Results of Meniscus Repair for the Hypermobile Medial Meniscus

Objectives: There have been very few studies on hypermobile lateral meniscus, but hypermobility of the medial meniscus has not been reported; the latter is more common in our practice. It is characterized by lax peripheral attachment of the middle 1/3 of the medial meniscus without a tear existing. In its most severe form (grade III) the meniscus can be displaced to the middle of the plateau and everted more than 60 degrees by probing the meniscocapsular attachment. The purpose of the present study is to analyse the clinical features of hypermobile medial meniscus and the results of meniscus repair. Methods: 14 patients (14 knees; 10 right) underwent arthroscopic meniscal repair for hypermobile medial meniscus. Men and women were equally affected; average age was 28 (14-46). The mean duration of symptoms was 18 (2-96) months. Six cases (43 %) had no history of trauma. The most common symptoms were medial joint line pain (n:14), locking (n:9), giving way (n:9), rest pain (n:9) and inability to squat (n:5). The most common clinical findings were medial joint line tenderness (n:11), positive McMurray’s test (n:9), medial retinacular tenderness (n:6), and effusion (n:3). 13 patients were rated as poor by the Lysholm scale; average 52(35-85), average Tegner activity level was 5.6 (3-9). MRI, available for eight patients, did not show any spesific findings. Arthroscopy did not reveal any other lesions to explain the mechanical symptoms. SPSS 16,00 for Windows (Statistical Program for the Social Services Inc, Chicago, IL, USA) program was used for statistical analysis. Continuous variables were defined as mean ± standard derivation. Variables were tested for normal distribution by using the Kolmogorov–Smirnow test. Differences between the groups were assessed by using unpaired t-test or Mann–Whitney U-test instead, if continuous variables did not have normal distribution. Paired sample t-test was used to compare continuous variables (data of Tegner and Lysholm scores, preoperative and at last control). P < 0.05 was accepted as statistically significant. Results: All the patients were available for follow-up; average 32 (6-59) months. 11 patients (78 %) had no mechanical symptoms. Patients’ own evaluation was; 3 very good, 7 good, 3 fair and 1 poor. 13 patients were better. At follow-up, significant improvement was obtained in Lysholm score which was 84(52-100) in average (p<0.01) ; 9 (64 %) good-excellent,4 (28%) fair and 1 (7%) poor. Tegner levels were almost regained: Decrease by 1 grade (4.7 in average (1-9)) (p=0.026). Despite satisfactory results, more than half had minor symptoms and findings. Conclusion: Hypermobile medial meniscus is characterized by medial pain and mechanical symptoms. Two types can be distinguished: traumatic and atraumatic. For significant hypermobility, the meniscus should be stabilized by repair. Patients benefit from repair, but more than half continue to have minor symptoms.

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Meniscal and Articular Cartilage Predictors of Outcome following Revision ACL Reconstruction: A 6-Year Follow-up Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00369 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0036

Author(s):

Rick Wright ◽

Keyword(s):

Articular Cartilage ◽

Acl Reconstruction ◽

Revision Surgery ◽

Medial Meniscus ◽

Lateral Meniscus ◽

Activity Level ◽

Activity Levels ◽

Revision Acl Reconstruction ◽

Acl Surgery

Objectives: Previous work has shown that having a lateral meniscectomy prior to revision ACL surgery, as well as grade 3-4 chondral damage to the trochlea at the time of revision ACL surgery results in poorer outcomes at 2 years. Alternatively, meniscal or articular cartilage (AC) pathology documented at the time of a revision surgery were not found to be significant risk factors for 2-year activity levels. The purpose of this study was to follow this cohort for a longer time period, to determine if either meniscal and/or articular cartilage pathology noted at the time of revision ACL surgery significantly affects a patient’s activity level, sports function, and OA symptoms at 6-year follow-up. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for age, gender, BMI, smoking status, activity level, baseline outcome scores, revision number, time since their last ACL reconstruction, graft choice, and previous and current meniscal and articular cartilage pathology, in order to assess the meniscal and AC pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. Results: 1234 patients met the inclusion criteria and were successfully enrolled, with 716 (58%) males and a median cohort age of 26 years. The median time since their last ACL reconstruction was 3.4 years. Surgeons noted previous pathology in the medial meniscus (39%), lateral meniscus (20%), and articular surfaces (12%) at the time of revision surgery. Surgeons reported current pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (MFC; 43%), lateral femoral condyle (LFC; 29%), medial tibial plateau (MTP; 11%), lateral tibial plateau (LTP; 17%), patella (30%), and trochlea (21%). At 6 years, follow-up was obtained on 77% (949/1234). Previous and current meniscal pathology (both medial and lateral), as well as current AC pathology (in the MFC, LTP, trochlea, and patella) were found to be significant drivers of poorer outcomes at 6 years. The most consistent cartilage-related factors driving outcome in revision patients were either a previous or current repair or excision of the medial meniscus and patellofemoral AC pathology. Six-year Marx activity levels were negatively impacted by having either a repair or an excision of the medial meniscus (odds ratio range =0.58-66; 95% CI=0.38-0.91; p=0.01) or having grade 3-4 patellar chondrosis (OR=0.57; 95% CI= 0.35-0.95; p=0.03). Conversely, 6-year activity levels significantly improved by having either a lateral meniscus repair or excision (OR=1.49-2.22; 95% CI=1.07-4.04; p=0.005). Previous medial or lateral meniscal pathology negatively affected all KOOS subscales except for sports/recreation (p<0.05). Articular pathology significantly impaired KOOS symptoms, sports/recreation and the quality of life subscales (p<0.05). The KOOS sports/recreation subscale was significantly affected by articular cartilage pathology (LTP, patella, trochlea; p<0.03). Lower baseline outcome scores, lower baseline activity level, and being a smoker all significantly increased the odds of reporting poorer clinical outcomes at 6 years. Conclusion: Meniscal and articular cartilage pathology was found to have a larger impact at 6 years following revision ACL surgery, as compared to 2-year follow-up. In contrast to 2-year follow-up, incidence of medial meniscal and AC pathology at the time of a patient’s revision surgery were found to significantly diminish a patient’s activity level at 6 years, whereas the incidence of lateral meniscal repair or excision was found to improve a patient’s activity level. Having a previous medial meniscal repair or excision or exhibiting grade 2-4 chondral damage noted at the time of ACL revision reconstruction results in poorer IKDC and KOOS scores and worse WOMAC pain and ADL scores at 6 years following revision surgery.

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Clinical Results after Arthroscopic Meniscus Repair for Recurrent Subluxation of the Lateral Meniscus

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00098 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0009

Author(s):

Sang Hak Lee ◽

Jin Hwan Ahn ◽

Kyung Ho Yoon ◽

Chan Il Bae

Keyword(s):

Full Range ◽

Lateral Meniscus ◽

Clinical Results ◽

Suture Technique ◽

Meniscus Repair ◽

Activity Level ◽

Discoid Lateral Meniscus ◽

Limited Function ◽

Tegner Activity Level

Purpose: This study was undertaken to diagnose and to document clinical results and the technical aspects of arthroscopic meniscus repair for treating the recurrent subluxation with peripheral tears around popoliteal hiatus of the LM. Methods: Twenty two patients (23 knees) with symptomatic recurrent subluxation of the LM treated by arthroscopic meniscus repair were included. The inclusion criteria were (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment, (2) non-discoid lateral meniscus, (3) stable knee, and (4) tears involving the red-white or red–red zone. All tears were repaired with either the modified all-inside suture technique only or a combination of the modified all-inside and modified outside-in techniques. Clinical results were evaluated preoperatively and at final follow-up using Tegner activity level, Lysolm knee, and Hospital for Special Surgery (HSS) scores. Results: All patients returned to their prior life activities with little or no limitations, and no reoperation was required after an average follow-up of 52.3 months(range, 24–160). At the final follow-up, all knees achieved a full range of motion. Catching sensation was experienced in three knees, and limited function during squatting and jumping was complained in two knees. However no patient had recurrence of a locking episode. At the last follow-up, the mean Tegner activity level had improved significantly from 3.7 (range, 2–6) to 7.2 (range, 3–10, p<0.0001), mean Lysolm knee score improved from 75.1 92.0 (range, 76-100) preoperatively to 92.0 (range, 76-100) at final follow-up (p < 0.0001), and mean preoperative HSS score improved from 83.4 to 94.6 at final follow-up (p < 0.0001). Conclusion: Arthroscopic meniscus repair using the modified all-inside suture and outside-in techniques showed excellent clinical outcomes for treating symptomatic recurrent subluxation with peripheral tears around popoliteal hiatus of the LM without any complications or recurrence. [Figure: see text][Figure: see text]

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Incidence and Predictors of Subsequent Surgery following ACL Reconstruction: A 6-Year Cohort Follow-up Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00352 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0035

Author(s):

Laura Huston ◽

Alex Zajichek ◽

Kurt Spindler ◽

Jaron Sullivan ◽

Keyword(s):

Risk Factors ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Medial Meniscus ◽

Sports Participation ◽

Meniscus Repair ◽

Activity Level ◽

Meniscus Tear ◽

Patient Demographic

Objectives: Subsequent surgeries after ACL reconstruction are known to negatively affect patient satisfaction and outcomes. Previous studies have identified risk factors for subsequent operations after ACL reconstruction, but few studies have identified factors which increase the risk for subsequent specific procedures related to meniscus and articular cartilage.The purpose of this study was two-fold: 1) to report the incidence and types of subsequent surgeries which occur in a cohort of ACL reconstructed patients 6 years following their index ACL reconstruction; and, 2) to predict which variables (i.e. patient demographic and surgical) may influence the incidence of a patient having a subsequent meniscus or articular cartilage related surgery following their index ACL reconstruction. Methods: This was a multicenter longitudinal prospective cohort study design. Each participant completed a questionnaire that included baseline demographics, injury descriptors, sports participation level, comorbidities, knee surgical history, and validated patient-reported outcome measures, and were followed up at 2 and 6 years. In addition, patients were also contacted to determine whether any underwent additional surgical knee procedures since baseline. Operative reports were obtained and independently read by two orthopaedic surgeons, and all procedures were categorized and recorded, along with the surgical date. If multiple procedures were done during an operation, all were recorded. Two separate logistical regression models were constructed to predict which independent variables (i.e. patient demographic and surgical) potentially influenced the incidence of a patient having a subsequent surgery following their index ACL reconstruction: model #1 examined subsequent meniscus-related surgeries on the ipsilateral knee and model #2 examined subsequent articular cartilage-related surgeries. Results: The cohort consisted of 3,276 subjects (56% male) with a median age of 23 years at the time of enrollment. Primary ACL reconstructions comprised 93% of the group, while 7% were enrolled as revision ACL reconstructions. The majority of subjects underwent bone-patellar tendon-bone (BTB) autograft reconstructions (43%), while 34% underwent hamstring autograft and 23% had allograft reconstructions. We obtained 92% (2999/3276) follow-up with regards to information on incidence and frequency of subsequent surgeries on the cohort. The remaining 8% (277/3276) were lost to follow-up. Overall, 20% (612/2999) of the cohort was documented to have had at least one subsequent surgery on the ipsilateral knee 6 years following their index ACL reconstruction. These 612 subjects encompassed 1,272 categorical procedures. The most common subsequent procedures on the ipsilateral knee were meniscus-related (n=357 procedures;11.9% of follow-up cohort), revision ACL reconstruction (226 procedures; 7.5% of cohort), arthrofibrosis-related (235 procedures; 7.8% of cohort), or articular cartilage-related (201 procedures; 6.7% of cohort). Collectively, subsequent procedures involving the medial meniscus (repairs and/or meniscectomies) occurred almost twice as frequently as the lateral meniscus (7.4% vs. 4.2%). Surprisingly, only 19 total knee arthroplasties (0.6% of cohort) were performed during this follow-up time period, at a median time of 45 months following the patient’s index ACL reconstruction. The variables that were found to be significant predictors of having a subsequent meniscal surgery on the ipsilateral knee were patients with lower age, higher baseline Marx activity level, patients who had quit smoking (compared to non-smokers), having a autograft hamstring or allograft (compared to an autograft BTB), or having a medial meniscus repair or a medial meniscus tear that was not treated at the time of index surgery. After adjusting for all other covariates, patients with an index medial meniscus repair were 4.4 times more likely to undergo a subsequent surgery related to the meniscus than patients with no initial medial meniscal pathology. The variables that were found to be significant predictors of having a subsequent surgery involving the articular cartilage (AC) were patients with higher BMI, higher baseline Marx activity level, having an autograft hamstring or allograft (compared to an autograft BTB), having a meniscus repair at the time of index surgery, or having Grade 3 or 4 AC pathology in any compartment. Specifically, if a patient has grade 4 changes in any compartment at the time of their index reconstruction, they are over 3 times more likely to have a subsequent AC-related surgery by 6 years, after controlling for all covariates (p<0.001). Conclusion: This study identified the incidence of subsequent surgeries and risk factors for having subsequent meniscus or articular cartilage related procedures over a 6-year follow up period. Identifying and understanding these risk factors is a critical step in helping to mitigate the risks to improve patient outcomes.

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Prospective Short-term MRI controlled investigation of the healing properties of the Meniscus

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00146 ◽

2017 ◽

Vol 5 (4_suppl4) ◽

pp. 2325967117S0014

Author(s):

Lukas Willinger ◽

Felix Förschner ◽

Andreas Imhoff ◽

Elmar Herbst

Keyword(s):

Classification System ◽

Statistical Significance ◽

Lateral Meniscus ◽

Meniscus Repair ◽

Lysholm Score ◽

Joint Fluid ◽

Short Term ◽

Meniscus Tears ◽

Meniscus Healing

Aims and Objectives: The purpose of the study was to prospectively investigate signal alterations in short-term follow-up after acute meniscus repair on specific magnetic resonance imaging (MRI) scan sequences. It was hypothesized that 1) there are different meniscus healing properties depending on lesion configuration and size, and 2) the tear zone has an influence on the healing properties of the meniscus. Materials and Methods: We conducted this prospective short-term clinical and radiological study to investigate the healing properties of acute meniscus tears. Inclusion criteria were patients (age 18-45 years) with traumatic meniscus lesion, subsequent arthroscopic meniscus repair within 6 weeks and preoperative MRI. Exclusion criteria were age < 18 or >45 years, arthrosis > grade III and multiligamentous knee injuries. Clinical examination and outcome scores (IKDC, KOOS, Lysholm Score) were surveyed preoperatively and 12 weeks after surgery. Meniscus tears were classified according to the ISAKOS meniscus classification system on MRI scans. Radiological assessment using a 3T-MRI was performed preoperatively and 2, 4, 6 and 12 weeks after operation. Meniscus healing were classified according to Henning’s criteria in A) healed, B) partially healed (> 50%) and C) not healed. Data were analyzed using SPSS statistics software version 21 (IBM, New York, USA). Statistical significance was set at a p value of < 0.05. Results: These are preliminary results of 14 patients (13 m, 1w) with a total of 16 meniscus tears. According to the ISAKOS meniscus classification system 9 medial and 7 lateral meniscus tears were included and average tear length was 21.5 mm (6 - 40 mm). 12 tears were located in the rim zone 1 and 4 tears were more medially in zone 2. In 8 (57%) patients an additional anterior cruciate ligament (ACL) reconstruction was performed. Six weeks postoperatively 8 menisci (50%) were deemed healed, 6 menisci (37%) partially healed whereas 2 menisci were not healed (13%). After 12 weeks 9 menisci (56%) were considered healed, 4 menisci (25%) partially healed and 3 menisci (19%) showed intrameniscal joint fluid in more than 50% of meniscus thickness. Two bucket handle tears of the medial meniscus and one radial tear of the lateral meniscus, all located in the red-red zone sized 35 mm, 25 mm and 12 mm, were not healed after 12 weeks. Clinical scores improved significantly 12 weeks after surgery: IKDC Score (preOP: 46.7, postOP: 67.8), KOOS (preOP: 49.7, postOP: 79.1) and Lysholm Score (preOP: 49.5, postOP: 77.7) (p < 0.05). Conclusion: Clinical and radiological follow-up showed good short-term results after meniscus repair. MRI revealed signal alteration in all menisci after 12 weeks, in most instances considered as scar tissue without intrameniscal joint fluid. In this cohohrt tear size and location was not correlated with non-healing. Arthroscopic meniscus repair achieves a high healing response of the meniscus and good clinical outcomes.

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Meniscal Root Repair in Pediatric Patients: Minimum 2-Year Outcomes (196)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00307 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0030

Author(s):

S. Clifton Willimon ◽

Michael Busch ◽

Asahi Murata ◽

Crystal Perkins

Keyword(s):

Patient Satisfaction ◽

Pediatric Patients ◽

Medial Meniscus ◽

Lateral Meniscus ◽

Injury Pattern ◽

Posterior Root ◽

Root Tear ◽

Meniscus Root ◽

Root Repair

Objectives: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. The anterior and posterior meniscus roots anchor the meniscus to bone. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and progressive degenerative articular wear. As a result of these deleterious effects, there has been increasing emphasis on repair of meniscus root injuries to restore structure and function. The purpose of this study is to describe meniscus root tears, associated injuries, and minimum 2-year treatment outcomes in a series of pediatric patients. Methods: A single-institution, IRB approved, retrospective review was performed of consecutive pediatric patients less than 19 years of age with a meniscus root tear treated with transosseous root repair over a 4-year period. All patients had minimum 24-month clinical follow-up. Partial root tears treated with partial meniscectomy or irreparable root tears were excluded. All meniscus root tears were classified arthroscopically based on the tear types described by LaPradeADDIN EN.CITE 9. The primary outcomes were revision meniscus surgery and patient reported outcome scores (PROs) (Lysholm, Patient Satisfaction, and Tegner activity). Results: Twenty-one patients, 11 males and 10 females with a mean age of 15 years (range 7 – 18 years), met inclusion criteria. There were 15 lateral meniscus root tears and 6 medial meniscus root tears. The tears occurred in the posterior root in 20 patients (95%). The most common injury pattern was a lateral meniscus posterior root tear (14 patients, 67%). 18 patients (86%) had an associated ligament tear: 13 ACL tears and 5 PCL tears. Two root tears occurred in isolation, and both were the posterior root of the medial meniscus. The majority of meniscus root tears (15 patients, 71%) were root avulsions (type 5). Mean follow-up was 42 months (range 25 – 71 months). Three patients had a second surgery on the affected knee. In two patients, one with revision ACL reconstruction and one treated with chondroplasty of the patella, the meniscus root repair was noted to be well healed. A third patient sustained a new injury to the knee 4 years following medial meniscus posterior root repair and underwent partial medial meniscectomy. At final follow-up, PROs were obtained for 17 patients (81%). Mean Lysholm score was 91 (range 51 – 100). Mean patient satisfaction score was 8.7 (range 5 – 10). Fourteen of 16 patients (88%) reported returning to the same or higher level of activity following surgery. Conclusions: Meniscus root tears occur in pediatric patients, most commonly as root avulsions of the posterior root of the lateral meniscus and in association with ACL tears. This is unique as compared to the adult population, in which the medial meniscus posterior root is often injured in isolation and radial tears adjacent the root are the most commonly described injury pattern. In our case series, transosseous root repair resulted in successful outcomes in the majority of patients with durable results at midterm follow-up.

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Increase in Fetal Hemoglobin Levels in Pediatric Patients with Sickle Cell Disease after Vitamin D Replacement

Blood ◽

10.1182/blood-2020-134852 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 28-28

Author(s):

Ashwin P Patel ◽

Dorothy Kim Waller ◽

Vivien A. Sheehan

Keyword(s):

Vitamin D ◽

Normal Distribution ◽

Vitamin D Deficiency ◽

Research Funding ◽

Reticulocyte Count ◽

Fetal Hemoglobin ◽

Categorical Variables ◽

Continuous Variables ◽

Vitamin D Levels

Background: High fetal hemoglobin (HbF) levels reduce mortality and morbidity in sickle cell disease (SCD). Results from a prior clinical trial to assess safety of high dose vitamin D and our unbiased genomic analyses identifying a vitamin D regulated protein as a HbF inducer suggests that vitamin D replacement may increase HbF levels in SCD patients. To test this hypothesis, we performed a single center retrospective chart review investigating the impact of vitamin D replacement on HbF levels in our pediatric SCD population. Methods: We reviewed electronic medical records of pediatric patients with SCD with one or more serum vitamin D level who used vitamin D replacement from January 2007 to March 2020. SCD patients on chronic blood transfusion were excluded. Our cohort contained 81 SCD patients (ages: 2.3-19.9 years; 40 males) 71 HbSS, 6 HbSC, 3 HbSβ0, and1 Hb S-δβ. Vitamin D deficiency was defined as vitamin D levels < 30 ng/ml. All subjects were on hydroxyurea, with stable MCV (mean 96 fL at baseline and 95.6 fL during the study period). The patients received a median vitamin D dose of 2002 IU/day for a median of 229 days with a median follow-up of 365 days after replacement. Statistical analyses: Vitamin D deficient and non-deficient SCD patients data was compared at baseline by t test (for continuous variables with normal distribution), Wilcoxon test (for continuous variables with non-normal distribution), chi2 test (for categorical variables), and Fisher exact test (for categorical variables with small sample size). Linear relationships between vitamin D levels and HbF, CBC, BMI, and age were assessed using scatter plots and correlation coefficients (r value). Non-normal variables were log transformed to achieve normal distribution. A linear mixed effect (MLE) models were run to analyze linear relationship of variables of time dependent variables, including variable number of clinic visits and variable follow-up time. All models had 'vitamin D level" as an exposure variable; hydroxyurea and folic acid use as covariates, and one of the following as an outcome variable: HbF, hemoglobin, MCV, MCHC, reticulocyte count, WBC count, and platelet count. We performed mediation analysis to determine if HbF or MCV were intermediate variables for the effect of vitamin D on reticulocyte count. All LME models and scatter plots were created separately for the period of vitamin D replacement and a one-year follow-up period after cessation of vitamin D replacement to capture any lag period in HbF induction and sustained effect of vitamin D replacement. Results: The LME model, adjusting for hydroxyurea and folic acid, indicated that HbF increased by 0.68 percentage points with every 10 ng/ml rise in vitamin D levels during the vitamin D replacement period (p=0.04) and continued to rise after replacement, exhibiting a 2.2 percentage point rise per 10 ng/mL increase above replacement HbF levels during a 12 month follow-up period (p=0.005) (Figure 1, Table 1). WBC and absolute reticulocyte count (ARC) decreased significantly following vitamin D replacement according to the LME models (p<0.05) (Table 1). Reduction in ARC was due to HbF induction as per the mediation analysis. Conclusion: SCD patients have a 56.4-96.4 % prevalence of vitamin D deficiency reported in the literature. Several studies have shown that vitamin D deficiency is associated with increased morbidity and mortality in SCD patients. However, vitamin D screening and replacement are not routinely implemented in clinical practice. Our study is the first to analyze the effect of vitamin D replacement on HbF levels as a primary objective using longitudinal panel data. Our findings strongly suggest that vitamin D replacement can increase HbF levels and reduce laboratory markers such as ARC and WBC, whose elevation is associated with clinical severity. Disclosures Sheehan: Emmaus: Research Funding; Novartis: Research Funding; Global Blood Therapeutics: Research Funding.

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Different Regional Healing Rates with the Outside-In Technique for Meniscal Repair

The American Journal of Sports Medicine ◽

10.1177/03635465980260031901 ◽

1998 ◽

Vol 26 (3) ◽

pp. 446-452 ◽

Cited By ~ 80

Author(s):

Michiel F. van Trommel ◽

Peter T. Simonian ◽

Hollis G. Potter ◽

Thomas L. Wickiewicz

Keyword(s):

Medial Meniscus ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Current Method ◽

Complete Healing ◽

Posterior Horn ◽

Resonance Imaging ◽

Anterior Portion ◽

Meniscus Tears

Fifty-one patients with meniscal repair using the outside-in technique were reassessed with second-look arthroscopic procedures (N 15), arthrographic examination (N 41), magnetic resonance imaging (N 36), or a combination of these techniques. Forty-one medial and 10 lateral menisci were repaired. The average clinical follow-up was 15 months (range, 3 to 80). Forty-five of 51 patients had tears that were located in or extended into the posterior horn of the medial or lateral meniscus. Complete healing occurred in 23 menisci (45%), partial healing was observed in 16 (15 medial, 1 lateral) (32%), and no healing occurred in 12 (24%). Remarkably, in all 15 patients who had tears extending from the posterior to the middle third of the medial meniscus that were partially healed, it was always the posterior third that had not fully healed. This finding is statistically significant. In addition, the middle third of these menisci had not fully healed in five patients. No healing occurred in the two patients with tears in the posterior third of the medial meniscus. Poor healing with the outside-in technique was observed in patients with tears into the posterior horn of the medial meniscus. For tears in the middle and anterior portion of the medial meniscus, as well as all lateral meniscus tears, the outside-in technique is our current method of choice.

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Jaunų sportininkų artroskopinis peties sąnario viršutinės-priekinės-užpakalinės lūpos komplekso pažeidimų gydymas: perspektyvusis randomizuotas tyrimas

Lietuvos chirurgija ◽

10.15388/lietchirur.2006.3.2264 ◽

2006 ◽

Vol 4 (3) ◽

pp. 0-0

Author(s):

Rimtautas Gudas ◽

Romas Jonas Kalesinskas ◽

Ramūnas Tamošiūnas

Keyword(s):

Clinical Study ◽

Shoulder Joint ◽

Suture Anchor ◽

Activity Level ◽

X Rays ◽

Duration Of Symptoms ◽

Slap Lesions ◽

Slap Repair ◽

Study Results

Rimtautas Gudas1, Romas Jonas Kalesinskas1, Ramūnas Tamošiūnas2Kauno medicinos universiteto klinikų ,1 Ortopedijos ir traumatologijos klinikos Sporto traumų ir artroskopijos sektorius,2 Anesteziologijos ir reanimatologijos klinika,Eivenių g. 2, LT-50009 KaunasEl. paštas: [email protected] Tikslas Perspektyviuoju būdu išanalizuoti jaunų fiziškai aktyvių sportininkų minimaliai invazinių artroskopinio peties sąnario SLAP pažeidimų operacinio gydymo rezultatus. Ligoniai ir metodai Perspektyviuoju tyrimu įvertinome 38 sportininkus, kuriems 2000–2003 metais KMUK Ortopedijos ir traumatologijos klinikos Sporto traumų ir artroskopijos sektoriuje dėl peties sąnario sąnarinės lūpos žiedo pažeidimų ir su tuo susijusių įvairaus intensyvumo simptomų buvo atliktos minimaliai invazinės artroskopinės peties sąnario operacijos. Gydymo rezultatai vertinti pagal Constant skale ir rentgeno tyrimą praėjus vidutiniškai 19,2 mėn. po operacijų. Operuojamų pacientų amžiaus vidurkis buvo 27,2 metų (nuo 16 iki 38 metų). Rezultatai 24 (63%) pacientams atlikta II ir IV tipo sąnarinės lūpos pažeidimo rekonstrukcinė operacija, naudojant tirpius inkaruojančius siūlus, 4 (11%) – I, III, V ir VI tipų sąnarinės lūpos pažeidimo rekonstrukcinė operacija naudojant tirpius inkaruojančius siūlus, 5 (13%) – esant I ir III tipo pažeidimams, atplaišų pašalinimas, 5 (13%) – dvigalvio raumens sausgyslės nukirpimas ir tenodezė. Kartu su minėtomis procedūromis 5 (13%) ligoniams atlikta sukamųjų raumenų ir užpakalinės sąnario kapsulės sutraukimas siūlais. Priešoperacinis Constant skalės įvertis buvo 58 ± 5,15 taško, po operacijos praėjus 19,2 mėn. – 96 ± 5,82 taško (p < 0,05). Išvados Praėjus 19,2 mėn. po peties sąnario SLAP pažeidimų artroskopinės rekonstrukcijos naudojant tirpius inkaruojančius siūlus, gautas statistiškai reikšmingas peties sąnario funkcijos pagal Constant skalę pagerėjimas ir skausmo išnykimas (p = 0,005). Artroskopinės minimaliai invazinės peties sąnario operacijos yra veiksmingos gydant jaunų fiziškai aktyvių žmonių peties sąnario SLAP pažeidimus ir 93% sportininkų grąžina prieš pažeidimus turėtą fizinio aktyvumo lygį. Pagrindiniai žodžiai: peties artroskopija, SLAP pažeidimas Arthroscopic shoulder SLAP injury treatment in young athletes: prospective randomized trial Rimtautas Gudas1, Romas Jonas Kalesinskas1, Ramūnas Tamošiūnas2Kaunas Medical University,1 Clinic of Ortopedics and Traumatology, Division of Sport Trauma and Artroscopy,2 Clinic of Anesthesiology and Reanimatology,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To evaluate the arthroscopic procedures for the treatment of the shoulder joint SLAP lesions in young active athletes under the age of 38. Patients and methods Between 2000 and 2003, a total of 38 athletes with a mean age of 27.2 years (16 to 38) and with a symptomatic lesion of the biceps-labrum complex in the shoulder were evaluated 19.2 months post operations on the Constant scale and with X-rays. All athletes were available for a follow-up. The mean duration of symptoms was 13.32 ± 5.57 months and none of the athletes had prior surgical interventions to the affected shoulder. Type of study: prospective nonrandomized clinical study. Results After 19.2 months, all athletes showed a significant clinical improvement (p < 0,05). Final evaluation revealed a statistically significant improvement of the Constant results from 58 ± 5.15 preoperatively to 96 ± 5.82 postoperatively (p < 0.05). According to the Constant score, the functional and objective assessment showed that 96% had excellent or good results after the suture anchor SLAP repair (p < 0.001). No serious complications were reported. X-ray evaluation demonstrated no osteolythic changes in the suture anchor insertion zones or osteoarthritic changes of the shoulder joint after operations. 36 (95%) athletes following SLAP repair returned to sports activities at the pre-injury level at an average of 5.2 months (range 5 to 9 months) after the operations. Others showed a decline in the sport activity level. Conclusion At an average of 19.2 months (range from 19 to 21 months) of follow-up, our prospective clinical study in young active athletes under the age of 38 (16 to 38) has shown significant improvement in terms of pain and the function of the suture anchor repair for SLAP lesions in the shoulder. Limitations of our study included a small number of athletes and a relatively short follow-up, while a long-term follow-up is needed to assess the durability of SLAP lesion repair using these methods in young active athletes. Key words: shoulder arthroscopy, SLAP

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Parental and Familial Factors Influencing Physical Activity Levels in Early Adolescence: A Prospective Study

Healthcare ◽

10.3390/healthcare8040532 ◽

2020 ◽

Vol 8 (4) ◽

pp. 532

Author(s):

Dora Maric ◽

Ivan Kvesic ◽

Ivana Kujundzic Lujan ◽

Antonino Bianco ◽

Natasa Zenic ◽

...

Keyword(s):

Physical Activity ◽

Early Adolescence ◽

Physical Activity Level ◽

T Test ◽

Activity Level ◽

Activity Levels ◽

Familial Factors ◽

Paternal Education ◽

Physical Activity Levels

Parental/familial factors are important determinants of the physical activity level (PAL) in children and adolescents, but studies rarely prospectively evaluate their relationships. This study aimed to evaluate the changes in physical activity levels among adolescents from Bosnia and Herzegovina over a two-year period and to determine parental/familial predictors of PAL in early adolescence. A total of 651 participants (50.3% females) were tested at baseline (beginning of high school education; 14 years old on average) and at follow-up (approximately 20 months later). The predictors included sociodemographic characteristics (age, gender) and parental/familial factors (socioeconomic status of the family, maternal and paternal education, conflict with parents, parental absence from home, parental questioning, and parental monitoring). Physical activity levels were evidenced by the Physical Activity Questionnaire for Adolescents (PAQ-A; criterion). Boys were more active than girls, both at baseline (t-test = 3.09, p < 0.001) and at follow-up (t-test = 3.4, p < 0.001). Physical activity level decreased over the observed two-year period (t-test = 16.89, p < 0.001), especially in boys, which is probably a consequence of drop-out from the sport in this period. Logistic regression evidenced parental education as a positive predictor of physical activity level at baseline (OR [95% CI]; 1.38 [1.15–170], 1.35 [1.10–1.65]), and at follow-up (1.35 [1.11–1.69], 1.29 [1.09–1.59], for maternal and paternal education, respectively). Parents with a higher level of education are probably more informed about the importance of physical activity on health status, and thus transfer this information to their children as well. The age from 14 to 16 years is likely a critical period for maintaining physical activity levels in boys, while further studies of a younger age are necessary to evaluate the dynamics of changes in physical activity levels for girls. For maintaining physical activity levels in adolescence, special attention should be paid to children whose parents are less educated, and to inform them of the benefits of an appropriate physical activity level and its necessity for maintaining proper health and growth.

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Clinical Characteristics and Outcomes After Primary ACL Reconstruction and Meniscus Ramp Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120912427 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091242 ◽

Cited By ~ 4

Author(s):

Nicholas N. DePhillipo ◽

Grant J. Dornan ◽

Travis J. Dekker ◽

Zachary S. Aman ◽

Lars Engebretsen ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Characteristics ◽

Medial Meniscus ◽

Lateral Meniscus ◽

Knee Stability ◽

Patient Reported ◽

Grade 3 ◽

Inside Out ◽

Contact Mechanism

Background: Satisfactory outcomes have been reported after all-inside meniscus ramp repair with combined anterior cruciate ligament reconstruction (ACLR). However, clinical outcomes after ACLR with inside-out meniscus ramp repair are limited. Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported outcomes for patients who underwent ACLR and medial meniscus ramp repair compared with those who underwent isolated ACLR; patients in the 2 groups were matched for age, sex, and sport/activity. The null hypothesis was that there would be no significant differences in clinical outcomes between groups at a minimum of 2 years postoperatively. Study Design: Cohort study; Level of evidence 3. Methods: Patients who underwent primary ACLR with bone–patellar tendon–bone (BPTB) autograft by a single surgeon were retrospectively identified. A subgroup of patients with combined ACLR and meniscus ramp repair with a minimum 2-year postoperative follow-up were matched to a cohort who underwent isolated ACLR. Subjective patient-reported questionnaires, knee stability, and return to level of activity/sport were collected. Results: There were 851 patients who underwent primary ACLR; of these, 158 (18.6%) had medial meniscus ramp lesions confirmed at arthroscopy. The most common clinical characteristics in patients with ramp lesions were chronic injuries (68.4%), contact mechanism (88%), concomitant lateral meniscus tears (63.2%), and concomitant lateral meniscus posterior root tears (22.2%). Further, 50 patients who underwent combined ACLR and meniscus ramp repair with minimum 2-year follow-up were matched to patients who underwent isolated ACLR. Both groups reported significant improvements in subjective outcomes from preoperative to postoperative assessments ( P < .001). No significant differences were found in postoperative outcomes for combined ACLR with ramp repair versus isolated ACLR ( P > .05). Patients with meniscus ramp repair had increased preoperative knee laxity demonstrated by grade 3 Lachman (44% vs 6%) and pivot-shift (38% vs 12%) test results compared with patients who underwent isolated ACLR ( P ≤ .005 for both). Conclusion: This study demonstrates similar clinical outcomes, knee stability on postoperative physical examination, and return-to-sport rates for patients who underwent combined ACLR with BPTB autograft and inside-out meniscus ramp repair versus a matched cohort who underwent isolated ACLR. Clinicians should have a high index of suspicion for the presence of ramp lesions in patients with ACL tears who have a contact mechanism of injury, grade 3 Lachman test result, and concomitant lateral meniscal abnormality.

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