The Effectiveness of Single Injection of Platelet-Rich Plasma for Knee Osteoarthritis Combined with Meniscus Injury: A Randomized Trial

Objectives : To explore the effectiveness of single injection of platelet-rich plasma with rehabilitation therapy for knee osteoarthritis combined with meniscus injury. Methods : Forty patients who met the inclusion criteria were randomly assigned to a rehabilitation group (REH group, 20 cases) receiving rehabilitation training, and a platelet-rich plasma group (PRP group, 20 cases) receiving an ultrasound-guided single injection of PRP in combination with rehabilitation training. Rehabilitation training in the two groups lasted for 2 weeks, and the patients were evaluated using the short-form McGill pain questionnaire (SF-MPQ), Western Ontario McMaster Universities index (WOMAC score), and infrared thermography (knee-joint mean temperature) before treatment, at 1 week, 1 month and 6 months after treatment. Results : Two patients were lost to follow-up in both the PRP group and the REH group. Significant reductions in pain scores, WOMAC scores and knee temperature were observed at 1 week and 1 month after treatment in both groups (p < 0.05). Significant lower SF-MPQ scores were observed in the PRP group than in the REH group at 6 months followup (p < 0.01). Similarly, the mean knee temperature was significantly lower in the PRP group than in the REH group at 6 months follow-up (p < 0.01). No severe complications occurred in either group. Conclusions: Compared to rehabilitation therapy alone, single injection of platelet-rich plasma in combination with rehabilitation therapy has beneficial effect on pain, knee function and mean knee temperature in patients with KOA combined with meniscus injury. Single injection of platelet-rich plasma combined with rehabilitation therapy has a good short-term effectiveness.

Correlation between CT images of lateral plateau and lateral meniscus injuries in patients with Schatzker II tibial plateau fractures:a retrospective study

Background There is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations. The purpose of the study was to analyze the exact correlation between CT images of lateral plateau and lateral meniscus injuries in Schatzker II TPFs. Methods A total of 296 patients with Schatzker II TPFs from August 2012 to January 2021 in two trauma centers were enrolled for the analysis. According to the actual situation during open reduction internal fixation (ORIF) and knee arthroscopic surgery, patients were divided into meniscus injury (including rupture, incarceration, etc.) and non-meniscus injury groups. The values of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on CT images were measured, and their correlation with lateral meniscus injury was then analyzed. The relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal cut-off point of the two indicators which could predict meniscus injury. Results The intra- and inter-observer reliabilities of LPD and LPW were acceptable (intraclass correlation coefficient (ICC) > 0.8). The average LPD was 13.2 ± 3.2 mm while the average value of the group without meniscus injury was 9.4 ± 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in meniscus injury and non-meniscus injury groups with a significant difference (P < 0.05). The optimal predictive cut-off value of LPD and LPW was 7.9 mm (sensitivity-95.0%, specificity-58.8%, area under the curve (AUC-0.818) and 7.5 mm (sensitivity-70.0%, specificity - 70.6%, AUC - 0.724), respectively. The meniscus injury group mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.1%, 157/160). Conclusions The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients with Schatzker II TPFs when LPD > 7.9 mm and/or LPW > 7.5 mm on CT. These findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention is required be paid to the treatment of the meniscus and the possible fracture reduction difficulties and poor alignment caused by meniscus rupture and incarceration should be fully considered in order to achieve better surgical results.

Post-Traumatic Osteoarthritis Assessment in Emerging and Advanced Pre-Clinical Meniscus Repair Strategies: A Review

Surgical repair of meniscus injury is intended to help alleviate pain, prevent further exacerbation of the injury, restore normal knee function, and inhibit the accelerated development of post-traumatic osteoarthritis (PTOA). Meniscus injuries that are treated poorly or left untreated are reported to significantly increase the risk of PTOA in patients. Current surgical approaches for the treatment of meniscus injuries do not eliminate the risk of accelerated PTOA development. Through recent efforts by scientists to develop innovative and more effective meniscus repair strategies, the use of biologics, allografts, and scaffolds have come into the forefront in pre-clinical investigations. However, gauging the extent to which these (and other) approaches inhibit the development of PTOA in the knee joint is often overlooked, yet an important consideration for determining the overall efficacy of potential treatments. In this review, we catalog recent advancements in pre-clinical therapies for meniscus injuries and discuss the assessment methodologies that are used for gauging the success of these treatments based on their effect on PTOA severity. Methodologies include histopathological evaluation of cartilage, radiographic evaluation of the knee, analysis of knee function, and quantification of OA predictive biomarkers. Lastly, we analyze the prevalence of these methodologies using a systemic PubMed® search for original scientific journal articles published in the last 3-years. We indexed 37 meniscus repair/replacement studies conducted in live animal models. Overall, our findings show that approximately 75% of these studies have performed at least one assessment for PTOA following meniscus injury repair. Out of this, 84% studies have reported an improvement in PTOA resulting from treatment.

Deep Learning-Based MRI in Diagnosis of Fracture of Tibial Plateau Combined with Meniscus Injury

This study aimed to explore the application value of magnetic resonance imaging (MRI) images based on deep learning algorithms in the diagnosis of tibial plateau fractures combined with meniscus injuries. The original MRI image was input into the deep learning convolutional neural network (CNN), and the knee joint undersampled and fully sampled MRI image data were used for training to obtain a neural network model that can effectively remove the noise and blur of the undersampled image. Then, the image was reconstructed by the Regridding model to obtain an image with less noise and clearer structure. At the same time, all subjects underwent knee MRI examinations, and algorithms were used to analyze the sensitivity, specificity, and accuracy of their images. It was found that of 160 menisci from 80 cases of tibial plateau fractures, 64 were normal meniscus and 88 were injured menisci. The sensitivity, specificity, and accuracy of optimized MRI in diagnosing fracture of tibial plateau combined with meniscus injury were 96.9%, 93.2%, and 95.3%, respectively. In conclusion, the restored MRI images have high sensitivity in the diagnosis of meniscus injury and high consistency with the intraoperative results. It suggests that the optimized MRI image is effective in the diagnosis of meniscus injury.

Magnetic Resonance Imaging Image under Low-Rank Matrix Denoising Algorithm in the Diagnosis and Evaluation of Tibial Plateau Fracture Combined with Meniscus Injury

This study was carried out to explore the diagnostic effect of magnetic resonance imaging (MRI) based on the low-rank matrix (LRM) denoising algorithm under gradient sparse prior for the tibial plateau fracture (TPF) combined with meniscus injury (TPF + MI). In this study, the prior information of the noise-free MRI image block was combined with the self-phase prior, the gradient prior of MRI was introduced to eliminate the ringing effect, and a new MRI image denoising algorithm was constructed, which was compared with the anisotropic diffusion fusion (ADF) algorithm. After that, the LRM denoising algorithm based on gradient sparse prior was applied to the diagnosis of 112 patients with TPF + MI admitted to hospital, and the results were compared with those of the undenoised MRI image. Then, the incidence of patients with all kinds of different meniscus injury parting was observed. A total of 66 cases (58.93%) of meniscus tears (MT) were found, including 56 cases (50.00%) of lateral meniscus (LM), 10 cases (8.93%) of medial meniscus (MM), 16 cases (14.29%) of meniscus contusion (MC), and 18 cases (16.07%) of meniscus degenerative injury (MDI). The incidences of MI in Schatzker subtypes were 0%, 53.33% (24/45), 41.67% (5/12), 76.47% (13/17), 78.94% (15/19), and 23.53% (4/17), showing no statistically significant difference ( P > 0.05 ), but the incidence of MT was 54.46% (61/112), which was greatly higher than that of MC (15.18% (17/112)), and the difference was statistically obvious ( P < 0.05 ). The diagnostic specificity (93.83%) and accuracy (95.33%) of denoised MRI images were dramatically higher than those of undenoised MRI images, which were 78.34% and 71.23%, respectively, showing statistically observable differences ( P < 0.05 ). In short, the algorithm in this study showed better denoising performance with the most retained image information. In addition, denoising MRI images based on the algorithm constructed in this study can improve the diagnostic accuracy of MI.

Coronal subluxation of the tibiofemoral joint before and after anterior cruciate ligament reconstruction

Background Studies have shown that medial subluxation of the tibia occurs after anterior cruciate ligament (ACL) rupture. However, it is unclear whether anterior cruciate ligament reconstruction (ACLR) can correct tibial coronal subluxation. Purpose To determine whether the tibia is medially subluxated after ACL rupture, and whether ACLR can correct medial subluxation of the tibia. Study design Case series; Level of evidence, 4, Retrospective clinical study. Methods The distance of tibial coronal subluxation before and after ACLR surgery was measured in 48 patients with ACL rupture and meniscus injury. Tibiofemoral subluxation was defined as the perpendicular distance between the long axis of the tibia and a second parallel line originating at the most proximal aspect of the femoral intercondylar notch. To determine the long axis of the tibia, two circles separated by 5 cm were centered on the proximal tibia. The proximal circle is 5 cm from the tibial plateau, and the distal circle is 5 cm from the proximal circle. The line passing through the center of the two circles was considered the long axis of the proximal tibia. Care was taken to ensure that each patient lied on the back with their patellae facing upward, to minimize rotational variation among the radiographs. At the same time, 30 patients with simple meniscus injury who underwent arthroscopy during the same period were selected to determine the degree of tibiofemoral coronal subluxation as the baseline value. The changes before and after operation were compared, as well as the differences with the baseline data. Result The average follow-up period was 21.2 ± 5.8 months. The average distance of tibial coronal subluxation before ACLR was 5.5 ± 2.1 mm, which was significantly different from that of baseline group (7.3 ± 2.1 mm) (P < 0.001). The tibial subluxation after ACLR was 7.7 ± 2.6 mm, which was significantly different from that before operation (P < 0.001). There was no significant difference in the distance between postoperative tibial subluxation and baseline group (P = 0.472). Conclusion The tibia was coronally medially subluxated after ACL rupture. ACLR can correct the medial subluxation of tibia. This finding is helpful in the diagnosis of ACL rupture, and can be used to assess the imaging status of the tibiofemoral joint on the coronal plane during or after ACLR.