ACL Injuries and Meniscal Lesion: Hand in Hand?

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

Magnetic Resonance Image Characterization of Knee Meniscus Signal Intensity using Crue’s Approach: Results from a Multi-centre Evidence

This study aimed to characterize knee meniscus signal-intensity using magnetic resonance imaging. Our research included knee MR images of 138 subjects from multi-centres in Nigeria, between September 2016 and December 2017. Knee images were retrieved from patients' folder of MRI scanners and transfered to a DICOM workstation (Onis 2.6) for image analysis. Knee meniscus was characterized into 0, 1, 2 & 3 grades using Crue’s grading approach. Our research revealed 58% incidence of meniscal lesion. Study yielded a significant relationship between meniscal lesion and gender (p <.005) with a greater proportion of these lesions in women than in men. Meniscal lesions showed significant association with osteoarthritis (OA) (p < 0.05). Grade 3 lesions (actual tears) were largely of horizontal configuration.

Evaluating Responsiveness of the Persian Version of the Western Ontario Meniscal Evaluation Tool (WOMET) in Iranian Patients with Meniscal Injury

Background This study aimed to evaluate the responsiveness of Western Ontario Meniscal Evaluation Tool (WOMET) and specify its Minimal Clinically Important Difference (MCID) in patients undergoing physiotherapy intervention following undergoing a meniscal lesion or surgery. Our hypothesis was that the WOMET would have adequate responsiveness in patients with meniscal injury. method: 100 patients undergoing physiotherapy interventions filled the Persian version of the WOMET and a questionnaire of the Knee injury and Osteoarthritis Outcome Score (KOOS) at Session 1 and Session 10 (4 weeks later). They also filled the 7-point Global Rating of Change (GRC) scale at Session 10. Internal responsiveness was calculated using T test and effect sizes (standard response mean (SRM) and Cohen's d); and external responsiveness was calculated via receiver operating characteristic curve and correlation analysis. The inclusion criterion was the age of 18 to 70 years old for the patients who had the ability of filling the questionnaire. The exclusion criteria included ligaments injury, severe osteoarthritis, inability to complete the questionnaire due to the lack of sufficient knowledge, malignancy, infection, neuromusculoskeletal disorder, rheumatologic disease, knee surgeries for any other reasons, and dissatisfaction for being enrolled in the study. Results All the WOMET subscales (AUC = 0.7) had acceptable external responsiveness. SRM was Trivial, and the scores of Cohen’s d were moderate to large and t tests showed significant differences. Conclusion Our findings showed that all of the WOMET subscales had acceptable external responsiveness, and thus this questionnaire could be used to study the effects of physiotherapy interventions on patients undergoing a meniscal lesion or surgery.

Meniscal ramp lesions: diagnostic performance of MRI with arthroscopy as reference standard

Background The posteromedial meniscal region is gaining interest among orthopedic surgeons, as lesions of this area has been reported to be significantly associated with anterior cruciate ligament tears. The current imaging literature is unclear. Purpose To evaluate the diagnostic performance of MR in the detection of meniscal ramp lesions having arthroscopy as reference standard. Materials and methods We retrospectively included 56 patients (mean age of 25 ± 7 years; 14 females) from January to November 2017 with a arthroscopically proved ACL tear and posterior meniscocapsular separation. On preoperative MRI, two radiologists with 13 and 2 years’ experience in musculoskeletal imaging assessed the presence/absence of ramp lesion, meniscotibial ligament lesion, peripheral meniscal lesion, or their combination, bone bruise. Having arthroscopy as reference standard, diagnostic performance of MRI in the evaluation of ramp area lesions was calculated. Cohen’s kappa (k) and Fisher's Exact Test statistics were used. Results Agreement between radiologists ranged from κ = 0.784 (meniscotibial ligament lesions) to κ = 0.918 red–red meniscal lesion. Sensitivities were 97.4% for ramp lesions, 95.8% for meniscotibial ligament lesion, 94.4% for peripheral meniscal lesions; specificities were 88.9%, 81.3%, and 97.4%, respectively; accuracies were 94.6%, 87.5%, and 96.4%, respectively. Agreement between MR and arthroscopy was almost perfect in identification of ramp lesions (κ = 0.871) and red–red zone meniscal lesions (κ = 0.908). The agreement between the two methods was substantial (κ = 0.751) for meniscotibial lesion. No significant association between tibial plateau bone bruise and the different type of lesions was found (κ ≥ 0.004 and p ≥ 0.08). Conclusion MR has high diagnostic performance in meniscal ramp area lesion assessment, with substantial to almost perfect inter-reader agreement.

Smoking is associated with prolonged time of the return to daily and sport activities and decreased knee function after meniscus repair with outside-in technique: Retrospective cohort study

Background: Arthroscopic repair of post-traumatic meniscal lesion is one of the most common procedures in the orthopedics. Although algorithm of the treatment of meniscal lesion, this procedure is rarely discussed in combination with smoking as a risk factor for the meniscal healing. Purpose: The aim of this study was to assess the knee function, and the amount of time needed to return to daily and sport activities after the non-bucket-handle meniscal outside-in repair depending on Tobacco use. Methods: Retrospective chart review identified 99 patients after isolated outside-in meniscal repair within a series of 292 consecutive patients who underwent meniscus repair during a 3 years period. Ninety-two patients were available for follow-up and were divided into smokers and non-smokers group. Demographic data were collected from their medical records which included: age and body mass index, gender, side of index knee, duration of symptoms prior to surgery, meniscal involvement. At the time of the minimum 2 years follow-up examination: KOOS, time of the return to daily activities, time of the return to sport activities, and Tegner scale were collected. Results: The smoking and non-smoking groups were similar in age, sex, BMI, side, meniscus involved, Tegner scale, and duration of symptoms. Smokers population was 3.5 years older on average. The knee function was significantly better in non-smokers group with average KOOS score 80.2 vs 67.4 in smokers group. In smokers population delayed time of return to daily activities (5.4 vs 4.2 months) and prolonged time of the return to sport activities (9.4 vs 7.6 months) were observed. Conclusions: Smoking is associated with significantly prolonged time of the return to daily and sport activities and decreased knee function after meniscus repair with outside-in technique. Level of evidence: III

Ten-Year Survivorship, Patient-Reported Outcome Measures, and Patient Acceptable Symptom State After Over-the-Top Hamstring Anterior Cruciate Ligament Reconstruction With a Lateral Extra-articular Reconstruction: Analysis of 267 Consecutive Cases

Background: Long-term patient-reported outcome measures (PROMs) and predictors of success or failure after anterior cruciate ligament (ACL) reconstruction are not fully understood, especially when combined with a lateral extra-articular reconstruction. Purpose: To assess the long-term PROMs, revision rate, and predictors of success or failure after ACL reconstructions using an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 267 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular augmentation between November 2007 and May 2009. The number of subsequent ACL revisions and reoperations were recorded. Subjective clinical status was assessed with PROMs—specifically, the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and visual analog scale for pain—at a minimum follow-up of 10 years. Results: Overall, 3% of patients underwent ACL revision, with a 10-year survival rate of 96.3%. High sport activity (hazard ratio, 6.9; P = .285) and concomitant meniscal lesion (hazard ratio, 2.6; P = .0487) were predictors of ACL revision or new meniscectomy. The mean ± SD Lysholm score was 94.1 ± 10.8, while that for the visual analog scale for pain was 0.2 ± 0.9 at rest and 2.1 ± 2.6 during activity. KOOS subscale scores were as follows: 95.7 ± 8.1 for Pain, 92.5 ± 10.5 for Symptoms, 98.4 ± 7.4 for Activities of Daily Living, 90.7 ± 17.2 for Sport, and 91.2 ± 17.1 for Quality of Life; respectively, 88%, 99%, 81%, 89%, and 91% of patients achieved the Patient Acceptable Symptom State. Female sex and chondropathy with Outerbridge grade ≥2 were predictors of worse KOOS subscales. Overall, 82% of patients returned to sport, and 57% were still participating at the 10-year evaluation. Conclusion: ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring autografts and a lateral extra-articular reconstruction provided satisfactory results in terms of function, symptoms, sports, and quality of life in 80% to 90% of patients after 10 years. Long-term survivorship was 96%. Sport participation declined from 82% postoperatively to 57% at long-term follow-up. A concomitant medial meniscal lesion was a predictor of higher risk of ACL failure or new meniscal lesion, while advanced chondropathy and female sex were predictors of higher pain, lower function, and poor quality of life scores.

Comparative Analysis of Vertical Forces in Dogs Affected with Cranial Cruciate Ligament Disease and Tibial Plateau Angles Greater or Less than 25 Degrees

Objective Our objective was to compare the peak vertical force (PVF) and vertical impulse (VI) between dogs with cranial cruciate ligament disease and a tibial plateau angle (TPA) greater or less than 25 degrees. Methods A retrospective study was performed in 18 dogs with cranial cruciate ligament disease in which kinetic gait data were obtained with a pressure walkway system. Dogs were distributed in two groups: dogs with a TPA ≤ 25 degrees (n = 8) and dogs with a TPA > 25 degrees (n = 10). Mean PVF and VI in per cent of body weight (%BW) were compared between groups with an unpaired t-test (p < 0.05). Results Mean PVF and VI for the cranial cruciate ligament disease limb were 14.39%BW and 3.57%BWs for dogs with a TPA >25 degrees and 14.44%BW and 3.47%BWs for dogs with a TPA ≤ 25 degrees. There was no significant difference in mean PVF and VI between the groups. Conclusion The results suggest that there is no difference in kinetic data between dogs with cranial cruciate ligament disease and a TPA greater or less than 25 degrees. Other factors such as body weight, time of injury or meniscal lesion could be more related to the magnitude of cranial cruciate ligament disease lameness.