Intra- and extra-capsular ganglia at the gastrocnemius origin and association with meniscal tears and severity of osteoarthritis of the knee joint

Background The association between size of ganglia or type of ganglia (intra-articular or extra-articular) and meniscal tears or severity of the osteoarthritis (OA) is not evaluated. Purpose To evaluate the prevalence, size, and location of intra- and extra-capsular ganglia at the gastrocnemius origin and to assess their associations with meniscal injury and grades of OA. Material and Methods This study included 301 consecutive patients who had knee pain and had undergone magnetic resonance imaging (MRI) of the knee. We evaluated presence of ganglia at the gastrocnemius muscle origin site and diagnosed whether it was an intra-capsular located or mixed-capsular located (intra-capsular and extra-capsular) and then measured the diameter of each ganglion. After two weeks, we evaluated whether articular cartilage injury existed. The presence of a meniscal tear was also recorded. Results A total of 186 patients (93%) had intra- and extra-capsular ganglia. Intra-capsular ganglia were found in 183 cases (91%) and mixed-capsular ganglia were found in 16 cases (8%). In cases with intra- and extra-capsular ganglia, more meniscal tears were found ( P = 0.029). Intra-capsular ganglia showed more meniscal tears ( P = 0.021). Intra-capsular ganglia were more likely to have high-grade OA ( P = 0.043). Patients who had a meniscal tear displayed larger-sized ganglia, especially of the intra-capsular type ( P = 0.044). Conclusion Patients with intra- and extra-capsular ganglia, especially of the intra-capsular type, are more likely to have meniscal injury and more severe OA. Patients with a meniscal tear or OA are more likely to have larger intra- and extra-capsular ganglia, especially of the intra-capsular type.

DOES PARTIAL MENISCECTOMY AFFECT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION RESULTS?

ABSTRACT Objective: To compare the application of partial meniscectomy concomitant with primary ACL reconstruction, using the graft from the patellar tendon with individuals who underwent only ACL reconstruction, in clinical functional criteria and degree of osteoarthritis (OA), after 10 years of the surgical process. Methods: This is a retrospective cross-sectional study with 37 patients who underwent ACL reconstruction with a graft from the patellar tendon, associated or not with partial meniscectomy, divided into 2 groups: with meniscal injury (n = 22) and without meniscal injury (n = 15). Anthropometric data and four outcome measures were used to analyze the results: SF-36 questionnaire, arc of motion assessment, Knee injury and Osteoarthritis Outcome Score (KOOS), and Ahlbäck Radiographic Classification. Results: No differences were found for health-related quality of life, arc of motion, functional condition and knee OA severity/grade in patients who underwent partial or no meniscectomy in conjunction with ACL reconstruction (p > 0.05). Conclusion: Participants who underwent partial meniscectomy in conjunction with primary ACL reconstruction with a graft from the patellar tendon, after 10 years of the surgical process, showed no significant differences in the clinical functional criteria and severity of knee OA, compared to individuals who underwent only ACL reconstruction. Level of Evidence II, Prognostic study.

EFFECTIVE USE OF VISCOSUPPLEMENTATION AFTER KNEE ARTHROSCOPY: EXPERIENCE FROM A WORKING GROUP

The aim of this work was to assess the efficacy of viscosupplementation after knee arthroscopy in a series of cases and to propose an adequate dosage regimen.The cases studied corresponded to patients undergoing arthroscopic surgery presenting meniscal injury and/or free bodies and where osteoarthritis could be present. Viscosupplementation started 3 weeks after arthroscopy and one set of patients received one shot of 5 ml of hyaluronic acid and the other set received three injections of 2.5 ml with weekly intervals. Patients were followed at 3 and 6 months. Improvements in pain and function as well as patient satisfaction were assessed and the appearance of adverse events was monitored. The groups studied were homogeneous with no differences in the type of surgery, associated gestures or other procedures performed during the intervention. Considering the patients as a whole, significant improvements were observed at 3 weeks post-arthroscopy (prior to intra-articular treatment) and at 3 and 6 months compared to pre-arthroscopy scores. Pain reductions were of 39.8%, 63.4% and 80.9% respectively and function improvement was of 20.9%, 58.8% and 77.9% respectively. There were no differences between the two groups in any of the parameters analysed. The treatment was rated by the patients as excellent. The group concluded that viscosupplementation inpost-arthroscopy achieves significant pain reduction and function improvement; moreover, one shot of hyaluronic acidis a safe and effective option as an adjuvant treatment in arthroscopic surgery favouring a better recovery with a lower cost for both the patient and the Healthcare System.

Development of a Pressure-Sensitive Conductive Rubber Sensor for Analyzing Meniscal Injury in Porcine Models

The assessment of the distribution of contact pressure on the meniscus is important in the elucidation of kinematics, etiology of joint diseases, and establishment of treatment methods. Compared with sensors widely used in recent years, pressure-sensitive conductive rubber sensors are easy to mold, flexible, durable, and resistant to shearing forces. This study is aimed at developing a rubber sensor for meniscal research and evaluating the pressure distribution after meniscal injury using porcine models. After confirming the reliability of the rubber sensor, contact pressure was obtained from the rubber sensor using the medial meniscus and femur of the porcine knee. Three test conditions of intact meniscus, radial tear, and meniscectomy were prepared, and a compressive load of 100 N was applied. After confirming the high reliability of the rubber sensor, the intact meniscus had the most uniform pressure distribution map, while the pressure in the meniscectomy model was concentrated in the resection region. The high-pressure region was significantly smaller in the intact group than in the radial tear models after 80 and 100 N ( P < 0.05 ). The rubber sensor captured the pressure concentration specific to each examination group and was useful for evaluating the relationship between the pattern of meniscal injury and changes in the biomechanical condition of the knee.

Six-Month Outcomes of Clinically Relevant Meniscal Injury in a Large-Animal Model

Background: The corrective procedures for meniscal injury are dependent on tear type, severity, and location. Vertical longitudinal tears are common in young and active individuals, but their natural progression and impact on osteoarthritis (OA) development are not known. Root tears are challenging and they often indicate poor outcomes, although the timing and mechanisms of initiation of joint dysfunction are poorly understood, particularly in large-animal and human models. Purpose/Hypothesis: In this study, vertical longitudinal and root tears were made in a large-animal model to determine the progression of joint-wide dysfunction. We hypothesized that OA onset and progression would depend on the extent of injury-based load disruption in the tissue, such that root tears would cause earlier and more severe changes to the joint. Study Design: Controlled laboratory study. Methods: Sham surgeries and procedures to create either vertical longitudinal or root tears were performed in juvenile Yucatan mini pigs through randomized and bilateral arthroscopic procedures. Animals were sacrificed at 1, 3, or 6 months after injury and assessed at the joint and tissue level for evidence of OA. Functional measures of joint load transfer, cartilage indentation mechanics, and meniscal tensile properties were performed, as well as histological evaluation of the cartilage, meniscus, and synovium. Results: Outcomes suggested a progressive and sustained degeneration of the knee joint and meniscus after root tear, as evidenced by histological analysis of the cartilage and meniscus. This occurred in spite of spontaneous reattachment of the root, suggesting that this reattachment did not fully restore the function of the native attachment. In contrast, the vertical longitudinal tear did not cause significant changes to the joint, with only mild differences compared with sham surgery at the 6-month time point. Conclusion: Given that the root tear, which severs circumferential connectivity and load transfer, caused more intense OA compared with the circumferentially stable vertical longitudinal tear, our findings suggest that without timely and mechanically competent fixation, root tears may cause irreversible joint damage. Clinical Relevance: More generally, this new model can serve as a test bed for experimental surgical, scaffold-based, and small molecule–driven interventions after injury to prevent OA progression.

Curing somatisation-induced paraplegia with experimental dice-based affective modulation

Following a minor meniscal injury to his right knee, a previously fit and well 58-year-old man developed profound somatisation leading to paraplegia. The patient developed a deep-seated belief that any exercise or walking would cause irreparable damage to his knee. Over the course of 2 years his, mobility reduced from active mountaineering to walking a short distance, and finally to paraplegia. Medical investigations were normal and organic causes were ruled out. Conventional therapy was exhausted, a number of medications were trialled over 5 years, including selective serotonin reuptake inhibitors (SSRIs) and antipsychotics without success. Eventually, with a combination of cognitive behavioural therapy, physiotherapy and a novel experimental therapy where the patient rolled dice and acted according to the roll results, the patient was able to literally and metaphorically get back on his feet.

MRI versus US in diagnosis of meniscal injury in the knee joint

Background Meniscal injuries are the most common type of knee injuries.MRI is the gold standard in the diagnosis of meniscal injuries. Aim of the work:- The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of meniscal injury. Patients and Methods:- This study was carried out at the Radiology Department, AinShams University Hospitals.Twenty patients with proven MRI meniscal tear underwent ultrasound(US) examination. Results :- The overall sensitivity of the US to diagnose meniscal injuries reached (85.0%), specificity (100%) and accuracy (92%),

A PROSPECTIVE STUDY EVALUATING ASSOCIATION BETWEEN TIBIAL PLATEAU FRACTURE MORPHOLOGY WITH LIGAMENT AND MENISCAL INJURY AROUND KNEE.

INTRODUCTION: In the modern world,due to advent of high speed motor vehicles , high energy trauma commonly involves the knee joint and results in complex tibial plateau fractures and associated ligament and meniscal injuries . Proper diagnosis and management of these injuries reduced the chances of degenerative changes around knee joint later on. MATERIAL AND METHOD: A prospective study was conducted in the Department of Orthopaedics in a tertiary health care center of western rajasthan from January 2018 to December 2020 . A total of eighty patients( 62 males: 18 females) with tibial plateau fractures and associated soft tissue injuries were included .Patients were assessed both clinically and radiologically and “ SCHATZKER'S classication was used to classify the tibial plateau fractures. Pre-operatively in every case CT-scan was used to study fracture pattern and MRI was done to see fracture morphology and associated soft tissue injuries. RESULT: A total 80 patient was included in our study,out of which 73 (91.25%) having ligaments( Cruciate and Collaterals) and meniscal injury . Injury to the lateral meniscus was found most frequently in Schatzker II fracture (p<0.0006) and medial meniscus in schatzker IV (p< 0.011). Variable association was shown by ACL and PCL injuries with tibial plateu fracture morphology ,but as the grade of designation increases within schatzker classication as does the frequency of cruciate ligament tear. Overall incidence of LCL rupture occurred least frequently in Schatzker II fractures (7 of 34; 20.5%), which was statistically signicant (P < 0.01). Complete MCL tear occurred in 27( 33.7%) of all fractures and in 41% of Schatzker II fractures. PLC tear had shown signicant association with medial tibial plateu fracture (schatzker IV). CONCLUSION: The likelihood of the cruciate , collateral ligament and PLC injury increases as the grade of designation within schatzker classication (schatzker I-VI). PLC injury had a signicant association with medial tibial plateu fracture (schatzker IV) and MCL had a signicant association with lateral tibial plateau fracture .