Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Recent reports have indicated that the maximum shear stress of cartilage increases as the resection volume of a meniscectomy increases (Bedi et al., 2010; Zhang et al., 2021; Liu et al., 2022) and further leads to joint pain, swelling, and even osteoarthritis (Bedi et al., 2010; Beamer et al., 2017; Bedrin et al., 2021; Ozeki et al., 2022). Advances in meniscal repair devices have allowed for all-inside arthroscopic meniscal repair techniques to evolve with the advantage of avoiding the need for accessory incisions. Bernstein J, Quach T. A perspective on the study of Moseley et al: questioning the value of arthroscopic knee surgery for osteoarthritis. Try to rest your knee for a few days and keep pressure off it. After the ILPM, the maximum von Mises stress increased the most among the five resections by 156.5% compared with the IMM (5.1MPa). It is recommended to preserve the posterior root and the remaining peripheral edge of the meniscus during surgery for an HTMM. Satisfactory clinical results were found in each group at 2 years follow up with no significant difference in terms of pain, function and patient satisfaction. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Effect of degenerative and radial tears of the meniscus and resultant meniscectomy on the knee joint: A finite element analysis. Core tip: Meniscal tears are a common orthopaedic pathology. After the ILPM, SLPM, and DLPM, the contact areas of MFC-MM were 0.9 mm2, 0.3mm2 and 0.5 mm2, which were 37.7%, 76.1%, and 65.2% lower than that of the IMM (1.4mm2), respectively. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Further evidence that bleeding can aid meniscal repair is from a study by Cannon and Vittori[50]. Tibiofemoral contact mechanics with horizontal cleavage tear and resection of the medial meniscus in the human knee. vanTrommel MF, Simonian PT, Potter HG, Wickiewicz TL. Treatment of meniscal tears: An evidence based approach Thus, it is strongly recommended to preserve the outer edge and posterior root of the meniscus to reduce the impact on the biomechanics of the knee joint despite higher technical requirements. Meniscus, Meniscectomy, Meniscal tear, Meniscal repair, Arthroscopic surgery. Barber FA, McGarry JE. Long-term follow-up of meniscectomy in athletes. Risk of total/subtotal meniscectomy for respective medial and lateral meniscus injury: Correlation with tear type, duration of complaint, age, gender and ACL rupture in 6034 asian patients. Other symptoms include: Feeling like your knee might give out beneath you. Grant JA, Wilde J, Miller BS, Bedi A. Surg. Pujol N, Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. Two ultrabraided sutures were passed through the posterior horn of the lateral meniscus using a suture passer. Am. Complications were associated with both techniques. In addition, the contact area after the TTM was similar to that of the intact rabbit knee joint. Seo HS, Lee SC, Jung KA. The team might place a clamp on your upper thigh to help with positioning during surgery. Arthroscopy-the J. Arthrosc. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy. Predicting meniscal tear stability across knee-joint flexion using finite-element analysis. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). Degenerative Meniscus Tear The .gov means its official. Treatment for Acute Anterior Cruciate Ligament Tear in Young A tendency for your knee to No use, distribution or reproduction is permitted which does not comply with these terms. (2022). sharing sensitive information, make sure youre on a federal Z., and Feeley, B. T. (2018). Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Suzanne werner, lars weidenhielm. It was also noted that acute repairs within 8 wk of injury did better than the more chronic repairs. Large tears (1 cm) and those with root involvement rarely heal spontaneously and are treated Author contributions: Mordecai SC and Al-Hadithy N wrote the manuscript; Ware HE and Gupte CM provided specialist input and edited the manuscript. Biotechnol. ZM, MD, XZ, and XM: Methodology, Validation, Writingreview & editing. Recovery will take about 6 to 8 weeks if your meniscus tear is treated conservatively, without surgery. The time varies, depending on: The meniscus is a C-shaped band of cartilage that goes around the knee joint and cushions the junction of your thighbone (femur) and shinbone (tibia). The tear tends to remain stable and no Functional outcomes of the crossover patients after 12 mo however, were similar to those patients who had surgery initially, suggesting that non-operative treatment is a reasonable first line strategy. The present study has some limitations. Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up - PMC Back to Top Skip to main content An official website of the United States government Here's how you know The .gov means its official. A prospective longitudinal study. doi:10.1097/BLO.0b013e3180303b5c, Herrlin, S. V., Wange, P. O., Lapidus, G., Hllander, M., Werner, S., and Weidenhielm, L. (2013). A pooled rate of failure from 20.2% to 24.3% was found for all repair techniques. Magnetic resonance images (MRI) were obtained from the right hind limb of a healthy New Zealand rabbit (male, 6 months, 4kg). Meniscal Lesions - Physiopedia Degenerative meniscus in knee osteoarthritis: From pathology to treatment. Kinetic loading applications like walking, running, and stair-climbing are more suitable for highlighting the role of meniscus horizontal tears and surgical treatments. Jbjs Rev. Meniscus Tear Repair Surgery: What To Expect & Recovery Time A prospective study of 93 cases. Rockborn P, Gillquist J. In contrast, patients from the other group had significantly worse results, with only one knee having an excellent outcome, and four knees having poor results. WebAnatomy Two bones meet to form your knee joint: the femur and the tibia. The blood supply to the menisci is of high relevance having important implications for the potential healing of a meniscal repair. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without They report a 93% healing rate in the anterior cruciate ligament reconstruction group compared to 50% in meniscal repair alone. 28 (11), 34743480. The output of the load in the axial direction between cartilage to menisci and cartilage to cartilage was exported. Having knee pain or stiffness or a swollen knee. Meniscal repair devices. The Youngs moduli of bone, cartilage, and menisci were 15,000MPa, 20MPa, and 120MPa, and their Poissons ratios were 0.30, 0.46, and 0.45, respectively (Sweigart and Athanasiou, 2005; Zhang et al., 2019). For a horizontal tear not spreading to the outer edge, the contact pressure and contact area of the articular cartilage changed slightly compared with the IMM. Multiple outcome scores were performed at eight weeks and 6 mo. Medical meniscus repairs. Knee 23 (3), 472477. Using one or two small incisions on the knee, the graft is taken from the patellar tendon or hamstring tendons, and a tunnel is drilled into both the tibia and femur. 27 (9), 11971203. In the early 1980s animal studies were performed to evaluate the response of the meniscus to injury, and showed that meniscal tissue was capable generating a healing response particularly at its periphery. Due to the limited healing capacity and tissue weakness of meniscal horizontal tears following meniscal repair (Kurzweil et al., 2014; Kurzweil et al., 2018; Ogawa et al., 2020) or conservative or nonsurgical methods (Haemer et al., 2007; Herrlin et al., 2013; Brown et al., 2016), the dominant clinical treatment for horizontal meniscal tears is arthroscopic meniscectomy to remove the single-leaf, double-leaf, subtotal body or total body of a meniscus (Seil et al., 2010; Yang et al., 2021). Problems Diagnostic Radiology 51 (5), 779786. Meniscal tear - Symptoms, diagnosis and treatment - BMJ Best Simultaneous changes in bone mineral density and articular cartilage in a rabbit meniscectomy model of knee osteoarthrosis. After a subtotal meniscectomy (STM), the axial load, the maximum von Mises stress, and the maximum contact pressure on the tibial cartilage increased compared with a partial meniscectomy with root retention. Meniscus Surgery Exercise has been shown to improve knee function and reduce joint pain[16,17]. Rev. 23 (4), 11531160. Baratz et al[27] conducted a biomechanical cadaveric study and found that following total medial meniscectomy there is a decrease in intra-articular contact area of approximately 75% and the peak contact pressure increased by approximately 235%. (2010). Cabaud et al[46] performed transverse medial meniscal lacerations and repair with a single Dexon suture on 20 canine and 12 rhesus knee joints. WebThe most common procedure for a torn meniscus is knee arthroscopy. Grant et al[67] performed a systematic review comparing 19 studies looking at different repair techniques for isolated meniscal tears. Katz et al[44] reviewed 105 patients following partial medial meniscectomy with aim to establish multiple predictors of functional outcome. Meniscus Surgery: Who Needs It, What to Expect Before & After Matsusue et al[40] conducted a retrospective analysis of 65 patients over forty years of age who had undergone partial medial meniscectomy. A horizontal meniscal tear, also known as a cleavage tear, is a type of meniscal tear in which the tear is oriented horizontally, parallel to the tibial plateau. If these patients were subjected to total knee replacements instead this carries a five times greater cost than arthroscopy. Rupture of the ACL in particular, in its most common form combined with meniscus injury is associated with a marked risk for the development of radiographic (2017). Meniscus repair and replacement. Pitfalls associated with FasT-Fix meniscal repair. Degenerative joint disease after meniscectomy. Eng. Longitudinal tears are more common medially, whereas radial tears are more frequently seen laterally[11]. The medial meniscus is U shaped covering around 60% of the medial compartment whereas the lateral meniscus is more C with a shorter distance between its anterior and posterior horns covering 80% of the lateral compartment[6]. doi:10.1016/j.biomaterials.2009.08.026, Brown, M. J., Farrell, J. P., Kluczynski, M. A., and Marzo, J. M. (2016). WebPurpose: Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Conditions Affecting the Inner (Medial) and Outer (Lateral) Knee. A preliminary report. The other simulated the stance phase of hopping (30) under static analysis, and the ratio of the total force on medial to lateral compartments was 0.97. However, the biomechanics of the rabbit knee joint has not been quantified, and its mechanical changes have not been fully studied. This vicious cycle could cause the horizontal tear to develop into larger and more complex tears, ultimately bringing about greater biomechanical changes. Johnson MJ, Lucas GL, Dusek JK, Henning CE. Meniscal tears are often classified according to their orientation. A preliminary study. Rev. Biomaterials 30 (31), 63946401. Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing. A biomechanical study[62] of rigid biodegradable devices found that at 24 wk hydrolysis was responsible for a significant decrease in failure strength. These tears are usually not amenable to repair. First, the linear elastic material model was adopted for menisci and cartilage, while the nonlinear model would better describe the actual behavior of knee joint tissues. Biomechanical consequences of meniscal tear, partial meniscectomy, and meniscal repair in the knee. WebIn summary, this study provides evidence that horizontal meniscal tears can be treated successfully with a nonoperative approach. Inclusion in an NLM database does not imply endorsement of, or agreement with, A Biomechanical Comparison of All-Inside Versus Transtibial 27 (1), 206214. Further studies on static analysis or dynamic analysis of different rabbit activities in the rabbit knee joint are necessary. Meniscus Tear Biomechanical characteristics of tibio-femoral joint after partial medial meniscectomy in different flexion angles: A finite element analysis. Meniscal tears are a common orthopaedic pathology. Treatment Results of open meniscus repair. WebExercise therapy is an effective intervention for individuals with degenerative meniscal tears and knee symptoms, without the associated risks of surgery. To date, there is no systematic research on the impact of meniscal horizontal tears and all the clinically used resection strategies on joint mechanics (Haemer et al., 2007; Brown et al., 2016), which is important for the selection of meniscectomy strategies during surgery (Feucht et al., 2015). Ahmed AM, Burke DL. 21 (2), 358364. The main purpose of the lateral meniscus is to absorb shock, The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results. Open meniscal repair through an incision posterior to the collateral ligaments is now rarely performed due to associated neurovascular injury. Biodegradable gelatin hydrogels incorporating fibroblast growth factor 2 promote healing of horizontal tears in rabbit meniscus. Northmore-Ball MD, Dandy DJ, Jackson RW. Radiographic degeneration was more frequently seen after lateral meniscectomy than medial. (2020). Therefore, although the clinical symptoms and biomechanical changes caused by an HTMM are not obvious, early management and promotion of meniscal tear healing are important. Pre-injury level of activity was achieved in 96.2% after repair compared with 50% after meniscectomy. Also as the knee replacements will be done earlier they are more likely to need revision further adding to the costs. meniscus tears TABLE 1. Rockbom and Gillquist[58] report on a 13 year follow-up of 31 patients who underwent open meniscal repair. This is due to the convexity of lateral tibial plateau mirroring the convexity of the distal femoral condyle. RICE Treatment usually starts with the RICE method: Rest. (2012). Purpose: (2022). This work was supported by the National Natural Science Foundation of China (11072021, 82072428, 11772038), the National Key Research and Development Program (2016YFC1103202, 2019YFB1706900). These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. FIGURE 2. It has also been shown that the risk of developing osteoarthritis after lateral meniscectomy is greater than the equivalent for the medial side[30,31]. The average follow-up period was just over 10 years. However care of neurovascular structures in particular the saphenous nerve medially and the common peroneal nerve laterally must be taken when making the accessory incisions[59]. Meniscus root tears are associated with chondral injury, early degenerative change, and a high conversion rate to total knee arthroplasty. Epidemiology. This tears can worsen. Meniscus structure in human, sheep, and rabbit for animal models of meniscus repair. Before In humans, the load ratio between the medial and lateral compartments of the knee joint is approximately 2:1, and approximately 70.9% of the total axial load is transmitted to the meniscus (Wang et al., 2022). It was noted that modern all-inside repair devices were not included in the review and long term results are still awaited before firm conclusion on the best repair technique and device can be made. No significant differences were found in the magnitude of improvement in functional status and pain between the partial meniscectomy and physical therapy aloneat twelve months follow up. Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL. MRI scans are only 80%-90% accurate at diagnosing meniscal tears initially and even less accurate post-operatively. Jaureguito JW, Elliot JS, Lietner T, Dixon LB, Reider B. doi:10.1097/JSA.0000000000000224, Kurzweil, P. R., Lynch, N. M., Coleman, S., and Kearney, B. (2018). When this happens, your knee can actually become stuck because the torn part of your meniscus is blocking normal knee motion. Finite element study of a partial meniscectomy of a complete discoid lateral meniscus in adults. Potential of centrifugal seeding method in improving cells distribution and proliferation on demineralized cancellous bone scaffolds for tissue-engineered meniscus. 23 (1), 119125. For the motion of the tibia and femur is relative, the axial and internal/external rotation degrees of the femur were released, and the other degrees of the femur and tibia were constrained. After the SLPM, ILPM, and DLPM, the maximum contact pressure of the medial menisci was 12.2 MPa, 11.1 MPa, and 18.5 MPa, which increased by 100.8%, 82.2%, and 202.7%, respectively, compared with the IMM (6.1MPa), respectively (Figure 2C). The maximum von Mises stress was concentrated at the remaining edge of the medial meniscus, which contacted the articular cartilage after the SLPM, ILPM, and DLPM. J. The radial displacement of the medial meniscal middle body was larger than that of any other part in all the models, and the radial displacement after the ILPM was the minimum, while after the STM, the radial displacement was the most obvious. 457 (457), 194202. Biomed. There is no similar reported finite element study to simulate the resting state (45) of the rabbit knee joint. doi:10.1166/jbt.2020.2326, Wang, S., Hase, K., Kita, S., and Ogaya, S. (2022). Bucket handle tear: A large type of horizontal tear. Attempts have been made to encourage bleeding in otherwise avascular zones. Am. Predictors of functional outcomes after arthroscopic partial meniscectomy. Received: 13 February 2023; Accepted: 13 June 2023;Published: 22 June 2023. (2019). FasT-Fix meniscal repair: mid-term results. Knee joint changes after meniscectomy. It is well-established that There were no studies reporting on non-operative management of acute meniscal tears in young patients. They are usually mechanically stable but may give rise to flap tears. Faun P, Nielsen AB. Finite element models of the rabbit knee joint: (A) Posterior view of the right knee; (B) Anterior view of the right knee; (C) intact medial meniscus (IMM); (D) horizontal tear of medial meniscus (HTMM); (E) superior leaf partial meniscectomy (SLPM); (F) inferior leaf partial meniscectomy (ILPM); (G) double-leaf partial meniscectomy (DLPM); (H) subtotal meniscectomy (STM). Patients were followed up multiple times over a 2 year period. Sports Med. They found no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. WebA radial tear of the lateral meniscus is often found together with an anterior-cruciate ligament tear. These results demonstrated the reliability of the model used in this study. Historically it was believed that the menisci served no functional purpose and they were often excised with open total meniscectomy[2]. Figure Figure22 summarises the evidence discussed in this review as well as contributions from the senior author in a decision tree for dealing with meniscal tears. Initially rigid biodegradable devices were used. Supply is from the periphery via the medial and lateral geniculate arteries. 33 (3), 617624. Eng. Bioeng. doi:10.1016/j.jot.2018.12.004, Zhang, X. H., Yuan, S., Wang, J., Liao, B. G., and Liang, D. (2021). An all-inside suture repair technique without bone tunnels has been proposed to treat LMRT. McDermott ID, Amis AA. In the lateral compartment, the contact areas of the LFC-LM and LTC-LM were 3.9 mm2 and 6.4mm2 after the STM, which decreased by 4.8% and 2.3% compared with the IMM, respectively. A locking or catching sensation may also be felt in the knee, and it will often become inflamed (swollen). A partial meniscectomy with an intact posterior root achieved fewer biomechanical changes than a subtotal meniscectomy. In a study[38] looking at 136 patients following partial meniscectomy for isolated meniscal tears, at 8.5 years follow-up there was a re-operation rate of 22.8% and 53% of patients had osteoarthritic radiographic changes compared to only 22% in the unaffected control knee. Copyright 2023 Xue, Mao, Zhu, Yang, Wang, Mao, Du, Ma, Jiang, Fan and Zhao. Krause WR, Pope MH, Johnson RJ, Wilder DG. the contents by NLM or the National Institutes of Health. Rabbits, as a relatively inexpensive animal model, have been commonly used to study meniscal injury and surgery (Narita et al., 2012; Zhang et al., 2015; Civitarese et al., 2016; Jiang et al., 2018), despite certain differences in cellularity, and vascularity (Chevrier et al., 2009). Arnoczky and Warren[47] reported on the vascular response to complete midportion transaction of the medial meniscus in 15 dogs. They are more common in the elderly and have associated osteoarthritic changes in the knee. Moseley JB, OMalley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. 2015;21:13451349. The attribute assignment of Neo-Hookean of major ligaments. Despite this most patients still showed clinical improvement suggesting that the favourable results seen after meniscal repair do not necessarily correlate with the appearance of a normal looking meniscus. They are usually mechanically stable but may give rise to flap Patients having simple meniscectomy can usually return to full work after a couple of weeks. The radial displacement of the middle body of the medial meniscal was larger than any other part in all the models.