scholarly journals The Natural History of Medial Meniscal Root Tears: A Biomechanical and Clinical Case Perspective

2021 ◽  
Vol 9 ◽  
Author(s):  
Edward R. Floyd ◽  
Ariel N. Rodriguez ◽  
Kari L. Falaas ◽  
Gregory B. Carlson ◽  
Jorge Chahla ◽  
...  
Keyword(s):  
Natural History ◽  
Contact Pressure ◽  
Case Series ◽  
Medial Compartment ◽  
Meniscal Extrusion ◽  
Meniscus Root ◽  
Anatomic Repair ◽  
Meniscal Root ◽  
History Of ◽  
Root Attachment

Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of degenerative disease. These injuries lead to an increase in average contact pressure in the medial compartment, along with increases in peak contact pressure and a decrease in contact area relative to the intact state. Loss of the root attachment impairs the function of the entire meniscus and leads to meniscal extrusion, thus impairing the force-dissipating role of the meniscus. Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repairs have been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA. In this study, the authors will describe the biomechanical basis of the natural history of medial meniscal root tears and will support the biomechanical studies with a case series including patients that either underwent non-operative treatment (5 patients) or non-anatomic repair of their medial meniscal root tears (6 patients). Using measurements derived from axial MRI, the authors will detail the distance from native root attachment center of the non-anatomic tunnels and discuss the ongoing symptoms of those patients. Imaging and OA progression among patients who were treated nonoperatively before presentation to the authors will be discussed as well. The case series thus presented will illustrate the natural history of meniscal root tears, the consequences of non-anatomic repair, and the findings of symptomatic meniscal extrusion associated with a non-anatomic repair position of the meniscus.

Utilization of Transtibial Centralization Suture Best Minimizes Extrusion and Restores Tibiofemoral Contact Mechanics for Anatomic Medial Meniscal Root Repairs in a Cadaveric Model

2019 ◽  
Vol 47 (7) ◽  
pp. 1591-1600 ◽  
Author(s):  
Blake T. Daney ◽  
Zachary S. Aman ◽  
Joseph J. Krob ◽  
Hunter W. Storaci ◽  
Alex W. Brady ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Contact Pressure ◽  
Posterior Border ◽  
Root Tear ◽  
Meniscal Extrusion ◽  
3 Dimensional ◽  
Anatomic Repair ◽  
Pull Out ◽  
Meniscal Root ◽  
Root Repair

Background: Although posterior medial meniscal root (PMMR) repairs are often successful, postoperative meniscal extrusion after a root repair has been identified as a potential clinical problem. Purpose/Hypothesis: The purpose was to quantitatively evaluate the tibiofemoral contact mechanics and extent of meniscal extrusion after a PMMR repair. It was hypothesized that the addition of a centralization suture (into the posterior medial tibial plateau) would help restore normal joint load-bearing characteristics and restore the native amount of meniscal extrusion after a root tear. Furthermore, we hypothesized that the amount of meniscal extrusion would be greatest in loaded and flexed knees when measured at the posterior border of the medial collateral ligament (MCL). Study Design: Controlled laboratory study. Methods: Meniscal extrusion and tibiofemoral contact mechanics were measured using 3-dimensional digitization and pressure sensors in 10 nonpaired, human cadaveric knees. The PMMR of each knee was tested under 6 states: (1) intact; (2) type 2A PMMR tear; (3) anatomic transtibial pull-out root repair; (4) anatomic transtibial pull-out repair with centralization; (5) nonanatomic transtibial pull-out repair; and (6) nonanatomic transtibial pull-out repair with centralization, with randomization of the order of conditions 3 and 4, and 5 and 6. The testing protocol loaded knees with a 1000-N axial compressive force at 4 flexion angles (0°, 30°, 60°, 90°) in each state. Meniscal extrusion was measured with a 3-dimensional coordinate digitizer at 0° and 90° in both the loaded and unloaded states and calculated from the difference from the articular margin of the tibia to the periphery of the meniscus. Peak contact pressure, contact area, and total contact pressure were also recorded for all states at all flexion angles. Statistical analysis investigated the independent effects of flexion, state, and loading using 3 distinct 2-factor models. Results: Differences in the contact mechanics between repair techniques were most notable at higher flexion angles, demonstrating significantly higher average and peak contact pressures for nonanatomic repair states when compared with anatomic repairs with and without centralization (all P < .05). In unloaded knees at full extension, the magnitude of medial meniscal extrusion was significantly higher at the posterior border of the MCL compared with the posterior medial tibia ( P < .001) and adjacent to the root attachment on the tibia locations ( P < .001). Both anatomic repair states had no significant difference in the degree of extrusion when compared with the intact state. Conclusion: The anatomic transtibial pull-out root repair and the anatomic transtibial pull-out root repair with centralization techniques best restored contact mechanics of the knee and meniscal extrusion when compared with root tear and nonanatomic repair states at time zero. There were no significant differences in contact pressure or magnitude of extrusion between the anatomic repair state and the anatomic repair with centralization state. We found that extrusion is best measured in the coronal plane at the posterior border of the MCL for unloaded knees. However, the degree of extrusion increased as the knee was loaded and flexed to 90°. Clinical Relevance: When there are concerns about meniscal extrusion with a medial meniscal root repair, the addition of a centralization suture may be beneficial for patients in reducing pathologic meniscal extrusion and restoring joint contact mechanics.

The natural history of laryngo‐onycho‐cutaneous syndrome: A case series of six pediatric patients and literature review

2021 ◽  
Author(s):  
Christine Prodinger ◽  
Subhanitthaya Chottianchaiwat ◽  
Jemima E. Mellerio ◽  
John A. McGrath ◽  
Linda Ozoemena ◽  
...  
Keyword(s):  
Natural History ◽  
Literature Review ◽  
Pediatric Patients ◽  
Case Series ◽  
History Of

scholarly journals The Natural History of Facial Schwannomas: A Meta-analysis of Case Series

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
John Leonetti ◽  
Matthew Bartindale ◽  
Jeffrey Heiferman ◽  
Cara Joyce ◽  
Neelam Balasubramanian
Keyword(s):  
Natural History ◽  
Meta Analysis ◽  
Case Series ◽  
History Of

scholarly journals Management of intracranial aneurysms associated with arteriovenous malformations

2014 ◽  
Vol 37 (3) ◽  
pp. E11 ◽  
Author(s):  
Bruno C. Flores ◽  
Daniel R. Klinger ◽  
Kim l. Rickert ◽  
Samuel l. Barnett ◽  
Babu G. Welch ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Case Series ◽  
Classification Systems ◽  
Vascular Lesions ◽  
Difficult Decision ◽  
Hemorrhagic Events ◽  
History Of ◽  
Hemorrhage Risk

Intracranial or brain arteriovenous malformations (BAVMs) are some of the most interesting and challenging lesions treated by the cerebrovascular neurosurgeon. It is generally believed that the combination of BAVMs and intracranial aneurysms (IAs) is associated with higher hemorrhage rates at presentation and higher rehemorrhage rates and thus with a more aggressive course and natural history. There is wide variation in the literature on the prevalence of BAVM-associated aneurysms (range 2.7%–58%), with 10%–20% being most often cited in the largest case series. The risk of intracranial hemorrhage in patients with unruptured BAVMs and coexisting IAs has been reported to be 7% annually, compared with 2%–4% annually for those with BAVM alone. Several different classification systems have been applied in an attempt to better understand the natural history of this combination of lesions and implications for treatment. Independent of the classification used, it is clear that a few subtypes of aneurysms have a direct hemodynamic correlation with the BAVM itself. This is exemplified by the fact that the presence of a distal flow-related or an intranidal aneurysm appears to be associated with an increased hemorrhage risk, when compared with an aneurysm located on a vessel with no direct supply to the BAVM nidus. Debate still exists regarding the etiology of the association between those two vascular lesions, the subsequent implications for patients’ risk of hemorrhagic stroke, and finally the determination of which patients warrant treatment and when. The ultimate goals of the treatment of a BAVM associated with an IA are to prevent hemorrhage, avoid stepwise neurological deterioration, and eliminate the mortality risk associated with recurrent hemorrhagic events. The treatment is only justifiable if the risks associated with an intervention are lower than or equivalent to the long-term risks of disability or mortality caused by the lesion itself. When faced with this difficult decision, a few questions need to be answered by the treating neu-rosurgeon: What is the mode of presentation? What is the symptomatic lesion? Which one of the lesions bled? What is the relationship between the BAVM and IA? Is it possible to safely treat both BAVM and IA? The objective of this review is to discuss the demographics, natural history, classification, and strategies for management of BAVMs associated with IAs.

scholarly journals The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

2020 ◽  
Author(s):  
Fan Yang ◽  
Yonggang Tu ◽  
Zhinan Hong ◽  
Fengxiang Pang ◽  
Wei He ◽  
...  
Keyword(s):  
Femoral Head ◽  
Natural History ◽  
Case Series ◽  
Retrospective Case ◽  
Children And Adolescent ◽  
Femoral Head Collapse ◽  
Lateral Subluxation ◽  
Hip Deformity ◽  
Neck Fracture ◽  
History Of

Abstract Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

scholarly journals Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2517 ◽  
Author(s):  
Michael Tirgan
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Medical Literature ◽  
Preventive Measures ◽  
Case Series ◽  
Retrospective Case ◽  
Ear Piercing ◽  
Keloid Formation ◽  
History Of ◽  
Triggering Factor

Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians.  Genetics of this disorder continues to be obscure and poorly understood.  Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids.  Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids.  This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

Pelvic ureteric junction obstruction: Natural history, nephrological considerations and current evidence base for surgical management in poorer functioning kidneys

2019 ◽  
Vol 13 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Dora Moon ◽  
Timothy Napier-Hemy
Keyword(s):  
Natural History ◽  
Systemic Disease ◽  
Case Series ◽  
Evidence Base ◽  
Poor Quality ◽  
Quality Data ◽  
Current Evidence ◽  
Current Evidence Base ◽  
History Of ◽  
Split Function

Pelvic ureteric junction obstruction (PUJO) can pose a management challenge to urologists. The natural history of the disease, particularly in adults is poorly understood and management decisions are largely based on historical, poor quality data. Additionally, many older patients may already have a degree of renal impairment secondary to systemic disease, further compounding the situation. The purpose of this paper is to detail the pathophysiology and natural history of PUJO, discuss the implications of chronic kidney disease in this population detailing the current evidence base for poorer functioning kidneys and describe the nephrological advantages of accurate renal function testing. There exists accurate methods to assess both glomerular filtration rate (GFR) and split function which could potentially provide both the urologist and patient with more relevant data on which to base their decisions when contemplating surgical intervention. The existing, low patient number case series currently published fail to address the relevance of overall GFR on the outcomes after pyeloplasty, no studies use single unit GFR and there is no clear consensus on what constitutes surgical success. PUJO is an area of benign upper tract disease that is in need of high-quality scientific studies to identify when intervention is necessary, long-term success of both surgery and conservative management in poorer functioning kidneys and clear guidelines for urologists.

scholarly journals The Natural History of Acute Recovery of Blast-Induced Mild Traumatic Brain Injury: A Case Series During War

2016 ◽  
Vol 181 (5S) ◽  
pp. 23-27 ◽  
Author(s):  
David T. Larres ◽  
Walter Carr ◽  
Elizandro G. Gonzales ◽  
Jason S. Hawley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Natural History ◽  
Mild Traumatic Brain Injury ◽  
Case Series ◽  
History Of
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