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.

AMR Sign: A Clinical Sign of Mechanical Integrity of Medial Meniscus

Introduction:Meniscus injury is now widely being diagnosed and managed. Meniscus acts as a shock absorber and transmits forces from femur to tibia. However, if the meniscus is torn, the hoop strength is lost. In hidden meniscus injuries, budding arthroscopy surgeons tend to miss the tear. AMR sign acts as a light-bearer for identifying the breach in the collagen architecture. Methods and Materials: 267 patients were included in the study. Informed written consent was taken from all the patients operated and included in the study. Following a fixed protocol of diagnostic arthroscopy, documentation of AMR sign and its relation with intactness of the medial meniscus was done. If medial meniscus tear was found, after repair, its relation with AMR sign was documented.

Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries

Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.

Does Surgery for Cruciate Ligament and Meniscus Injury Increase the Risk of Comorbidities at 2 Years in the Military System?

This study aims to determine whether surgery for cruciate ligament (anterior or posterior) or meniscus injury increased risks of subsequent comorbidities in beneficiaries of the Military Health System. The study was a retrospective case-control design in which individuals with cruciate or meniscus injuries were divided into two groups (surgery or none). Data were pulled 12 months prior and 24 months following each respective event and presence of comorbidities were compared between the two groups. Bivariate analyses and logistic regression were used to determine if surgery increased the odds of comorbidities. Participants included 1,686 with a cruciate ligament injury (30.1% treated surgically) and 13,146 with a meniscus injury (44.4% treated surgically). Bivariate comparisons of surgery versus nonsurgical treatment found multiple significant differences. After adjusting for covariates, a significant (p < 0.05) protective effect was seen only for meniscus surgery for concussion, insomnia, other mental health disorders, depression, and substance abuse. Surgery had no increased/decreased risk of comorbidities for cruciate ligament injuries. For meniscus injuries, surgery demonstrated a protective effect for six of the comorbidities we assessed. The treatment approach (surgery vs. nonsurgical) did not change the risk of comorbidities in those with a cruciate ligament injury. It is noteworthy that three of the six comorbidities involved mental health disorders. Although the study design does not allow for determination of causation, these findings should compel future prospective study designs that could confirm these findings.

Effectiveness of rehabilitation for osteoarthritis of the knee associated with isolated meniscus injury: a scoping review protocol v1

Objective: The purpose of this scoping review is to examine whether there are differences in rehabilitation according to the degree of damage to the isolated medial and lateral meniscus and to determine whether it is of value to conduct a systematic review in the future. ⮚ Introduction: The prevalence of meniscus injuries in middle-aged and elderly people (>50 years) is 31%, and they occur more frequently in medial meniscus injuries than in lateral meniscus injuries (28%＞12%). The treatment of meniscus injuries consists of conservative therapy and surgery, and the benefit of combining surgery with rehabilitation has become clear. However, the effectiveness of rehabilitation alone, according to the degree of isolated meniscus injury, has not been clarified. ⮚ Eligibility criteria: The review will be a scoping review of the effectiveness of rehabilitation for osteoarthritis of the knee with unilateral or bilateral isolated meniscus injuries in patients over 40 years of age. Outcomes will be pain, function, and re-injury. All types of research will be accepted without restrictions as to location, race, gender, or language of the original article. ⮚ Methods: A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Physiotherapy Evidence Database (PEDro) databases using the keywords "meniscus" and "physical therapy" will be conducted during September 2021. In addition, we will not limit the language of the search, in order to include all studies. Data extraction tools will be used to specifically show findings in extracted articles related to participants, concepts, context, research design, and review questions. Outcomes should be pain, function, and re-injury, and results should be specified for each outcome.

Knee meniscus suturing techniques in children and indications for their use

Relevance The problem of meniscus injuries in children has acquired a particular relevance. The growth in their incidence has been caused not only by an active sports- and lifestyle of pediatric patients but also by improved diagnosis due to magnetic resonance and arthroscopic techniques. Aim To formulate indications for the use of various methods of meniscus suturing in children and to evaluate the results of treatment of meniscus injuries in children, depending on the location of the tears. Materials and methods Our study included 74 patients who underwent meniscus suturing from March 2018 to December 2020. The age of the children ranged from 10 to 17 years. Time since the injury ranged from one day to 3 years. Before surgery, they underwent instrumental examination; knee joint radiography was performed in all patients, knee MRI was performed in 66 patients. Results Meniscus sutures were evaluated clinically and instrumentally at 6 months after the operation (MRI). One year after the meniscus repair, X-rays of the knee were taken to assess osteoarthritis. There was no pain after surgery in 68 children (91.9 %). There were no blocks of the knee joint after surgery in all children. Full recovery of the range of motion in the knee joint was observed in 69 children (93.2 %). Complications were noted in five children. Conclusion Poor results after meniscectomy has led to the emergence of several methods that allow meniscus repair and avoid meniscectomy that impairs knee functions. In children, the potential for restoration of menisci after their reconstruction is higher than in adults. It is possible to repair lesions not only in the white zone but after periods of more than three months since the injury. The choice of the meniscus suture technique used is determined by the location of the tear, taking into account possible complications. The use of a combination of methods allows reconstruction of the damaged meniscus regardless of the location of the tear and the complexity of the injury. Good clinical results, absence of complaints and return to usual physical activities in the immediate postoperative period should be regarded as positive outcomes subjected to further study.

Artificial Intelligence in Repairing Meniscus Injury in Football Sports with Perovskite Nanobiomaterials

Knee meniscus injuries are more likely to occur in young adults in clinical practice, and their lower age of onset and greater impact on joint function after injury also put forward higher requirements for the treatment and rehabilitation of meniscus injuries. With the rapid development of artificial intelligence technology and arthroscopic minimally invasive technology, arthroscopic meniscus plasty and perovskite nanobiomaterial repair have gradually replaced the previous open meniscus surgery of the knee joint and has become the main method of meniscus injury treatment, and the perovskite nanobiomaterial repair technique that incorporates artificial intelligence technology is also gradually being applied. Therefore, this article studies the role of perovskite nanobiomaterials in the repair of meniscus injuries in football sports and analyzes the biological characteristics of the inner and outer meniscus to provide help to improve the healing rate of meniscus injuries. The study selected six male meniscus-injured patients (meniscus injuries caused by football sports) and obtained six injured menisci. The same cross section of the same part of the meniscus was analyzed inside and outside the meniscus. At the same time, a meniscal injury step was performed on the patient. The biological characteristics of perovskite nano-biomaterials in the repair of meniscus injuries in football sports were compared and analyzed, and the patient's gait before and after surgery was also compared. Experiments have shown that the percentage of the postoperative support phase of the affected limb is significantly higher than that before surgery ( P < 0.05 ), the percentage of the postoperative support phase and flatfoot phase decreased compared with that before surgery, and the gait cycle parameters of both lower extremities improved after surgery, obviously ( P < 0.05 ). It explains that the arthroscopic repair of perovskite nanobiomaterials combined with the artificial intelligence technology to repair the meniscus anterior angle injury is simple and does not require special equipment, has fewer complications, is safe and reliable, and has a high clinical healing rate and a high patient satisfaction rate after surgery. The curative effect is significant; artificial intelligence technology and the application of perovskite nanobiomaterials provide more possibilities for meniscus repair.

Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis

Objectives: to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years. Methods: an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D. Results: the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected. Conclusion: the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.