, meniscal tears in pediatrics are not uncommon. Repairs of this injury were associated with good to excellent outcomes in most patients, regardless of the injury pattern, zone, or technique. Reported complications were minimal; however, higher quality studies are needed to confirm the findings of this systematic review. This is a systematic review study with Level IV.

Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears

2010 ◽  
Vol 38 (8) ◽  
pp. 1542-1548 ◽  
Author(s):  
Thomas Stein ◽  
Andreas Peter Mehling ◽  
Frederic Welsch ◽  
Rüdige von Eisenhart-Rothe ◽  
Alwin Jäger
Keyword(s):  
Meniscal Repair ◽  
Partial Meniscectomy ◽  
Meniscal Tears ◽  
Arthroscopic Partial Meniscectomy ◽  
Term Outcome ◽  
Long Term Outcome

Meniscal transplantation: state of the art

2017 ◽  
Vol 2 (6) ◽  
pp. 339-349 ◽  
Author(s):  
Pablo E Gelber ◽  
Peter Verdonk ◽  
Alan M Getgood ◽  
Juan C Monllau
Keyword(s):  
State Of The Art ◽  
Surgical Techniques ◽  
Return To Sport ◽  
Reoperation Rate ◽  
Controversial Issues ◽  
Future Perspectives ◽  
Meniscal Allograft Transplantation ◽  
Meniscal Allograft ◽  
Feasible Option ◽  
Chondroprotective Effect

Meniscal resection is the most common surgical procedure in orthopaedics. When a large meniscal loss becomes clinically relevant, meniscal allograft transplantation (MAT) is a feasible option. However, although this technique has evolved since the ‘80s, there are still several controversial issues related to MAT. Most importantly, its chondroprotective effect is still not completely proven. Its relatively high complication and reoperation rate is another reason for this procedure not yet being universally accepted. Despite its controversial chondroprotective effect, nevertheless, MAT has become a successful treatment for pain localised in a previously meniscectomised knee, in terms of pain relief and knee function. We conducted a careful review of the literature, highlighting the most relevant studies in various aspects of this procedure. Precise indications, how it behaves biomechanically, surgical techniques, return to sport and future perspectives are among the most relevant topics that have been included in this state-of-the-art review.

scholarly journals THE LATE RESULTS OF ARTHROSCOPIC SURGERIES WITH KNEE INJURIES IN CHILDREN

2010 ◽  
Vol 16 (3) ◽  
pp. 55-60
Author(s):  
V. D. Bogatov ◽  
N. Kh. Bakhteeva ◽  
V. A. Mitrofanova
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Knee Injuries ◽  
Young Patients ◽  
Late Results ◽  
Meniscal Tears

The purpose of the work is the follow-up of the late results of management of children and adolescents with knee injuries. Arthroscopy was performed to 68 patients. Resection and suturing of the torn meniscus and ACL reconstruction were performed. The results were followed up to eight years after operations. It was shown, that meniscal tears in children should be treated conservatively in most cases. The suturing of the torn menisci is preferable method. Indications for suturing are wider in children that in adults. ACL reconstruction in young patients is unpredictable in its results.

Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair

2020 ◽  
Vol 48 (4) ◽  
pp. 853-860
Author(s):  
Shinya Yamasaki ◽  
Yusuke Hashimoto ◽  
Yohei Nishida ◽  
Takanori Teraoka ◽  
Shozaburo Terai ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
T2 Mapping ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
T2 Relaxation Time ◽  
Resonance Imaging ◽  
T2 Relaxation ◽  
Conventional Mri ◽  
Meniscal Healing ◽  
The Mean

Background: Although the sensitivity and specificity of magnetic resonance imaging (MRI) for the diagnosis of primary meniscal tears are high, these values are lower for the assessment of healing status of repaired menisci. Purpose: To compare the accuracy of MRI T2 mapping and conventional MRI in assessing meniscal healing after repair. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent meniscal repair with concurrent anterior cruciate ligament reconstruction between 2012 and 2016 and had a follow-up second-look arthroscopy were enrolled. The patients were divided into healed and incompletely/not healed groups based on the second-look arthroscopy findings. For the repaired menisci, the following were compared between the groups, (1) Stoller and Crues classification on conventional MRI with a proton density-weighted fat-saturated sequence and (2) the remaining colored meniscal tear line on T2 mapping coincident with the high signal line showing the primary tear on conventional MRI were compared. The change of T2 relaxation time (ΔT2) of the colored meniscal tear line pre- to postoperatively was compared between the groups. The mean T2 relaxation time of the whole area of the postoperative meniscus at each slice was also compared with that of control menisci to assess the whole quality of the repaired meniscus. Results: A total of 26 menisci from 24 knees were assessed (16 healed menisci, 10 incompletely/not healed menisci). According to the Crues classification on conventional MRI, 8 of 16 healed menisci and 3 of 10 incompletely/not healed menisci improved from grade 3 to 2, with there being no significant difference between the groups ( P = .43). However, the colored meniscal tear line remained in only 3 of the 16 healed menisci as compared with 9 of the 10 incompletely/not healed menisci, and the presence of this colored line allowed differentiation between healed menisci and incompletely/not healed menisci (sensitivity, 81.3%; specificity, 90.0%; odds ratio, 39.0; P = .001). The mean (SD) ΔT2 was −31.1 ± 3.2 and −19.9 ± 4.4 ms in the healed and incompletely/not healed groups, respectively ( P < .001). Receiver operating characteristic curve analysis showed a cutoff ΔT2 value of −22.3 ms for separation of meniscal healing ( P < .001). The T2 relaxation times of the whole area of the repaired menisci were 31.7 ± 3.4 and 32.8 ± 3.8 ms in the healed and incompletely/unhealed groups, respectively ( P = .69), with these values being significantly longer than the 26.9 ± 2.2 ms in the controls ( P < .001). Conclusion: MRI T2 mapping allowed the differentiation of healing status after meniscal repair, with high sensitivity and specificity as compared with conventional MRI.

scholarly journals Return to Play After Isolated Meniscal Repairs in Athletes: A Systematic Review

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096209
Author(s):  
Erica R. Blanchard ◽  
Christopher J. Hadley ◽  
Eric D. Wicks ◽  
William Emper ◽  
Steven B. Cohen
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Return To Play ◽  
Meniscal Tears ◽  
Arthroscopic Technique ◽  
Level Of Evidence ◽  
Study Results ◽  
Anterior Cruciate

Background: Meniscal tears are a common knee injury. Isolated meniscal tears are less common; however, unaddressed tears can be troublesome, particularly for athletes. There is currently a lack of data in the literature on athletes returning to play after isolated meniscal repair. Purpose: To evaluate the return to play rate and time to return to play for athletes with isolated meniscal injuries. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, EMBASE, and Cochrane electronic databases was conducted to identify studies that reported the time and the rate of return to play in athletes after repair of isolated meniscal tears. Studies were excluded if there was a concomitant anterior cruciate ligament reconstruction, if there was a meniscectomy instead of a meniscal repair, or if the study was a systematic review. Quality assessment and data extraction were performed by 2 examiners. Results: Overall, 21 studies were included in this review. There were 355 athletes (358 knees) with a mean age of 22.5 years (range, 9-68 years). A sex breakdown was noted in 16 of the 21 (76.2%) studies with 224 men and 71 women. The specific repair technique was described in 259 (72.3%) knees. Of the total knees, 109 (30.4%) had an open repair, 128 (35.8%) had an inside-out arthroscopic technique repair, and 22 (6.1%) had an all-inside arthroscopic technique repair. Complications were addressed in 11 studies, with 13 out of 155 (8.4%) patients across the 11 articles having a postoperative complication. Of the total 355 patients, 295 (83.1%) returned to play, and 17 of these 21 (81.0%) articles reported the time it took for athletes to return to play, with a mean return of 8.7 months. Conclusion: The study results indicate that return to play rates after isolated meniscal repair are high, with an overall return to play rate of 83.1% and a mean return to play time of 8.7 months. However, the limited number of studies, particularly ones with larger patient numbers, highlights the need for further investigation regarding isolated meniscal repair in athletes.

scholarly journals Children and Adolescents With Eating Disorders: The State of the Art

PEDIATRICS ◽  
2003 ◽  
Vol 111 (1) ◽  
pp. e98-e108 ◽  
Author(s):  
E. S. Rome ◽  
S. Ammerman ◽  
D. S. Rosen ◽  
R. J. Keller ◽  
J. Lock ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Children And Adolescents ◽  
State Of The Art ◽  
The State
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