MEDIAL MENISCAL TEAR

Knee joint is type of hinge joint Knee joint consist of medial menisci and lateral menisci. Menisci plays an important role to maintain healthy cartilage. Medial meniscus commonly injured than lateral meniscus due to it is relatively lack of mobility. A case of 32 year female is presented in this report. Patient complaints of pain in medial side of right knee joint, inability to stand for longer time, restriction in daily activities. McMurray test was done and diagnosed medial meniscus tear. Physiotherapy treatment is mentioned in this report. The study conclude that there is significant improvement in range of motion , muscle strength , can able to perform activities of daily living with the help of physiotherapy treatment without any surgical approach.

Fabellar prevalence, parameters and association with medial meniscal tear: causality or coincidence?

Background: Fabella is a sesamoid bone of knee that has potential biomechanical function. The correlation between medial meniscal (MM) tear and fabella has not been rigorously examined. The aim of this study is to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology are associated with MM tear.Methods: A total of 1011 knee magnetic resonance imaging scans were analyzed. The fabellar presence was documented and parameters were measured. Further ratios were calculated to present fabellar morphology. Differences among subgroups were compared and correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors have relationship with MM tear. Diagnostic performance of risk factors was assessed and cut values were determined.Results: The overall prevalence of fabellae was 39.8% and increased with the increasing age (r = .237, P < .001). The fabellar were larger in male and ones with an articulating groove (all p < .001). The length/thickness ratio and width/thickness ratio were found significantly different between gender, age and articulating groove condition (all P < .05) and showed a moderate correlation with age (r = .463, p < .001; r = .303, p < .001), respectively. Fabella presented more often in knees with MM tears with a multivariate OR of 2.960 (95% CI, 1.853-3.903). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604-0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the diagnostic performance was improved to an AUC of 0.791 (95% CI, 0.744-0.837), a sensitivity of 73.0% and a specificity of 74.6% (OR, 7.939; 95% CI, 4.094-12.852). Conclusion: The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them.

Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease

Objective This study aimed to evaluate frequency, location and severity of cartilage pathology in dogs with naturally occurring cranial cruciate ligament (CCL) disease. Study Design Stifle arthroscopic video recordings (n = 120) were reviewed. A modified Outerbridge classification system (MOCS) (0–4) was used to score cartilage at 10 locations in the femorotibial (medial and lateral femoral condyles and tibial plateaus) and patellofemoral compartments (proximal, middle and distal locations of the patella and femoral trochlear groove) of the stifle joint. Synovial pathology was scored and the presence of a medial meniscal tear was recorded. A Kruskal–Wallis test was used to evaluate association of location and synovitis with cartilage score; and presence of meniscal tear with cartilage and synovitis scores. Bonferroni correction was utilized and p < 0.05 was considered significant. Results Cartilage pathology and synovitis were identified in all joints. Overall cartilage severity scores were low (median MOCS 1). The median MOCS of the proximal trochlear groove (2) was significantly higher than all other locations evaluated. Higher synovitis scores were significantly associated with higher cartilage severity scores and a medial meniscal tear had no association with cartilage severity scores or synovitis. Conclusion Arthroscopic articular cartilage lesions are common in dogs with CCL disease at the time of surgical intervention, although the severity of cartilage damage is mild. The proximal trochlear groove of the femur had the most severe cartilage score in the stifle joint.

Development of OA Following ACL Reconstruction: Unexpected Finding in Medial Versus Lateral Meniscus Pathology

Objectives: Recent studies have described increased risk of OA following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The literature reports a 50% incidence of OA following medial meniscectomy, two times the risk compared to lateral meniscectomy. The purpose of this study was to determine the influence of meniscal pathology on the incidence of OA following ACLR. Methods: All patients who underwent primary autograft or allograft BPTB transtibial ACLR by a single surgeon between 1999-2015 were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Meniscus pathology and treatment were recorded. OA was defined at follow-up as Kellgren-Lawrence grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 103 patients (56 males, 47 females; age 36.1±11.4 years) with BPTB ACLR with an average follow-up of 8.81±4.96 (range 2-20 years) were included. The prevalence of medial meniscus tears at the time of ACL injury was 47.6% (49/103) and prevalence of lateral meniscus tears was 56.3% (58/103) (p=0.166). Medial compartment OA was seen in 9.7% (10/103) of patients. Prevalence of medial compartment OA was greater in patients with medial meniscus tear (14.3%; 7/49) compared to those without a medial meniscus tear (5.6%; 3/54); however, this was not significant (p=0.135). Of the 7 patients with medial meniscal tear and medial compartment OA, 5 underwent partial medial meniscectomy and 2 underwent repair. Lateral compartment OA was seen in 14.6% (15/103). The prevalence of lateral compartment OA was greater in patients with a lateral meniscus tear (22.4%; 13/58) compared to patients without lateral meniscus tears (4.4%; 2/45) (p=0.01). Patients with lateral meniscus tear were 5.04 [95%CI: 1.2 to 21.2] times more likely to develop OA. Thirteen of the 47 (28%) patients that underwent partial lateral meniscectomy developed lateral OA compared to 0% of patients (0/10) that underwent lateral meniscal repair (p=0.068). Conclusion: While studies with multiple surgeons and rehabilitation protocols have shown the development of OA following ACLR is increased with medial meniscal pathology, we found that the prevalence of medial OA was not significantly higher in these patients with medial meniscal tear at an average of 8.81 years follow-up. Whereas, lateral meniscal repair dramatically reduced the development of knee OA compared to partial meniscectomy in this cohort of patients with ACLR. These findings can inform clinical practice as despite prior literature indicating a relationship between medial meniscal tear and osteoarthritis, we did not see a greater prevalence of OA amongst patients undergoing ACLR with a medial meniscal tear. Further, a lateral meniscal repair offers superior protection against OA when compared to partial lateral meniscectomy in treating lateral meniscal tears and is essential in the treatment of these complex patients.

Characterization of OA development between sexes in the rat medial meniscal transection model

ObjectiveOsteoarthritis (OA) is a chronic degenerative disease of the joints characterized by articular cartilage degradation. While there are clear sex differences in OA development in humans, most pre-clinical research has been conducted solely in male animals thus limiting the ability of these findings to be generalized to both sexes in the context of this disease. The objective of this study was to determine if sex impacts the progression and severity of OA in the rat medial meniscal tear (MMT) preclinical animal model used to surgically induce OA. It was hypothesized that differences would be observed between males and females following MMT surgery.DesignA MMT model was employed in male and female Lewis rats to induce OA. Animals were euthanized 3 weeks post-surgery and EPIC-μCT was used to quantitatively evaluate articular cartilage structure and composition, osteophyte volumes and subchondral bone structure.ResultsQuantitative analysis of the medial 1/3 articular cartilage via EPIC-μCT showed increased cartilage thickness and proteoglycan loss in the MMT of both sexes, when compared to sham. Additionally, both male and female animals in the MMT group had increased subchondral bone mineral density and larger total osteophyte volumes due to MMT.ConclusionThese data demonstrate that OA can be induced in both sexes using the rat MMT model. Moving forward, adding sex as a factor in preclinical OA studies should be standard practice in pre-clinical studies in order to elucidate more inclusive and translatable results into the clinic.

A Definition of Significant Instability and a Scoring System for Predicting Meniscal Tears in ACL-Deficient Knees

Background: Patients with anterior cruciate ligament (ACL)–deficient knees risk recurrent instability of the affected knee, which may predispose to meniscal injuries. Various studies have correlated the incidence of meniscal tear with elapsed time from ACL tear and number of instability events. However, it is not clear how significant an instability event needs to be to contribute to a meniscal tear. Purpose/Hypothesis: The purpose of this study was to (1) define a significant instability episode and (2) develop a checklist and scoring system for predicting meniscal tears based on significant instability episode. We hypothesized that patients with ACL-deficient knees who met the scoring threshold for a significant instability episode would have a higher incidence of meniscal tears compared with those who did not meet the threshold. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: This retrospective study included patients with magnetic resonance imaging (MRI)–confirmed isolated ACL tear for longer than 3 months. We determined parameters for assessing instability episodes and defined any instability events between the MRI and ACL reconstruction as significant or insignificant. Patients were then grouped into a significant instability group (≥1 significant episode) and an insignificant instability group, and the incidence and types of meniscal tears found during surgery were compared between groups. Results: There were 108 study patients: 62 in the significant instability group and 46 in the insignificant instability group. During surgery, 58 meniscal tears (46 medial, 12 lateral) were recorded, for an overall meniscal injury rate of 53.70%. In the significant instability group, 47 patients (75.81%) had a meniscal tear and 15 (24.19%) had intact menisci ( P < .001). In the insignificant instability group, 11 patients (23.91%) had a meniscal tear and 35 (76.08%) had intact menisci ( P < .001). Regarding the 58 patients with a meniscal tear, 47 (81.03%) had ≥1 significant episode of instability before surgery, as compared with 11 (18.97%) who had insignificant or no instability. The odds of having a medial meniscal tear at ACL reconstruction was 10 times higher in the significant instability group versus the insignificant instability group. Conclusion: The incidence of a medial meniscal tear was 10 times greater in patients with a significant episode of instability versus those with insignificant instability, as defined using a predictive scoring system. The incidence of lateral meniscal tear did not change with instability episodes.