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

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.

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.

Usefulness of ultrasonography for dynamic evaluation of medial meniscus hoop function in early knee osteoarthritis

This study aimed to evaluate the dynamics of the medial meniscus during knee flexion–extension by ultrasonography and compare them with MRI findings to confirm the usefulness of ultrasonography for evaluating early knee osteoarthritis (KOA). In total, 100 patients were diagnosed with early KOA using clinical and radiographical findings. Dynamic ultrasonographic evaluation and MRI were performed in all patients. Medial meniscal extrusion (MME) and medial meniscal tears were evaluated via ultrasonography and MRI. Abnormal MME was defined as MME > 2 mm on ultrasonography during knee extension. Patients with abnormal MME were divided into two groups: a decrease group (group D) and a non-decrease group (group N). Age, sex, absence or type of meniscus tear, and MME were compared between the two groups. Of the 100 patients, 75 demonstrated MME > 2 mm at knee extension. MME at all assessment positions using ultrasonography and MRI were significantly greater in group N (n = 34) than that in group D (n = 41). Medial meniscus posterior root tears or radial tears were observed in most cases in group N. A lack of decrease in MME from 0° to 90° of flexion on ultrasonography was a characteristic finding in patients with a loss of meniscal hoop function.

Meniscal Repair and Parameniscal Cyst Excision with Knee Arthroscopic Surgery: A Case Report

Background: Meniscal cysts were rare case. There’s a 50 to 100% chance forming cyst to the tear if there was an injury happens. Trauma would cause tears happen in meniscus, leads to formation of hemorrhage which formed mucoid degeneration. The necrosis happens locally plus degeneration of mucoid forming a cyst. Thus, the meniscal cysts challenge the clinician to have clinical reasoning so then the patient can get accurate diagnosis and preferred management. Method: This paper is a case report of surgery on a patient present with cysts on lateral para meniscus which done arthroscopically with all inside technique. Results: The procedure which done by arthroscope and motorized shaver had a great outcome in this patient which were analyze from Visual Analog Scale (VAS) and Western Ontario and McMaster Index (WOMAC) 3 months after the procedure, and reach VAS score of 2/10 which was mild pain and 59,8 in WOMAC score. Conclusion: The arthroscopy and all inside technique with motorized shaver is a choice of lateral para meniscal cysts surgery with good results to be considered by orthopedic surgeons. Key words: Lateral, Meniscus Tear, Parameniscal cyst, Arthroscopy.

Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)

Objectives: Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors. Methods: In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear. Results: Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05). Conclusions: Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.

Predicting Reparability of Meniscal Tears Pre-Operatively Using 3-Tesla MRI (111)

Objectives: The ability to predict meniscus tear reparability based on pre-operative MRI is desirable for pre-operative patient counseling. However, the accuracy of MRI-based predictive methods varies widely within the orthopedic and radiology literature. We hypothesized that modern higher resolution 3-Tesla (T) MRI improves the accuracy of predicting reparability compared to prior investigations using 1.5T MRI assessments. Methods: We identified 44 patients (age 16 to 40 years) who were known to have undergone arthroscopic meniscal repair at our institution between the dates of January 1, 2013 and June 1, 2019. The MRI characteristics of this meniscus repair group were then compared to 43 age- and sex-matched patients who underwent arthroscopic partial meniscectomy during the same time period. 3T MRI images from the repair (Figure 1A) and the partial meniscectomy (Figure 1B) groups were all obtained pre-operatively at the author’s institution. Images from all 87 patients were independently reviewed by two fellowship-trained musculoskeletal radiologists and one orthopedic surgery fellow specializing in sports medicine. Each examiner was blinded with regard to meniscus tear treatment (repair versus partial meniscectomy). Meniscal tear MRI characteristics were evaluated based on established arthroscopic criteria including tear length greater than 10 mm, tear location within 3 mm of the menisco-synovial junction, tear greater than 50% thickness, and the presence of an intact inner meniscal fragment. We then analyzed the predictive accuracy and interrater reliability of this method. Results: With regards to accurately predicting meniscal reparability using the established criteria, the three MRI examiners accurately predicted repair 58% (orthopedist), 60% (radiologist 1), and 63% (radiologist 2) of the time, with respective positive predictive values of 60%, 62%, and 70%. The three examiners agreed upon tear reparability (i.e., a score of 4 versus not 4) only 41% of the time (κ = 0.173, p = .005). For 2 of the examiners (orthopedist and radiologist), none of the individual criteria were significantly predictive of tear reparability. For the 3rd examiner (radiologist), tear location within 3mm of the meniscosynovial junction was the most predictive individual criterion and the only criteria that reached statistical significance (OR = 9.83, p = .04). Conclusions: Although 3T MRI is higher resolution than 1.5T MRI, 3T MR imaging assessments performed by experienced examiners demonstrated a poor ability to predict the reparability of meniscus tears based on the application of previously established arthroscopic criteria. In addition, inter-observer reliability in this setting was also poor. Arthroscopic inspection remains the gold standard for the determination of meniscus tear reparability.