scholarly journals The Problems of Meniscal Root Tears

2020 ◽  
pp. 51-60
Author(s):  
I.M. Zazirnyi ◽  
O.O. Kostrub ◽  
R. Smigielski ◽  
A. Andreev
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Contact Area ◽  
Surgical Repair ◽  
Root Avulsion ◽  
Meniscal Extrusion ◽  
Early Osteoarthritis ◽  
Meniscal Root ◽  
Hoop Stresses ◽  
Contact Pressures

Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony root avulsion. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stresses resulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment. These changes are detrimental to the articular cartilage and ultimately lead to the development of early osteoarthritis. Surgical repair is the treatment of choice in patients without significant osteoarthritis (Outerbridge grades 3 or 4). Root repairs have been reported to improve clinical outcomes, decrease meniscal extrusion and slow the onset of degenerative changes. In this article, we describe the anatomy, biomechanics, clinical evaluation, treatment methods, outcomes, and post-operative rehabilitation for posterior meniscal root tears.

Nonanatomic Placement of Posteromedial Meniscal Root Repairs: A Finite Element Study

2020 ◽  
Vol 142 (8) ◽  
Author(s):  
Brett D. Steineman ◽  
Robert F. LaPrade ◽  
Tammy L. Haut Donahue
Keyword(s):  
Finite Element ◽  
Contact Mechanics ◽  
Contact Area ◽  
Hoop Stress ◽  
Meniscal Extrusion ◽  
Meniscal Root ◽  
Knee Mechanics ◽  
Total Contact Area ◽  
And Cartilage ◽  
Element Study

Abstract Nonanatomic placement of posteromedial meniscal root repairs alters knee mechanics; however, little is known about how the position and magnitude of misplacement affect knee mechanics. Finite element knee models were developed to assess changes in cartilage and meniscus mechanics for anatomic and various nonanatomic repairs with respect to intact. In total, 25 different repair locations were assessed at loads of 500 N and 1000 N. The two-simple-suture method was represented within the models to simulate posteromedial meniscal root repairs. Anatomic repairs nearly restored total contact area; however, meniscal hoop stress decreased, meniscal extrusion increased, and cartilage–cartilage contact area increased. Repairs positioned further posterior altered knee mechanics the most and repairs positioned further anterior restored knee mechanics for posteromedial root repairs. Despite this, repair tension increased with further anterior placement. Anterior placement of repairs results in more restorative contact mechanics than posterior placement; however, anterior placement also increased the risk of suture cut-out or failure following repairs. Anatomic placement of repairs remains the best option because of the risks involved with anterior placement; however, suture methods need to be improved to better restore the strength of repairs to that of the native insertion. Proper placement of repairs is important to consider with meniscal root repairs because misplacement may negatively affect cartilage and meniscus mechanics in patients.

scholarly journals Meniscal root tear repair: why, when and how?

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Pietro Pellegrino ◽  
Andrea D'Amelio ◽  
Umberto Cottino ◽  
Roberto Rossi
Keyword(s):  
Clinical Outcomes ◽  
Contact Surface ◽  
Knee Injuries ◽  
Surgical Techniques ◽  
Knee Kinematics ◽  
Root Tear ◽  
Meniscal Extrusion ◽  
Meniscal Root ◽  
Meniscal Root Tear ◽  
Meniscal Attachments

The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging. In addition, the most common surgical techniques, together with the clinical outcomes, are described.

Computationally Efficient Finite Element Evaluation of Natural Patellofemoral Mechanics

2010 ◽  
Vol 132 (12) ◽  
Author(s):  
Clare K. Fitzpatrick ◽  
Mark A. Baldwin ◽  
Paul J. Rullkoetter
Keyword(s):  
Finite Element ◽  
Articular Cartilage ◽  
Rigid Body ◽  
Contact Mechanics ◽  
Contact Area ◽  
Probabilistic Methods ◽  
Computationally Efficient ◽  
Subject Specific ◽  
Contact Pressures

Finite element methods have been applied to evaluate in vivo joint behavior, new devices, and surgical techniques but have typically been applied to a small or single subject cohort. Anatomic variability necessitates the use of many subject-specific models or probabilistic methods in order to adequately evaluate a device or procedure for a population. However, a fully deformable finite element model can be computationally expensive, prohibiting large multisubject or probabilistic analyses. The aim of this study was to develop a group of subject-specific models of the patellofemoral joint and evaluate trade-offs in analysis time and accuracy with fully deformable and rigid body articular cartilage representations. Finite element models of eight subjects were used to tune a pressure-overclosure relationship during a simulated deep flexion cycle. Patellofemoral kinematics and contact mechanics were evaluated and compared between a fully deformable and a rigid body analysis. Additional eight subjects were used to determine the validity of the rigid body pressure-overclosure relationship as a subject-independent parameter. There was good agreement in predicted kinematics and contact mechanics between deformable and rigid analyses for both the tuned and test groups. Root mean square differences in kinematics were less than 0.5 deg and 0.2 mm for both groups throughout flexion. Differences in contact area and peak and average contact pressures averaged 5.4%, 9.6%, and 3.8%, respectively, for the tuned group and 6.9%, 13.1%, and 6.4%, respectively, for the test group, with no significant differences between the two groups. There was a 95% reduction in computational time with the rigid body analysis as compared with the deformable analysis. The tuned pressure-overclosure relationship derived from the patellofemoral analysis was also applied to tibiofemoral (TF) articular cartilage in a group of eight subjects. Differences in contact area and peak and average contact pressures averaged 8.3%, 11.2%, and 5.7% between rigid and deformable analyses in the tibiofemoral joint. As statistical, probabilistic, and optimization techniques can require hundreds to thousands of analyses, a viable platform is crucial to component evaluation or clinical applications. The computationally efficient rigid body platform described in this study may be integrated with statistical and probabilistic methods and has potential clinical application in understanding in vivo joint mechanics on a subject-specific or population basis.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

Medial Meniscal Root Avulsion: A Biomechanical Comparison of Four Different Repair Constructs.

2013 ◽  
Vol 29 (10) ◽  
pp. e76-e77
Author(s):  
Matthew J. Matava ◽  
Richard J. Mitchell ◽  
Ryan T. Pitts ◽  
Young-Mo Kim
Keyword(s):  
Root Avulsion ◽  
Meniscal Root ◽  
Biomechanical Comparison

scholarly journals Contact pressures and the impact of farm equipment on Latosol with the presence and absence of sugarcane straw

2016 ◽  
Vol 40 (3) ◽  
pp. 265-278 ◽  
Author(s):  
Reginaldo Barboza da Silva ◽  
Piero Iori ◽  
Zigomar Menezes de Souza ◽  
Danilo de Moraes Gomes Pereira ◽  
Oswaldo Julio Vischi Filho ◽  
...  
Keyword(s):  
Contact Pressure ◽  
Contact Area ◽  
Structural Changes ◽  
Front Axle ◽  
Real Contact Area ◽  
Digital Measurement ◽  
Farm Equipment ◽  
Presence And Absence ◽  
The Impact ◽  
Contact Pressures

ABSTRACT High contact pressures applied to soil result in a greater degree of compaction, in addition to promoting other negative effects. The objective of this study was to quantify contact areas by using different methodologies, and pressures of farm equipment employed in production activity and evaluate structural changes caused in a Red Latosol with the presence and absence of straw cover. The design was completely randomized in a factorial scheme of type 4 (tire on front axle, tire on rear axle, tire on a sugarcane wagon and metallic track of sugar cane Harvester) x 2 (presence and absence of straw). The contact area (CA) of the run was obtained by three procedures: analytical measure of the area of an ellipse (CA1); digital measurement of area of an ellipse (CA2); and measurement of real contact area (RCA), with digital resources. The contact pressure was calculated from the ratio of mass of each machine's axle and the contact area of the run. The contact area obtained according to the procedure of the ellipse (CA1 and CA2) is overrated when compared to actual area obtained digitally (RCA). The straw reduces the contact pressure in the soil, due to the deep tire treads and consequently, increased contact area. Areas where the traffic of the machines occurred with soil covered with the presence of straw showed reduced soil resistance to penetration, cone index and pre-consolidation pressure, confirming that the increased contact area produced by straw reduced the pressure applied and the compression power dissipated in the soil.

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