Dissertations / Theses on the topic 'Meniscectomy'

Meniscal tears are the commonest knee injury and currently are addressed almost exclusively by arthroscopy. Ian Smillie the late Professor of orthopaedics in Tayside, popularised open total meniscectomy worldwide during the 1950s believing that this was necessary for a functioning fibrocartilage replica to completely occupy the ensuing space. The cohort in this study underwent open total meniscectomy under his care prior to their 19th birthday. It was documented in their then records that no other knee pathology was observed during the operation and that the same post operative regime was followed by all. This presents a unique opportunity to evaluate the long term outcomes of open total knee meniscectomy during adolescence and to further investigate biological markers of osteoarthritis 40 years down the line. Fifty-three patients who underwent radiographic evaluation at the 30 year follow-up were further studied at this 40 year review. All surviving and contactable patients were consented prior to assessment and were evaluated clinically; biochemically, radiologically and subjectively once ethical approval and funding were secured. Standardisation of all methods used for examination, radiographic evaluation, sampling of serum and synovial fluid and patient reported outcome measures (PROMs) was achieved by the use of recognised, validated and credible systems as well as good communication between all involved parties. Such examples include the construction of a wooden apparatus standardising the weight bearing skyline views and the need for a smooth and efficient transition between sampling, preparing, storing and transferring the synovial and serum samples. Once all the data were collected, the first striking finding was the proportion of total knee arthroplasties (TKAs) observed as a hard endpoint in this cohort, which suggested a 132 fold increase when compared to their age and geographically matched population data, as per Scottish Arthroplasty Project. It was important to assess if in this cohort the site of meniscectomy demonstrated a significant difference in terms of tibiofemoral joint (TFJ) osteoarthritis, range of motion (ROM) and PROMs as per our chosen scoring systems. As this proved not to be the case, the operated knee was assessed against the non-operated knee where possible and not as per site of meniscectomy. Also the assessed sagittal laxity between the knees did not demonstrate any significant difference and as such was excluded as a confounding factor in terms of initiators of osteoarthritis. A linear correlation was observed between the chosen scoring systems of TFJ osteoarthritis. The calculated relative risk (RR) of developing osteoarthritis (OA) in the operated vs. non-operated knee was calculated for both the KL & Ahlback grading systems with presumed osteoarthritis as =2 for KL & =1 for Ahlback. This was found to be 4.5 & 4.25 respectively. Decreased ROM between the Index and Non-index knees was observed, with the ROM correlating with PROMs and inversely with TFJ OA. In addition the usually under investigated patellofemoral joint was assessed. Patellofemoral joint osteoarthritis was noted in the index knees as opposed to the non-index knees with an observed RR of 1.8 as per presence of osteophytes. There was no significant difference in the degree of patellofemoral joint (PFJ) osteoarthritis between lateral and medial meniscectomies. There was however significant correlations between the joint space narrowing (JSN) and PROMs, TFJ OA and ROM. Worsening results were observed where the PFJ was <5mm. Malalignment was greater in those knees that underwent medial meniscectomy as opposed to either lateral or medial & lateral meniscectomies. Malalignment demonstrated correlation with ROM and TFJ OA. Serum and synovial fluid was processed and analysed with regards to biomarkers of OA in the form of MMP-3 and GAG. Neither serum nor synovial MMP-3 demonstrated any significant correlation with other measured parameters. GAG on the other hand demonstrated a significant difference between the index and non-index knee as well as a positive correlation to IKDC and an inverse correlation with TFJ OA. Although this is suggesting that synovial GAG as a biomarker for OA may indicate progression of disease and symptoms, the wider spread of values questions this. Two different PROMs were utilised to assess this cohort. Interestingly the KOOS demonstrated that in all its 5 parameters the cohort was symptomatic. Correlations were observed between the KOOS ADL & Sport as well as IKDC with TFJ OA. This is currently the longest follow-up of open total meniscectomy in adolescence worldwide. A >4 fold increased risk of osteoarthritis in the operated knee as compared to the non-operated knee was demonstrated and possibly a 132 fold increase in TKA as compared to their aged matched geographical peers.

This study investigated the effects of hyperbaric oxygen (HBO2) therapy following partial arthroscopic meniscectomy surgery on swelling, perceived pain, range of motion at the knee joint, isokinetic strength, and leg function. Subjects were 8 males and 1 female with an acute tear to the meniscus. Subjects were randomly assigned to either a control group (n = 5) or an HBO2 treatment group (n = 5). The HBO 2 group received 5 HBO2 treatments at 2.5 ATA for 90 minutes at 95% O2 beginning 24 hours post-operation. Both groups were tested pre-operation (day 0) and on days 1, 2, 3, 4, 5, 20, 35, and 50 post-surgery. No significant difference was found between groups for any of the dependant variables. The results indicated that the control and HBO2 groups responded in a similar pattern when assessed for swelling, perceived pain, range of motion at the knee joint, leg function and isokinetic strength.

Pre-operatively (pre-op) and following arthroscopic partial meniscectomy (every 2 weeks for 12 weeks), bilateral knee extensor and flexor peak torques (PT) were evaluated at the Sports Medicine Lab (SML) and Sacre Coeur Hospital (SCH) via Cybex II or II+, in 22 subjects. Three submaximal contractions were followed by 3 maximal contractions at 60, 120, 180 and 240 deg/sec, with a 2 minute rest between sets. For both groups, the quadriceps had a significant deficit in PT at pre-op, except at 180 and 240 deg/sec at the SML, whereas the hamstrings only had a significant deficit at 60 deg/sec. Despite significant differences in PT (SML $>$ SCH) and percent deficit (SCH $>$ SML) the recovery pattern was similar in both groups. Extensor PT dropped significantly at 2 and 4 weeks post-op, returned to pre-op values by 6 weeks post-op and plateaued at this level until and including 12 weeks post-op. Flexor PT dropped significantly at 2 weeks post-op, except at the faster speeds, and was fully recovered 2 weeks later. These results indicate that while the hamstrings were minimally involved, the extensors were not able to recover beyond their pre-op level of strength within 3 months, without training. The differences between the SML and SCH may be attributed to differences in Cybex machines, thigh muscle cross sectional area and tourniquet time.

Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-Esqueléticas
Enquadramento: A ruptura meniscal do joelho, apresenta uma taxa de ocorrência estimada por ano de 23.8/100000 (Clayton, & Court-Brown’s, 2008). Os tratamentos artroscópicos, a rupturas meniscais, estão entre os mais comuns realizados pelos cirurgiões ortopédicos, constituindo 10% a 20% de todas as cirurgias em alguns centros cirúrgicos (Renstrom & Johnson, 1990 cit. por Shybut & Strauss, 2011). Os objectivos da Fisioterapia, pós-operatória da artroscopia meniscal, são assim resolver os sintomas, restaurar a função, prevenir lesões futuras e promover o retorno à atividade. (Goodyear-Smith & ·Arroll, 2001). Objetivo: Este estudo teve por objetivo investigar prospetivamente a evolução da intensidade da dor, rigidez articular e função física, em utentes que se encontravam a realizar fisioterapia pós-meniscectomia. Adicionalmente, pretendeu-se conhecer o beneficio percepcionado pelos participantes, relativamente à evolução da sua condição. Tipo de Estudo: Trata-se de um estudo do tipo observacional de Coorte prospectivo no qual se registou a evolução da dor, rigidez e funcionalidade ao longo de 8 semanas, em indivíduos submetidos a cirurgia de meniscectomia e que se encontram a realizar tratamento de Fisioterapia. No final da 4ª e 8ª semanas de intervenção foi ainda avaliada a percepção de mudança do estado de saúde e satisfação com o tratamento. Instrumentos: Questionário de caracterização sócio-demográfica e clínica, END, WOMAC, PGIC-PT. Amostra: Dos 33 pacientes iniciais, 8 foram excluídos, constituindo os restantes 25 a amostra em estudo. Resultados: Ocorreu uma diminuição da dor de 52% de 5 (T0) para 2.4 (T3) segundo a END, a sub-escala dor da WOMAC reportou uma diminuição da dor de 45% de 7.92 (T0) para 4.36 (T3). A sub-escala rigidez da WOMAC apresentou uma diminuição de 65,2% de 4.2 (T0) para 1.5 (T3). Verificou-se um aumento da funcionalidade, através da sub-escala da funcionalidade da WOMAC 36,12 (T0) para 16.92 (T3) representando um aumento funcional de 53.26%. Relativamente à WOMAC total observouse uma redução na pontuação de 48.32 (T0) para 22.88 (T3), o que se traduziu numa melhoria de 52.81% da função final. Os resultados mostram ainda que após a intervenção de Fisioterapia ocorreu uma redução significativa da, intensidade dor X2 (3)= 46.130, p<0.0005, e da incapacidade funcional X2 (3)= 53.069, p<0.0005. As melhorias foram percepcionadas como clinicamente importantes (PGICPT ≥5) para 72% dos participantes no estudo. Foi também possível observar parcialmente uma associação positiva e significativa entre a intensidade da dor e o nível de incapacidade funcional autoreportado. Verificou-se ainda que existe uma associação positiva e significativa entre a redução da incapacidade funcional e a melhoria percepcionada pelos indivíduos pós-meniscectomia, durante e após o tratamento de Fisioterapia. Conclusão: Com base nos resultados observados, este estudo parece indicar uma melhoria clínica dos pacientes a realizar Fisioterapia pós-meniscectomia, quer a nível dos resultados clínicos, quer na melhoria percepcionada pelo paciente.
Background: The knee meniscal rupture has a rate estimated to occur each year 23.8/100000 (Clayton & Court-Brown’s, 2008). Arthroscopic treatments of meniscal injuries are among the most common orthopaedic procedures performed, constituting 10% to 20% of all surgeries at some centers (Renstrom & Johnson, 1990 cit. por Shybut & Strauss, 2011). The rehabilitation objectives in meniscal postoperatory arthroscopy are resolving the symptoms, restore function, prevent further injuries and promote return to activity. Post-operatory rehabilitation generally follows a phased progressive approach (Goodyear-Smith &·Arroll, 2001). Objective: This study aimed to prospectively investigate the evolution of the intensity of pain, stiffness and physical function in users who were conducting physiotherapy after meniscectomy. Additionally, we sought to understand the benefit perceived by participants regarding the progress of his condition. Study Type: This is a study of a prospective observational cohort study, in which was recorded the evolution of pain, stiffness and function over 8 weeks in patients undergoing meniscectomy surgery and are conducting physiotherapy treatment. At the end of the 4th and 8th weeks of intervention was also assessed, perceptions of change in health status and satisfaction with treatment. Instruments: Questionnaire of socio-demographic and clinical characterization, Numerical Rating Pain Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Patients Global Impression of Change Scale. Participants: Of the initial 33 patients, 8 participated to the 4th week the remaining 25 patients completed the study, which (n=25) were subject to statistical analysis. Results: Results show pain diminishment of 52% from a initial 5 (T0) to 2.4 (T3) occurred according to NRPS, the pain subscale of WOMAC reported a pain reduction of 45% from 7.92 (T0) to 4:36 (T3). A stiffness subscale of the WOMAC fell by 65.2% from 4.2 (T0) to 1.5 (T3). There was an increased functionality through the sub-range of functionality of WOMAC 36.12 (T0) to 16.92 (T3) representing a functional increase of 53.26 %. For the total WOMAC is observed 48.32 (T0) to 22.88 (T3), which resulted in an improvement of 52.81 % of the final function. The study also found that after the intervention of physical therapy a significant reduction in pain intensity X2 (3) = 46,130, p < 0.0005, a significant reduction in disability X2 (3) = 53,069, p < 0.0005 occurs. Users who reported a clinically important change (≥5) in PGIC - PT, the improvements were perceived as clinically important in 72 % of study participants. Is partially corroborated a positive and significant association between pain intensity and the level of self-reported functional disability. It was also found that there is a positive and significant association between reduction in functional disability and perceived improvement by post-meniscectomy individuals, during and after treatment of Physiotherapy. Conclusion: Based on the observed results, this study demonstrates clear implications not only in the clinical improvement of patients undergoing physiotherapy after meniscectomy, and lets say that the patient perceives it as very useful for the resumption of normal life.

Thigh muscle strength and endurance were measured following partial arthroscopic meniscectomy of the knee in 24 patients divided into group 1 (age < 20 yr), group 2 (age 24-40 yr), and group 3 (age > 50 yr). Subjects were studied during and after release from isokinetic rehabilitation. Isokinetic testing was performed at 1.04, 2.09, 3.14, 4.19, and 5.24 radians/second, with release from rehabilitation when quadriceps strength achieved 85% recovery of the non-surgical leg.No significant difference existed among the 3 groups in days from the time of surgery to the start of the first test or for the weeks to release from rehabilitation. Approximately 50% quadricep muscle strength loss was observed at the time of the initial isokinetic test. Quadriceps torque (mean + SE) measured in newton-meters for group 1 at the 1.04 rad/sec speed showed the surgical leg significantly weaker (P<0.001) than the non-surgical leg when tested at the initial test (101.6 +18.2 vs. 189.6 +17.2) and at release from rehabilitation (157.4 +13.3 vs. 176.3 +15.2). Torque measured at the other 4 speeds reached non-significance by the second or third week of rehabilitation. Isokinetic testing for groups 2 and 3 showed surgical leg strength significantly weaker (P<0.05) at the initial test and at week 1 of rehabilitation for the 5 testing speeds, with 85% return of strength by weeks 2 or 3. Strength recovery for all 3 groups showed no significant weakness between legs for hamstring torque after the initial or after the first week of rehabilitation. Percent of knee extensor torque achieved by the knee flexor muscles of the surgical leg for the 3 groups showed significantly greater (P<0.001) values only for the initial test at speeds 1.04 and 2.09 rad/sec. Measures of total work, average power, and endurance calculated from work tests showed little change in muscle endurance between legs.These data indicate that quadricep muscle function is negatively affected following arthroscopic meniscectomy. Release from rehabilitation when surgical to non-surgical leg strength is between 85% to 90X appears to be a valid measure for most patients, which indicates age alone does not appear to be a limiting factor in regaining strength.

A rabbit lateral meniscectomy model was used to induce osteoarthritis. Separate studies were conducted to evaluate the progression of osteoarthritis and to identify possible biological markers. First, 21 male, New Zealand White rabbits were divided into 3 groups (n = 7 / group). A randomly selected left or right stifle underwent a lateral meniscectomy. The 3 groups were: corticosteroid administration, forced exercise and surgical control. An open field maze was used to assess mobility weekly. The rabbits were euthanitized 47 days after surgery. Histopathologic examination found that the lateral meniscectomy induced more severe lesions than in the non-surgical contralateral stifle. It also showed a significant sparing effect on erosion of cartilage in the corticosteroid group. The corticosteroid group, but not the exercise group, caused a significant increase in mobility (p = 0.008) compared to the surgical control. Secondly, synovial fluid was harvested from the 12 rabbits on days 0, 6, 26, 40, and 57 with surgery occurring on day 12. Trypan blue was used in the lavage fluid to estimate the volume of harvested synovial fluid. There was a significant increase in the volume harvested on day 26 (p < 0.001). Superoxide dismutase concentration in synovial fluid increased after surgery, although not significantly. These studies verify that the lateral meniscectomy model produce histopathologic lesions consistent with osteoarthritis. Furthermore, use of trypan blue appears to be a reliable concentration marker in a lavage sample to measure harvested synovial fluid.
Master of Science

[Truncated abstract] Previous research has found that full recovery of knee function following arthroscopic partial meniscectomy (APM) is often not achieved, and in the long-term, over 50% of these patients will develop knee osteoarthritis (OA). Mechanical factors are believed to contribute largely to the development of knee OA. High frequency loading has been shown to lead to degenerative joint changes in animal models. In human gait, the knee adduction moment during stance phase, which tends to load the medial articular surface of the tibiofemoral joint, has been associated with the presence, severity and progression of knee OA. Quadriceps weakness, which is common in people with knee pathology, has been associated with abnormal sagittal plane knee moments during gait, yet no studies have investigated the effect of knee strength on frontal plane kinetics. This work aimed to investigate gait mechanics in a post-APM population, determine the influence of neuromuscular factors on gait, and assess recovery of function over 12 months while examining factors associated with recovery. One hundred and six APM subjects were examined between one and three months postsurgery. Data were compared to an age-matched control group of 49 healthy adults. Subjects were aged 20 to 50 years and had been screened for: clinical and radiographic evidence of knee OA; previous or current knee joint disease or injury (other than the current meniscus pathology); or any other previous or existing disease or injury that may have an effect on gait, or predispose to joint disease. Three-dimensional gait analysis was performed at a freely-chosen walking velocity, using a 50 Hz VICON three-dimensional motion analysis system, instrumented with two force platforms and 10-channel electromyography system. Subjects also underwent knee strength testing on a Biodex isokinetic dynamometer. Information was collected regarding subject’s physical activity levels, general health and knee function, as well as patient’s surgery specifics and rehabilitation regime.

Através da meniscectomia no lado esquerdo, seguida ou não de enxerto, objetiva-se verificar as possíveis alterações nas superfícies articulares da ATM. Os animais formaram os grupos: GI (meniscectomia); GII (meniscectomia e enxerto); GIII (somente o acesso cirúrgico) que originaram subgrupos conforme o período pós-operatório (10 e 30 dias) e lado (direito e esquerdo). Nos animais GIII, GId, GIId, a Cm e a superfície articular da fossa mandibular (Fm) estavam organizadas em camadas com o predomínio de fibras colágenas do tipo I. Alterações morfológicas como erosão da Cm e Fm e amplos cistos subcondrais no osso subjacente foram verificadas nos animais GIe e GIIe. Em GIIe, a Cm apresentou um nível razoável de organização sob o enxerto. Fibras colágenas do tipo I constituíam as camadas articular e condroblástica nos animais GIe e GIIe e fibras do tipo III predominaram na camada pré-condroblástica. Amplos espaços vasculares eram evidentes na zona bilaminar dos animais GI e GII.
The morphological features of the temporomandibular joint (TMJ) of rats were studied after meniscectomy in the left side of the joint. The specimens were submitted or not to an interpositional auricular cartilage graft. The animals formed the following groups: GI (meniscectomy); GII (meniscectomy and graft); GIII (sham). The post-operative periods (10, 30 days) and the side allowed to form the subgroups. The articular surface of the TMJ exhibited organized layers (GIII, GId, GIId groups) where the type I collagen fibers arranged in regular nets prevailed. Morphological changes as erosion of the articular surface with large subchondral cysts in the subjacent bone were verified (GIe, GIIe). The condyle\'s surface of GII was regular and structurally preserved under the graft. The type I collagen fibers constituted the articular and chondroblastic layers in the GIe and GIIe animals where the type III collagen fibers were predominant in the prechondroblastic layer. Wide vascular spaces were evident in the bilaminar zone of the GI and GII animals.

O objetivo deste estudo foi avaliar a efetividade da fisioterapia para pacientes submetidos à meniscectomia parcial por via artroscópica. Foram incluídos estudos que avaliaram a efetividade da fisioterapia para este tipo de paciente. A busca foi realizada por dois pesquisadores, nas seguintes bases de dados: Medline; Embase; Cinahl; Lilacs; Scielo; Web of Science; PEDro; Academic Search Premier and the Cochrane Central Register of Controlled Trials entre os anos de 1950 e 2011. Os seguintes descritores foram usados: physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, systematic review e meta-analysis. A avaliação do risco de viés foi realizada por dois avaliadores independentes para os seguintes itens: aleatorização, ocultação da alocação, mascaramento, análise por intenção de tratar e seguimento. Foram encontrados 1.029 estudos, destes apenas 18 foram inclusos nesta revisão. Estes foram classificados em 8 categorias: Fisioterapia ambulatorial + Exercícios domiciliares X Exercícios domiciliares; Fisioterapia ambulatorial X Exercícios domiciliares; Fisioterapia ambulatorial X Grupo controle; Artroscopia X Fisioterapia ambulatorial; Fisioterapia convencional X Modalidades específicas; Tratamento em enfermaria X Tratamento em enfermaria + Ambulatorial; Fisioterapia de rotina X Fisioterapia intensiva; Fisioterapia precoce X Fisioterapia tardia. Para a categoria Fisioterapia ambulatorial + Exercícios domiciliares X Exercícios domiciliares foram realizadas duas metanálises; a primeira para o desfecho funcionalidade, avaliado por meio do questionário Lysholm, foi encontrada uma diferença estatisticamente significante a favor do grupo fisioterapia ambulatorial + exercícios domiciliares - realizados entre 18 dias; 4x semana - (Diferença da Média (DM) = 10,3; Intervalo de Confiança (IC) de 95% [1,3;19,3], P = 0,02). Para o desfecho amplitude de movimento (ADM) de flexão de joelho foi encontrada uma diferença a favor do primeiro grupo - realizados entre 14 dias; 4x semana - (DM = 9,13; IC 95% [3,74;14,53], P = 0,0009). Na categoria Tratamento em enfermaria X Tratamento em enfermaria + Ambulatorial os estudos não apontaram diferenças entre os grupos, entretanto, o resultado encontrado na metanálise para o desfecho presença de edema mostra uma diferença a favor do grupo tratamento em período de internação - realizados em 10 dias - (Odds Ratio (OR) = 0,25; IC 95% [0,10;0,61], P = 0,003). A maioria dos estudos não realizou ocultação da alocação e mascaramento e, dos 18 estudos, somente 2 realizaram análise por intenção de tratar. Esta revisão demonstrou que fisioterapia associada a exercícios domiciliares é efetiva na melhora da funcionalidade, ADM e redução do edema para os pacientes submetidos à artroscopia parcial do menisco.
The objective of this study was to evaluate the effectiveness of physical therapy for patients who had undergone arthroscopic partial meniscectomy. Studies were included that evaluated the effectiveness of physical therapy for this type of patient. The search was conducted by two reviewers in the following databases: Medline; Embase; Cinahl; Lilacs; Scielo; Web of Science; PEDro; Academic Search Premier and the Cochrane Central Register of Controlled Trials the search range was from 1950-2011. The following keywords were used: physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, systematic review e meta-analysis. Assessment of risk of bias was performed by two independent reviewers for the following items: randomization, allocation concealment, blinding, analysis by intention to treat and follow up. 1029 studies were found, of which only 18 were included in this review. These were classified into eight categories: Outpatient physical therapy (PT) + Home exercise X Home exercise; Outpatient PT X Home exercise; PT X Control group; Arthroscopic X Conservative treatment; Outpatient treatment X Specific modalities; Ward treatment X Ward + Outpatient treatment; Routine PT X Intensive PT; Early X Delayed Treatment. For category Outpatient PT + Home exercise X Home exercise 2 meta-analysis were performed; the first one found a statistically significant difference in favor of outpatient PT + home exercise group - carried out within 18 days; 4x weeks - (Mean Difference (MD) = 10.3, 95% Confidence Interval (CI) [1.3;19.3], P = 0.02). For the outcome range of motion (ROM) of knee flexion a difference was found in favor of the first group - carried out within 14 days; 4x weeks - (MD = 9.13, 95% CI [3.74;14.53], P = 0.0009). In the category Ward treatment X Ward + Outpatient treatment the studies showed no difference between the groups, however, the results found in meta-analysis for the outcome effusion showed a difference in favor of the ward treatment group - carried out within 10 days - (Odds Ratio (OR) = 0.25 95% CI [0.10;0.61], P = 0.003). Most studies did not perform allocation concealment as well as blinding and, out of the 18 studies, only two made the intention-to-treat analyses. This review showed that physical therapy associated with home exercises is effective in improving the functionality, ROM and in the reduction of the oedma for patients who had undergone arthroscopic partial meniscectomy.

A evolução do conhecimento acerca das funções dos meniscos e do tratamento das suas lesões, impulsionada pelo advento da cirurgia artroscópica, consagrou e popularizou a meniscectomia por esta via, por ser uma técnica menos invasiva, com menor morbidade e menores custos hospitalares, a ponto de torná-la, atualmente, a cirurgia ortopédica mais frequentemente realizada no mundo. Embora a maior parte dos pacientes submetidos a esta intervenção cirúrgica tenha resultados favoráveis e resolução rápida dos sintomas, percebe-se que parte considerável dos pacientes, especialmente os mais idosos, não apresenta uma evolução póscirúrgica satisfatória, apresentando piora dos sintomas e, eventualmente, necessitando de nova cirurgia. Partindo da hipótese que em determinados pacientes a meniscectomia, em vez de tratar, precipita e acentua um desequilíbrio biomecânico do joelho, o autor realizou estudo observacional prospectivo não-controlado com 86 pacientes de ambos os gêneros, com idade superior a 50 anos (média de 60,2 ± 7,1 anos), submetidos à meniscectomia artroscópica para tratamento de lesão do menisco medial de natureza degenerativa, com o objetivo de determinar variáveis demográficas, clínicas, anatômicas e cirúrgicas relacionadas aos resultados desfavoráveis. As avaliações funcionais pré e pós-operatórias foram realizadas utilizandose o Índice do KOOS (Knee Injury and Osteoarthritis Outcome Score), aplicado a todos os pacientes antes da cirurgia e 60 meses depois. Após análise estatística dos resultados obtidos, o autor verificou que 10 fatores podem ser considerados preditivos das meniscectomias mediais artroscópicas neste grupo etário, sendo quatro fatores fortemente associados aos resultados desfavoráveis: lesão da raiz posterior do menisco medial, dor pré-operatória intensa, claudicação antes da cirurgia e tempo decorrido entre o início dos sintomas e a cirurgia; dois fatores foram considerados moderadamente associados aos resultados desfavoráveis: presença de edema de medula óssea na ressonância magnética (RM) préoperatória e duração da cirurgia; quatro fatores foram considerados associados de modo fraco aos resultados desfavoráveis: Índice de Massa Corporal (IMC) >= 30 kg/m2 , varismo do joelho, presença de cisto poplíteo na RM pré-operatória e extensão da ressecção do menisco medial
The evolution of knowledge concerning meniscal functions and the treatment of their injuries, boosted by the development of arthroscopic surgery, has established and popularized arthroscopic meniscectomy due to its less invasiveness, less post-operative morbidity and lower hospital costs, to the point it has become, nowadays, the most frequently performed orthopedic procedure in the world. Although the majority of patients undergoing this operation is quite pleased with the outcomes and with the prompt resolution of their symptoms, it is noticeable that a considerable amount of patients with meniscal injuries, mainly the older, does not have a satisfactory postoperative outcome, with worsening of symptoms after being operated on and occasionally requiring another surgery. Based on observations of his medical practice and on the assumption that meniscectomy, rather than treat, can hasten and accentuate a biomechanical imbalance of the knee in those patients, the author conducted an observational prospective uncontrolled study with 86 patients of both genders, aged over 50 years old (average 60.2 ± 7.1 years), who underwent arthroscopic meniscectomy for the treatment of degenerative medial meniscal lesions, aiming to determine demographic, anatomical, clinical and surgical variables related to poor outcomes. The functional pre and post-operative evaluations were performed using the KOOS index (Knee Injury and Osteoarthritis Outcome Score) applied to all patients before surgery and 60 months later. After statistical analysis of the results, the author found that 10 factors can be considered predictors of arthroscopic medial meniscectomy in this age group: four factors were strongly associated with unfavorable results - posterior root lesion of the medial meniscus, intense pre-operative pain, claudication before surgery and time elapsed between onset of symptoms and surgery; two factors were moderately associated with unfavorable results - bone marrow edema in preoperative magnetic resonance imaging (MRI) and surgery time length; four factors that were weakly associated with poor results - bone mass index (BMI) >= 30 kg/m2, varus knee, poplyteal cyst in pre-operative MRI and extension of meniscal ressection

碩士
中原大學
資訊工程研究所
104
A major medical application of computer graphics is surgical simulation. The body''s largest joint: knee involves surgery of the highest proportion in all joints, also many types of surgical procedures. Knee surgery has two categories. The first needs to open the knee to operate mainly the main constituent of the knee bones: the femur, tibia and patella. The other is arthroscopic surgery in which the knee arthroscopy makes a slight wound to insert the arthroscopy into the knee. Meanwhile, another surgical tool such as a bur or a knife makes another slight wound and inserted into the knee for repairing, replacing or cutting articular ligaments, meniscus or bone cartilage. This thesis proposes a method and prototype system for meniscectomy simulations in which ligament, meniscus, articular and bone surface of from MRI slices can be semi-automatically bordered to form a volume data set. Then, the meniscus can be deleted based on manipulating the volume data. The meniscus simulations help surgical plan, validation, surgical practice and teaching.

碩士
國立臺灣海洋大學
食品科學系
105
Osteoarthritis (OA) has become one of the most common disabilities among elders, especially in female and those with metabolic diseases. The risk factors involved in OA include gender, obesity, previous injury, and heredity. Obesity-related OA is attributed to joint loading, cartilage disintegration, bone loss along with inflammation. Fucoidan is a sulfated polysaccharide extracted from brown algae. It has been studied for its antitumor, antiviral, anticoagulation and immunomodulation. In this study, we investigate the effect of fucoidan in surgery-induced OA on diet-induced obesity male rats. OA was induced by anterior cruciate ligament transection (ACLT) and medial meniscectomy (MMx) method. Male Sprague Dawley (SD) rats were fed 40% high fat diet for 4 weeks to induce obesity before ACLT+MMx to initiate OA. OA rats were administered intragastrically with water or fucoidan P.O. in three different concentration, 32 mg/kg, 64 mg/kg, and 320 mg/kg after surgeries for 40 days with high-fat diet in parallel. We observed that the swelling in the OA knee was alleviated and the hind paw weight distribution was rectified after feeding fucoidan, with significant effect on body weight and body fat reduction and plasma lipid were also analyzed. Our result indicated no significant variation on HDL-cholesterol, but reduced plasma triglycerides, total cholesterol, and LDL-cholesterol level. In addition, weight-bearing tests showed some improvement on fucoidan-fed groups. Our result suggests that the feeding of fucoidan may potentially improve meniscal/ligamentous injury of obesity induced OA.

Author: Bc. Aneta Vránová Title: Changes of rheological properties during various degrees of knee flexion Aim of the thesis: To find out if there is a difference in rheological properties in varoius degrees of flexion in the knee with meniscal tear and compare the results with measurement after physical aktivity. To compare changes of the reological properties of patients who have undegone meniscectomy a few years ago with patients with recent meniscectomy. Method: Experimental measurements were done by using the method of biorheometry which detects the passive resistance of the knee in movement from flexion to extension. Patients completed case history and a special questionnaire relevant to clinical changes connected to meniscal tear. Measuring data were evaluated and converted in the form of biorheogramme. We measured 6 persons. At first were done measurements in three different sequences for both lower extremities, the same measurement was repeated after the physical activity (50 squats). Results: We found changes of rheological properties in higher degrees of knee flexion with typical rising followed by fall of biorheogramme around flexion of 80ř. They were more remarkable after physical activity. Changes of rheological properies were more expressive in patients who have undergone meniscectomy...

Introdução: Os meniscos são estruturas anatómicas essenciais na biomecânica do joelho; estes desempenham funções essenciais na locomoção, bem como na prática de atividade física. A absorção do choque, a lubrificação articular, a proprioceção e a estabilidade que proporcionam ao ser humano são essenciais na função locomotora. A rotura meniscal, devido à sua crescente incidência e limitação funcional associada, assume-se atualmente como uma patologia relevante do joelho. O prognóstico depende do tipo de rotura, lesões associadas e tratamento realizado Objetivos: Esta revisão bibliográfica pretende sistematizar o conhecimento existente na Literatura sobre rotura meniscal, incidindo sobre epidemiologia, fatores de risco, métodos de diagnóstico e estratificação da gravidade, bem como reunir os consensos atuais existentes no que concerne ao tratamento. Metodologia: Para a realização desta dissertação foi efetuada pesquisa bibliográfica, contemplando revisão de literatura científica acerca de Roturas Meniscais do joelho através da plataforma PubMed. Não obstante, foram também consultados livros de Ortopedia, bem como outras publicações consideradas pertinentes. Foi dada primazia a artigos publicados desde 2010. Conclusão: A meniscectomia parcial artroscópica é um procedimento cirúrgico que não deve ser utilizado como primeira linha na maioria das roturas meniscais. Ao invés, a reparação meniscal, através de técnicas de sutura, demonstra ter resultados otimistas no seguimento dos doentes intervencionados, devendo ser privilegiada. A evolução da impressão 3D guiada por imagens de Ressonância Magnética Nuclear fará parte da solução, num futuro a curto prazo, na construção de próteses eficazes.
Introduction: Menisci are essential anatomical structures in the biomechanics of the knee; these perform essential functions in locomotion, as well as in the practice of physical activity. Shock absorption, joint lubrification, proprioception and stability are essential in locomotion. Meniscal tears, due to its increasing incidence and associated functional limitation, is currently considered a relevant knee pathology. Prognosis depends of the type of tear, associated injuries and treatment involved. Objectives: This systematic review intends to gather the existing knowledgein the Literature about meniscal tears, focusing on epidemiology, risk factors, methods of diagnosis and severity stratification, as well as to reunite the current consensus, regarding treatment. Materials and Methods: To develop this dissertation, a bibliographic search was carried out, contemplating a scientific knowledge review of Meniscal tears through the PubMed platform. Besides, orthopedics books were consulted, as well as other publications considered relevant. Priority was given to articles published since 2010. Conclusion: Arthroscopic partial meniscectomy should not be used as the first line treatment in most meniscal tears. On the contrary, meniscal repair, using suture-based techniques, has shown optimistic results in the follow up of patients and should be privileged. The evolution of 3D printing guided by Magnetic Ressonance Imaging will be part of the solution in the short term, in order to fabricate effective scaffolds.