Journal articles on the topic 'Meniscu'
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Sandhya H, Sangeeta M, Khizer Hussain Afroze M, and Varalakshmi KL. "Retrospective Cross Sectional MRI Study of Morphometry of Menisci of Knee Joint." International Journal of Anatomy and Research 10, no. 2 (June 5, 2022): 8318–24. http://dx.doi.org/10.16965/ijar.2022.101.
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Introduction: Meniscal tears are commonly encountered in clinical practice and cause significant musculoskeletal morbidity. Most of the data available on Morphometry of menisci in Indian population are through cadaveric studies and very few MRI studies are available to substantiate the available data. Aim of the study: To gather data on the Morphometry of menisci in South Indian population and compare it with the existing literature. Material and Method: 100 MRI images collected retrospectively were used to study menisci. Height and width of MM and LM were measured both in sagittal and coronal planes. Results: It was observed that in both sexes the height of the Anterior horn of Medial meniscus was significantly higher than that of Lateral meniscus. Width of the Anterior horn and body showed significantly higher values in Lateral meniscus whereas width of Posterior horn of Medial meniscus showed significantly higher values in both sexes. Height of Medial meniscus in all the segments was higher in males though the difference was significant only in anterior horn and Posterior horn segments. Height of Lateral meniscus was significantly higher in males in all the segments. Conclusion: Results of this study will add to the existing literature on the Morphometry of menisci and will serve as a database for patients undergoing meniscal allografts. KEY WORDS: Medial meniscus, Lateral meniscus, Meniscal tears, musculoskeletal morbidity.
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Shea, Kevin G., Aleksei B. Dingel, Alexandra Styhl, Connor G. Richmond, Peter C. Cannamela, Allen F. Anderson, Theodore J. Ganley, Andrew Hill, and Yi-Meng Yen. "The Position of the Popliteal Artery and Peroneal Nerve Relative to the Menisci in Children: A Cadaveric Study." Orthopaedic Journal of Sports Medicine 7, no. 6 (June 1, 2019): 232596711984284. http://dx.doi.org/10.1177/2325967119842843.
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Background: Meniscal injury in skeletally immature patients is increasingly reported. During meniscal repair, all-inside devices may protrude beyond the posterior limits of the meniscus, putting the neurovascular structures at risk. Purpose: The purposes of this study were (1) to examine the relationship between the popliteal artery and the posterolateral and posteromedial aspects of the menisci, (2) to examine the relationship of the peroneal nerve to the posterolateral meniscus, and (3) to develop recommendations for avoiding neurovascular injury during posterior meniscal repair in pediatric patients. Study Design: Descriptive laboratory study. Methods: A total of 26 skeletally immature knee cadaveric specimens (7 females and 19 males) were included. Specimens were divided into age groups: 2-4, 5-8, and 9-11 years. The most posterior extent of the lateral and medial menisci was identified via sagittal and axial views on computed tomography (CT) scans. The shortest distance from the most posterior aspect of the lateral and medial menisci to the popliteal artery and the shortest distance from the posterior aspect of the lateral menisci to the anterior rim of the peroneal nerve were measured, and 3-dimensional models of representative specimens were re-created through use of CT scans. Results: For the age groups 2-4, 5-8, and 9-11 years, the mean minimum distance from the posterolateral meniscus to the popliteal artery was 5.2, 6.7, and 8.2 mm, respectively, and the mean minimum distance from the posteromedial meniscus to the popliteal artery was 12.7, 15.4, and 20.3 mm, respectively. In all groups, the distance between the posteromedial meniscus and the popliteal artery was greater than that between the posterolateral meniscus and the popliteal artery. The mean distance from the peroneal nerve to the lateral meniscus was 13.3, 15.0, and 17.9 mm for the respective groups. Conclusion: Many all-inside meniscal repair devices have sharp tips that penetrate posterior to the meniscus and capsule. This study demonstrated that the distance between the posterior meniscus and popliteal artery is relatively small in pediatric patients, especially for the lateral meniscus region. Clinical Relevance: Because of the higher potential for meniscal healing, meniscal repair is more likely to be performed in pediatric patients. The data in this study regarding the proximity of the lateral meniscus and neurovascular structures may be used to guide safe surgical repair of posterior meniscal tears during the use of all-inside meniscal repair devices in these patients.
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Van Dyck, Pieter, Filip M. Vanhoenacker, Jan L. Gielen, Lieven Dossche, Joost Weyler, and Paul M. Parizel. "Three-tesla magnetic resonance imaging of the meniscus of the knee: What about equivocal errors?" Acta Radiologica 51, no. 3 (April 2010): 296–301. http://dx.doi.org/10.3109/02841850903515403.
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Background: The significance of borderline magnetic resonance (MR) findings that are equivocal for a tear of the knee meniscus remains uncertain. Given their higher signal-to-noise ratio (SNR) and greater spatial resolution, these equivocal meniscal tears could be expected to be less frequent using a 3.0T MR system. Purpose: To investigate the prevalence of equivocal meniscal tears using 3.0T MR, and to study their impact on MR accuracy compared with arthroscopy in the detection of meniscal tears. Material and Methods: The medical records of 100 patients who underwent 3.0T MR imaging and subsequent arthroscopy of the knee were retrospectively reviewed. Two observers interpreted MR images in consensus, and menisci were diagnosed as torn (abnormality on two or more images), equivocal for a tear (abnormality on one image), or intact, using arthroscopy as the standard of reference. The prevalence of equivocal meniscal tears was assessed, and MR accuracy was calculated as follows: first, considering both torn menisci and equivocal diagnoses as positive for a tear; and second, considering only torn menisci as positive for a tear. Results: Evidence of meniscal tears on MR images was equivocal in 12 medial (12%) and three lateral (3%) menisci. Of these equivocal MR diagnoses, tears were found at arthroscopy in eight medial and one lateral meniscus. In our study, the specificity and positive predictive value increased for both the medial and lateral meniscus when only menisci with two or more abnormal images were considered to be torn: from 80% and 89% to 91% and 94% for the medial meniscus, and from 91% and 73% to 93% and 78% for the lateral meniscus, respectively. Conclusion: Subtle findings that are equivocal for a tear of the knee meniscus still make MR diagnosis difficult, even at 3.0T. We recommend that radiologists should rather be descriptive in reporting subtle or equivocal MR findings, alerting the clinician of possible meniscal tear.
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Yoon, Kyoung Ho, Sang Jun Song, Hee Sung Lee, and Cheol Hee Park. "Meniscal Injury Does Not Significantly Affect the Dimensions of the Intact Meniscus in the Opposite Compartment of the Knee." Orthopaedic Journal of Sports Medicine 8, no. 2 (February 1, 2020): 232596712090432. http://dx.doi.org/10.1177/2325967120904328.
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Background: Meniscal allograft transplant requires precise matching of the size of the allograft with the dimensions of the recipient knee. Estimation of contralateral meniscal size on magnetic resonance imaging (MRI) has been considered the ideal method to measure menisci before transplant. We questioned whether a contralateral intact meniscus with meniscal injury in the opposite compartment could be used as a reference to determine allograft size. Our question was derived from knowledge of meniscal injury influencing structures of the opposite compartment of the knee, including the meniscus. Purpose: To compare meniscal dimensions between intact meniscus with meniscal injury in the opposite compartment and normal meniscus with a normal opposite compartment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This observational, cross-sectional study was performed between 2016 and 2017. The control group consisted of 200 knees with normal medial and lateral menisci. The medial intact group consisted of 150 cases of medial intact meniscus with injured lateral meniscus, and the lateral intact group consisted of 150 cases of lateral intact meniscus with injured medial meniscus. All patients were male. Mean age, height, and weight did not differ among groups. We investigated meniscal dimensions on MRI, including anteroposterior and mediolateral lengths, distance between the anterior and posterior horns (AHPH distance), and widths and heights of the anterior and posterior horns and midbody. Results: Most medial meniscal dimensions were similar between the control and medial intact groups, but the AHPH distance was smaller in the medial intact group ( P < .001). Likewise, most lateral meniscal dimensions were similar between the control and lateral intact groups, but the AHPH distance was smaller in the lateral intact group ( P < .001). Conclusion: Most dimensions of the intact meniscus with meniscal injury in the opposite compartment were similar to those of the normal meniscus with normal opposite compartment. Measuring the dimensions of the contralateral intact meniscus with meniscal injury in the opposite compartment on MRI can be an appropriate method to determine meniscal allograft size.
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Lin, Kenneth M., Naomi E. Gadinsky, Craig E. Klinger, Jonathan P. Dyke, Scott A. Rodeo, Daniel W. Green, Peter D. Fabricant, David L. Helfet, Kevin G. Shea, and Lionel E. Lazaro. "MAGNETIC RESONANCE QUANTIFICATION OF MENISCUS VASCULARITY IN PEDIATRIC VERSUS ADULT KNEES." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0023. http://dx.doi.org/10.1177/2325967120s00232.
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Background: Despite advances in surgical techniques, implant technology, and biological augmentation, one innate limitation to meniscus healing is lack of vascularity. Ability to quantify meniscal vascularity has been limited with previous techniques, and minimal data exists describing differential vascular zones in the skeletally immature meniscus. Purpose/Hypothesis: The objective of this study is to use quantitative contrast-enhanced magnetic resonance imaging (MRI) to compare meniscal vascularity in pediatric cadaveric specimens to adults. We hypothesize that the developing meniscus has greater and more uniform vascularity throughout all zones. Methods: We utilized 10 fresh-frozen human cadaveric knees (5 immature knees, age 0-6 months; 5 mature knees, age 34-67 years). Gadolinium-enhanced MRI was performed using a previously established vascularity quantification protocol. Regions of interest corresponding to peripheral and central zones of the meniscus were identified on pre-contrast coronal images, and signal enhancement (normalized against background tissue) was compared between pre-and post-contrast images (Figure 1). Results: Quantitative MRI demonstrated increased perfusion in the peripheral zones compared to the central zones (2.3:1 in immature knees and 3:1 in mature knees) in the medial and lateral menisci separately, and both menisci aggregated. Overall, the medial and lateral menisci had similar levels of perfusion in all specimens (45.9% ± 8.3% medial vs. 54.1% ± 8.3% lateral in immature knees; 50.5% ± 11.3% medial vs. 49.5% ± 11.3% lateral in mature knees). Immature specimens demonstrated greater overall normalized meniscal signal uptake, with the 0-month specimen demonstrating the greatest proportional signal enhancement. Conclusion: While blood flow to peripheral zones is greater than to central zones in both immature and adult menisci, younger menisci receive proportionally greater overall blood flow compared to adults, including greater blood flow to the inner zone, challenging the conventional wisdom of the central zone being avascular. As younger patients become increasingly active in sports, thorough understanding of the immature meniscus is required. Greater overall vascularity, including centrally, to the developing meniscus suggests improved healing potential following injury, and further encourages meniscal preservation when possible. [Figure: see text][Figure: see text]
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Hifny, Abdalla, Kamal Eldin Hashem Abdalla, Yousria A. Abdel Rahman, Khaled Aly, and Ruwaida Abdelmoaty Elhanbaly. "Morphometric studies on the passive role of menisci in upward fixation of the patella in buffalo and cattle." Veterinary Science Development 2, no. 1 (November 14, 2012): 14. http://dx.doi.org/10.4081/vsd.2012.4412.
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The present study showed that the medial and lateral compartments of the femorotibial joint have an intervening meniscus located between the femur and tibia. The lateral meniscus is semicircular and covers a larger portion of the tibial condyle than the medial meniscus. The lateral meniscus has cranial and caudal meniscal ligaments anchoring it to the tibia. The present investigation shows that the dimensions of the meniscal ligaments of buffalo and cattle are almost the same except for the caudal ligament of lateral meniscus and the meniscofemoral ligament. The caudal ligament of lateral meniscus is longer in buffalo than in cattle. Therefore, the femur moves more cranially than normal to straighten the joint. The meniscofemoral ligament is thicker in cattle (6.55±0.04 mm) than in buffalo (3.85±0.05 mm). Therefore, it helps to stabilize the movement of the menisci. Furthermore, the presence of the transverse genual ligament which fixes the two menisci cranially increases stability and prevents a more forward movement of the femur.
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Murphy, Caroline A., Atul K. Garg, Joana Silva-Correia, Rui L. Reis, Joaquim M. Oliveira, and Maurice N. Collins. "The Meniscus in Normal and Osteoarthritic Tissues: Facing the Structure Property Challenges and Current Treatment Trends." Annual Review of Biomedical Engineering 21, no. 1 (June 4, 2019): 495–521. http://dx.doi.org/10.1146/annurev-bioeng-060418-052547.
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The treatment of meniscus injuries has recently been facing a paradigm shift toward the field of tissue engineering, with the aim of regenerating damaged and diseased menisci as opposed to current treatment techniques. This review focuses on the structure and mechanics associated with the meniscus. The meniscus is defined in terms of its biological structure and composition. Biomechanics of the meniscus are discussed in detail, as an understanding of the mechanics is fundamental for the development of new meniscal treatment strategies. Key meniscal characteristics such as biological function, damage (tears), and disease are critically analyzed. The latest technologies behind meniscal repair and regeneration are assessed.
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Grimm, Nathan L., James Lee Pace, Benjamin J. Levy, D’Ann Arthur, Mark Portman, Matthew J. Solomito, and Jennifer M. Weiss. "Demographics and Epidemiology of Discoid Menisci of the Knee: Analysis of a Large Regional Insurance Database." Orthopaedic Journal of Sports Medicine 8, no. 9 (September 1, 2020): 232596712095066. http://dx.doi.org/10.1177/2325967120950669.
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Background: A discoid meniscus is a morphological variant of normal knee joint meniscus shape and ultrastructure that can lead to traumatic tearing of this tissue and early joint osteoarthritis. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of discoid menisci in a large, ethnically diverse regional cohort and to evaluate possible risk factors. The hypothesis was that there would be no difference in the epidemiological distribution of discoid menisci based on ethnicity or sex. Study Design: Descriptive epidemiology study. Methods: The study population was from a regional, integrated health care system cohort from Kaiser Permanente of Southern California that, as of 2016, included more than 4.5 million patients. Patient demographics included age, sex, and ethnicity within this cohort. Potential risk factors analyzed included age, sex, ethnicity, and body mass index (BMI). Unique characteristics of a discoid meniscus were analyzed, including a symptomatic versus asymptomatic meniscus, location of meniscal tear and type of meniscus, and frequency of meniscal surgical treatment. Results: A total of 223 patients with a confirmed discoid meniscus were identified, yielding an overall prevalence rate of 4.88 per 100,000 patients. Those identifying as Black had the lowest prevalence (2.68/100,000), while Hispanic ethnicity had the highest (6.01/100,000). However, there was no significant difference with regard to ethnicity ( P = .283), nor any significant difference between sexes. BMI did not significantly influence the rate of discoid menisci ( P = .504). A majority (77.5%) of patients were symptomatic, while 22.5% of patients with discoid menisci were asymptomatic and discovered incidentally. Symptomatic discoid menisci were more likely to be operated on compared with asymptomatic discoid menisci (71% vs 14%, respectively; P = .001; odds ratio, 14.8 [95% CI, 5.8-37.2]). Horizontal and bucket-handle tears were the more common tear types. Of the discoid menisci in this cohort, 55.6% underwent surgery, with 95.2% undergoing reported saucerization. Conclusion: In this very diverse population-based cohort of patients, there did not seem to be a significant predilection of discoid menisci with regard to ethnicity. Neither sex nor BMI significantly influenced the rate of discoid menisci. More than three-quarters of those with a diagnosed discoid meniscus were symptomatic. Of the tears that occurred with discoid menisci, horizontal and bucket-handle tears made up the largest proportion.
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Kim, Sung-Soo, and Myung-Sang Moon. "CPM on Meniscal Regeneration and Maturation after Meniscectomy in Rabbits." Journal of Musculoskeletal Research 02, no. 03 (September 1998): 209–16. http://dx.doi.org/10.1142/s0218957798000202.
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This study in rabbit knees was carried out to clarify the effect of the application of CPM, after meniscectomy, on the regeneration rate of the meniscus and histology of the regenerated menisci. Twenty-seven mature rabbits were used: three rabbits as control (non-CPM) and 24 rabbits as experimental ones. Among them, four rabbits were used as the immediate CPM group and 20 rabbits as the delayed CPM group. In each animal, the medial meniscus was totally excised from the right knee, and the lateral meniscus was totally excised from the left knee. In three control animals, 16 weeks after meniscectomy, there was (hold) Grade II to III meniscal regeneration in two, and small meniscal mold was formed in one. In the immediate CPM group, meniscal regeneration failed and there was would disruption in all four knees. In the delayed CPM group, grades II to III regeneration was observed in 15 of the 20 medial meniscectomized knees, while in the lateral meniscectomized knees, the same size of meniscal regeneration was observed only in 3 of the 20 knees. The regenerated menisci in the delayed CPM group overall looked normal in appearance. Application of the delayed CPM induced the early fibrocartilaginous metaplasia of the regenerated fibrous menisci even at 6 to 12 weeks after meniscectomy. It is speculated that the application of delayed CPM promotes early focal fibrocartilagenous metaplasia of the fibrous meniscus following meniscectomy.
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Zantop, Thore, Yusuke Hashimoto, and Hiroaki Nakamura. "Prevalence, Development, and Factors Associated with Cyst Formation after Meniscal Repair with the All-Inside Suture Device." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0032. http://dx.doi.org/10.1177/2325967120s00321.
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Aims and Objectives: The aim of this study is to investigate the prevalence of cyst formation as a complication of all-inside meniscal suture device using magnetic resonance imaging (MRI) and analyze the risk factors. Materials and Methods: Of the patients who had undergone meniscal repair surgery 46 cases (46 knees) were selected to be in the case-control study. 51 menisci (34 medial menisci, 17 lateral menisci) of 46 cases were included to the study. Out of 51 menisci, 46 menisci combined anterior cruciate ligament (ACL) ruptures and had performed ACL reconstruction (ACLR). 5 cases (5 menisci) had been performed meniscal repair (MR). MRIs of the knee were performed 6, 12 and 24 months post-meniscal surgery. The MRIs were examined to detect the new development of cysts encasing the suture anchors and evaluate meniscal healing. Univariate and multivariate risk factor analyses was used to account for the suture technique (suture device alone versus suture device and inside-out suture repair), concurrent operation (MR alone versus MR with ACL reconstruction), patient gender, medial versus lateral menisci, number of device use, side-to-side difference of knee arthrometer, type of anchor (acetal resin versus PEEK material) and clinical scores (Lysholm score, Tegner activity scale, IKDC score). Results: MRI examinations revealed cyst formation in 15 of 51 menisci. 3 menisci were detected cyst formation at 6 months of surgery, 9 at 12 months and 3 at 24 months. Only 3 patients (6.5%) were symptomatic. Tecxhniques using suture device alone was more likely to develop cysts: odds ratio (OR) was 10.67 (95% confidence interval (CI) 1.25 to 91.41). Medial meniscus statistically tended to develop cyst compared with lateral meniscus and OR was 7.92 (95% confidence interval (CI) 1.23 to 51.07). Patients who have instability (side-to-side difference of knee arthrometer > 3mm) are more likely to develop cysts than that ofless than or equal to 3mm (p = 0.06). Conclusion: This study revealed the risk factors and prevalence rate for cyst formation after using the all-inside meniscal suture device. The prevalence rate of cyst formation around suture implant was 29%, however most cases didn’t have any symptoms. Suture device only and medial meniscus were significant risk factors for cyst formation. Knee instability was greater in the cyst developed menisci though it was not significant, which suggested that knee instability could affect cyst formation around suture anchors.
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Otsuki, Shuhei, Kosuke Nakagawa, Tomohiko Murakami, Shunsuke Sezaki, Hideki Sato, Masakazu Suzuki, Nobuhiro Okuno, Hitoshi Wakama, Kunihiro Kaihatsu, and Masashi Neo. "Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold." American Journal of Sports Medicine 47, no. 8 (June 7, 2019): 1804–15. http://dx.doi.org/10.1177/0363546519850578.
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Background: Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. Purpose: To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. Study Design: Controlled laboratory study. Methods: The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. Results: Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. Conclusion: Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. Clinical Relevance: This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
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Ichinohe, S., M. Yoshida, H. Murakami, H. Takayama, S. Izumiyama, and T. Shimamura. "Meniscal Tearing after ACL Reconstruction." Journal of Orthopaedic Surgery 8, no. 1 (June 2000): 53–59. http://dx.doi.org/10.1177/230949900000800110.
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The knees of 72 patients with unilateral anterior-cruciate-ligament (ACL) injury were analyzed before ACL reconstruction as well as by follow-up arthroscopy on the day of staple removal. At ACL reconstruction 31 lateral menisci and 40 medial menisci were found to be normal. 28 lateral menisci and 24 medial menisci were treated surgically, while 13 lateral menisci and 8 medial menisci with small or incomplete meniscal tearing were not treated. At follow-up arthroscopy there were 3 new cases of lateral meniscal tearing and 3 new cases of medial meniscal tearing in the groups diagnosed as normal prior to surgery. Two of the 13 cases with small or incomplete lateral meniscal tearing required resection, 8 healed and the other 3 demonstrated no progressive change. Four of the 8 cases with small or incomplete medial meniscal tears healed, 3 exhibited no progressive change and one required surgical treatment. There was no correlation between meniscal tearing and knee instability as indicated by a positive Lachman test or a positive pivot shift sign. The results of the present study indicate that ACL reconstruction prevents progressive changes in meniscal tears and will prevent secondary osteoarthritis, and that some small tears of the lateral meniscus require no surgical treatment.
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Yamasaki, Shinya, Yusuke Hashimoto, Yohei Nishida, Takanori Teraoka, Shozaburo Terai, Junsei Takigami, and Hiroaki Nakamura. "Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair." American Journal of Sports Medicine 48, no. 4 (March 2020): 853–60. http://dx.doi.org/10.1177/0363546520904680.
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Background: Although the sensitivity and specificity of magnetic resonance imaging (MRI) for the diagnosis of primary meniscal tears are high, these values are lower for the assessment of healing status of repaired menisci. Purpose: To compare the accuracy of MRI T2 mapping and conventional MRI in assessing meniscal healing after repair. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent meniscal repair with concurrent anterior cruciate ligament reconstruction between 2012 and 2016 and had a follow-up second-look arthroscopy were enrolled. The patients were divided into healed and incompletely/not healed groups based on the second-look arthroscopy findings. For the repaired menisci, the following were compared between the groups, (1) Stoller and Crues classification on conventional MRI with a proton density-weighted fat-saturated sequence and (2) the remaining colored meniscal tear line on T2 mapping coincident with the high signal line showing the primary tear on conventional MRI were compared. The change of T2 relaxation time (ΔT2) of the colored meniscal tear line pre- to postoperatively was compared between the groups. The mean T2 relaxation time of the whole area of the postoperative meniscus at each slice was also compared with that of control menisci to assess the whole quality of the repaired meniscus. Results: A total of 26 menisci from 24 knees were assessed (16 healed menisci, 10 incompletely/not healed menisci). According to the Crues classification on conventional MRI, 8 of 16 healed menisci and 3 of 10 incompletely/not healed menisci improved from grade 3 to 2, with there being no significant difference between the groups ( P = .43). However, the colored meniscal tear line remained in only 3 of the 16 healed menisci as compared with 9 of the 10 incompletely/not healed menisci, and the presence of this colored line allowed differentiation between healed menisci and incompletely/not healed menisci (sensitivity, 81.3%; specificity, 90.0%; odds ratio, 39.0; P = .001). The mean (SD) ΔT2 was −31.1 ± 3.2 and −19.9 ± 4.4 ms in the healed and incompletely/not healed groups, respectively ( P < .001). Receiver operating characteristic curve analysis showed a cutoff ΔT2 value of −22.3 ms for separation of meniscal healing ( P < .001). The T2 relaxation times of the whole area of the repaired menisci were 31.7 ± 3.4 and 32.8 ± 3.8 ms in the healed and incompletely/unhealed groups, respectively ( P = .69), with these values being significantly longer than the 26.9 ± 2.2 ms in the controls ( P < .001). Conclusion: MRI T2 mapping allowed the differentiation of healing status after meniscal repair, with high sensitivity and specificity as compared with conventional MRI.
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Shea, Kevin G., Peter C. Cannamela, Peter D. Fabricant, Allen F. Anderson, John D. Polousky, Elizabeth B. Terhune, Matthew D. Milewski, and Theodore J. Ganley. "Anatomic all-epiphysial tibial tunnels for anterior cruciate ligament reconstruction in skeletally immature knees may be placed without damaging the anterior meniscus root." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 3, no. 1 (January 2018): 3–7. http://dx.doi.org/10.1136/jisakos-2017-000177.
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ObjectivesThe purpose of this study was to evaluate the spatial relationship of the anterior horns of the menisci and the tibial tunnel during all-epiphysial drilling of skeletally immature specimens and identify any iatrogenic damage or destabilisation to the meniscus and meniscal root.MethodsFour skeletally immature cadaveric knee specimens (aged 9–11 years) were used to create three-dimensional models from CT images. All-epiphysial anterior cruciate ligament (ACL) tibial tunnel drilling was performed in 14 specimens (aged 7–11 years), entering the joint surface at the ACL footprint and avoided the proximal tibial physis. The anterior meniscal roots and horns were closely inspected visually and probed for stability, prior to drilling. After drilling, the meniscus and attachment points were re-evaluated for damage to the meniscus, meniscus root and probed to evaluate for destabilisation.ResultsAll-epiphysial tunnels entered the joint at the anatomic ACL tibial footprint. Direct visual inspection of the menisci demonstrated an absence of damage to either meniscus or anterior horn regions in all specimens. Probing and traction of the medial and lateral meniscal tissue did not demonstrate evidence of instability or destabilisation of the anterior horn or meniscus root before or after drilling. All tunnels were circumferentially intact at the joint surface, with no evidence of superior tunnel perforation due to shallow tunnel angle.ConclusionIn this study, tunnel placement did not produce damage to either meniscus, nor noticeably destabilise the meniscal roots. This study also demonstrated that drill holes can be placed within the ACL footprint without entering the joint on the proximal tibia surface anterior to the ACL attachment, although the ‘safe zone’ for drill hole placement is limited. All-epiphysial ACL tibial tunnels can create a large aperture at the tibial joint surface, but these tunnels can be placed at the anatomic footprint of the ACL, without causing gross anterior medial or lateral meniscus horn or root injury.
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Salman Alhassan, Mohammed. "Radiological incidence of meniscus and knee injury in ACL tear." MOJ Sports Medicine 3, no. 2 (April 8, 2019): 20–21. http://dx.doi.org/10.15406/mojsm.2019.03.00073.
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Although data demonstrate the ability of the menisci to transmit load, they do not contribute to the primary stability of the knee. In absence of ACL, the menisci have shown to enhance the knee's stability in AP, varus-valgus, internal-external direction in vitro. The importance of addressing meniscal pathology associated with anterior cruciate ligament (ACL) insufficiency stems from the increased incidence of meniscal tear with chronic instability. Most of the studies showed Lateral meniscus injury with acute ACL tear
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Vuong, Brian, Nicole Segovia, Sahej Randhawa, Sunny Trivedi, Emily Tran, Theodore Ganley, Henry Ellis, Philip Wilson, Peter Fabricant, and Kevin Shea. "GROWTH OF THE PEDIATRIC KNEE MENISCUS: A CADAVERIC STUDY." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (July 1, 2021): 2325967121S0005. http://dx.doi.org/10.1177/2325967121s00053.
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Background: The menisci of the knee play a critical role in maintaining structural integrity, as well as in load bearing and shock absorption. In adolescent patients, meniscal tear is a very common sports injury, and is frequently associated with concomitant traumatic injuries including tibial eminence fracture or ACL tear. The incidence of pediatric meniscal tears is increasing, and anatomic studies to guide repair, saucerization and transplantation do not exist. Hypothesis/Purpose: This study’s purpose was to evaluate meniscus dimensions in the developing meniscus and provide anatomic parameters for repair, saucerization, resection, transplantation. Methods: From images of 29 dissected cadaveric knee specimens between 1 month and 132 months of age obtained on a copy stand (14 left knee, 15 right knee), we made direct length measurements from the inner to outer meniscus rim at 45 degree intervals (12, 1:30/10:30, 3:00/9:00, 4:30/7:30 o’clock, 6 o’clock) using Autodesk Fusion 360 software (Figure 1.1). We also measured width between the outer medial and lateral meniscus rims, as well as CT measurements of coronal and sagittal width of the tibial plateau using OsiriX DICOM software. Generalized linear models were used to evaluate the associations of meniscal length measurements with age, tibial width, and meniscal width measurements. All statistical analyses were completed with a two-sided level of significance of 0.05. Results: All radial length measurements were predicted to increase significantly with age (p < 0.01), as coronal tibial width increases (p < 0.05), and as lateral-medial meniscal width increases (p < 0.001) (Figure 1.2). Other than the lateral 3 o’clock measurement (p = 0.119), all radial measurements were predicted to increase significantly as sagittal tibial width increases (p < 0.05). The posterior zones of the medial meniscus (6:00, 4:30/7:30) were found to increase in radial length at a faster rate than the anterior zones. The anterior zones of the medial meniscus (12:00, 1:30/10:30) had the slowest rate of growth. Discussion/Conclusion: Meniscus radial length is related to age, tibial plateau width, and lateral-medial meniscus width. Radial dimensions from normal lateral menisci may allow the surgeon to obtain ideal size of resection, saucerization of discoid menisci. The growth of medial meniscus posterior zones is greater than the anterior zones. This may be attributed to increased posterior region load bearing which increases with ambulation in the developing child. Improved anatomic understanding may help surgeons plan for discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation. [Figure: see text][Figure: see text]
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Xie, Jing, Demao Zhang, Yunfeng Lin, Quan Yuan, and Xuedong Zhou. "Anterior Cruciate Ligament Transection–Induced Cellular and Extracellular Events in Menisci: Implications for Osteoarthritis." American Journal of Sports Medicine 46, no. 5 (March 7, 2018): 1185–98. http://dx.doi.org/10.1177/0363546518756087.
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Background: The meniscus plays an important role in knee joint diseases such as osteoarthritis (OA). Meniscal injuries can be accompanied by joint catabolic events initiated by inflammation, leading to articular cartilage destruction, but the cellular events responsible for intrinsic meniscal injury and the extracellular matrix changes necessary for meniscal degradation are not well known. Purpose: To explore the cellular and matrix-related changes of menisci based on a mouse OA model of anterior cruciate ligament transection (ACLT). Study Design: Controlled laboratory study. Methods: A mouse ACLT OA model was established by transection of anterior cruciate ligaments on the right knee joints of 8-week-old male (n = 34) and female (n = 34) C57 mice. The knee joints were collected at 1, 2, 4, and 8 weeks after ACLT surgery, and the meniscal changes were analyzed by radiography, histology, immunohistochemistry, immunoblot, and quantitative real-time polymerase chain reaction. Results: The deterioration of menisci was more extensive than that of articular cartilage and subchondral bone at 4 weeks after ACLT surgery. The rapid loss of collagen II and Sox9 in chondrocyte-like cells in the white-white zone of menisci was confirmed, and the activation of potential meniscus progenitor cells and chondroblasts was identified based on the increase of CD90, CD105, and Runx2. Further, the intrinsic inflammation in the bone marrow–like zone of menisci was activated by enhancement of dendritic cells (CD11c+), T cells (CD3+), and macrophages (F4/80+) with the increase of the inflammatory factors interleukin 1β and tumor necrosis factor α. Finally, the extracellular matrix events involving changes in chemokines, increases of matrix proteases (matrix metalloproteinases and ADAMTS5), and decreases of lysyl oxidase family were elucidated. Conclusion: ACLT-induced meniscal changes not only could explain the contribution of the meniscus to the progress of OA but also could provide a cue for initiation of preventive treatments in the early stages of OA. Clinical Relevance: This study provides support for better protection of menisci in ACL injury–induced conditions such as OA and indicates that menisci should be considered in the development of clinical pharmacological interventions.
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Okazaki, Yuki, Takayuki Furumatsu, Yuya Kodama, Yoshinori Matsumoto, Motoki Takahashi, and Toshifumi Ozaki. "Medial and Lateral Meniscus Posterior Root Tears with an Intact Anterior Cruciate Ligament." Case Reports in Orthopedics 2020 (July 18, 2020): 1–5. http://dx.doi.org/10.1155/2020/8842167.
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Background. Medial meniscus (MM) posterior root tear (PRT) is often caused by meniscal degeneration, whereas lateral meniscus (LM) PRT is mainly caused by trauma, especially trauma associated with anterior cruciate ligament (ACL) injuries. Although there are a few reports on PRTs of both menisci with an ACL injury, to our knowledge, there is no report on those with an intact ACL. Thus, the purpose of this study was to describe a rare case of both meniscal PRTs with an intact ACL. Case Presentation. A 67-year-old woman complained of right knee pain during weeding in a deep knee flexion position. At presentation, three days after the injury, physical examination revealed signs of meniscal injury without ACL rupture. Magnetic resonance imaging showed PRTs of both menisci and damaged cartilage, especially on the medial femoral condyle and lateral tibial plateau. MM was sutured using the FasT-Fix dependent modified Mason-Allen suture technique, and LM by a single simple stitch using the Knee Scorpion suture passer. Referring to previous cadaveric studies, transtibial pullout repair using a single tibial tunnel for MM fixation was performed. The stability of the repaired menisci was checked by probing during second-look arthroscopy at one year after the primary surgery, and no meniscal signs and symptoms were present at the last follow-up one year after the surgery. Conclusions. This rare case showed PRTs of both menisci with an intact ACL. We speculated that, in this case, both roots tore because of the degenerative menisci. A good clinical outcome was achieved after single-transtibial pullout repair. This technique may be an effective surgical approach for PRTs of both menisci.
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Devaraj, Ashwin Kumar, Kiran Kumar V. Acharya, and Raviraja Adhikari. "Experimental and Finite Element Investigations on the Biomechanical Effects of Meniscal Tears in the Knee Joint: A Review." Journal of Biomimetics, Biomaterials and Biomedical Engineering 50 (April 2021): 1–14. http://dx.doi.org/10.4028/www.scientific.net/jbbbe.50.1.
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The knowledge of the complex biomechanical behaviour of the injured knee joints is of paramount importance in various clinical situations. A review of the biomechanical effects of meniscal tears based on experimental and finite element analysis has not been reported in the literature. The objective of this study is to present a review of experimental and finite element investigations on the consequences of meniscal tears such as longitudinal, radial, horizontal cleavage and root tears in the medial and lateral menisci. It is found that larger longitudinal tear in the medial meniscus has a significant impact on the magnitude of strain in the meniscus associated with a dramatic increase in CP in the tibial cartilage. Also, the untreated fragment of the torn meniscus leads to a significant rise in contact pressure in the cartilage resulting in the progressive degeneration of the cartilage surface. The radial tears in the lateral meniscus of more than 66% width and those in the medial meniscus of more than 75% width result in a substantial increase in the contact pressure in the cartilage compared to that in the intact knee joint. The root tears in the menisci demonstrate a significant influence on the biomechanical response of the knee joint. The results of finite element analysis studies are compared with experimental findings. Finally, some recommendations for future work are proposed to predict the realistic biomechanical response of the knee joints with meniscal tears. The results of this study present a rationale that could help surgeons in making clinical decisions when managing patients with meniscal tears.
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Bryceland, James Kevin, Andrew John Powell, and Thomas Nunn. "Knee Menisci." CARTILAGE 8, no. 2 (July 7, 2016): 99–104. http://dx.doi.org/10.1177/1947603516654945.
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The menisci of the knees are semicircular fibrocartilaginous structures consisting of a hydrophilic extracellular matrix containing a network of collagen fibers, glycoproteins, and proteoglycans maintained by a cellular component. The menisci are responsible for more than 50% of load transmission across the knee and increase joint congruity thereby also aiding in fluid film lubrication of the joint. In the United Kingdom, meniscal tears are the most common form of intra-articular knee injury and one of the commonest indications for orthopedic intervention. The management of these injuries is dependent on the location within the meniscus (relative to peripheral blood supply) and the pattern of tear. Removal of meniscus is known to place the knee at increased risk of osteoarthritis; therefore repair of meniscal tears is preferable. However, a significant proportion of tears are irreparable and can only be treated by partial or even complete meniscectomy. More recent studies have shown encouraging results with meniscal replacement in this situation, though further work is required in this area.
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Fedje-Johnston, William, Ferenc Tóth, Melissa Albersheim, Cathy S. Carlson, Kevin G. Shea, Aaron Rendahl, and Marc Tompkins. "Changes in Matrix Components in the Developing Human Meniscus." American Journal of Sports Medicine 49, no. 1 (November 25, 2020): 207–14. http://dx.doi.org/10.1177/0363546520972418.
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Background: Treatment of meniscal tears is necessary to maintain the long-term health of the knee joint. Morphological elements, particularly vascularity, that play an important role in meniscal healing are known to change during skeletal development. Purpose: To quantitatively evaluate meniscal vascularity, cellularity, collagen, and proteoglycan content by age and location during skeletal development. Study Design: Descriptive laboratory study. Methods: Medial and lateral menisci from 14 male and 7 female cadavers aged 1 month to 11 years were collected and evaluated. For each meniscus, histologic and immunohistologic techniques were used to establish the ratio of the area of proteoglycan (safranin O) positivity to the total area (proteoglycan ratio), collagen type I and type II immunostaining positivity, number of blood vessels, and cell density. These features were evaluated over the entire meniscus and also separately in 5 circumferential segments: anterior root, anterior horn, body, posterior horn, and posterior root. Additionally, cell density and number of blood vessels were examined in 3 radial regions: inner, middle, and periphery. Results: Age was associated with a decrease in meniscal vessel count and cell density, while the proteoglycan ratio increased with skeletal maturity. Differences in vessel counts, cellular density, and proteoglycan ratio in different anatomic segments as well as in the inner, middle, and peripheral regions of the developing menisci were also observed. Collagen immunostaining results were inconsistent and not analyzed. Conclusion: The cellularity and vascularity of the developing meniscus decrease with age and the proteoglycan content increases with age. All of these parameters are influenced by location within the meniscus. Clinical Relevance: Age and location differences in meniscal morphology, particularly in the number of blood vessels, are expected to influence meniscal healing.
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Djurasovic, Mladen, John W. Aldridge, Robert Grumbles, Melvin P. Rosenwasser, David Howell, and Anthony Ratcliffe. "Knee Joint Immobilization Decreases Aggrecan Gene Expression in the Meniscus." American Journal of Sports Medicine 26, no. 3 (May 1998): 460–66. http://dx.doi.org/10.1177/03635465980260032101.
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Aggrecan is the major proteoglycan of the meniscus, and its primary function is to give the meniscus its viscoelastic compressive properties. The objective of this study was to determine the effect of joint immobilization on aggrecan gene expression in the meniscus. The right hindlimbs of six mature beagles were knee cast-immobilized in 90° of flexion and supported by a sling to prevent weightbearing, while the contralateral limb was left free to bear weight. The animals were sacrificed at 4 weeks, and the anterior and posterior halves of the medial and lateral menisci were analyzed separately. Analysis of aggrecan gene expression by quantitative polymerase chain reaction showed decreased aggrecan gene expression in menisci from immobilized knees (P 0.01, two-way analysis of variance). Aggrecan gene expression decreased by a factor of 2 to 5.5 in the different regions examined. Analysis of the composition of the meniscus also showed decreased proteoglycan content and increased water content with immobilization (P 0.05, two-way analysis of variance). These results show that joint immobilization can significantly affect meniscal cellular activity and composition and can therefore potentially affect meniscal function.
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Yao, Jiang, Jason Snibbe, Michael Maloney, and Amy L. Lerner. "Stresses and Strains in the Medial Meniscus of an ACL Deficient Knee under Anterior Loading: A Finite Element Analysis with Image-Based Experimental Validation." Journal of Biomechanical Engineering 128, no. 1 (September 14, 2005): 135–41. http://dx.doi.org/10.1115/1.2132373.
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The menisci are believed to play a stabilizing role in the ACL-deficient knee, and are known to be at risk for degradation in the chronically unstable knee. Much of our understanding of this behavior is based on ex vivo experiments or clinical studies in which we must infer the function of the menisci from external measures of knee motion. More recently, studies using magnetic resonance (MR) imaging have provided more clear visualization of the motion and deformation of the menisci within the tibio-femoral articulation. In this study, we used such images to generate a finite element model of the medial compartment of an ACL-deficient knee to reproduce the meniscal position under anterior loads of 45, 76, and 107N. Comparisons of the model predictions to boundaries digitized from images acquired in the loaded states demonstrated general agreement, with errors localized to the anterior and posterior regions of the meniscus, areas in which large shear stresses were present. Our model results suggest that further attention is needed to characterize material properties of the peripheral and horn attachments. Although overall translation of the meniscus was predicted well, the changes in curvature and distortion of the meniscus in the posterior region were not captured by the model, suggesting the need for refinement of meniscal tissue properties.
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Abumandour, Mohamed M. A., Naglaa Fathi Bassuoni, Samir El-Gendy, Ashraf Karkoura, and Raafat El-Bakary. "Comparative Morphological Studies of the Stifle Menisci in Donkeys, Goats and Dogs." Journal of Morphological Sciences 36, no. 02 (April 17, 2019): 072–84. http://dx.doi.org/10.1055/s-0039-1685487.
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AbstractThe present work aims to provide more anatomical information on the stifle joint of the investigated species using computed tomography with gross anatomical cross-sections. The current work analyzed the stifle joint of the pelvic limbs of 12 adult donkeys, goats and dogs of both genders. The medial condyle of the femur was larger than the lateral one in the donkey, while it was smaller and lower than the lateral one in the goat and in the dog. The unsuitable femoral and tibial condyles were adapted by the presence of menisci. In the donkey, the medial meniscus was crescentic in shape, but it was semicircular in the goat, while in the dog, the medial and lateral menisci were C-shaped. In the donkey, the medial meniscus was larger than the lateral one, but in the goat and in the dog, the lateral meniscus was the largest, and more concave and thicker. The lateral meniscus was semicircular in the donkey, but it was shaped like an elongated kidney in the goat. In the goat and in the dog, the central border of two menisci was thin, concave and notched centrally. The meniscal ligaments included cranial and caudal ligaments of the medial and lateral menisci, and meniscofemoral ligament of the lateral meniscus. In the dog, the cranial ligament of the medial meniscus was absent, and the medial meniscus had no bony attachment to the tibia but it attached to the transverse intermeniscal ligament, which connected the cranial horn of the medial meniscus with the cranial ligament of the lateral meniscus. The meniscofemoral ligament connected the caudal pole of the lateral meniscus with the intercondyloid fossa of the femur.
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Rohila, Jyoti, Suresh Kanta Rathee, Suresh Kumar Dhattarwal, and Zile Singh Kundu. "Morphometric analysis of menisci of adult human knee joint in North Indian population." International Journal of Research in Medical Sciences 5, no. 2 (January 23, 2017): 569. http://dx.doi.org/10.18203/2320-6012.ijrms20170154.
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Background: Of the synovial joints in the body knee joint is the largest. Each meniscus is a piece of fibrocartilage with a thickened outside edge and a thin inner edge so that it is wedge-shaped in cross section. The purpose of the present study was to establish database on standard dimensions in knee menisci of adults of north Indian population.Methods: The sample for this study was collected from April, 2012 to June, 2013. For this study, 200 menisci (100 right and left each) of 50 adult humans were taken for analysis. Measurements were done with the help of non-elastic thread and digital vernier calipers. All dissections were performed in a systematic fashion.Results: The width of the lateral meniscus was significantly different form medial meniscus with lateral and medial menisci widest in middle and posterior third respectively. The middle one third of both lateral and middle menisci was the thickest.Conclusions: It is always good to have a set of anatomical morphometric parameters of the menisci like the width and thickness. The measurements of suitable grafts may provide a more acceptable meniscal replacement in the future.
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Merkely, Gergo, Tom Minas, Takahiro Ogura, Jakob Ackermann, Alexandre Barbieri Mestriner, and Andreas H. Gomoll. "Safety, Feasibility, and Radiographic Outcomes of the Anterior Meniscal Takedown Technique to Approach Chondral Defects on the Tibia and Posterior Femoral Condyle: A Matched Control Study." CARTILAGE 12, no. 1 (October 31, 2018): 62–69. http://dx.doi.org/10.1177/1947603518809409.
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Objective Takedown of the anterior meniscus to facilitate exposure of the cartilage defects located on the tibial plateau and/or posterior femoral condyle with subsequent reattachment is being performed clinically; however, clinical evidence is lacking to support the safety of this technique. The aim of this study was therefore to investigate whether meniscal extrusion develops after patients undergo meniscus takedown and transosseous refixation during autologous chondrocyte implantation (ACI). Design We analyzed data from 124 patients with a mean follow-up of 6.8 ± 2.5 years. Sixty-two patients who underwent (ACI) with anterior meniscus takedown and refixation by the senior surgeon (TM), were compared with a matched control group of patients who underwent ACI without meniscus takedown. Meniscal extrusion was investigated by measuring the absolute value and the relative percentage of extrusion (RPE) on 1.5-T magnetic resonance images (MRI) at final follow-up. The number of menisci with radial displacement greater or lesser than 3 mm was determined. In cases where a preoperative MRI was available, both pre- and postoperative meniscal extrusion was evaluated ( n = 30) in those patients undergoing meniscal takedown. Results There was no significant difference in either absolute meniscus extrusion, RPE, or extrusion rate in patients with and without meniscus takedown. Among patients with meniscal takedown and both pre- and postoperative MRI scans, absolute meniscus extrusion, RPE, and extrusion rate showed no significant differences. Conclusion Meniscal takedown and subsequent transosseous refixation is a safe and effective technique for exposure of the tibial plateau and posterior femoral condyle.
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Kaya, Alper, Tekin Kerem Ülkü, Barış Kocaoğlu, Hüseyin Arel Gereli, and Burak Akan. "Arthroscopic Repair of Horizontal Meniscus Tears by Vertical Sutures With Packing Technique." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0026. http://dx.doi.org/10.1177/2325967114s00262.
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Objectives: The aim of this study is to report short term results of arthroscopic repair of horizontal meniscus tears by vertical sutures with packing technique Methods: Seventeen patients with an average age of 33 years were treated. Repair was performed to the patients that horizontal component of the tear extends into the capsular zone of the meniscus after excision of the unstable, central or flap components of the tears. The repair was performed after rasping and trephination, with vertical sutures that one leg of the suture is on the superior surface of the menisci and the other leg of the suture is under the inferior surface of the menisci by inside-out technique using the zone-specific curved canulas and all-inside technique using all inside meniscal devices. 9 medial and 8 lateral meniscus tears were treated. Results: Evaluation was performed by Lysholm functional knee scores. All patients were followed clinically and radiological by means of MRI to assess meniscus integrity at the repair site with an average follow-up of 12 months. MRI showed a healed meniscus at the repair sites in only five cases (29%) but with no further disruption of the tear components and osteoarthritic changes in all cases. Mean of Lysholm scores improved from 58 preoperatively to 92 postoperatively that was found statistically significant. Conclusion: Repairing of horizontal meniscus tears that extend into capsular zone instead of resection improves activity level and prevents meniscal loss.
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Wu, Jinglei, Jiazhu Xu, Yihui Huang, Liping Tang, and Yi Hong. "Regional-specific meniscal extracellular matrix hydrogels and their effects on cell–matrix interactions of fibrochondrocytes." Biomedical Materials 17, no. 1 (December 23, 2021): 014105. http://dx.doi.org/10.1088/1748-605x/ac4178.
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Abstract Decellularized meniscal extracellular matrix (ECM) material holds great potential for meniscus repair and regeneration. Particularly, injectable ECM hydrogel is highly desirable for the minimally invasive treatment of irregularly shaped defects. Although regional-specific variations of the meniscus are well documented, no ECM hydrogel has been reported to simulate zonally specific microenvironments of the native meniscus. To fill the gap, different (outer, middle, and inner) zones of porcine menisci were separately decellularized. Then the regionally decellularized meniscal ECMs were solubilized by pepsin digestion, neutralized, and then form injectable hydrogels. The hydrogels were characterized in gelation behaviors and mechanical properties and seeded with bovine fibrochondrocytes to evaluate the regionally biochemical effects on the cell–matrix interactions. Our results showed that the decellularized inner meniscal ECM (IM) contained the greatest glycosaminoglycan (GAG) content and the least collagen content compared with the decellularized outer meniscal ECM (OM) and middle meniscal ECM (MM). The IM hydrogel showed lower compressive strength than the OM hydrogel. When encapsulated with fibrochondrocytes, the IM hydrogel accumulated more GAG, contracted to a greater extent and reached higher compressive strength than that of the OM hydrogel at 28 days. Our findings demonstrate that the regionally specific meniscal ECMs present biochemical variation and show various effects on the cell behaviors, thus providing information on how meniscal ECM hydrogels may be utilized to reconstruct the microenvironments of the native meniscus.
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Grogan, Shawn P., Jihye Baek, and Darryl D. D'Lima. "Meniscal tissue repair with nanofibers: future perspectives." Nanomedicine 15, no. 25 (October 2020): 2517–38. http://dx.doi.org/10.2217/nnm-2020-0183.
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The knee menisci are critical to the long-term health of the knee joint. Because of the high incidence of injury and degeneration, replacing damaged or lost meniscal tissue is extremely clinically relevant. The multiscale architecture of the meniscus results in unique biomechanical properties. Nanofibrous scaffolds are extremely attractive to replicate the biochemical composition and ultrastructural features in engineered meniscus tissue. We review recent advances in electrospinning to generate nanofibrous scaffolds and the current state-of-the-art of electrospun materials for meniscal regeneration. We discuss the importance of cellular function for meniscal tissue engineering and the application of cells derived from multiple sources. We compare experimental models necessary for proof of concept and to support translation. Finally, we discuss future directions and potential for technological innovations.
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Wu, W. Howard, Thomas Hackett, and John C. Richmond. "Effects of Meniscal and Articular Surface Status on Knee Stability, Function, and Symptoms after Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 30, no. 6 (November 2002): 845–50. http://dx.doi.org/10.1177/03635465020300061501.
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Background Concomitant injuries to secondary structures have been proposed as a major cause of failure of anterior cruciate ligament reconstruction. Purpose Our purpose was to determine the relationship between meniscal status at the time of anterior cruciate ligament reconstruction and ultimate long-term function and stability. Study Design Prospective cohort study. Methods We prospectively studied 63 patients for an average of 10.4 years after arthroscopically assisted bone-patellar tendon-bone anterior cruciate reconstruction. All surgeries were performed between 1988 and 1991; concomitant meniscal surgery was performed if necessary. Subjects were divided into subgroups relative to the integrity of their menisci at the end of the reconstruction procedure (intact meniscus, partial meniscectomy, complete meniscectomy). Results Patients who had undergone any degree of meniscal resection reported significantly more subjective complaints and activity limitations than those with intact menisci. Subjective International Knee Documentation Committee and Lysholm scores were lower in the meniscectomy subgroups than in the meniscus-intact group. Objective testing revealed a significantly lower ability to perform the single-legged hop in the meniscectomy subgroups. Ligament stability based on instrumented laxity measurements was not significantly different between the subgroups. Radiographic abnormalities were also more common in the subgroups that had undergone meniscectomy. Conclusions The menisci should be repaired if at all possible, especially in the setting of anterior cruciate ligament reconstruction, for optimal functional outcome and patient satisfaction.
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van Trommel, Michiel F., Peter T. Simonian, Hollis G. Potter, and Thomas L. Wickiewicz. "Different Regional Healing Rates with the Outside-In Technique for Meniscal Repair." American Journal of Sports Medicine 26, no. 3 (May 1998): 446–52. http://dx.doi.org/10.1177/03635465980260031901.
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Fifty-one patients with meniscal repair using the outside-in technique were reassessed with second-look arthroscopic procedures (N 15), arthrographic examination (N 41), magnetic resonance imaging (N 36), or a combination of these techniques. Forty-one medial and 10 lateral menisci were repaired. The average clinical follow-up was 15 months (range, 3 to 80). Forty-five of 51 patients had tears that were located in or extended into the posterior horn of the medial or lateral meniscus. Complete healing occurred in 23 menisci (45%), partial healing was observed in 16 (15 medial, 1 lateral) (32%), and no healing occurred in 12 (24%). Remarkably, in all 15 patients who had tears extending from the posterior to the middle third of the medial meniscus that were partially healed, it was always the posterior third that had not fully healed. This finding is statistically significant. In addition, the middle third of these menisci had not fully healed in five patients. No healing occurred in the two patients with tears in the posterior third of the medial meniscus. Poor healing with the outside-in technique was observed in patients with tears into the posterior horn of the medial meniscus. For tears in the middle and anterior portion of the medial meniscus, as well as all lateral meniscus tears, the outside-in technique is our current method of choice.
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Güney, Ahmet, Ali Saltuk Argün, Murat Kahraman, İbrahim Kafadar, and Ökkeş Bilal. "Arthroscopic Repair of Separation of Anterior Intermeniscal Ligament." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0020. http://dx.doi.org/10.1177/2325967114s00201.
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Objectives: Aim of this article is to present and discuss a patient with separation of anterior intermeniscal ligament which was repaired arthroscopically. Methods: Anterior intermeniscal ligament (AIML) (transverse geniculate ligament or anterior transvers ligament) is an intraarticular structure connecting anterior convex edge of lateral meniscle to anterior tip of medial meniscle; limits anterior movement of menisci during extension and prevents pressure application of condylar surfaces onto menisci; and also limits anterior-posterior separation of anterior horn of medial meniscus during low degrees of flexion. AIML was found in 69 to 94 percent in different studies. Results: A thirty-eight year-old female patient referred our clinic with complaints of pain in right knee for a year that responds to pain killers, increasing with climbing stairs and decreasing with rest. Synovium origined mass was seen on MRI with contrast applied after an intraarticular mass seen on MRI. She undervent surgery and the mass in the medial of joint space considered as pigmented villonodular sinovitis was resected arthroscopically. During arthroscopy, separation of anterior marge of AIML and elevation of anterior horns of both medial and lateral were noticed. Using no 1 PDS suture AIML was pulled downwards from anterior marge and fixed. After fixation AIML and anterior horns of menisci replaced on tibial plateu again. Conclusion: As injuries of AIML which has an important role at stabilization of menisci during knee motions are seen very rarely, freuquency of AIML was reported 9.75 percent in a cadaver study and 75 percent of them was accompanied by medial meniscal tear. We could not find any other clinical study reporting AIML injury in the literature. As we apply arthroscopical intervention in order to resect intraarticular mass considered as pigmented villonodular synovitis, anterior separation of AIML and elevation of anterior horn of both menisci were noticed coincidentally and then were repaired. As the arthroscopical evaluation due to injuries of intraarticular structures is performed, AIML should also be evaluated, if necessary, repair should be performed in order to obtain stabilization of anterior horns of menisci.
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Herrera Millar, Valentina Rafaela, Laura Mangiavini, Umberto Polito, Barbara Canciani, Van Thi Nguyen, Federica Cirillo, Luigi Anastasia, Giuseppe Maria Peretti, Silvia Clotilde Modina, and Alessia Di Giancamillo. "Hypoxia as a Stimulus for the Maturation of Meniscal Cells: Highway to Novel Tissue Engineering Strategies?" International Journal of Molecular Sciences 22, no. 13 (June 27, 2021): 6905. http://dx.doi.org/10.3390/ijms22136905.
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The meniscus possesses low self-healing properties. A perfect regenerative technique for this tissue has not yet been developed. This work aims to evaluate the role of hypoxia in meniscal development in vitro. Menisci from neonatal pigs (day 0) were harvested and cultured under two different atmospheric conditions: hypoxia (1% O2) and normoxia (21% O2) for up to 14 days. Samples were analysed at 0, 7 and 14 days by histochemical (Safranin-O staining), immunofluorescence and RT-PCR (in both methods for SOX-9, HIF-1α, collagen I and II), and biochemical (DNA, GAGs, DNA/GAGs ratio) techniques to record any possible differences in the maturation of meniscal cells. Safranin-O staining showed increments in matrix deposition and round-shape “fibro-chondrocytic” cells in hypoxia-cultured menisci compared with controls under normal atmospheric conditions. The same maturation shifting was observed by immunofluorescence and RT-PCR analysis: SOX-9 and collagen II increased from day zero up to 14 days under a hypoxic environment. An increment of DNA/GAGs ratio typical of mature meniscal tissue (characterized by fewer cells and more GAGs) was observed by biochemical analysis. This study shows that hypoxia can be considered as a booster to achieve meniscal cell maturation, and opens new opportunities in the field of meniscus tissue engineering.
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Wesdorp, Marinus A., Susanne M. Eijgenraam, Duncan E. Meuffels, Sita M. A. Bierma-Zeinstra, Gert-Jan Kleinrensink, Yvonne M. Bastiaansen-Jenniskens, and Max Reijman. "Traumatic Meniscal Tears Are Associated With Meniscal Degeneration." American Journal of Sports Medicine 48, no. 10 (July 14, 2020): 2345–52. http://dx.doi.org/10.1177/0363546520934766.
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Background: Meniscal tears are traditionally classified into traumatic versus degenerative tears. Although this classification plays a major role in clinical decision making, no consensus exists on the exact definition of a traumatic or degenerative tear, and the histopathological basis for this classification is unclear. Purpose: To assess the histological degree of meniscal degeneration in patients with a traumatic meniscal tear, as compared with intact meniscal tissue and osteoarthritic meniscal tissue. Study Design: Descriptive laboratory study. Methods: Traumatically torn meniscal tissue was collected during arthroscopic partial meniscectomy. As a control group, intact meniscal tissue was used from transfemoral amputations or direct postmortem dissections. Meniscal tissue from osteoarthritic knees was obtained during total knee replacement surgery. Meniscal tissue was processed, stained, and histologically analyzed with the Pauli scoring system (range, 0-18), comprising the subdomains surface integrity, cellularity, collagen organization, and matrix staining. Scoring was performed by 2 independent observers, blinded to condition, region, and patient data of the meniscus. Results: The traumatic meniscal tear group contained 43 patients (34 men; median age, 29 years; median body mass index [BMI], 24 kg/m2); the intact meniscal tissue group, 8 patients (3 men; median age, 58 years; median BMI, 30 kg/m2); and the osteoarthritic group, 14 patients (4 men; median age, 66 years; median BMI, 28 kg/m2). After adjustment for sex, age, and BMI, patients with a traumatic meniscal tear had a significantly higher histological score than patients with intact meniscal tissue (2.7-point difference; P = .035). Histological score between the traumatic and osteoarthritic groups was not different. Conclusion: Traumatically torn menisci possess a higher degree of degeneration than intact menisci. Our results suggest that patients with a traumatic meniscal tear may already have had a certain degree of meniscal degeneration. These findings potentially challenge the classic view of traumatic versus degenerative meniscal tears. Clinical Relevance: Our findings provide a better understanding of the tissue condition of a torn meniscus. This knowledge may help clinicians decide on choice of treatment and may lead to new perspectives to prevent knee osteoarthritis in patients with a torn meniscus.
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Ristic, Vladimir, Mirsad Maljanovic, Ivan Mihajlov, Vukadin Milankov, and Vladimir Harhaji. "Concomitant injuries of anterior cruciate ligament and meniscus." Medical review 69, no. 7-8 (2016): 217–23. http://dx.doi.org/10.2298/mpns1608217r.
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Introduction. The aim of this study was to determine the correlation between meniscal injuries with injuries of the anterior cruciate ligament, as well as risk factors for those associated injuries. Material and Methods. This study included 496 operated patients. Almost half of patients with meniscal injury were between the ages of 21 and 30 years. Results. Meniscal injuries were diagnosed in 187 patients (38%). These patients were significantly older than the patients without meniscal injury. Meniscal injuries were significantly more frequent in patients who played sports recreationally than in professional athletes. The patients with meniscal injury underwent surgery almost four months later than the patients with preserved menisci. Meniscal injuries occurred significantly more frequently by non - contact mechanism, as a result of landing and sudden changes of direction and rhythm of running. Conclusion. Male patients hurt the medial meniscus more often, ?bucket handle? type of lesion being much more frequent than on the lateral meniscus. The increase of body mass index is exactly proportional to the increase in the incidence of meniscal injuries.
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Saavedra, Manuel, Matías Sepúlveda, María Jesús Tuca, and Estefanía Birrer. "Discoid meniscus: current concepts." EFORT Open Reviews 5, no. 7 (July 2020): 371–79. http://dx.doi.org/10.1302/2058-5241.5.190023.
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Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population. The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears. Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined. Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus. Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears. Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus. Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023
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Crawford, Matthew D., Justin E. Hellwinkel, Zachary Aman, Ramesses Akamefula, J. Thomas Singleton, Chelsea Bahney, and Robert F. LaPrade. "Microvascular Anatomy and Intrinsic Gene Expression of Menisci From Young Adults." American Journal of Sports Medicine 48, no. 13 (October 12, 2020): 3147–53. http://dx.doi.org/10.1177/0363546520961555.
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Background: Meniscal vascular supply is an important determinant of its healing potential. It has been reported that only the peripheral 30% of the meniscus is vascularized in cadavers aged 53 to 94 years; however, the vascularity in young patients, in whom meniscal repair is more often performed, is unknown. Purpose: The primary objective was to analyze and measure the microvascular anatomy of the meniscus in adult cadaveric specimens <35 years old. The secondary objective was to assess angiogenic potential by quantifying regional gene expression in a meniscal allograft cohort <45 years old. Study Design: Descriptive laboratory study. Methods: In part 1 of this study, 13 fresh-frozen cadaveric knees (age range, 22-34 years; mean, 28.5 years) underwent popliteal artery India ink injection and tissue clearing using a Spalteholz technique, followed by microvascular vascular measurement. In part 2, mRNA was isolated from 13 meniscal allografts (age range, 17-43 years; mean, 27.2 years), and expression of angiogenic genes, vascular endothelial growth factor ( VEGF), and vascular endothelial growth factor receptor 1 ( FLT1) was quantified using real-time polymerase chain reaction. Results: The maximal depth of vascular penetration into the periphery of the medial and lateral menisci ranged from 0% to 42% and 0% to 48%, respectively. There was variation in the degree of vascular penetration within the medial meniscus, with the posterior horn having a significantly smaller depth of penetration (median, 8.7%) than that of the anterior horn (median, 17.4%; P < .0001) or midbody (median, 17.5%; P = .0003). There were no differences in angiogenesis gene expression ( VEGF/ FLT1) based on circumferential or radial meniscal locations. Conclusion: The vascular supply of the medial and lateral menisci in specimens from adults <35 years of age extended farther than what was reported in specimens from older individuals; however, median values remained consistent. Gene expression of the angiogenic marker VEGF was low throughout all regions of uninjured menisci from young adults, which is consistent with reports in older specimens. Clinical Relevance: Improved understanding of meniscal vascular supply in young adults is critical to informing clinical treatment decisions.
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Hata, Yutaka, Syoji Kobashi, Katsuya Kondo, and Tomoharu Nakano. "Automated 3D Surface Display for Evaluating Meniscal Tears Aided by Fuzzy Expert System." Journal of Advanced Computational Intelligence and Intelligent Informatics 9, no. 1 (January 20, 2005): 70–79. http://dx.doi.org/10.20965/jaciii.2005.p0070.
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This paper proposes an automated procedure for segmenting menisci in MR images of a human knee aided by fuzzy expert system. A three-dimensional (3D) MR volumetric images composed of many slice images consists of several parts: bone marrow, meniscus, periarticular liquor, cartilage and others. We employ both T1-weighted and T2-weighted MR images to identify the menisci with high accuracy. After a registration between these images is manually done on a computer display, our procedure aided by fuzzy expert system can automatically segment meniscal regions from 3D MR images. Physicians can observe the 3D shapes of meniscal tears from any point of view on the display. We examined five subjects including a normal knee and three injured knees. The all meniscal regions were significantly identified, and these 3D shapes were displayed. The patterns of meniscal tears were identified on the display for all subjects. In a subject, since the preoperative and postoperative 3D meniscal shapes were clearly viewed, we easily recognized the operated meniscal regions. Thus, the system can provide useful information for diagnosing meniscal tears.
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Baek, Jihye, Kwang Il Lee, Ho Jong Ra, Martin K. Lotz, and Darryl D. D'Lima. "Collagen fibrous scaffolds for sustained delivery of growth factors for meniscal tissue engineering." Nanomedicine 17, no. 2 (January 2022): 77–93. http://dx.doi.org/10.2217/nnm-2021-0313.
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Aim: To mimic the ultrastructural morphology of the meniscus with nanofiber scaffolds coupled with controlled growth factor delivery to modulate cellular performance for tissue engineering of menisci. Methods: The authors functionalized collagen nanofibers by conjugating heparin to the following growth factors for sustained release: PDGF-BB, TGF-β1 and CTGF. Results: Incorporating growth factors increased human meniscal and synovial cell viability, proliferation and infiltration in vitro, ex vivo and in vivo; upregulated key genes involved in meniscal extracellular matrix synthesis and enhanced generation of meniscus-like tissue. Conclusion: The authors' results indicate that functionalizing collagen nanofibers can create a cell-favorable micro- and nanoenvironment and can serve as a system for sustained release of bioactive factors.
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Aidos, Lucia, Silvia Clotilde Modina, Valentina Rafaela Herrera Millar, Giuseppe Maria Peretti, Laura Mangiavini, Marco Ferroni, Federica Boschetti, and Alessia Di Giancamillo. "Meniscus Matrix Structural and Biomechanical Evaluation: Age-Dependent Properties in a Swine Model." Bioengineering 9, no. 3 (March 15, 2022): 117. http://dx.doi.org/10.3390/bioengineering9030117.
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The analysis of the morphological, structural, biochemical, and mechanical changes of the Extracellular Matrix (ECM), which occur during meniscus development, represents the goal of the present study. Medial fully developed menisci (FD, 9-month-old pigs), partially developed menisci (PD, 1-month-old piglets), and not developed menisci (ND, from stillbirths) were collected. Cellularity and glycosaminoglycans (GAGs) deposition were evaluated by ELISA, while Collagen 1 and aggrecan were investigated by immunohistochemistry and Western blot analyses in order to be compared to the biomechanical properties of traction and compression tensile forces, respectively. Cellularity decreased from ND to FD and GAGs showed the opposite trend (p < 0.01 both). Collagen 1 decreased from ND to FD, as well as the ability to resist to tensile traction forces (p < 0.01), while aggrecan showed the opposite trend, in accordance with the biomechanics: compression test showed that FD meniscus greatly resists to deformation (p < 0.01). This study demonstrated that in swine meniscus, clear morphological and biomechanical changes follow the meniscal maturation and specialization during growth, starting with an immature pattern (ND) to the mature organized meniscus of the FD, and they could be useful to understand the behavior of this structure in the light of its tissue bioengineering.
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Koç, Ali, Turgut Tursem Tokmak, Özgür Karabıyık, and Gamze Türk. "Evaluation of anterior intermeniscal ligament in discoid lateral meniscus cases and presenting the accompanying meniscal pathologies with MRI." Acta Radiologica 60, no. 1 (May 12, 2018): 100–105. http://dx.doi.org/10.1177/0284185118776499.
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Background Although several studies were conducted to put forth the biomechanical function of anterior intermeniscal ligament (AIML) on the stability of meniscal structures, there are few data on the etiology of the early degeneration of discoid type compared to the normal shaped ones. Purpose To determine the AIML subtypes and accompanying meniscal pathologies in discoid lateral menisci (DLM) on knee MRI exams. Material and Methods Knee MRI exams of 171 individuals with DLM were reviewed. DLMs and AIMLs were typed according to Watanabe’s classification and Nelson-Laprade classification, respectively. Medial and lateral menisci were evaluated for tear and menisco-capsular pathology. Pearson’s correlation test was used for statistical analysis. Results DLM was type I in 83 (48.5%) individuals and type II in 88 (51.5%) individuals. AIML was absent in 90 (52.6%) participants; type I AIML was seen in 38 out 81 (22.2%), type II in 31 out of 81(18.1%), and type III in 12 out of 81 (7%). Meniscal pathology was observed in 56 (32.7%) individuals as follows: menisco-capsular strain/separation in 25 (14.6%); medial meniscal tear in 22 (12.8%); and lateral meniscal tear in nine (5.2%); Of these 56 cases, 26 (46%) had no AIML, 15 cases (27%) had type I, nine cases (16%) had type II, and six cases (11%) had type III AIML. Conclusion No statistically significant correlation was found between the type of DLM and type of AIML ( P = 0.855), between the type of DLM and meniscal pathology ( P = 0.791), or between the type of AIML and meniscal pathology ( P = 0.282).
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Hayashi, Kei, Brian Caserto, Ryan Breighner, Mary Norman, Hollis Potter, Matthew Koff, and Sarah Pownder. "Quantitative Magnetic Resonance Imaging and Histological Comparison of Normal Canine Menisci." Veterinary and Comparative Orthopaedics and Traumatology 31, no. 06 (October 22, 2018): 452–57. http://dx.doi.org/10.1055/s-0038-1668115.
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Objective The purpose of this observational study was to establish normative data for the canine menisci using magnetic resonance imaging (MRI). Methods Ten fresh stifles from five normal male Beagles were obtained from animals with no known lameness. Conventional MRI and ultrashort echo time (UTE) imaging were performed and T2* values calculated. Five stifles were assessed histologically. Results The caudal horn of the medial meniscus had significantly prolonged T2* values (4.6 ± 1.27 ms; p = 0.002) as compared with the cranial horn of the medial meniscus (3.25 ± 0.86 ms), and the cranial (3.06 ± 0.54 ms) and caudal (3.64 ± 0.72 ms) horns of the lateral meniscus. Histology demonstrated normal tibial, femoral, interior and peripheral meniscal margins, and normal cellularity. The medial meniscus was noted to be obliquely oriented to the scan plane compared with the relatively perpendicular orientation of the lateral meniscus as compared with the bore of the magnet in a limb-extended orientation. Clinical Significance Variability of MRI UTE T2* is seen in the normal canine meniscus, with prolongation of the caudal horn, medial meniscus. Prolongation may be due to magic angle effects, as the medial meniscus of the Beagle is not perpendicular to the axis of the main magnetic field. Canine meniscal injury is a common sequela to cruciate tear, and detecting meniscal damage is important for directing patient care. The non-invasive quantitative MRI technique of UTE imaging can be used for the evaluation of collagen orientation, while acknowledging inherent regions of prolongation.
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RYTTER, SØREN, LILLI KIRKESKOV JENSEN, JENS PETER BONDE, ANNE GRETHE JURIK, and NIELS EGUND. "Occupational Kneeling and Meniscal Tears: A Magnetic Resonance Imaging Study in Floor Layers." Journal of Rheumatology 36, no. 7 (May 1, 2009): 1512–19. http://dx.doi.org/10.3899/jrheum.081150.
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Objective.To evaluate the association between occupational kneeling and degenerative meniscal tears.Methods.Magnetic resonance imaging (MRI) of both knees was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42–70 yrs). The presence of grade 3 MRI signal intensities indicating degenerative tears of the anterior, middle, and posterior one-third of the lateral and medial menisci was assessed on 1.5-Tesla MRI scans. The odds ratio (OR) of meniscal tears was determined among floor layers compared to graphic designers. Using logistic regression, models were adjusted for age, body mass index, and knee-straining sports.Results.Degenerative tears were significantly more prevalent in the medial meniscus among floor layers than among graphic designers [OR 2.28, 95% confidence interval (CI) 1.10–4.98] and significantly more floor layers had medial tears in both knees (OR 3.46, 95% CI 1.41–8.48). Tears extending to the tibial aspect and localized in the middle and posterior one-third of the medial meniscus were most prevalent. Lateral meniscal tears were predominantly unilateral and the prevalence of lateral tears did not differ between the 2 study groups. Knee complaints occurred in about 50% of all floor layers, irrespective of the presence of meniscal tears.Conclusion.Occupational kneeling increases the risk of degenerative tears in the medial but not the lateral menisci in both knees.
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de Faria, José Leonardo Rocha, Douglas Mello Pavão, Alfredo Villardi, Eduardo Branco de Sousa, João Matheus Guimarães, José Maurício do Carmo, and Alan de Paula Mozella. "Continuous Meniscal Suture Technique of The Knee." Orthopaedic Journal of Sports Medicine 9, no. 6_suppl2 (June 1, 2021): 2325967121S0018. http://dx.doi.org/10.1177/2325967121s00184.
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The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal repair should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called “meniscal stitching,” for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device, called the “Meniscus 4 A-II” device (Síntegra Surgical, Pompéia,SP, Brazil).
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Dong, Yue Fu, Ying Hai Dong, Qing Rong Xu, Guang Hong Hu, and Wan Peng Dong. "The Effect of Varying Degrees of Radial Meniscal Tears on the Knee Contact Stresses: A Finite Element Analysis." Advanced Materials Research 304 (July 2011): 135–41. http://dx.doi.org/10.4028/www.scientific.net/amr.304.135.
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Knee osteoarthritis (OA) is believed to result from high levels of the contact stresses on the cartilages and menisci after radial meniscal tears but not clearly proved. This research investigated the effect of varying degrees of radial meniscal tears on the peak compressive and shear stresses in the knee joint. An elaborate three-dimensional (3D) knee finite element (FE) model was developed from CT (computerized tomography) and MRI (magnetic resonance imaging) images. This model was used to model varying degrees of radial meniscal tears (involving 0%-90% radial width of the medial meniscus). Two different conditions were compared: a healthy knee joint and a knee joint with meniscal tears. The peak compressive and shear stresses were found in the posterior region of the medial meniscus and the corresponding zone of the cartilage, and they increased with the increasing width of radial tears. After meniscal tear involving 90% radial width, the peak compressive and shear stresses got their highest values. It shows that meniscal tear greater than 40% radial width drastically increases the contact stresses in the knee joint.
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Daszkiewicz, Karol, and Piotr Łuczkiewicz. "Biomechanics of the medial meniscus in the osteoarthritic knee joint." PeerJ 9 (November 24, 2021): e12509. http://dx.doi.org/10.7717/peerj.12509.
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Background Increased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus. Methods The finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone. Results The maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model. Conclusions Higher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.
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Bursac, Predrag, Amanda York, Paulette Kuznia, Lauren M. Brown, and Steven P. Arnoczky. "Influence of Donor Age on the Biomechanical and Biochemical Properties of Human Meniscal Allografts." American Journal of Sports Medicine 37, no. 5 (March 31, 2009): 884–89. http://dx.doi.org/10.1177/0363546508330140.
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Background Although the use of meniscal allografts to replace severely damaged or absent menisci is commonplace, little is known about the effects of donor age on the biochemical and biomechanical properties of human menisci. Hypothesis The mechanical and biochemical properties of human medial and lateral menisci from donors less than 45 years of age do not vary with donor age. Study Design Controlled laboratory study. Methods Thirty-three lateral and 25 medial menisci from 34 donors (26 male and 8 female) ranging from 15 to 44 years of age were harvested and immediately stored at —80°C. The outer third of each meniscus was subjected to static and dynamic tensile analysis. In addition, the biochemical composition (collagen, proteoglycan, and water content) of these samples was analyzed. Results There was no correlation between donor age and static tensile stiffness for either the lateral (R2 = .003) or medial (R2 = .002) meniscus. Likewise, there was no correlation between donor age and dynamic tensile modulus for either the lateral or medial meniscus. Although there was a weak, positive correlation between water content and age in both lateral (R2 = .22) and medial (R2 = .25) menisci, there was no effect of age on collagen or proteoglycan content. There were no differences (P > .05) between female and male menisci in any of the measured biomechanical or biochemical parameters tested. Conclusion The tensile properties, as well as the collagen and proteoglycan content, of menisci from donors less than 45 years of age were not age dependent. Clinical Relevance The age of the donor does not appear to affect the initial tensile properties of menisci from donors less than 45 years of age.
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Lombardo, Michele D. M., Laura Mangiavini, and Giuseppe M. Peretti. "Biomaterials and Meniscal Lesions: Current Concepts and Future Perspective." Pharmaceutics 13, no. 11 (November 7, 2021): 1886. http://dx.doi.org/10.3390/pharmaceutics13111886.
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Menisci are crucial structures for knee homeostasis. After a meniscal lesion, the golden rule, now, is to save as much meniscus as possible; only the meniscus tissue that is identified as unrepairable should be excised, and meniscal sutures find more and more indications. Several different methods have been proposed to improve meniscal healing. They include very basic techniques, such as needling, abrasion, trephination and gluing, or more complex methods, such as synovial flaps, meniscal wrapping or the application of fibrin clots. Basic research of meniscal substitutes has also become very active in the last decades. The aim of this literature review is to analyze possible therapeutic and surgical options that go beyond traditional meniscal surgery: from scaffolds, which are made of different kind of polymers, such as natural, synthetic or hydrogel components, to new technologies, such as 3-D printing construct or hybrid biomaterials made of scaffolds and specific cells. These recent advances show that there is great interest in the development of new materials for meniscal reconstruction and that, with the development of new biomaterials, there will be the possibility of better management of meniscal injuries
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Mansmann, K. A., T. P. Schaer, and R. B. Modesto. "Arthroscopy of the normal cadaveric ovine femorotibial joint: a systematic approach to the cranial and caudal compartments." Veterinary and Comparative Orthopaedics and Traumatology 27, no. 05 (2014): 387–94. http://dx.doi.org/10.3415/vcot-14-03-0039.
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SummaryObjectives: Preclinical studies using large animal models play an intergral part in translational research. For this study, our objectives were: to develop and validate arthroscopic approaches to four compartments of the stifle joint as determined via the gross and arthroscopic anatomy of the cranial and caudal aspects of the joint.Methods: Cadaveric hindlimbs (n = 39) were harvested from mature ewes. The anatomy was examined by tissue dissection (n = 6), transverse sections (n = 4), and computed tomography (n = 4). The joint was arthroscopically explored in 25 hindlimbs.Results: A cranio-medial portal was created medial to the patellar ligament. The craniolateral portal was made medial to the extensor digitorum longus tendon. The medial femoral condyle was visible, as well as the cranial cruciate ligament, caudal cruciate ligament and both menisci with the inter-meniscal ligament. Valgus stress improved visibility of the caudal horn of the medial meniscus and tibial plateau. To explore the caudal compartments, a portal was created 1 cm proximal to the most caudal aspect of the tibial condyle. Both femoral condyles, menisci, caudal cruciate ligament, the popliteal tendon and the menisco-femoral ligament were visible. The common peroneal nerve and popliteal artery and vein are vulnerable structures to injury during arthroscopy.Clinical significance: The arthroscopic approach developed in this research is ideal to evaluate the ovine stifle joint.
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Koch, Matthias, Felix P. Achatz, Siegmund Lang, Christian G. Pfeifer, Girish Pattappa, Richard Kujat, Michael Nerlich, Peter Angele, and Johannes Zellner. "Tissue Engineering of Large Full-Size Meniscus Defects by a Polyurethane Scaffold: Accelerated Regeneration by Mesenchymal Stromal Cells." Stem Cells International 2018 (May 7, 2018): 1–11. http://dx.doi.org/10.1155/2018/8207071.
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The endogenous healing potential of avascular meniscal lesions is poor. Up to now, partial meniscectomy is still the treatment of choice for meniscal lesions within the avascular area. However, the large loss of meniscus substance predisposes the knee for osteoarthritic changes. Tissue engineering techniques for the replacement of such lesions could be a promising alternative treatment option. Thus, a polyurethane scaffold, which is already in clinical use, loaded with mesenchymal stromal cells, was analyzed for the repair of critical meniscus defects in the avascular zone. Large, approximately 7 mm broad meniscus lesions affecting both the avascular and vascular area of the lateral rabbit meniscus were treated with polyurethane scaffolds either loaded or unloaded with mesenchymal stromal cells. Menisci were harvested at 6 and 12 weeks after initial surgery. Both cell-free and cell-loaded approaches led to well-integrated and stable meniscus-like repair tissue. However, an accelerated healing was achieved by the application of mesenchymal stromal cells. Dense vascularization was detected throughout the repair tissue of both treatment groups. Overall, the polyurethane scaffold seems to promote the vessel ingrowth. The application of mesenchymal stromal cells has the potential to speed up the healing process.