Development of OA Following ACL Reconstruction: Unexpected Finding in Medial Versus Lateral Meniscus Pathology

Objectives: Recent studies have described increased risk of OA following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The literature reports a 50% incidence of OA following medial meniscectomy, two times the risk compared to lateral meniscectomy. The purpose of this study was to determine the influence of meniscal pathology on the incidence of OA following ACLR. Methods: All patients who underwent primary autograft or allograft BPTB transtibial ACLR by a single surgeon between 1999-2015 were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Meniscus pathology and treatment were recorded. OA was defined at follow-up as Kellgren-Lawrence grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 103 patients (56 males, 47 females; age 36.1±11.4 years) with BPTB ACLR with an average follow-up of 8.81±4.96 (range 2-20 years) were included. The prevalence of medial meniscus tears at the time of ACL injury was 47.6% (49/103) and prevalence of lateral meniscus tears was 56.3% (58/103) (p=0.166). Medial compartment OA was seen in 9.7% (10/103) of patients. Prevalence of medial compartment OA was greater in patients with medial meniscus tear (14.3%; 7/49) compared to those without a medial meniscus tear (5.6%; 3/54); however, this was not significant (p=0.135). Of the 7 patients with medial meniscal tear and medial compartment OA, 5 underwent partial medial meniscectomy and 2 underwent repair. Lateral compartment OA was seen in 14.6% (15/103). The prevalence of lateral compartment OA was greater in patients with a lateral meniscus tear (22.4%; 13/58) compared to patients without lateral meniscus tears (4.4%; 2/45) (p=0.01). Patients with lateral meniscus tear were 5.04 [95%CI: 1.2 to 21.2] times more likely to develop OA. Thirteen of the 47 (28%) patients that underwent partial lateral meniscectomy developed lateral OA compared to 0% of patients (0/10) that underwent lateral meniscal repair (p=0.068). Conclusion: While studies with multiple surgeons and rehabilitation protocols have shown the development of OA following ACLR is increased with medial meniscal pathology, we found that the prevalence of medial OA was not significantly higher in these patients with medial meniscal tear at an average of 8.81 years follow-up. Whereas, lateral meniscal repair dramatically reduced the development of knee OA compared to partial meniscectomy in this cohort of patients with ACLR. These findings can inform clinical practice as despite prior literature indicating a relationship between medial meniscal tear and osteoarthritis, we did not see a greater prevalence of OA amongst patients undergoing ACLR with a medial meniscal tear. Further, a lateral meniscal repair offers superior protection against OA when compared to partial lateral meniscectomy in treating lateral meniscal tears and is essential in the treatment of these complex patients.

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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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MEDIAL MENISCAL TEAR

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1264 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3340-3342

Author(s):

Om C. Wadhokar

Keyword(s):

Knee Joint ◽

Medial Meniscus ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Meniscus Tear ◽

Physiotherapy Treatment ◽

Medial Side ◽

Healthy Cartilage ◽

Medial Meniscal Tear ◽

Time Restriction

Knee joint is type of hinge joint Knee joint consist of medial menisci and lateral menisci. Menisci plays an important role to maintain healthy cartilage. Medial meniscus commonly injured than lateral meniscus due to it is relatively lack of mobility. A case of 32 year female is presented in this report. Patient complaints of pain in medial side of right knee joint, inability to stand for longer time, restriction in daily activities. McMurray test was done and diagnosed medial meniscus tear. Physiotherapy treatment is mentioned in this report. The study conclude that there is significant improvement in range of motion , muscle strength , can able to perform activities of daily living with the help of physiotherapy treatment without any surgical approach.

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EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00105 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0010

Author(s):

Brett Heldt ◽

Elsayed Attia ◽

Raymond Guo ◽

Indranil Kushare ◽

Theodore Shybut

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Medial Meniscus ◽

Skeletal Maturity ◽

Cruciate Ligament ◽

Demographic Data ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Meniscus Tears ◽

Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

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Which factors are associated with the prevalence of meniscal repair?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04107-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaoxiao Song ◽

Dongyang Chen ◽

Xinsheng Qi ◽

Qing Jiang ◽

Caiwei Xia

Keyword(s):

Cruciate Ligament ◽

Demographic Data ◽

Meniscal Tear ◽

Univariate Analysis ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Acl Injury ◽

Partial Meniscectomy ◽

Meniscus Tear ◽

Confounding Factors

Abstract Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. Study design Case-control study; level of evidence, 3.

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Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00309 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0030

Author(s):

Laura Keeling ◽

Alexandra Galel ◽

Cooper Ehlers ◽

David Wang ◽

Edward Chang

Keyword(s):

Meniscal Repair ◽

Meniscus Tear ◽

Patient Specific ◽

Surgical Decision ◽

Meniscus Tears ◽

Patient Reported ◽

Specific Factors ◽

Surgical Decision Making ◽

Bucket Handle

Objectives: Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors. Methods: In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear. Results: Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05). Conclusions: Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.

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Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

The Journal of Knee Surgery ◽

10.1055/s-0038-1675783 ◽

2018 ◽

Vol 32 (11) ◽

pp. 1128-1132

Author(s):

Kun-Hui Chen ◽

En-Rung Chiang ◽

Hsin-Yi Wang ◽

Hsiao-Li Ma

Keyword(s):

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Acl Injury ◽

Meniscus Tear ◽

Meniscal Tears ◽

Anterior Cruciate ◽

Late Group ◽

Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

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Bilateral, Simultaneous Medial Meniscus Bucket Handle Tears in a 23-Year-Old Female

Case Reports in Orthopedics ◽

10.1155/2014/689130 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Brett Walker ◽

Andrew Limbert

Keyword(s):

Medial Meniscus ◽

Weight Bearing ◽

Treatment Options ◽

Meniscal Tear ◽

Meniscal Tears ◽

Automobile Accident ◽

Meniscus Tears ◽

Pubmed Search ◽

Bucket Handle

Traumatic tears of the meniscus are well reported in the literature. Rarely, bilateral meniscal tears occur. A PubMed search found that only three cases of bilateral medial meniscus bucket handle type tears have been reported. Treatment options range from partial meniscectomy to repair of the meniscal tear. Repair is reported to be more successful in the vascular red-red or red-white zones. We present the case of a 23-year-old female who sustained simultaneous bilateral medial meniscus bucket handle type tears in an automobile accident. She was treated in a staged fashion with knee arthroscopy. Her meniscus tears were both found to be in the vascularized zone and meniscal tear repair was conducted. At two weeks postoperatively, she had excellent resolution of her symptoms and has returned to pain-free weight-bearing. She has remained pain-free at six-month follow-up.

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ACL Injuries and Meniscal Lesion: Hand in Hand?

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i57a34013 ◽

2021 ◽

pp. 405-412

Author(s):

U. Nivetha ◽

. Vignesh ◽

. Anvesh ◽

. Munis ◽

Navin Balasubramaniam

Keyword(s):

Statistical Tests ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Meniscus Tear ◽

Age Group ◽

Meniscal Tears ◽

Meniscal Lesion ◽

Acl Tear ◽

Bucket Handle

Objective: To assess the incidence, nature and pattern of meniscal tear in ACL injury. Methodology: A retrospective study was conducted among the patients who were admitted and treated for ACL tear in Saveetha Medical And College And Hospital over a 2-year period from August 2019-August 2021. There were 52 patients admitted and treated for the same. The case records of each of the patients were reviewed to find the incidence of meniscal lesion in ACL tear and were then analyzed using appropriate statistical tests. Results: 52 patients with ACL tear were reviewed in this study. ACL tear was most commonly reported in younger age group of 20-29 (46.15%). Out of which, 19(36.54%) patients had meniscal tears. About 9(47.37%) patients had lateral meniscus tear, 6(31.58%) had medial meniscus tear and 4(21.05%) had bilateral meniscal tear. It was seen that bucket handle injury (n=12) was the most common meniscus tear overall. Radial tear was most specifically common in bilateral meniscus injury (N=4). Conclusion: Meniscal tears are the most common intra articular lesions associated with ACL tear. It was most commonly reported in the age group of 20-29. We found that the incidence of lateral meniscal tear was significantly higher in the patients rather than medial meniscal tear. Bucket handle injury was the most commonly reported tear in meniscal injury. Therefore, the surgeon needs to equip himself with the necessary meniscal repair instruments in his armamentarium

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Evaluation of functional outcome of bucket handle medial meniscus repair along with anterior cruciate ligament reconstruction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201485 ◽

2020 ◽

Vol 6 (3) ◽

pp. 499

Author(s):

Akshay Jain ◽

Adhir Jain ◽

Manjeet Singh ◽

Prateek Pathak

Keyword(s):

Anterior Cruciate Ligament ◽

Functional Outcomes ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Meniscus Repair ◽

Meniscus Tears ◽

Anterior Cruciate ◽

Bucket Handle

Background: Bucket-handle meniscus tears (BHMT) are often displaced and unstable and comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. The aim of present prospective longitudinal cohort study was to evaluate the functional outcomes of bucket handle medial meniscus repair along with anterior cruciate ligament (ACL) reconstruction at 2 years follow up.Methods: Between January 2017 to December 2018, 30 patients who underwent ACL reconstruction along with bucket handle medial meniscus repair were included in the study. Meniscus repair was done using the all inside, outside in, inside out or hybrid techniques. All patients were evaluated clinically at pre op and at 2 year follow up using knee injury and osteoarthritis outcome score and compared. Meniscal healing was assessed clinically using Barrett’s criteria.Results: The study comprised 30 patients with a mean age of 27.47 years (range from 13 to 49 years) with 66.67% males. According to clinical examination and Barrett criteria’s the clinical failure rate was 6.67% (2 out of 30 patients) who underwent partial menisectomy later. We also compared functional outcomes of sedentary and active peoplesand also between meniscal repair of less than 3 cm and more than 3 cm’s. There was no statistically significant difference in the functional outcomes in both the groups; however range of motion was significantly higher in tear length 3 cm or less compared to more than 3 cm.Conclusions: Meniscal repair should be aggressively considered in young patients to enhance functional recovery and durability of the knee joint, if the meniscus is reparable.

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The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

Radiology and Oncology ◽

10.1515/raon-2017-0053 ◽

2017 ◽

Vol 51 (4) ◽

pp. 401-406 ◽

Cited By ~ 1

Author(s):

Mustafa Resorlu ◽

Davut Doner ◽

Ozan Karatag ◽

Canan Akgun Toprak

Keyword(s):

Medial Meniscus ◽

Meniscal Tear ◽

Lateral Collateral Ligament ◽

Lateral Compartment ◽

Medial Compartment ◽

Meniscus Tear ◽

Collateral Ligament ◽

Medial Meniscal Tear ◽

Chondromalacia Patella ◽

Grade Iii

Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

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