Repair of a Complete Radial Tear of the Lateral Meniscus

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110142
Author(s):  
Anthony J. Ignozzi ◽  
Greg Anderson ◽  
David R. Diduch
Keyword(s):  
Lateral Meniscus ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
High Rate ◽  
Joint Effusion ◽  
Convex Shape ◽  
Axial Forces ◽  
Outer Capsule ◽  
Meniscus Healing ◽  
Radial Tear

Background: Recognizing and repairing a lateral meniscus complete radial tear is critical, as this tear pattern makes the meniscus nonfunctional for load sharing of axial forces, and the convex shape of the lateral tibial plateau increases contact pressure. Indications: The diagnosis of a lateral meniscus complete radial tear was supported by joint effusion, lateral joint line tenderness, positive McMurray test, and magnetic resonance imaging findings. Arthroscopy confirmed the complete radial tear. Technique Description: During the procedure, a self-capturing suture passer was used to pass a size 0 high-strength suture through the meniscus. To start the repair, the free ends of the suture were passed from top to bottom on both sides of the tear. These free ends were then crossed on the bottom of the meniscus to create an X configuration and passed from the bottom to top slightly further back from the first suture passes. A spinal needle and a chia were used from outside-in to create a side-to-side suture across the tear to reinforce the repair, and a knot was then tied on the outer capsule. The chia was used once again to shuttle the size 0 sutures to the exterior portion of the knee and the knots were tied on top of the capsule. Results: Postoperatively, patients are 25% weightbearing with a 0° to 90° range of motion restriction for 6 weeks, with no deep squatting for 3 months. With an isolated radial tear repair, the patient can expect to return to sport by 5 months. Radial tear repair outcomes demonstrate reduced lateral meniscus extrusion, complete meniscus healing in 86.4% of patients, and significantly improved International Knee Documentation Committee, Lysholm, and Tegner scores. Discussion/Conclusion: Repairing a complete radial tear of the lateral meniscus restores the function of the meniscus. This surgical technique provides a high rate of complete meniscus healing and excellent patient satisfaction.

The sheep as a knee osteoarthritis model: early cartilage changes after meniscus injury and repair

2007 ◽  
Vol 41 (4) ◽  
pp. 420-431 ◽  
Author(s):  
C Burger ◽  
M Mueller ◽  
P Wlodarczyk ◽  
H Goost ◽  
R H Tolba ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Lateral Compartment ◽  
Joint Effusion ◽  
Magnetic Resonance Imaging Scan ◽  
Meniscal Surgery ◽  
Meniscus Healing ◽  
Radial Tear ◽  
One Year ◽  
Injury And Repair ◽  
The Right

The purpose of this study was to analyse cartilage changes after traumatic meniscal lesions and to provide a detailed description of the model used with a view to reducing the number of animals used in future studies. The sheep's knee was chosen, as ovine biomechanics are similar to that of humans. In two groups of 10 animals each, a radial tear in the medial meniscus was either sutured with polydioxanone (PDS) or left untreated (sham-operated). Half of the animals in each group were sacrificed after six months, the other half after one year. The time periods to achieve weight bearing, meniscus healing, joint effusion (magnetic resonance imaging scan) and knee cartilage in the medial, lateral and patellofemoral compartments were evaluated in comparison to the opposite knee (control). Osteoarthritis (OA) was assessed by a modified Outerbridge classification and confirmed by scanning electron microscopy. Only one sutured meniscus remained completely adapted. In all other meniscus lesions, the rupture healed with a scar. In the PDS and sham-operated groups, OA was significantly higher in the medial knee compartment than in the lateral compartment and in controls ( P < 0.001). In the operated groups, joint effusion was higher in the right hindlimb knee than in the normal left hindlimb knee (control) after six and 12 months ( P < 0.001). Non-treated, displaced and even adapted sutured radial ovine meniscus tears produced intense OA within less than six months. Therefore, this animal model is suitable for assessment of new therapeutic regimens in meniscal surgery.

scholarly journals Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children

Children ◽  
2020 ◽  
Vol 7 (10) ◽  
pp. 173
Author(s):  
Stefano Stallone ◽  
Filippo Selleri ◽  
Giovanni Trisolino ◽  
Alberto Grassi ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Sport Activity ◽  
Return To Sport ◽  
Knee Laxity ◽  
International Knee Documentation Committee ◽  
High Rate ◽  
Special Focus ◽  
Early Return ◽  
Complete Restoration ◽  
Sport Activities

Avulsion fracture of the tibial spine (TSA) is uncommon in children, although its incidence is increasing with the earlier practice of competitive sport activities. This study aims to report mid to long term outcomes in children who sustained a TSA, with a special focus on a return to sport activities. Skeletally immature patients with a TSA, treated in two orthopedic hospitals, were evaluated for range of motion and knee laxity using KT1000, KiRA and Rolimeter. The pediatric International Knee Documentation Committee score (Pedi-IKDC) and the Hospital for Special Surgery pediatric Functional Activity Brief Scale (Pedi-FABS) questionnaires were recorded during the latest visit. Forty-two children were included. Twenty-six were treated nonoperatively and 16 underwent surgery. At a mean follow-up of 6.9 ± 3.6 years, 36 patients completed the questionnaires and 23 patients were tested with arthrometers. Among them, 96% had normal knee laxity. The Pedi-IKDC score averaged 96.4 ± 5.7 points, while the mean Pedi-FABS was 22.2 ± 5.9 points, without statistically significant differences between groups. Twenty-eight patients (78%) returned to their previous level of sport activity (eight amateur, 13 competitive, seven elite athletes). Eight patients (22%) quit sport, mostly because of re-injury fear. If properly treated, pediatric TSAs achieve a high rate of successful healing, with complete restoration of knee stability and an early return to sport activities.

scholarly journals Return to Sport After Ankle Syndesmotic Injury: A Systematic Review

2018 ◽  
Vol 11 (2) ◽  
pp. 116-122 ◽  
Author(s):  
Seline Y. Vancolen ◽  
Ibrahim Nadeem ◽  
Nolan S. Horner ◽  
Herman Johal ◽  
Bashar Alolabi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Return To Sport ◽  
Nonoperative Treatment ◽  
High Rate ◽  
Rate Of Return ◽  
Syndesmotic Injury ◽  
Level Of Evidence ◽  
Treatment Groups ◽  
Pertinent Data

Context: Ankle syndesmotic injuries present a significant challenge for athletes due to prolonged disability and recovery periods. The optimal management of these injuries and rates of return to sport in athletes remains unclear. Objective: The purpose of this study was to evaluate return to sport for athletes after ankle syndesmotic injuries. Data Source: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from database inception to January 15, 2017, and pertinent data were abstracted. Study Selection: Only studies reporting return-to-sport rates after ankle syndesmotic injuries were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Two reviewers extracted data from the included studies, which were stored in a standardized collection form (Microsoft Excel). Recorded data included demographics (eg, author, year of publication, study design), descriptive statistics (eg, patient age, percentage male, number of athletes, sample size), and outcomes (eg, time to return to sport, proportion of those who returned to sport, the self-reported questionnaire the Olerud-Molander Ankle Score). Results: A total of 10 studies and 312 patients with ankle syndesmotic injuries were included in this systematic review. The rate of return to preinjury or any injury level of sport after ankle syndesmotic injuries was 93.8% ± 1.2% and 97.6% ± 1.5%, respectively, for the corresponding 7 and 3 studies that reported this characteristic. The mean time to return to sport was 46.4 days (range, 15.4-70 days), with 55.2 ± 15.8 and 41.7 ± 9.8 days for operative and nonoperative management, respectively. Conclusion: This systematic review found a high rate of return to any as well as preinjury level of sport after ankle syndesmotic injury in both operative and nonoperative treatment groups. However, further high-level studies are required to compare operative and nonoperative treatment groups associated with return to sport after ankle syndesmotic injury.

scholarly journals Influential factors of postoperative outcomes of symptomatic lateral discoid meniscus

2020 ◽  
Author(s):  
ShunJie Yang ◽  
Zhong-Jun Ding ◽  
Jian Li ◽  
Yang Xue ◽  
Gang Chen
Keyword(s):  
Clinical Symptoms ◽  
Age Of Onset ◽  
Arthroscopic Surgery ◽  
Lateral Meniscus ◽  
International Knee Documentation Committee ◽  
Influential Factors ◽  
Postoperative Outcomes ◽  
Discoid Lateral Meniscus ◽  
Ikdc Score ◽  
Male Sex

Abstract Background: Due to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM. Methods: Patients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes. P<0.05 was considered statistically significant.Results: A total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4~97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9~ 64.9; IQR, 9.7) (P<0.001). Male sex was predictive of a higher IKDC score (P=0.023, OR=1.702). Compared with BMI ≥25 kg/m2, <18.5 kg/m2 was associated with better IKDC score (P=0.026, OR=3.016). Contrasting with age of onset ≥45 years, ≤14 years (P<0.001, OR=20.780) and 14~25 years (P<0.001, OR=8.516) were associated with better IKDC score. In comparison with symptoms duration>24 months, IKDC scores for patients with symptoms duration ≤1 month (P=0.001, OR=3.511), 1 ~ 6 months (P < 0.001, OR = 3.463) and 6 ~ 24 months (P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III ~ IV, no injury (P<0.001, OR=6.379) and grade I (P=0.01, OR=4.332) were associated with higher IKDC score.Conclusions: Arthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5kg/m2, age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade≥2) reduces postoperative effect.

Measuring Physical Activity and Sports Participation After Autologous Cartilage Implantation: A Systematic Review

2014 ◽  
Vol 23 (3) ◽  
pp. 171-181 ◽  
Author(s):  
Andre Filipe Santos-Magalhaes ◽  
Karen Hambly
Keyword(s):  
Physical Activity ◽  
Sport Participation ◽  
Rating Scale ◽  
Evidence Synthesis ◽  
Return To Sport ◽  
Sports Participation ◽  
International Knee Documentation Committee ◽  
Primary Treatment ◽  
Functional Score ◽  
Sport And Exercise

Context:The assessment of physical activity and return to sport and exercise activities is an important component in the overall evaluation of outcome after autologous cartilage implantation (ACI).Objective:To identify the patient-report instruments that are commonly used in the evaluation of physical activity and return to sport after ACI and provide a critical analysis of these instruments from a rehabilitative perspective.Evidence Acquisition:A computerized search was performed in January 2013 and repeated in March 2013. Criteria for inclusion required that studies (1) be written in English and published between 1994 and 2013; (2) be clinical studies where knee ACI cartilage repair was the primary treatment, or comparison studies between ACI and other techniques or between different ACI generations; (3) report postoperative physical activity and sport participation outcomes results, and (4) have evidence level of I–III.Evidence Synthesis:Twenty-six studies fulfilled the inclusion criteria. Three physical activity scales were identified: the Tegner Activity Scale, Modified Baecke Questionnaire, and Activity Rating Scale. Five knee-specific instruments were identified: the Lysholm Knee Function Scale, International Knee Documentation Committee Score Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Modified Cincinnati Knee Score, and Stanmore-Bentley Functional Score.Conclusions:Considerable heterogeneity exists in the reporting of physical activity and sports participation after ACI. Current instruments do not fulfill the rehabilitative needs in the evaluation of physical activity and sports participation. The validated instruments fail in the assessment of frequency, intensity, and duration of sports participation.

scholarly journals Performance and Return to Sport After Thumb Ulnar Collateral Ligament Surgery in National Football League Players

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 487-493 ◽  
Author(s):  
Kyle R. Sochacki ◽  
Robert A. Jack ◽  
Richard Nauert ◽  
Shari R. Liberman ◽  
Patrick C. McCulloch ◽  
...  
Keyword(s):  
National Football League ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Rate ◽  
Collateral Ligament ◽  
Postoperative Performance ◽  
Paired Samples ◽  
Significant Difference ◽  
Postoperative Time ◽  
And Performance

Background: Acute ruptures of the ulnar collateral ligament (UCL) of the thumb are common injuries in sports. Surgical repair of complete tears has yielded excellent results in elite athletes. Methods: National Football League (NFL) players who underwent thumb UCL surgery and matched controls were identified. Demographic and performance data were collected. Performance scores were calculated using a standardized scoring system. Return to sport (RTS) in the NFL was defined as playing in at least 1 NFL game after thumb UCL surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired-samples Student t tests. Results: Twenty-three players were identified (mean age: 28.8 ± 3.4 years and mean experience in the NFL: 5.9 ± 3.4 years). Twenty-two players (95.7%) were able to return to sport in the NFL at an average of 132.2 ± 126.1 days. The overall 1-year NFL career survival rate of players undergoing thumb UCL surgery was 87.0%. There was not a statistically significant decrease in games per season and career length for any position following surgery. No positions had a significant difference in postoperative performance when compared with preoperative performance, and there was no significant performance difference postoperatively when compared with matched controls. Conclusions: There is a high rate of RTS in the NFL following thumb UCL surgery. Players who underwent thumb UCL surgery played in a similar number of games per season and had similar career lengths in the NFL as controls. No position group had any significant postoperative performance score differences when compared with postindex matched controls.

Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players

2018 ◽  
Vol 46 (7) ◽  
pp. 1720-1726 ◽  
Author(s):  
Robert A. Jack ◽  
Matthew B. Burn ◽  
Kyle R. Sochacki ◽  
Patrick C. McCulloch ◽  
David M. Lintner ◽  
...  
Keyword(s):  
Major League Baseball ◽  
Return To Sport ◽  
High Rate ◽  
Position Change ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Postoperative Performance ◽  
Career Length ◽  
Major League ◽  
Tommy John

Background: The anterior bundle of the medial ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow and is often injured among overhead throwing athletes. Despite prevention strategies, injuries to the elbow UCL are on the rise. Purpose: To determine (1) the return-to-sport (RTS) rate of Major League Baseball (MLB) position players after elbow medial UCL reconstruction, (2) postoperative career length and games per season, (3) pre- and postoperative performance, (4) postoperative performance versus matched control players, and (5) whether position players changed positions after UCL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players who underwent elbow UCL reconstruction were identified (cases). Demographic and performance data were collected for each player. Matched controls were identified. RTS in MLB was defined as playing in at least 1 MLB game after UCL reconstruction. Comparisons between case and control groups and pre- and postoperative time points were made via paired samples Student t tests. Results: Thirty-three players (34 surgical procedures) were identified with a mean ± SD age of 30.2 ± 4.2 years and a mean experience in the MLB of 6.3 ± 3.9 years at the time of surgery. Twenty-eight players (84.8%) were able to RTS in MLB at a mean 336.9 ± 121.8 days. However, players ≥30 years old demonstrated a significantly lower RTS rate (53.3%) than players <30 years old (89.4%; P < .05). Catchers had a significantly shorter postoperative career length (2.8 ± 1.8 years) versus matched controls (6.1 ± 1.9 years; P < .05). Outfielders had a significantly lower wins above replacement postoperatively (0.8 ± 0.7) versus preoperatively (1.5 ± 1.1; P < .05). There were no performance differences between cases and matched controls. Twelve players (48%) returned to a different position postoperatively. Conclusion: The RTS rate for MLB position players after elbow UCL reconstruction is similar to that of pitchers. Catchers had a significantly shorter career length than that of matched controls. Outfielders performed worse postoperatively versus preoperatively. There is a high rate of position change after Tommy John surgery for infielders and outfielders.

Return to Sport after ACL Surgery: A Comparison between Two Different Reconstructive Techniques

2018 ◽  
Vol 32 (06) ◽  
pp. 513-518 ◽  
Author(s):  
Matteo Baldassarri ◽  
Luca Perazzo ◽  
Diego Ghinelli ◽  
Marco Ricciarelli ◽  
Federico Pilla ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Rating Scale ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Imaging Data ◽  
Sports Activity ◽  
Long Run ◽  
Reconstructive Techniques

AbstractThe anterior cruciate ligament reconstruction (ACLR) has become a very common surgical procedure. One of the main success indicators of the surgical procedure is the return to preinjury sporting level. In recent years, reconstructive techniques have been geared toward less morbidity and optimized ligaments process to speed up the recovery of sports activity. This study compares clinical and imaging data, to evaluate the timing of return to sport, of two populations undergoing ACLR using two different techniques: ACLR with hamstring maintaining tibial insertion (MHG) and an all-inside technique with complete hamstring detachment (DHG). Patients were clinically evaluated with Marx rating scale, International Knee Documentation Committee (IKDC) score, and Tegner activity scale at a minimum follow-up (FU) of 4 years. The two groups have homogeneous characteristics: age, sex, type, and level of sports activity. Since November 2012, 59 patients with unilateral ACL insufficiency underwent ACLR: 31 patients using the MHG technique and 28 patients using the DHG technique. In both groups, a significant improvement in the clinical scores of the administered tests was observed. The MHG group reported a higher percentage of normal knees (83.8%) compared with the DHG group (78.6%). IKDC subjective score improved at each FU. Comparing the two techniques, at 12 months' FU the MHG group achieved better IKDC results (89.6) compared with the DHG technique (84.2). Marx and Tegner score values improved over time reaching comparable results at final FU. At final FU, 98% of patients returned to the same preinjury professional sporting level. Both techniques have been able to provide good clinical results. The MHG group, however, had a resumption of sports activity of the same level and intensity slightly longer (6.3 months) than that in the DHG group (5.9 months). Furthermore, the resumption of training and athletic gestures for the type of sport practiced was earlier than the DHG group. However, in the long run the level of sporting activity leveled in both groups, demonstrating the effectiveness of both techniques.

Lateral meniscal allograft transplantation and stabilisation in a dog with stifle subluxation

2020 ◽  
Vol 8 (3) ◽  
pp. e000940
Author(s):  
Patrick Alan Ridge ◽  
Alba Rial García
Keyword(s):  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Vigorous Exercise ◽  
Active Lifestyle ◽  
Meniscal Allograft Transplantation ◽  
Cranial Cruciate Ligament ◽  
Meniscal Allograft ◽  
Radial Tear ◽  
Significant Injury ◽  
Cranial Cruciate Ligament Rupture

This case describes the clinical features and the favourable clinical outcome after a lateral meniscal allograft transplant and stifle stabilisation in a dog that suffered a significant injury to its stifle, which included irreparable injury to the lateral meniscus, cranial cruciate ligament rupture and medial collateral rupture. The lateral meniscus was extensively damaged having avulsed from its peripheral attachments and with a radial tear across 70 per cent of its mid-body. After four years, the owners reported that the dog continued with an active lifestyle and only occasionally required non-steroidal anti-inflammatory analgesics for sporadic episodes of mild lameness after vigorous exercise.

Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation

2005 ◽  
Vol 46 (3) ◽  
pp. 297-305 ◽  
Author(s):  
D. J. Theodorou ◽  
S. J. Theodorou ◽  
D. C. Fithian ◽  
L. Paxton ◽  
D. H. Garelick ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Medial Meniscus ◽  
Biceps Tendon ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Joint Effusion ◽  
Popliteus Tendon ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Posterolateral Complex

Purpose: To describe the magnetic resonance imaging (MRI) findings of injuries of the posterolateral aspect of the knee and to evaluate the diagnostic capabilities of MRI in the assessment of these injuries. Material and Methods: The MRI studies of 14 patients (mean age 33 years) with trauma to the posterolateral aspect of the knee were retrospectively reviewed, and the imaging findings were correlated with those of surgery. Results: In all patients, MRI showed an intact iliotibial (ITB) band. MRI showed injury to the biceps tendon in 11 (79%), the gastrocnemius tendon in 1 (7%), the popliteus tendon in 5 (36%), and the lateral collateral ligament (LCL) in 14 (100%) patients. Tear of the anterior cruciate ligament (ACL) was seen in 11 (79%) patients and tear of the posterior cruciate ligament (PCL) in 4 (29%) patients. With routine MRI, visualization of the popliteofibular or fabellofibular ligaments was incomplete. On MRI, the lateral meniscus and the medial meniscus were torn with equal frequency ( n = 4; 29%). Osteochondral defects were seen in 5 (36%) cases and joint effusion in all 14 (100%) cases on MRI. Using surgical findings as the standard for diagnosis, MRI proved 86% accurate in the detection of injury to the ITB band, the biceps tendon (93%), the gastrocnemius tendon (100%), the popliteus tendon (86%), the LCL (100%), the ACL (79%), the PCL (86%), the lateral meniscus (90%), the medial meniscus (82%), and the osteochondral structures (79%). Surgical correlation confirmed the MRI findings of joint effusion in all cases. Conclusion: MRI is well suited for demonstrating the presence and extent of injuries of the major structures of the posterolateral complex of the knee, allowing characterization of the severity of injury.

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