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Sample records for bicompartmental bucket-handle meniscal

  1. The quadruple cruciate sign of simultaneous bicompartmental medial and lateral bucket-handle meniscal tears

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    Bugnone, Alejandro N. [University of Miami School of Medicine/Jackson Memorial Hospital, Department of Radiology, Miami, FL (United States); Ramnath, R.R. [Neuroskeletal Imaging, Merritt Island, FL (United States); Davis, S.B. [Orthopedic Center, Huntsville, Alabama (United States); Sedaros, R. [Space Coast Orthopedics, Merritt Island, FL (United States)

    2005-11-01

    We report the second known case of bicompartmental bucket-handle tears of the medial and lateral menisci and the first documented case of the bucket-handle tears occurring simultaneously following trauma, which occurred after a motorcycle accident. Both bucket-handle fragments were displaced into the intercondylar notch. An anterior cruciate ligament tear was also present. Coronal images demonstrated four structures in the intercondylar notch: the anterior and posterior cruciate ligaments and the medial and lateral bucket-handle meniscal fragments. (orig.)

  2. Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report

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    Beris Alexandros E

    2010-02-01

    Full Text Available Abstract Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation.

  3. Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion

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    Schlossberg, S. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Umans, H. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Flusser, G. [Tel Aviv Sourasky Medical Center, Department of Radiology, Tel Aviv (Israel); DiFelice, G.S. [Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Lerer, D.B. [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States)

    2007-01-15

    To determine the frequency of medial meniscal extrusion (MME) versus ''medial meniscal intrusion'' in the setting of bucket handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial tear, degenerative joint disease and joint effusion. Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME, medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded. Thirteen females and 27 males (age 12-62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present in all 41 cases. Given an intact medial meniscal root in the setting of a ''pure'' bucket handle tear, there is no MME. (orig.)

  4. Displaced Medial and Lateral Bucket Handle Meniscal Tears With Intact ACL and PCL.

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    Boody, Barrett S; Omar, Imran M; Hill, James A

    2015-08-01

    Bucket handle lesions are vertical longitudinal tears in the meniscus that may displace centrally into the respective medial or lateral compartment, frequently causing mechanical symptoms, including pain, perceived instability, and mechanical locking. Bucket handle meniscal tears are most commonly from a traumatic etiology and are frequently found with concomitant anterior cruciate ligament (ACL) injuries. Multiple imaging signs and associations have been described for the diagnosis of bucket handle meniscus tears, including coronal truncation, absent bow tie sign, double posterior cruciate ligament (PCL), double ACL, displacement of the bucket handle fragment, and disproportionate posterior horn signs. Among meniscal pathology encountered on magnetic resonance imaging or during arthroscopy, bucket handle meniscal tears are infrequent occurrences. Furthermore, the occurrence of displaced medial and lateral bucket handle tears found on imaging and during arthroscopy is very uncommon and is only sparsely reported in the literature. When displaced medial and lateral bucket handle meniscal segments are visualized within the intercondylar notch along with the ACL and PCL, the radiologic findings are referred to as the "quadruple cruciate" sign or the "Jack and Jill lesion." Of the few case reports described in the literature, only one noted displaced medial and lateral bucket handle meniscus tears with an intact ACL and PCL. The current case report outlines a similar rare case of the quadruple cruciate sign: displaced medial and lateral bucket handle meniscal tears located within the intercondylar notch and an intact ACL and PCL.

  5. MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification

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    Aydingoez, Uestuen; Firat, Ahmet K. [Department of Radiology, Hacettepe University Medical Center, 06100 Ankara (Turkey); Atay, Ahmet Oe.; Doral, Nedim M. [Department of Orthopaedics and Traumatology, Hacettepe University Medical Center, 06100 Ankara (Turkey)

    2003-03-01

    Our objective was to review the MR imaging signs of meniscal bucket-handle tears and assess the relevance of these signs to the arthroscopic classification of displaced meniscal tears. Forty-five menisci in 42 patients who had a diagnosis of bucket-handle tear either on MR imaging or on subsequent arthroscopy (in which Dandy's classification of meniscal tears was used) were retrospectively analyzed for MR imaging findings of double posterior cruciate ligament (PCL), fragment within the intercondylar notch, absent bow tie, flipped meniscus, double-anterior horn, and disproportional posterior horn signs. Arthroscopy, which was considered as the gold standard, revealed 41 bucket-handle tears (either diagnosed or not diagnosed by MR imaging) in 38 patients (33 males, 5 females). There was a stastistically significant male preponderance for the occurrence of meniscal bucket-handle tears. Overall, sensitivity and positive predictive value of MR imaging for the detection of meniscal bucket-handle tears were calculated as 90%. Common MR imaging signs of meniscal bucket-handle tears in arthroscopically proven cases of such tears were the fragment in the notch and absent bow tie signs (98% frequency for each). Double-PCL, flipped meniscus, double-anterior horn, and disproportional posterior horn signs, however, were less common (32, 29, 29, and 27%, respectively). An arthroscopically proven bucket-handle tear was found in all patients who displayed at least three of the six MR imaging signs of meniscal bucket-handle tears. The presence of three or more MR imaging signs of meniscal bucket-handle tears is highly suggestive of this condition. (orig.)

  6. Self-Reduction of Displaced Bucket-Handle Medial Meniscal Tear in a 71-Year-Old Patient

    OpenAIRE

    2015-01-01

    Background: Bucket-handle meniscal tears are rare in geriatric patients. Displaced bucket-handle meniscal tears are usually treated operatively. Due to the rarity of these tears in elderly patients and conflicting evidence regarding the use of arthroscopy versus conservative treatment, it is valuable to report the clinical presentation, treatment, and outcome of these injuries in elderly patients. Case Description: We describe a 71-year-old man who presented with an acute, displaced, magnetic...

  7. Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs

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    Dorsay, Theodore A.; Helms, Clyde A. [Department of Radiology, Duke University Medical Center, Erwin Road, Room 1504, NC 27710, Durham (United States)

    2003-05-01

    To determine the sensitivity and specificity of reported MRI signs in the evaluation of bucket-handle tears of the knee.Design and patients A retrospective analysis of 71 knee MR examinations that were read as displaying evidence of a bucket-handle or ''bucket-handle type'' tear was performed. We evaluated for the presence or absence of the absent bow tie sign, the coronal truncation sign, the double posterior cruciate ligament (PCL) sign, the anterior flipped fragment sign, and a fragment displaced into the intercondylar notch. Sensitivity and specificity were calculated relative to the gold standard of arthroscopy. Forty-three of 71 cases were surgically proven as bucket-handle tears. The absent bow tie sign demonstrated a sensitivity of 88.4%. The presence of at least one of the displaced fragment signs had a sensitivity of 90.7%. A finding of both the absent bow tie sign and one of the displaced fragment signs demonstrated a specificity of 85.7%. The double PCL sign demonstrated a specificity of 100%. The anterior flipped meniscus sign had a specificity of 89.7%. Bucket-handle tears of the menisci, reported in about 10% of most large series, have been described by several signs with MRI. This report gives the sensitivity and specificity of MRI for bucket-handle tears using each of these signs independently and in combination. MRI is shown to be very accurate for diagnosing bucket-handle tears when two or more of these signs coexist. (orig.)

  8. Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear Resolução espontânea da lesão alça de balde do menisco medial associado com rotura de LCA

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    Neiffer Nunes Rabelo

    2013-01-01

    Full Text Available We report a case of injury of the medial bucket handle meniscal tears (BH, which resolved spontaneously, in association with anterior cruciate ligament (ACL injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of ABNeste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB, que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA. O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.

  9. Meniscal tears

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    Nicola Maffulli

    2010-04-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Stefano Campi2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, Rome, ItalyAbstract: The menisci are two semilunar-shaped fibrocartilagenous structures, which are interposed between the femoral condyles and tibial plateaux. They have an important role in knee function. Long-term follow-up studies showed that virtually all meniscectomized knees develop arthritic changes with time. The meniscus has functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity. Because of these functions, meniscal tissue should be preserved whenever possible. A well-trained surgeon can safely rely on clinical examination for diagnosing meniscal injuries. History and clinical examination are at least as accurate as magnetic resonance imaging in the skilled orthopedic surgeon’s hand. When meniscal repair is not possible, partial resection of the meniscus is indicated. Meniscal repair has evolved from open to arthroscopic techniques, which include the inside-out and outside-in suture repairs and the all-inside techniques. Meniscal transplantation is generally accepted as a management alternative option for selected symptomatic patients with previous complete or near-complete meniscectomy.Keywords: meniscus, arthroscopy, meniscectomy, meniscal repair, sports

  10. Reversed double PCL sign: unusual location of a meniscal fragment of the knee observed by MR imaging

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    Niitsu, M.; Itai, Y. [Dept. of Radiology, Inst. of Clinical Medicine, Univ. of Tsukuba, Ibaraki (Japan); Ikeda, K. [Inst. of Clinical Medicine, Univ. of Tsukuba, Ibaraki (Japan)

    2003-12-01

    A 36-year-old woman with tears of the anterior cruciate ligament and medial meniscus received a meniscectomy. The MR images obtained prior to the partial meniscectomy showed a bucket-handle meniscal tear with centrally displaced fragment lying anterior to the posterior cruciate ligament (PCL), representing a ''double PCL sign''; however, after the meniscectomy, MR images demonstrated a fragment in the space posterior to the PCL where no structure is generally recognized except for the ligament of wrisberg. This article reports a ''reversed'' double PCL sign, caused by inadequate surgical clearance of a bucket-handle tear of the medial meniscus. (orig.)

  11. Rotura em "alça de balde" simultânea dos meniscos no mesmo joelho Simultaneous "bucket-handle" tear of both menisci on the same knee

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    Andre Francisco Gomes

    2009-01-01

    Full Text Available Rotura em "alça de balde" de ambos os meniscos do mesmo joelho é um fenômeno raro. Apresentamos o caso de um paciente em que a ressonância magnética demonstrou rotura em "alça de balde" dos meniscos medial e lateral do mesmo joelho, associada a rotura do ligamento cruzado anterior, confirmado por videoartroscopia. A ressonância magnética demonstra sinais que permitem o diagnóstico preciso.Simultaneous "bucket-handle" tear of menisci on the same knee is a rare phenomenon. We describe a case of a bucket-handle tear of menisci and tear of anterior cruciate ligament of the same knee showed on magnetic resonance imaging and confirmed by arthroscopy. The magnetic resonance imaging can provide accurate diagnosis of this type of injury.

  12. The Relationship of Anterior Cruciate Ligament Lesions and Osteochondral Lesions with Meniscal Tears in Patients Younger than Fifty Years of Age

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    Samed Ordu

    2014-09-01

    Full Text Available Aim: The purpose of this study was to determine the incidence of anterior cruciate ligament (ACL lesions and osteochondral lesions according to type and localization of the meniscal tear and age, gender in patients who have been arthroscopicaly treated, besides, to make the coexisting lesions more predictable in these patients. Methods: We retrospectively investigated 352 patients under 50 years of age who underwent surgery for a meniscal tear between 2008 and 2012. We scanned the surgical operation notes, preoperative questionnaires and the magnetic resonance imaging findings. We recorded patients who had ACL lesions, such as elongation, partial rupture and total rupture. Osteochondral lesions were classified according to the Outerbridge classification from grade 1 to grade 4. Results: Chondral lesions were present in 77.4% of patients with degenerative meniscal tears and in 63% of patients with radial meniscal tears. One the other hand, osteochondral lesions were observed in only 33.9% of patients with other types of meniscal tears. 46.6% of ACL lesions accompanied by meniscal tears with longitudinal pattern, such as longitudinal tears, bucket handle tears and root tears. For the other types of meniscal tears, this percentage was 20.7. When we excluded degenerative type meniscal tears, the mean age of the patients with radial tears was 40.86±9.03 years and the mean age of the patients with other types of tear was 35.44±9.44 years. The difference was statistically significant. Conclusion: We found close relationship between osteoarthritic chondral lesions and radial tears in the root of the posterior horn of the medial meniscus. On the other side, longitudinal tears were related with ACL lesions. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 177-80

  13. Influence of Bicompartmental Knee Replacement on Stand-to-Sit Movement

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    Wang, He; Frame, Jeff; Rolston, Lindsey

    2012-01-01

    Knee osteoarthritis often occurs in medial and patellofemoral compartments. A bicompartmental knee replacement system replaces these two affected knee compartments and keeps the lateral compartment and cruciate ligaments intact. It is yet to be determined whether limbs with bicompartmental knee systems can demonstrate frontal-plane knee mechanics…

  14. Meniscal injury: II. Management.

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    Greis, Patrick E; Holmstrom, Michael C; Bardana, Davide D; Burks, Robert T

    2002-01-01

    Meniscal repair is a viable alternative to resection in many clinical situations. Repair techniques traditionally have utilized a variety of suture methods, including inside-out and outside-in techniques. Bioabsorbable implants permit all-inside arthroscopic repairs. The success of meniscal repair depends on appropriate meniscal bed preparation and surgical technique and is also influenced by biologic factors such as tear rim width and associated ligamentous injury. Successful repair in >80% of cases has been reported in conjunction with anterior cruciate ligament reconstruction. Success rates are lower for isolated repairs. Complications related to repair include neurologic injury, postoperative loss of motion, recurrence of the tear, and infection. Meniscal allograft transplantation may provide a treatment option when meniscus salvage is not possible or when a previous total meniscectomy has been done.

  15. Meniscal Ramp Lesions

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    Chahla, Jorge; Dean, Chase S.; Moatshe, Gilbert; Mitchell, Justin J.; Cram, Tyler R.; Yacuzzi, Carlos; LaPrade, Robert F.

    2016-01-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn of the medial meniscus should be performed. Several treatment options have been reported, including nonsurgical management, inside-out meniscal repair, or all-inside meniscal repair. In cases of isolated ramp lesions, a standard meniscal repair rehabilitation protocol should be followed. However, when a concomitant ACL reconstruction (ACLR) is performed, the rehabilitation should follow the designated ACLR postoperative protocol. The purpose of this article was to review the current literature regarding meniscal ramp lesions and summarize the pertinent anatomy, biomechanics, diagnostic strategies, recommended treatment options, and postoperative protocol. PMID:27504467

  16. The iDuo Bi-compartmental Knee Replacement: Our Early Experience.

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    Peter Jemmett

    2016-12-01

    Our early results suggest that the iDuo knee is a good option for those with isolated bi-compartmental disease and outcome scores are comparable with those reported for the BKA. This bi-compartmental design may bridge the gap between the uni-compartmental and total knee replacement. The choice between monolithic or modular designs remains in debate. We will continue to use this prosthesis for a carefully selected group of patients.

  17. Analysis of meniscal degeneration and meniscal gene expression

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    Norton James H

    2010-01-01

    Full Text Available Abstract Background Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1 to determine the prevalence of meniscal degeneration in OA patients, and 2 to examine gene expression in OA meniscal cells compared to normal meniscal cells. Methods Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens, and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR. Results The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P HLA-DPA1, integrin, beta 2 (ITGB2, ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1, ankylosis, progressive homolog (ANKH and fibroblast growth factor 7 (FGF7, were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5 and prostaglandin E synthase (PTGES, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific. Conclusion Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel

  18. MAGNETIC RESONANCE IMAGING EVALUATION OF LIGAMENTOUS TEARS OF THE KNEE JOINT AND ASSOCIATION OF MENISCAL TEARS WITH ANTERIOR CRUCIATE LIGAMENT TEARS

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    Bommandapalli Madhaiah

    2016-05-01

    Full Text Available Anterior cruciate ligament tears are most commonly sustained sports injury, often occurring in association with meniscal tears and trauma to other ligamentous structures around the knee. Magnetic resonance imaging is vital in assessing acute knee injuries and plays an important role in deciding treatment options and planning surgical intervention. Magnetic Resonance (MR imaging has emerged as investigation of choice to evaluate the status of the ACL and other associated structures in the knee. AIMS AND OBJECTIVES The purpose of this study is to determine the association of subtle meniscal injury in the presence of anterior cruciate ligament injury and other associated pathology on MR imaging. MATERIAL AND METHODS A prospective cross-sectional case study done on 40 patients including both the sexes in age group of 15 to 35 years presenting with knee joint injuries and subsequently underwent MRI of the knee joint. The data was analysed and the findings on MRI were correlated with that of arthroscopy and/or operative findings. RESULTS The commonest soft tissue injury identified on MRI of the knee joint was ACL injury and it was associated with injuries of medial meniscus followed by of lateral meniscus, medial collateral ligament and lateral collateral ligament. CONCLUSION MRI is an excellent, non-invasive, radiation free imaging modality with multiplanar capabilities and excellent soft tissue delineation. It can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis, thereby guiding further management of the patient. Medial meniscal tears were more commonly associated with ACL tear. Various patterns of meniscal injuries were identified in this study, out of which bucket handle pattern was more common among medial meniscal tears and radial pattern was common in the lateral meniscal injuries. Radiologists while interpreting MR studies of knee injuries

  19. Meniscal Ramp Lesions

    OpenAIRE

    2016-01-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, ...

  20. 关节镜下联合修补技术治疗内侧半月板桶柄样撕裂20例临床分析%Arthroscopic hybrid suture technique for repairing 20 bucket-handle tear of inside meniscus

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    麦鸿飞; 冯光; 黎国权; 覃海宁

    2011-01-01

    Objective To investigate the arthroscopic inside-out repairing technique(hybrid suture technique) for bucket-handle tear of inside meniscus and present the short-term clinical outcome. Methods Twenty patients with 20 repairable inside meniscus tears were enrolled. With arthroscopic technique,the midbody portion and anterior portion of the lesion were repaired using standard inside-out technique with vertical and interlacing tibial and femoral side arrangement. For the most posterior portion, all-inside suture technique with two posterior portals were performed. For isolated red-white zone tears,fibrin clot was implanted into the repaired region for enhancing the healing pro-ACL injuries were reconstructed simultaneously. Results Twenty patients with 20 meniscal repairs were available for 5-36 (19.2 ± 2.3)months follow-up. Eighteen cases were asymptomatic at the latest clinical evaluation,and joint space tenderness in 2 cases. Twenty cases received MRI evaluation during follow-up, showing that 15 menisci were completely healed, 5 partially healed. Postoperative Lysholm scores of the knee joint function [82-97(90.3 ±1.5) points] were significantly improved compared with their preoperative scores [45-69 (56.7 ± 2.0)points] (P = 0.024).Conclusion For meniscal tears involving red-red and red-white zones,arthroscopic hybrid suture technique provides stable strength along the whole length of injured region, and consequently achieves satisfactory clinical outcomes.%目的 探讨关节镜下联合修补技术治疗内侧半月板桶柄样撕裂的临床疗效.方法 采用关节镜下联合修补技术修补20例(20个)内侧半月板桶柄样撕裂,均累及内侧半月板后角至前体部区域.半月板体部和前角采用标准的自内向外缝合;半月板后角采用全关节内缝合:经两个后内侧入路在关节内完成垂直褥式缝合.单纯的红-白交界处撕裂修补后局部植入血凝块促进愈合,合并前十字韧带损伤者同

  1. New observations on meniscal cysts

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    Anderson, Jada Jean; Connor, Gregory F.; Helms, Clyde A. [Duke University Medical Center, Durham, NC (United States)

    2010-12-15

    The purpose of this study was to determine the incidence of meniscal cysts, assess the frequency of various magnetic resonance (MR) imaging characteristics, and emphasize radiographic observations not commonly reported. A total of 2,095 consecutive knee MR imaging reports from a 22 month period were retrospectively reviewed for the presence of meniscal cysts. Two musculoskeletal radiologists reviewed the cases where cysts were reported. A meniscal cyst was considered present if abnormally increased signal was identified within an enlarged meniscus (i.e., intrameniscal cyst) or if a loculated fluid-intensity lesion with a clear connection to the adjacent meniscus was identified (i.e., parameniscal cyst). Presence or absence of a meniscal tear, intrameniscal and parameniscal signal intensity, patient age, sex, location of meniscal cyst, presence of discoid meniscus, and size of the parameniscal cyst component were recorded. All knee imaging examinations were performed on a 1.5T MR unit. Imaging findings were correlated with arthroscopic reports when available. A total of 167 cases (8.0%) of meniscal cysts were diagnosed in 161 patients. Of the 167 cysts, 69 (41.3%) were located in the lateral meniscus and 98 (58.7%) in the medial meniscus. In 6 patients (3.7%), meniscal cysts were present in both menisci of the same knee. Twelve (7.2%) meniscal cysts were associated with discoid menisci. Ninety-seven (57.8%) meniscal cysts were associated with meniscal tears. Of the total number of meniscal cysts, 104 (62.3%) had a parameniscal cyst. An isolated intrameniscal cyst was present in 63 (37.7%) cases. One hundred (96%) of the parameniscal cyst components were isointense to fluid on T2-weighted FSE images. All cysts exhibited abnormal intrameniscal signal. Only 14 (8.4%) of the intrameniscal components were isointense to fluid on T2-weighted FSE images. The arthroscopic reports of 88 of the 161 (54.7%) patients were available for review and correlation. A tear extending to

  2. [Management of the meniscal lesion].

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    Baillon, B; Cermak, K; Vancabeke, M

    2011-01-01

    About 1,5 million arthroscopies are each year performed in the world, 50 % for meniscal affections. The menisci participate in the femoro-tibial load transmission and in the joint shock absorption; they contribute to the knee stability and play a role in the joint lubrication. The menisci are therefore important structures, and, in the case of a lesion, surgical abstention or repair should be favoured. When a meniscectomy has to be performed, it should be economical, preserving the meniscal wall. Meniscectomy is contra-indicated in the child and in the case of knee osteoarthrosis. Meniscal healing is compromised if the knee is unstable. If after total meniscectomy a patient presents symptomatic early osteoarthrosis, without marked loss of alignment, meniscal allografting is a therapeutic option, especially at the lateral compartment.

  3. Meniscal ossicle in a professional soccer player.

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    Ogassawara, R; Zayni, R; Orhant, E; Noel, E; Fournier, Y; Hager, J-P; Chambat, P; Sonnery-Cottet, B

    2011-06-01

    Meniscal ossicles are an unusual finding and a rare cause for knee pain. They are often initially diagnosed as a loose body, chondrocalcinosis or meniscal calcification within the knee joint. Few cases have been reported in the literature. We present a case of a meniscal ossicle with an associated femoral cartilage lesion in a healthy 26-year-old male professional soccer player who presented with swelling and pain. The purpose of this article is to discuss the origins, radiological features, clinical symptoms and prognosis of meniscal ossicles.

  4. Oxford phase III meniscal bearing fracture: case report.

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    Lim, Hong-Chul; Shon, Won-Yong; Kim, Seung-Ju; Bae, Ji-Hoon

    2014-01-01

    Meniscal bearing fracture is a rare complication of phase III Oxford unicompartmental knee replacement (UKR). We report a case of a meniscal bearing fracture that occurred 7 years after phase III Oxford medial UKR. The meniscal bearing showed uneven delamination of the polyethylene in the thinnest articular surface and an impingement lesion. This lesion initiated a fatigue crack that propagated to cause failure of the meniscal bearing. This is the first report of a meniscal bearing fracture without a posterior marker wire.

  5. Medial meniscal cyst: a case report.

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    Spina, Mauro; Sabbioni, Giacomo; Tigani, Domenico

    2008-12-01

    Meniscal cysts are a rare disease constantly combined with a horizontal meniscal lesion. Currently, nuclear magnetic resonance (MRI) is the main diagnostic tool, because of its high sensitivity and specificity, and decompression arthroscopy combined with selective meniscectomy is the treatment of choice. The Authors report a case of a voluminous medial meniscal cyst where instrumental examination, MRI, was fundamental for the preoperative diagnosis of the horizontal meniscal lesion causing the cystic degeneration of the meniscus. The treatment performed was selective meniscectomy of the body and posterior horn of the medial meniscus and decompression of the voluminous cyst by arthroscopy. Physical examination after six months showed the complete resolution of swelling at the medial hemirima, no walking pain and normal range of motion.

  6. Evaluation of three approaches to meniscal release.

    Science.gov (United States)

    Austin, B; Montgomery, R D; Wright, J; Bellah, J R; Tonks, C

    2007-01-01

    Three approaches to medial meniscal release (MMR) were compared using 48 canine cadaver stifles. The approaches included a caudomedial arthrotomy approach, a blind stab incision based on anatomic landmarks, and an arthroscopic guided approach. The cranial cruciate ligament was intact in all specimens. The time required to perform the meniscal release and joint capsule closure was recorded, as well as completeness and location of the meniscal transection. Damage to the caudal cruciate ligament, femoral cartilage, and medial collateral ligament were recorded. The mini-arthrotomy was 81% successful in accomplishment of MMR with a 4% rate of iatrogenic damage. The blind technique was 56% successful in the accomplishment of MMR with a 4% rate of iatrogenic damage. The arthroscopic guided approach was 62.5% successful in accomplishment of MMR, with a 10% rate of iatrogenic damage. Accomplishment and iatrogenic damage rates were not significantly different among procedures (p > 0.05). Significantly less time was required to perform the blind technique, and significantly greater time was required to perform the arthroscopic guided technique (p > 0.05). Significant differences were not noted among the procedures regarding the ability to accomplish the meniscal release or damage surrounding structures. None of the evaluated approaches for meniscal release resulted in a complete and accurate meniscal release for over 81% of the time.

  7. Treatment of meniscal injury: a current concept review

    Institute of Scientific and Technical Information of China (English)

    GU Yang-lin; WANG Yu-bin

    2010-01-01

    Meniscal injury is one of the most common injuries to the knee. The menisci are important for normal knee function. And loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. Now there are different techniques available for meniscal injury. These techniques include expectant treatment, meniscectomy, meniscal repair, meniscal replacement, and meniscal tissue engineering. Expectant treatment is the appropriate treatment for minor tears of the menisci. Meniscectomy being favored at the beginning is now obsolete. Meniscus repair has become a standard procedure. Meniscal replacement and tissue engineering are used to deal with considerable meniscal injuries. The purpose of this paper is to provide current knowledge regarding the anatomy and function of the menisci, incidence,aetiology, symptoms, signs, investigations and treatments of meniscal injury.

  8. Arthroscopic meniscal allograft transplantation without bone plugs.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Seijas Vázquez, Roberto; García Balletbó, Montserrat; Álvarez Díaz, Pedro; Steinbacher, Gilbert; Cuscó Segarra, Xavier; Rius Vilarrubia, Marta; Cugat Bertomeu, Ramón

    2011-02-01

    Partial or total meniscectomy are common procedures performed at Orthopedic Surgery departments. Despite providing a great relief of pain, it has been related to early onset knee osteoarthritis. Meniscal allograft transplantation has been proposed as an alternative to meniscectomy. The purposes of this study were to describe an arthroscopic meniscal allograft transplantation without bone plugs technique and to report the preliminary results. All meniscal allograft transplantations performed between 2001 and 2006 were approached for eligibility, and a total of 35 patients (involving 37 menisci) were finally engaged in the study. Patients were excluded if they had ipsilateral knee ligament reconstruction or cartilage repair surgery before meniscal transplantation or other knee surgeries after the meniscal transplantation. Scores on Lysholm, Subjective IKDC Form, and Visual Analogue Scale (VAS) scale for pain were obtained at a mean follow-up of 38.6 months and compared to pre-operative data. Data on chondral lesions were obtained during the arthroscopic procedure and through imaging (radiographs and MRI) studies pre-operatively. Two graft failures out of 59 transplants (3.4%) were found. Daily life accidents were responsible for all graft failures. Significant improvements for Lysholm, Subjective IKDC Form, and VAS for pain scores following the meniscal allograft transplantation were found (P lesion, there was no significant interactions for Lysholm (n.s.), Subjective IKDC Form (n.s.), and VAS for pain scores (n.s.). This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. Improvements were observed independently of the degree of chondral lesion.

  9. Rehabilitation of meniscal injury and surgery.

    Science.gov (United States)

    Cavanaugh, John T

    2014-12-01

    Meniscal cartilage plays an essential role in the function and biomechanics of the knee joint. The meniscus functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity. Individuals today are increasingly more active in later decades of life. Although the incidence of meniscal pathology is difficult to estimate, this increased exposure to athletic activity increases the risk of injury to these structures. Hede and coworkers reported the mean annual incidence of meniscus tears as 9.0 in males and 4.2 in females per 10,000 inhabitants. Tears were found to be more common in the third, fourth, and fifth decades of life. It has become clearer in recent decades that meniscal excision leads to articular cartilage degeneration. Degenerative changes have been found to be directly proportional to the amount of meniscus removed. Therefore, it has been generally recognized that the amount of meniscal tissue removed should be minimized, repaired, or replaced. Whether a meniscal lesion is treated conservatively or surgically, the rehabilitation program will play an important role in the functional outcome. This article will discuss these programs and the various treatment strategies employed.

  10. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs

    NARCIS (Netherlands)

    van Tienen, TG; Heijkants, RGJC; de Groot, JH; Pennings, AJ; Poole, AR; Veth, RPH; Buma, P

    2003-01-01

    Objective: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce ingr

  11. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs.

    NARCIS (Netherlands)

    Tienen, Tony van; Heijkants, R.G.J.C.; Groot, J.H. de; Pennings, A.J.; Poole, A.R.; Veth, R.P.H.; Buma, P.

    2003-01-01

    OBJECTIVE: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce ingr

  12. Cartilage change after arthroscopic repair for an isolated meniscal tear.

    Science.gov (United States)

    Soejima, Takashi; Murakami, Hidetaka; Inoue, Takashi; Kanazawa, Tomonoshin; Katouda, Michihiro; Nagata, Kensei

    2005-01-01

    To investigate the direct effect to the cartilage caused by the meniscal repair, we examined patients who underwent an isolated meniscal repair without any other abnormalities by arthroscopic examination. A total of 17 patients were examined by second-look arthroscopy after an average interval of 9 months from the meniscal repair, and have been evaluated the status of the repaired meniscus and of the relative femoral condylar cartilage. Changes in the severity of the cartilage lesion between at the time of meniscal repair and the time of the second-look arthroscopy were considered based on the status of the repaired meniscus. Regardless of the healing status of the repair site, it was possible to prevent degeneration in the cartilage in 9 of the 10 patients who demonstrated no degeneration in the meniscal body. Of the 7 patients who demonstrated degeneration in the meniscal body, progression in cartilage degeneration was noted as 1 grade in 2 patients and 2 grades in another 3 patients. Even in those in which stable fusion of the repair site was achieved, the condition of the inner meniscal body was not necessarily maintained favorably in all cases, indicating that degeneration in the meniscal body was a risk factor for cartilage degeneration. It was concluded that recovery could not be expected even at 9 months after the repair if the lesion had already demonstrated degeneration in the meniscal body at the time of repair.

  13. Arthroscopic Decompression for a Giant Meniscal Cyst.

    Science.gov (United States)

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    The authors report the case of a giant medial meniscal cyst in an osteoarthritic knee of an 82-year-old woman that was successfully treated with only arthroscopic cyst decompression. The patient noticed a painful mass on the medial side of the right knee that had been gradually growing for 5 years. Magnetic resonance imaging showed an encapsulated large medial cystic mass measuring 80×65×40 mm that was adjacent to the medial meniscus. An accompanying horizontal tear was also detected in the middle and posterior segments of the meniscus. The medial meniscus was resected up to the capsular attachment to create bidirectional flow between the joint and the cyst with arthroscopic surgery. Magnetic resonance imaging performed 14 months postoperatively showed that the cyst had completely disappeared, and no recurrence was observed during a 2-year follow-up period. An excellent result could be obtained by performing limited meniscectomy to create a channel leading to the meniscal cyst, even though the cyst was large. Among previously reported cases of meniscal cysts, this case is the largest to be treated arthroscopically without open excision.

  14. Intra-articular Injected synovial stem cells differentiate into meniscal cells directly and promote meniscal regeneration without mobilization to distant organs in rat massive meniscal defect.

    Science.gov (United States)

    Horie, Masafumi; Sekiya, Ichiro; Muneta, Takeshi; Ichinose, Shizuko; Matsumoto, Kenji; Saito, Hirohisa; Murakami, Takashi; Kobayashi, Eiji

    2009-04-01

    Osteoarthritis in the knees, which can be caused by meniscal defect, constitutes an increasingly common medical problem. Repair for massive meniscal defect remains a challenge owing to a lack of cell kinetics for the menisci precursors in knee joint. The synovium plays pivotal roles during the natural course of meniscal healing and contains mesenchymal stem cells (MSCs) with high chondrogenic potential. Here, we investigated whether intra-articular injected synovium-MSCs enhanced meniscal regeneration in rat massive meniscal defect. To track the injected cells, we developed transgenic rats expressing dual luciferase (Luc) and LacZ. The cells derived from synovium of the rats demonstrated colony-forming ability and multipotentiality, both characteristics of MSCs. Hierarchical clustering analysis revealed that gene expression of meniscal cells was closer to that of synovium-MSCs than to that of bone marrow-MSCs. Two to 8 weeks after five million Luc/LacZ+ synovium-MSCs were injected into massive meniscectomized knee of wild-type rat, macroscopically, the menisci regenerated much better than it did in the control group. After 12 weeks, the regenerated menisci were LacZ positive, produced type 2 collagen, and showed meniscal features by transmission electron microscopy. In in-vivo luminescence analysis, photons increased in the meniscus-resected knee over a 3-day period, then decreased without detection in all other organs. LacZ gene derived from MSCs could not be detected in other organs except in synovium by real-time PCR. Synovium-MSCs injected into the massive meniscectomized knee adhered to the lesion, differentiated into meniscal cells directly, and promoted meniscal regeneration without mobilization to distant organs.

  15. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Brauer, Charlotte; Pedersen, Ellen Bøtker;

    2016-01-01

    Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain......, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort...... hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84) after five years as a baggage handler...

  16. An anatomical and histological study of human meniscal horn bony insertions and peri-meniscal attachments as a basis for meniscal transplantation

    Institute of Scientific and Technical Information of China (English)

    WANG Yong-jian; YU Jia-kuo; LUO Hao; YU Chang-long; AO Ying-fang; XIE Xing; JIANG Dong; ZHANG Ji-ying

    2009-01-01

    Background Allograft meniscal transplantation is an increasingly popular treatment option for the symptomatic young patients with meniscus deficiency. However, many questions still surround it. In this research, we studied the anatomical location and histological structure of human meniscal horn bony insertions and to observe the anatomical morphology and histomorphology of peri-meniscal attachments based on meniscal allograft transplantation.Methods Twenty-two fresh-frozen adult cadaver knees were dissected. The locations of meniscal anterior and posterior horn bony insertions to tibia were measured. The anatomical morphology of peri-meniscal attachments was observed and the histological structure of meniscal horn bony insertions and peri-meniscal attachment were studied by HE staining.Results The anterior horn bony insertion of medial meniscus was (9.19±1.83) mm inferior to the corresponding anterior border of tibial plateau, and (7.81±2.25) mm lateral to the axial line of the medial intercondylar eminence. The posterior horn bony insertion of medial meniscus was in the posterior intercondylar fossa of tibia, located between the anterior fibers of the posterior cruciate ligament (PCL) tibial insertion and anterior border of the tibial posterior intercondylar fossa,and was (5.05±1.18) mm lateral to the axial line of the medial intercondylar eminence. The distance between anterior and posterior horn bony insertions of the lateral meniscus was (13.68±2.19) mm. Anterior horn bony insertion of the lateral meniscus was (3.99±1.27) mm medial to the axial line of the lateral intercondylar eminence, and the posterior horn bony insertion of the lateral meniscus was (5.80±1.36) mm medial to the axial line of the lateral intercondylar eminence. Except for the meniscal horn bony insertions, which is the typical enthesis, we call the attachment of the other parts of menisci as 'peri-meniscal attachment'. The morphological and histological study showed that the main peri-meniscal

  17. The potential of optical coherence tomography for diagnosing meniscal pathology

    Science.gov (United States)

    Hang-Yin Ling, Carrie; Pozzi, Antonio; Thieman, Kelley M.; Tonks, Catherine A.; Guo, Shuguang; Xie, Huikai; Horodyski, MaryBeth

    2010-04-01

    Meniscal tears are often associated with anterior cruciate ligament (ACL) injury and may lead to pain and discomfort in humans. Maximal preservation of meniscal tissue is highly desirable to mitigate the progression of osteoarthritis. Guidelines of which meniscal tears are amenable to repair and what part of damaged tissues should be removed are elusive and lacking consensus. Images of microstructural changes in meniscus would potentially guide the surgeons to manage the meniscal tears better, but the resolution of current diagnostic techniques is limited for this application. In this study, we demonstrated the feasibility of using optical coherence tomography (OCT) for the diagnosis of meniscal pathology. Torn medial menisci were collected from dogs with ACL insufficiency. The torn meniscus was divided into three tissue samples and scanned by OCT and scanning electron microscopy (SEM). OCT and SEM images of torn menisci were compared. Each sample was evaluated for gross and microstructural abnormalities and reduction or loss of birefringence from the OCT images. The abnormalities detected with OCT were described for each type of tear. OCT holds promise in non-destructive and fast assessment of microstructural changes and tissue birefringence of meniscal tears. Future development of intraoperative OCT may help surgeons in the decision making of meniscal treatment.

  18. Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells

    Science.gov (United States)

    2015-09-01

    AWARD NUMBER: W81XWH-13-1-0244 TITLE: Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells PRINCIPAL...2014 - 31 Aug 2015 4. TITLE AND SUBTITLE Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells 5a. CONTRACT NUMBER 5b...the development of knee osteoarthritis (OA). New treatments centered on the stem/ progenitor cell population resident within the adult meniscus will be

  19. A STUDY OF ARTHROSCOPIC MANAGEMENT OF MENISCAL INJURIES

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-09-01

    Full Text Available BACKGROUND : Meniscal injuries are common as a result of sports related injuries and motor vehicle accidents. Current arthroscopic partial menisectomy / repairs indicated for management of meniscal tears because of early rehabilitation and return to work and minimal complications . MATERIALS AND METHODS: Present study is a hospital based prospective study of 20 adult cases admitted for a period of 14 months, age group involved was between 10 - 40 years with 17 patients were male and 3 patients were female. RESULTS : Meniscal injuries on Right K nee were 11 cases and Left Knee were 9 cases. Type of meniscal tear were longitudinal 10 cases, oblique 5 cases, horizontal 3 cases, radial 1 case and complex (with discoid meniscus tear 1 case. Meniscal injuries associated with partial/complete ACL tear were 6 cases. There was one case of discoid meniscus. Surgery was performed at an average 1 month after Meniscal tear, duration of hospital stay was 3 . 6 days ranging from 3 - 6 days, mean time for earliest return to work was 14.35 days with range 10 - 16 days. Excellent to good results were seen in 95 %.of cases. CONCLUSION : Arthroscopic menisectomy is minimally invasive technique. Advantage of which includes early return to work, minimal complications, early post - operative rehabilitation, Short duration of hos pital stay.

  20. Biological Activities of Phosphocitrate: A Potential Meniscal Protective Agent

    Directory of Open Access Journals (Sweden)

    Yubo Sun

    2013-01-01

    Full Text Available Phosphocitrate (PC inhibited meniscal calcification and the development of calcium crystal-associated osteoarthritis (OA in Hartley guinea pigs. However, the mechanisms remain elusive. This study sought to examine the biological activities of PC in the absence of calcium crystals and test the hypothesis that PC is potentially a meniscal protective agent. We found that PC downregulated the expression of many genes classified in cell proliferation, ossification, prostaglandin metabolic process, and wound healing, including bloom syndrome RecQ helicase-like, cell division cycle 7 homolog, cell division cycle 25 homolog C, ankylosis progressive homolog, prostaglandin-endoperoxide synthases-1/cyclooxygenase-1, and plasminogen activator urokinase receptor. In contrast, PC stimulated the expression of many genes classified in fibroblast growth factor receptor signaling pathway, collagen fibril organization, and extracellular structure organization, including fibroblast growth factor 7, collagen type I, alpha 1, and collagen type XI, alpha 1. Consistent with its effect on the expression of genes classified in cell proliferation, collagen fibril organization, and ossification, PC inhibited the proliferation of OA meniscal cells and meniscal cell-mediated calcification while stimulating the production of collagens. These findings indicate that PC is potentially a meniscal-protective agent and a disease-modifying drug for arthritis associated with severe meniscal degeneration.

  1. An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee.

    Science.gov (United States)

    Ogawa, Hiroyasu; Itokazu, Mansho; Ito, Yoshiki; Fukuta, Masashi; Simizu, Katsuji

    2006-04-01

    A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.

  2. MR imaging of meniscal cysts: evaluation of location and extension using a three-layer approach

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de E-mail: midema@village.uunet.be; Shahabpour, Maryam; Vanderdood, Kurt; Machiels, Freddy; Ridder, Filip de; Osteaux, Michel

    2001-08-01

    Purpose: To analyze the extension of medial and lateral meniscal cysts relative to the capuloligamentous planes of the knee. Materials and methods: The MR images of 32 patients with meniscal cysts were reviewed. The location and extension of the meniscal cysts with reference to the capsule and ligaments were recorded. Results: Most medial meniscal cysts were located posteromedially. Posteromedial meniscal cysts usually penetrated the capsule and were located between layer I and the fused layers II+III. From this site some extended anteriorly and then became located superficial to the superficial MCL. The location of lateral meniscal cysts was more varied. Anteriorly the cysts were located deep to the iliotibial band, whereas posterolateral cysts were located deep to the lateral collateral ligament. Conclusion: Although the site of capsular penetration of meniscal cysts is determined by the location of meniscal tears, the possible pathways of extension appear to be determined by the capsuloligamentous planes of the knee.

  3. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers.

    Directory of Open Access Journals (Sweden)

    Sigurd Mikkelsen

    Full Text Available Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort. The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84 after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of

  4. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers.

    Science.gov (United States)

    Mikkelsen, Sigurd; Brauer, Charlotte; Pedersen, Ellen Bøtker; Alkjær, Tine; Koblauch, Henrik; Simonsen, Erik Bruun; Helweg-Larsen, Karin; Thygesen, Lau Caspar

    2016-01-01

    Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84) after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of symptomatic

  5. Posterior horn medial meniscal root tear: the prequel

    Energy Technology Data Exchange (ETDEWEB)

    Umans, H. [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Morrison, W. [Thomas Jefferson University Hospital, Philadelphia, PA (United States); DiFelice, G.S. [Hospital for Special Surgery, New York, NY (United States); Vaidya, N. [Crystal Run Healthcare, Middletown, NY (United States); Winalski, C.S. [Cleveland Clinic, Imaging Institute, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

    2014-06-15

    To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging centers over a 7-year period. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. MRI in 11 of 15 (73 %) cases with subsequent PHMMR tear demonstrated linear subcortical marrow edema deep to the meniscal root anchor on the antecedent MRI compared to only 1 of 29 (3 %) non-tear controls (p < 0.0001). The abnormal signal resolved on post-tear MRI in all but two patients. Cyst-like changes deep to the PHMMR were present on initial MRI in three of 15 (23 %) cases and three of 29 (10 %) controls, persisting in all but one case on follow-up imaging. The PHMMR was gray on the initial MRI in seven of 15 (47 %) of cases that developed tears compared to four of 29 (14 %) controls (p < 0.0001). There was medial meniscal extrusion (MME) prior to tear in two of 15 (13 %) patients and in ten of 15 (67 %) patients after PHMMR failure. In the control group, MME was present in one (3 %) and three (10 %) of 29 subjects on the initial and follow-up MRIs, respectively. Articular cartilage loss was noted in two of 15 (15 %) cases before tear and nine of 15 (69 %) on follow-up imaging, as compared to one (3 %) and four (14 %) of 29 subjects in the control group. Subcortical marrow edema deep to the PHMMR may result from abnormal stresses and thus be a harbinger of meniscal root failure. This hypothesis is supported by resolution of these marrow signal changes after root tear. Following tear, extrusion of the

  6. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Moatshe, Gilbert; Mitchell, Justin J; Cram, Tyler R; Yacuzzi, Carlos; LaPrade, Robert F

    2016-07-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn of the medial meniscus should be performed. Several treatment options have been reported, including nonsurgical management, inside-out meniscal repair, or all-inside meniscal repair. In cases of isolated ramp lesions, a standard meniscal repair rehabilitation protocol should be followed. However, when a concomitant ACL reconstruction (ACLR) is performed, the rehabilitation should follow the designated ACLR postoperative protocol. The purpose of this article was to review the current literature regarding meniscal ramp lesions and summarize the pertinent anatomy, biomechanics, diagnostic strategies, recommended treatment options, and postoperative protocol.

  7. New Complication Associated With All-Inside Meniscal Repair Device

    Science.gov (United States)

    Warth, Lucian C.; Bollier, Matthew J.; Hoffman, Douglas F.; Cummins, Justin S.; Hall, Mederic M.

    2016-01-01

    Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair. PMID:27635413

  8. Meniscal Transplants and Scaffolds: A Systematic Review of the Literature

    Science.gov (United States)

    Dangelmajer, Sean; Familiari, Filippo; Simonetta, Roberto; Kaymakoglu, Mehmet; Huri, Gazi

    2017-01-01

    The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison. PMID:28231642

  9. Current concepts on posterior meniscal root lesion: A treatment algorithm based on the currently available evidence

    Directory of Open Access Journals (Sweden)

    Guan-Yang Song

    2014-07-01

    Full Text Available Meniscal root lesion is defined as an avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion, which is commonly observed at the posterior region in the clinical practice. Although a number of biomechanical and clinical studies have shown the importance of the integrity of the posterior meniscal roots, the appropriate treatment is still controversial. The purposes of this review are to develop a current understanding of how the posterior meniscal root functions and to review the available treatment options for posterior meniscal root lesion.

  10. Patología meniscal: opciones terapéuticas

    OpenAIRE

    Fernández, E

    2015-01-01

    La cirugía de la patología meniscal es uno de los procedimientos más frecuentes en la cirugía ortopédica. Los estudios de los últimos años han supuesto una modificación de los tratamientos y planteamientos antes las roturas meniscales. La sutura meniscal, con el tratamiento de lesiones concomitantes, como las lesiones del ligamento cruzado anterior o lesiones condrales , han mejorado los resultados clínicos. Pero, al mismo tiempo, surgen problemas derivados de la meniscectomía, en...

  11. Advances and Prospects in Tissue-Engineered Meniscal Scaffolds for Meniscus Regeneration

    Directory of Open Access Journals (Sweden)

    Weimin Guo

    2015-01-01

    Full Text Available The meniscus plays a crucial role in maintaining knee joint homoeostasis. Meniscal lesions are relatively common in the knee joint and are typically categorized into various types. However, it is difficult for inner avascular meniscal lesions to self-heal. Untreated meniscal lesions lead to meniscal extrusions in the long-term and gradually trigger the development of knee osteoarthritis (OA. The relationship between meniscal lesions and knee OA is complex. Partial meniscectomy, which is the primary method to treat a meniscal injury, only relieves short-term pain; however, it does not prevent the development of knee OA. Similarly, other current therapeutic strategies have intrinsic limitations in clinical practice. Tissue engineering technology will probably address this challenge by reconstructing a meniscus possessing an integrated configuration with competent biomechanical capacity. This review describes normal structure and biomechanical characteristics of the meniscus, discusses the relationship between meniscal lesions and knee OA, and summarizes the classifications and corresponding treatment strategies for meniscal lesions to understand meniscal regeneration from physiological and pathological perspectives. Last, we present current advances in meniscal scaffolds and provide a number of prospects that will potentially benefit the development of meniscal regeneration methods.

  12. Effect of Microfracture on Meniscal Tear Healing in a Goat (Capra hircus) Model.

    Science.gov (United States)

    Howarth, William R; Brochard, Kevin; Campbell, Scot E; Grogan, Brian F

    2016-01-01

    Meniscal injuries are an extremely common cause of knee pain. Meniscal repairs performed with concomitant anterior cruciate ligament reconstruction appear to heal at a higher rate than meniscal repairs performed in isolation. This may be due in part to the release of marrow elements into the knee and the time of meniscal repair. In cases of isolated meniscal repair, some orthopedic surgeons use microfracture to release marrow elements into the joint as an adjunct to enhance meniscal healing. This study evaluated rates of meniscal tear healing with or without the performance of microfracture in a goat (Capra hircus) model. Forty castrated young adult male goats underwent either a horizontal or a longitudinal 1.0-cm meniscal tear with or without microfracture. All procedures were performed open, in a bloodless field. Meniscal tears were created in the peripheral half of the body of the medial meniscus. The goats were euthanized at 6 months, and meniscal tears were analyzed and classified as complete healing, partial healing, or no healing by direct visualization. A probe was used as an aid to evaluate and classify the meniscal tears. Twenty (87%) of 23 goat meniscal tears showed at least partial healing when performed with concomitant microfracture. Only 5 (29%) of 17 menisci showed any healing in goats that did not receive microfracture. This difference in healing rates was statistically significant (P<.001). Fifteen (65%) meniscal tears accomplished with microfracture were completely healed, whereas only 2 (12%) menisci showed complete healing without microfracture (P<.001). The results of this study suggest that the release of bone marrow elements into the knee by microfracture improves meniscal healing rates.

  13. Anatomical Knee Variants in Discoid Lateral Meniscal Tears

    Science.gov (United States)

    Chen, Xu-Xu; Li, Jian; Wang, Tao; Zhao, Yang; Kang, Hui

    2017-01-01

    Background: Discoid lateral meniscus was a common meniscal dysplasia and was predisposed to tear. There were some anatomical knee variants in patients with discoid lateral meniscus. The aim of this study was to analyze the relationship between anatomical knee variants and discoid lateral meniscal tears. Methods: There were totally 125 cases of discoid lateral meniscus enrolled in this study from February 2008 to December 2013. Eighty-seven patients who underwent arthroscopic surgery for right torn discoid lateral meniscus were enrolled in the torn group. An additional 38 patients who were incidentally identified as having intact discoid lateral menisci on magnetic resonance imaging (MRI) findings were included in the control group. All patients were evaluated for anatomical knee variants on plain radiographs, including lateral joint space distance, height of the lateral tibial spine, height of the fibular head, obliquity of the lateral tibial plateau, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau, lateral femoral condylar notch, and condylar cutoff sign. The relationship between anatomical variants and meniscal tear was evaluated. These anatomical variants in cases with complete discoid meniscus were also compared with those in cases with incomplete discoid meniscus. Results: There were no significant differences between the two groups in lateral joint space distance (P = 0.528), height of the lateral tibial spine (P = 0.927), height of the fibular head (P = 0.684), obliquity of the lateral tibial plateau (P = 0.672), and the positive rates of squaring of the lateral femoral condyle (P = 0.665), cupping of the lateral tibial plateau (P = 0.239), and lateral femoral condylar notch (P = 0.624). The condylar cutoff sign was significantly different between the two groups, with the prominence ratio in the torn group being smaller than that in the control group (0.74 ± 0.11 vs. 0.81 ± 0.04, P = 0.049). With the decision value of the

  14. Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival.

    Science.gov (United States)

    van der Wal, Robert J P; Thomassen, Bregje J W; Swen, Jan-Willem A; van Arkel, Ewoud R A

    2016-07-01

    Arthroscopic meniscal repair is the gold standard for longitudinal peripheral meniscal tears. The time interval between trauma and meniscal repair remains controversial. The aim of this study was to evaluate failure rates and clinical outcome of arthroscopic meniscal repair in relation to chronicity of injury. A total of 238 meniscal repairs were performed in 234 patients. Anterior cruciate ligament (ACL) was reconstructed in almost all ACL-deficient knees (130 out of 133). Time interval between injury and repair was divided into acute ( 2 to  12 weeks). Patients completed postal questionnaires to evaluate clinical outcome and failure rates. Study instruments included Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner scoring systems. At a median follow-up of 41 months (interquartile range [IQR], 34-53 months) 55 medial and 10 lateral meniscal repairs failed (overall failure rate, 27%). There was a significant higher failure rate for medial meniscal repair (p meniscal repair has no influence on the failure rate. Differences in survival rate of meniscal repair are more dependent on location of the lesion and ACL status, rather than chronicity of injury.

  15. Automatic CAD of meniscal tears on MR imaging: a morphology-based approach

    Science.gov (United States)

    Ramakrishna, Bharath; Liu, Weimin; Safdar, Nabile; Siddiqui, Khan; Kim, Woojin; Juluru, Krishna; Chang, Chein-I.; Siegel, Eliot

    2007-03-01

    Knee-related injuries, including meniscal tears, are common in young athletes and require accurate diagnosis and appropriate surgical intervention. Although with proper technique and skill, confidence in the detection of meniscal tears should be high, this task continues to be a challenge for many inexperienced radiologists. The purpose of our study was to automate detection of meniscal tears of the knee using a computer-aided detection (CAD) algorithm. Automated segmentation of the sagittal T1-weighted MR imaging sequences of the knee in 28 patients with diagnoses of meniscal tears was performed using morphologic image processing in a 3-step process including cropping, thresholding, and application of morphological constraints. After meniscal segmentation, abnormal linear meniscal signal was extracted through a second thresholding process. The results of this process were validated by comparison with the interpretations of 2 board-certified musculoskeletal radiologists. The automated meniscal extraction algorithm process was able to successfully perform region of interest selection, thresholding, and object shape constraint tasks to produce a convex image isolating the menisci in more than 69% of the 28 cases. A high correlation was also noted between the CAD algorithm and human observer results in identification of complex meniscal tears. Our initial investigation indicates considerable promise for automatic detection of simple and complex meniscal tears of the knee using the CAD algorithm. This observation poses interesting possibilities for increasing radiologist productivity and confidence, improving patient outcomes, and applying more sophisticated CAD algorithms to orthopedic imaging tasks.

  16. Meniscal pathology in children: differences and similarities with the adult meniscus

    Energy Technology Data Exchange (ETDEWEB)

    Francavilla, Michael L.; Restrepo, Ricardo; Zamora, Kathryn W.; Sarode, Vijaya [Department of Radiology, Miami Children' s Hospital, Miami, FL (United States); Swirsky, Stephen M. [Department of Orthopedics, Miami Children' s Hospital, Miami, FL (United States); Mintz, Douglas [Hospital for Special Surgery, New York, NY (United States)

    2014-08-15

    The normal meniscus undergoes typical developmental changes during childhood, reaching a mature adult appearance by approximately 10 years of age. In addition to recognizing normal meniscal appearances in children, identifying abnormalities - such as tears and the different types of discoid meniscus and meniscal cysts, as well as the surgical implications of these abnormalities - is vital in pediatric imaging. The reported incidence of meniscal tears in adolescents and young adults has increased because of increased sports participation and more widespread use of MRI. This review discusses the normal appearance of the pediatric meniscus, meniscal abnormalities, associated injuries, and prognostic indicators for repair. (orig.)

  17. All-inside arthroscopic suturing technique for meniscal ruptures.

    Science.gov (United States)

    Darabos, Nikica; Dovzak-Bajs, Ivana; Bilić, Vide; Darabos, Anela; Popović, Iva; Cengić, Tomislav

    2012-03-01

    The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The "all inside" arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The "all inside" technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.

  18. Arthroscopic Meniscal Repair: “Modified Outside-In Technique”

    Science.gov (United States)

    Keyhani, Sohrab; Abbasian, Mohammad Reza; Siatiri, Nasim; Sarvi, Ali; Kivi, Mohsen Mardani; Esmailiejah, Ali Akbar

    2015-01-01

    Background: Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “modified outside-in technique” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated. Methods: The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients’ satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months. Results: Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients’ satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. Conclusions: The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard. PMID:26110176

  19. Value of modern sonography in the assessment of meniscal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Wareluk, Pawel, E-mail: pwareluk@wum.edu.pl [Department of Diagnostic Imaging, Second Faculty of Medicine, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw (Poland); Szopinski, Kazimierz T., E-mail: kszopinski@wum.edu.pl [Department of Dental and Maxillofacial Radiology, First Faculty of Medicine, Medical University of Warsaw, ul. Nowogrodzka 59, 02-006 Warsaw (Poland)

    2012-09-15

    The aim of this prospective study was to assess the accuracy of modern ultrasonography in diagnostic imaging of meniscal tears. One hundred and sixty menisci were evaluated in 80 patients (42 females, 38 males, mean age = 36.2 years, range = 16–70 years). Inclusion criteria for the study were twofold: clinical suspicion of meniscal injury and clinical indication for arthroscopy. Knee examination was performed with the Voluson 730 Expert ultrasound system (General Electric). After sonographic examination, all patients underwent arthroscopic procedures within 1–4 days. The final diagnosis of meniscal tears was taken from surgical reports. The overall sensitivity, specificity, positive predictive value and negative predictive value of sonographic examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index (BMI), weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of ultrasonography. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a BMI > 25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The positive predictive value (PPV) of sonographic examination was higher than 90% only in recent injuries (<1 month), however, the negative predictive value of ultrasound is high, being less than 90% in males with lesions of lateral menisci and in sequelae of sports injuries.

  20. Discrimination of meniscal cell phenotypes using gene expression profiles

    Directory of Open Access Journals (Sweden)

    M Son

    2012-03-01

    Full Text Available The lack of quantitative and objective metrics to assess cartilage and meniscus cell phenotypes contributes to the challenges in fibrocartilage tissue engineering. Although functional assessment of the final resulting tissue is essential, initial characterization of cell sources and quantitative description of their progression towards the natural, desired cell phenotype would provide an effective tool in optimizing cell-based tissue engineering strategies. The purpose of this study was to identify quantifiable characteristics of meniscal cells and thereby find phenotypical markers that could effectively categorize cells based on their tissue of origin (cartilage, inner, middle, and outer meniscus. The combination of gene expression ratios collagen VI/collagen II, ADAMTS-5/collagen II, and collagen I/collagen II was the most effective indicator of variation among different tissue regions. We additionally demonstrate a possible application of these quantifiable metrics in evaluating the use of serially passaged chondrocytes as a possible cell source in fibrocartilage engineering. Comparing the ratios of the passaged chondrocytes and the native meniscal cells may provide direction to optimize towards the desired cell phenotype. We have thus shown that measurable markers defining the characteristics of the native meniscus can establish a standard by which different tissue engineering strategies can be objectively assessed. Such metrics could additionally be useful in exploring the different stages of meniscal degradation in osteoarthritis and provide some insight in the disease progression.

  1. PHYSICAL EXAMINATIONS FOR DIAGNOSING MENISCAL INJURIES: CORRELATION WITH SURGICAL FINDINGS

    Science.gov (United States)

    Gobbo, Ricardo da Rocha; Rangel, Victor de Oliveira; Karam, Francisco Consoli; Pires, Luiz Antônio Simões

    2015-01-01

    Objective: A set of five maneuvers for meniscal injuries (McMurray, Apley, Childress and Steinmann 1 and 2) was evaluated and their sensitivity, specificity, accuracy and likelihood were calculated. The same methods were applied to each test individually. Methods: One hundred and fifty-two patients of both sexes who were going to undergo videoarthroscopy on the knee were examined blindly by one of five residents at this hospital, without knowledge of the clinical data and why the patient was going to undergo an operation. This examination was conducted immediately before the videoarthroscopy and its results were recorded in an electronic spreadsheet. The set of maneuvers was considered positive when one was positive. In the individual analysis, it was enough for the test to be positive. Results: The analysis showed that the set of five meniscal tests presented sensitivity of 89%, specificity of 42%, accuracy of 75%, positive likelihood of 1.53 and negative likelihood of 0.26. Individually, the tests presented accuracy of between 48% and 53%. Conclusion: The set of maneuvers for meniscal injuries presented a good accuracy and significant value, especially for ruling out injury. Individually, the tests had less diagnostic value, although the Apley test had better specificity. PMID:27047833

  2. Association of peripheral vertical meniscal tears with anterior cruciate ligament tears

    Energy Technology Data Exchange (ETDEWEB)

    Vinson, Emily N.; Gage, Jeffrey A.; Lacy, Joe N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2008-07-15

    The purpose of this article is to describe a type of meniscal tear seen on magnetic resonance (MR) imaging, the peripheral vertical tear, and to determine the prevalence of anterior cruciate ligament (ACL) tears in knees with this type of meniscal tear compared to knees with other types of meniscal tears. Following Institutional Review Board approval, a retrospective review of 200 knee MR examinations with imaging diagnoses of 'meniscal tear' was performed to assess the location and morphology of the meniscal tear, and to assess the status of the ACL. Nineteen peripheral vertical meniscal tears were identified in 17 patients, 14 of whom had acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. Three peripheral vertical tears were seen in the setting of a normal ACL. Of the 183 examinations with other types of meniscal tears, there were 17 cases with acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. The difference in the prevalence of ACL tear, reconstruction, or deficiency in knees with meniscal tears of the peripheral vertical type (82.4%) compared with the prevalence of ACL tear, reconstruction, or deficiency in knees with other types of meniscal tears (9.3%) was statistically significant (P < 0.001). The calculated specificity of the presence of peripheral vertical tear morphology in detecting an ACL injury in patients with meniscal tears was 98.2%. Peripheral vertical meniscal tears, particularly when involving the posterior horn, are highly associated with ACL tear, deficiency, or reconstruction. The finding of this type of tear on knee MR imaging should prompt close inspection of the ACL for evidence of acute or chronic injury, and its presence may help make the diagnosis of ACL tear in equivocal cases. (orig.)

  3. MRI follow-up of conservatively treated meniscal knee lesions in general practice

    NARCIS (Netherlands)

    E.H.G. Oei (Edwin); I.M. Koster (Ingrid); J.H.J. Hensen; S.S. Boks (Simone); H.P.A. Wagemakers (Harry); B.W. Koes (Bart); D. Vroegindeweij (Dammis); S.M. Bierma-Zeinstra (Sita); M.G.M. Hunink (Myriam)

    2010-01-01

    textabstractObjective: To evaluate meniscal status change on follow-up MRI after 1 year, prognostic factors and association with clinical outcome in patients with conservatively treated knee injury. Methods: We analysed 403 meniscal horns in 101 conservatively treated patients (59 male; mean age 40

  4. A porous polymer scaffold for meniscal lesion repair--a study in dogs.

    NARCIS (Netherlands)

    Tienen, Tony van; Heijkants, R.G.J.C.; Buma, P.; Groot, J.H. de; Pennings, A.J.; Veth, R.P.H.

    2003-01-01

    Meniscal lesions often occur in the avascular area of the meniscus with little chance of spontaneous repair. An access channel in the meniscal tissue can function as an entrance for ingrowing repair tissue from the vascular periphery of the meniscus to the lesion in the avascular zone which again in

  5. A porous polymer scaffold for meniscal lesion repair - A study in dogs

    NARCIS (Netherlands)

    Tienen, TG; Heijkants, RGJC; Buma, P; De Groot, JH; Pennings, AJ; Veth, RPH

    2003-01-01

    Meniscal lesions often occur in the avascular area of the meniscus with little chance of spontaneous repair. An access channel in the meniscal tissue can function as an entrance for ingrowing repair tissue from the vascular periphery of the meniscus to the lesion in the avascular zone which again in

  6. A porous polymer scaffold for meniscal lesion repair--a study in dogs.

    Science.gov (United States)

    Tienen, T G; Heijkants, R G J C; Buma, P; De Groot, J H; Pennings, A J; Veth, R P H

    2003-06-01

    Meniscal lesions often occur in the avascular area of the meniscus with little chance of spontaneous repair. An access channel in the meniscal tissue can function as an entrance for ingrowing repair tissue from the vascular periphery of the meniscus to the lesion in the avascular zone which again induced healing of the lesion. Implantation of a porous polymer in a full-thickness access channel induced healing. However, a better integration between meniscal tissue and the implant might be achieved with the combination of the newly developed porous polymers and a modified surgical technique. This might improve meniscal lesion healing and the repair of the access channel with neo-meniscal tissue. Longitudinal lesions were created in the avascular part of 24 canine lateral menisci and a partial-thickness access channel was formed to connect the lesion with the meniscal periphery. In 12 menisci, the access channel was left empty (control group), while in the remaining 12 menisci the polymer implant was sutured into the access channel. Repair of the longitudinal lesions was achieved with and without polymer implantation in the partial-thickness access channel. Polymer implants induced fibrous ingrowth with cartilaginous areas, which resembled neo-meniscal tissue. Implantation did not prevent articular cartilage degeneration.

  7. MRI follow-up of conservatively treated meniscal knee lesions in general practice

    Energy Technology Data Exchange (ETDEWEB)

    Oei, Edwin H.G.; Hunink, M.G.M. [University Medical Center Rotterdam, Program for the Assessment of Radiological Technology (ART Program), Erasmus MC, Rotterdam (Netherlands); University Medical Center Rotterdam, Department of Radiology, Erasmus MC, Rotterdam (Netherlands); University Medical Center Rotterdam, Department of Epidemiology, Erasmus MC, Rotterdam (Netherlands); Koster, Ingrid M. [University Medical Center Rotterdam, Department of Radiology, Erasmus MC, Rotterdam (Netherlands); Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Hensen, Jan-Hein J.; Vroegindeweij, Dammis [Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Boks, Simone S. [University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Rotterdam (Netherlands); Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Diaconessenhuis Meppel, Department of Radiology, Meppel (Netherlands); Wagemakers, Harry P.A.; Koes, Bart W.; Bierma-Zeinstra, Sita M.A. [University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Rotterdam (Netherlands)

    2010-05-15

    To evaluate meniscal status change on follow-up MRI after 1 year, prognostic factors and association with clinical outcome in patients with conservatively treated knee injury. We analysed 403 meniscal horns in 101 conservatively treated patients (59 male; mean age 40 years) in general practice who underwent initial knee MRI within 5 weeks of trauma. We performed ordinal logistic regression analysis to analyse prognostic factors for meniscal change on follow-up MRI after 1 year, and we assessed the association with clinical outcome. On follow-up MRI 49 meniscal horns had deteriorated and 18 had improved. Age (odds ratio [OR] 1.3/decade), body weight (OR 1.2/10 kg), total anterior cruciate ligament (ACL) rupture on initial MRI (OR 2.4), location in the posterior horn of the medial meniscus (OR 3.0) and an initial meniscal lesion (OR 0.3) were statistically significant predictors of meniscal MRI appearance change after 1 year, which was not associated with clinical outcome. In conservatively treated patients, meniscal deterioration on follow-up MRI 1 year after trauma is predicted by higher age and body weight, initial total ACL rupture, and location in the medial posterior horn. Change in MRI appearance is not associated with clinical outcome. (orig.)

  8. A prospective study on knee proprioception after meniscal allograft transplantation.

    Science.gov (United States)

    Thijs, Y; Witvrouw, E; Evens, B; Coorevits, P; Almqvist, F; Verdonk, R

    2007-06-01

    The meniscus plays an important role in the proprioceptive ability of the knee joint. The aim of this prospective study was to assess the short-term influence of a meniscus replacement on the proprioception of the knee. Fourteen patients who had undergone a fresh meniscal allograft transplantation between May 2001 and June 2003 were tested pre-operatively and 6 months post-operatively. Disability regarding pain, stiffness and functionality of the affected knee during daily activities was measured by the Western Ontario and McMaster Universities Arthritis (WOMAC) scale. The knee joint position sense was assessed using the Biodex System 3 isokinetic dynamometer. The results of the WOMAC scale showed no significant differences concerning pain, stiffness or knee function between the pre- and post-operative condition of the knee. Assessment of the knee joint position sense at a reference point of 70 degrees of knee flexion revealed a significant improvement of the proprioception of the operated knee at 6 months after surgery compared with the pre-operative condition. The results of this study suggest that although no significant improvement of pain and functionality of the operated knee occurred at this short-term follow-up period, a meniscal allograft transplantation seems to have a significant positive effect on the joint position sense of the previously meniscectomised knee.

  9. Unusual Presentation of Synovial Sarcoma as Meniscal Cyst: A Case Report.

    Science.gov (United States)

    Jamshidi, Khodamorad; Yahyazadeh, Hooman; Bagherifard, Abolfazl

    2015-10-01

    Periarticular cyst and cystic soft tissue lesion around the knee are common. Synovial sarcoma is a rare and malignant soft tissue tumor accounting for approximately 5% of soft tissue sarcoma. A case is presented where a lesion adjacent to the joint line of the knee was diagnosed clinically and on imaging as a meniscal cyst. MRI signal was homogenous and no concomitant meniscal tears were seen. The tissue diagnosis was monophasic synovial sarcoma.

  10. Unusual Presentation of Synovial Sarcoma as Meniscal Cyst: A Case Report

    Directory of Open Access Journals (Sweden)

    Khodamorad Jamshidi

    2015-09-01

    Full Text Available Periarticular cyst and cystic soft tissue lesion around the knee are common. Synovial sarcoma is a rare and malignant soft tissue tumor accounting for approximately 5% of soft tissue sarcoma. A case is presented where a lesion adjacent to the joint line of the knee was diagnosed clinically and on imaging as a meniscal cyst. MRI signal was homogenous and no concomitant meniscal tears were seen. The tissue diagnosis was monophasic synovial sarcoma.

  11. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.

    Science.gov (United States)

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-02-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18-77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results - 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation - Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

  12. Cartilage Degeneration, Subchondral Mineral and Meniscal Mineral Densities in Hartley and Strain 13 Guinea Pigs.

    Science.gov (United States)

    Sun, Yubo; Scannell, Brian P; Honeycutt, Patrick R; Mauerhan, David R; H, James Norton; Hanley, Edward N

    2015-01-01

    Osteoarthritis is a joint disease involved in articular cartilage, subchondral bone, meniscus and synovial membrane. This study sought to examine cartilage degeneration, subchondral bone mineral density (BMD) and meniscal mineral density (MD) in male Hartley, female Hartley and female strain 13 guinea pigs to determine the association of cartilage degeneration with subchondral BMD and meniscal MD. Cartilage degeneration, subchondral BMD and meniscal MD in 12 months old guinea pigs were examined with histochemistry, X-ray densitometry and calcium analysis. We found that male Hartley guinea pigs had more severe cartilage degeneration, subchondral BMD and meniscal MD than female Hartley guinea pigs, but not female strain 13 guinea pigs. Female strain 13 guinea pigs had more severe cartilage degeneration and higher subchondral BMD, but not meniscal MD, than female Hartley guinea pigs. These findings indicate that higher subchondral BMD, not meniscal MD, is associated with more severe cartilage degeneration in the guinea pigs and suggest that abnormal subchondral BMD may be a therapeutic target for OA treatment. These findings also indicate that the pathogenesis of OA in the male guinea pigs and female guinea pigs are different. Female strain 13 guinea pig may be used to study female gender-specific pathogenesis of OA.

  13. THE EFFECTIVENESS OF ELECTROMYOGRAPHIC BIOFEEDBACK AS PART OF A MENISCAL REPAIR REHABILITATION PROGRAMME

    Directory of Open Access Journals (Sweden)

    Mihaela Oravitan

    2013-09-01

    Full Text Available The objective of the study was to assess the effectiveness of using electromyographic biofeedback in the early stages of rehabilitation after meniscal repair. In this randomised, controlled, parallel group study, the evolution of patients with meniscal lesions treated by meniscal suture who received (study group, n = 33 or did not receive (control group, n = 31 electromyographic biofeedback as part of their early rehabilitation programme has been compared. A total of 64 patients with previous meniscal repair participated in the study. The patients received a baseline assessment (after 1 postoperative week and a follow-up (after 8 postoperative weeks consisting of surface electromyography, dynamometry of thigh muscles and the assessment of the Knee injury and Osteoarthritis Outcome Score (KOOS. The electrical potential in contraction and the speed for contraction and relaxation for all monitored muscles increased significantly in the study group (p < 0.05. The difference between groups in the assessed score was significant for sport and recreational function (p < 0.05. The strength of the thigh muscles was not significantly influenced by the introduction of electromyographic biofeedback (EMG- BFB in the rehabilitation programme. Electromyographic biofeedback helped patients to control their muscles after meniscal repair to accomplish physical activities that require better neuromuscular coordination and control. For these reasons, one may consider electromyographic biofeedback as an important component of rehabilitation after meniscal repair

  14. The structural and compositional transition of the meniscal roots into the fibrocartilage of the menisci.

    Science.gov (United States)

    Andrews, Stephen H J; Rattner, Jerome B; Jamniczky, Heather A; Shrive, Nigel G; Adesida, Adetola B

    2015-02-01

    The meniscal roots, or insertional ligaments, firmly attach the menisci to tibial plateau. These strong attachments anchor the menisci and allow for the generation of hoop stress in the tissue. The meniscal roots have a ligament-like structure that transitions into the fibrocartilagenous structure of the meniscal body. The purpose of this study was to carry out a complete analysis of the structure and tissue organization from the body of the meniscus through the transition region and into the insertional roots. Serial sections were obtained from the meniscal roots into the meniscal body in fixed juvenile bovine menisci. Sections were stained for collagen and proteoglycans (PG) using fast green and safranin-o staining protocols. Unstained sections were imaged used a backlit stereo microscope. Optical projection tomography (OPT) was employed to evaluate the three-dimensional collagen architecture of the root-meniscus transition in lapine menisci. Tie-fibres were observed in the sections of the ligaments furthest from the bovine meniscal body. Blood vessels were observed to be surrounded by these tie-fibres and a PG-rich region within the ligaments. Near the tibial insertion, the roots contained large ligament-like collagen fascicles. In sections approaching the meniscus, there was an increase in tie-fibre size and density. Small tie-fibres extended into the ligament from the epiligamentous structure in the outermost sections of the meniscal roots, while large tie-fibre bundles were apparent at the meniscus transition. The staining pattern indicates that the root may continue into the outer portion of the meniscus where it then blends with the more fibrocartilage-like inner portions of the tissue. In unstained sections it was observed that the femoral side of the epiligamentous structure surrounding the root becomes more fibrous and thickens in the inferior inner portion of the posterior medial root. This thickening changes the shape of the root to more closely

  15. Regeneration of whole meniscus using meniscal cells and polymer scaffolds in a rabbit total meniscectomy model.

    Science.gov (United States)

    Kang, Sun-Woong; Son, Sun-Mi; Lee, Jae-Sun; Lee, Eung-Seok; Lee, Kwon-Yong; Park, Sang-Guk; Park, Jung-Ho; Kim, Byung-Soo

    2006-09-01

    The current treatments of meniscal lesion in knee joint are not perfect to prevent adverse effects of meniscus injury. Tissue engineering of meniscus using meniscal cells and polymer scaffolds could be an alternative option to treat meniscus injury. This study reports on the regeneration of whole medial meniscus in a rabbit total meniscectomy model using the tissue engineering technique. Biodegradable scaffolds in a meniscal shape were fabricated from polyglycolic acid (PGA) fiber meshes that were mechanically reinforced by bonding PGA fibers at cross points with 75:25 poly(lactic-co-glycolic acid). The compressive modulus of the bonded PGA scaffold was 28-fold higher than that of nonbonded scaffold. Allogeneic meniscal cells were isolated from rabbit meniscus biopsy and cultured in vitro. The expanded meniscal cells were seeded onto the polymer scaffolds, cultured in vitro for 1 week, and transplanted to rabbit knee joints from which medial menisci were removed. Ten or 36 weeks after transplantation, the implants formed neomenisci with the original scaffold shape maintained approximately. Hematoxylin and eosin staining of the sections of the neomenisci at 6 and 10 weeks revealed the regeneration of fibrocartilage. Safranin-O staining showed that abundant proteoglycan was present in the neomenisci at 10 weeks. Masson's trichrome staining indicated the presence of collagen. Immunohistochemical analysis showed that the presence of type I and II collagen in neomenisci at 10 weeks was similar to that of normal meniscal tissue. Biochemical and biomechanical analyses of the tissue-engineered menisci at 36 weeks were performed to determine the quality of the tissue-engineered menisci. Tissue-engineered meniscus showed differences in collagen content and aggregate modulus in comparison with native meniscus. This study demonstrates, for the first time, the feasibility of regenerating whole meniscal cartilage in a rabbit total meniscectomy model using the tissue engineering

  16. USG AND MRI CORRELATION IN THE EVALUATION OF MENISCAL LESIONS OF KNEE

    Directory of Open Access Journals (Sweden)

    Ravichandra

    2014-09-01

    Full Text Available AIMS AND OBJECTIVE: The objective of this study was to evaluate the role of a handheld USG of 7-13 MHz in evaluating meniscal lesions of knee and comparing it to the results obtained with magnetic resonance imaging. MATERIAL AND METHODS: A comparative double blind study was done between ultrasonography and MRI of fifty patients with a history of knee trauma or with suspected knee meniscal lesions, who were referred to the department of Radiodiagnosis. MRI and USG results were finally correlated with arthroscopy findings. All these patients had a significant history and clinical evaluation suggested meniscal lesion of the knee joint. Cases which have been operated previously on the same knee were excluded from this study. RESULTS: Out of the 50 patients, a total of 100 menisci were examined, out of which after final arthroscopy confirmation, 34 had meniscal tears, 3 degenerative tears, and two patients had meniscal cysts both of which were not associated with a tear of the meniscus. CONCLUSION: The specificity of USG matched that of MRI and it can reasonably be applied to confirm the clinical diagnosis before undertaking arthroscopy. However, the lower sensitivity suggests that there is still a need to improve the technique to reduce the number of false-negative diagnoses and thus to avoid unnecessary arthroscopy. USG may be used as a screening tool prior to arthroscopy in selected cases where MRI is a contraindication or is not available or if the patient is not affording.

  17. Ultrasound-guided percutaneous drainage of meniscal cysts: preliminary clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    MacMahon, P.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)]. E-mail: petermacmahon@yahoo.com; Brennan, D.D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Duke, D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Forde, S. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Eustace, S.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)

    2007-07-15

    Aim: To evaluate the efficacy of ultrasound-guided percutaneous drainage of symptomatic meniscal cysts. Materials and methods: Patients with lateral knee joint tenderness and swelling and confirmed meniscal cyst on magnetic resonance imaging (MRI) were consecutively enrolled for ultrasound-guided percutaneous cyst aspiration. Cysts were injected with local anaesthetic and steroid before completion of procedure. All 18 patients (all male, average age 33 years) were subsequently followed up (average time 10 months) and meniscal cyst symptoms assessed by questionnaire. Fischer's exact test used to analyse the data. Results: In every case the procedure was well tolerated, and each patient indicated that they would be willing to have a repeat procedure in the future. Ten patients reported complete resolution of symptoms secondary to therapeutic cyst aspiration and had resumed participation in high-performance sport. Two patients reported a satisfactory sustained response, reporting only occasional 'twinges of pain'. In the remaining six patients, symptoms returned after an initial pain-free period. The pain-free period ranged from 1-8 weeks. In this study, patient outcome did not significantly correlate with any meniscal cyst characteristic. Conclusion: Ultrasound-guided percutaneous aspiration of meniscal cysts is a well-tolerated, simple, and safe procedure. In this small patient series, it was associated with positive early results with favourable outcomes in the mid to long-term. It should be considered in patients unsuitable for surgical debridement or as an interim therapy if surgery is delayed or postponed.

  18. Role of computer aided detection (CAD) integration: case study with meniscal and articular cartilage CAD applications

    Science.gov (United States)

    Safdar, Nabile; Ramakrishna, Bharath; Saiprasad, Ganesh; Siddiqui, Khan; Siegel, Eliot

    2008-03-01

    Knee-related injuries involving the meniscal or articular cartilage are common and require accurate diagnosis and surgical intervention when appropriate. With proper techniques and experience, confidence in detection of meniscal tears and articular cartilage abnormalities can be quite high. However, for radiologists without musculoskeletal training, diagnosis of such abnormalities can be challenging. In this paper, the potential of improving diagnosis through integration of computer-aided detection (CAD) algorithms for automatic detection of meniscal tears and articular cartilage injuries of the knees is studied. An integrated approach in which the results of algorithms evaluating either meniscal tears or articular cartilage injuries provide feedback to each other is believed to improve the diagnostic accuracy of the individual CAD algorithms due to the known association between abnormalities in these distinct anatomic structures. The correlation between meniscal tears and articular cartilage injuries is exploited to improve the final diagnostic results of the individual algorithms. Preliminary results from the integrated application are encouraging and more comprehensive tests are being planned.

  19. Meniscal repair by all-inside technique with Fast-Fix device

    Directory of Open Access Journals (Sweden)

    Leonardo Jose Bernardes Albertoni

    2013-09-01

    Full Text Available OBJECTIVE: The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device. METHODS: A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Student's t test. RESULTS: The mean follow-up was 59 months (16-84. The Lysholm score showed 72% (16 patients of excellent and good results (84-100 points, 27% (6 patients fair (65-83 points and no cases classified as poor (<64 points. According to the IKDC: 81% (18 patients of excellent and good results (75-100 points, 18% of cases regular (50-75 points and no patient had poor results (<50 points. There were no failures or complications. CONCLUSION: The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.

  20. [THE EVOLUTION IN TREATING MENISCAL TEARS--FROM RESECTION TO SUTURING].

    Science.gov (United States)

    Stahl, Ido; Shapira, Jackob; Peskin, Bezalel; Hous, Nir; Norman, Doron; Falah, Mazen

    2016-05-01

    The meniscus has an important biomechanical role in the normal function of the knee including load bearing, shock absorption and joint stability. Tears of the meniscus are one of the common sports injuries. The knowledge that total meniscectomy causes early development of degenerative changes has raised the prevalence of meniscal tear repair in order to preserve as much as possible of the meniscal tissue. The type of tear (degenerative of traumatic), shape and location have a critical effect on healing ability after suture of the tear and thus will determine the treatment plan.

  1. Painful locking of the knee due to bucket handle tear of mediopatellar plica

    Institute of Scientific and Technical Information of China (English)

    HE Rui; YANG Liu; GUO Lin

    2011-01-01

    A case of swelling and anterior painful knee due to tear of mediopatellar plica is reported. The patient also felt clunk of the patellofemoral joint and knee locking. Under arthroscopic examination, a thick and fibrous plica was found medial to patellar, and a bucket tear along the plica fi.om medial patellar retinaculum to infrapatellar fat pad. Polarized microscopic examination showed collagen fiber fragment and loss of light reflecting property. Neuroimmunohistology suggested up-regulation of synovial plica innervation in the area around the crack. This may be related to the pain. The bucket tear of mediopatellar plicacaused pain and lock of knee are more common than previously reported.

  2. Kinetic study of the replacement of porcine small intestinal submucosa grafts and the regeneration of meniscal-like tissue in large avascular meniscal defects in dogs.

    Science.gov (United States)

    Cook, J L; Tomlinson, J L; Arnoczky, S P; Fox, D B; Reeves Cook, C; Kreeger, J M

    2001-06-01

    Porcine small intestinal submucosa (SIS) was used to replace large, avascular defects in the medial menisci of dogs. Twelve dogs received SIS grafts and 3 dogs were left untreated as controls. Dogs were evaluated at 4, 8, and 12 weeks by means of lameness scoring and ultrasonography. Dogs were sacrificed at 1, 6, or 12 weeks after implantation, and the tissue at the site of meniscal resection was evaluated for gross and histologic appearance, cross-sectional and surface area, and collagen types I and II. The femoral and tibial condyles were assessed for articular cartilage damage. Control dogs were significantly more lame than grafted dogs 8 and 12 weeks after instrumentation. Grafted dogs' replacement tissue appeared meniscal-like when evaluated grossly and ultrasonographically 12 weeks after instrumentation. The amount of replacement tissue was significantly greater in both cross-sectional and surface area for grafted dogs than for controls at all time points. Histologically, the SIS biomaterial could be identified in all grafted dogs at 1 week post-implantation, but in none at 6 weeks post-implantation. Subjectively, grafted dogs' replacement tissue was histologically superior to that of controls with respect to tissue type, organization, and architecture. Collagen types I and II immunoreactivity in grafted menisci were similar to that of normal menisci. Control dogs had significantly more articular cartilage damage than grafted dogs. SIS appears to induce regeneration of meniscal-like tissue in large, avascular meniscal defects in dogs, resulting in superior clinical function and articular cartilage protection compared to ungrafted controls.

  3. Meniscal tissue regeneration in porous 50/50 copoly(L-lactide/epsilon-caprolactone) implants

    NARCIS (Netherlands)

    deGroot, JH; Zijlstra, FM; Kuipers, HW; Pennings, AJ; Veth, RPH; Jansen, HWB

    1997-01-01

    Porous materials of a high-molecular-weight 50/50 copolymer of L-lactide and epsilon-caprolactone with different compression moduli were used for meniscal repair. In contrast to the previously used 4,4'-diphenylmethane and 1,6-trans-cyclohexane diisocyanates containing polyurethanes, degradation pro

  4. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers

    DEFF Research Database (Denmark)

    Rytter, Søren; Jensen, Lilli Kirkeskov; Bonde, Jens Peter;

    2009-01-01

    ). 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...

  5. Arthroscopic all-inside meniscal repair - Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Hoffelner, Thomas; Resch, Herbert; Mayer, Michael; Tauber, Mark [Department of Traumatology and Sports Injuries, Salzburg (Austria); Forstner, Rosemarie [University Hospital of Salzburg, Department of Radiology, Salzburg (Austria); Minnich, Bernd [University of Salzburg, Department of Organismic Biology, Salzburg (Austria)

    2011-02-15

    The purpose of this study was to correlate clinical and radiological results using a 3-T MRI to verify meniscal healing after arthroscopic all-inside meniscus repair. We selected 27 patients (14 men and 13 women) with an average age of 31 {+-} 9 years and retrospective clinical examinations and radiological assessments using a 3-T MRI after all-inside arthroscopic meniscal repair were conducted. Repair of the medial meniscus was performed in 19 patients and of the lateral meniscus in eight. In 17 patients (63%), we performed concomitant anterior cruciate ligament reconstruction. The mean follow-up period was 4.5 {+-} 1.7 years. The Lysholm score and Tegner activity index were used for clinical evaluation. Four grades were used to classify the radiological signal alterations within the meniscus: central globular (grade 1); linear horizontal or band-like (grade 2); intrameniscal alterations and linear signal alterations communicating with the articular surface (grade 3); and complex tears (grade 4). At follow-up, the average Lysholm score was 76 {+-} 15 points, with ten of the patients placed in group 6 based on the Tegner activity index. MRI examinations revealed no signal alteration in three patients, grade 1 in 0, grade 2 in five, grade 3 in 13, and grade 4 in six. The MRI findings correlated positively with the clinical scores in 21 patients (78%). Correlation of clinical and radiological examination was performed using 3-T MRI. In spite of satisfactory clinical outcomes at follow-up, a radiological signal alteration may still be visible on MRI, which was believed to be scar tissue, but could not be proven definitively. Imaging with a 3-Tesla MRI after meniscal suture surgery provides good but no definitive reliability on meniscus healing and therefore gives no advantage compared to 1.5-T MRI, with good clinical outcome using an all-inside arthroscopic meniscal repair. 3T-MRI can not substitute diagnostic arthroscopy in patients with persistent complaints after

  6. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns

    Energy Technology Data Exchange (ETDEWEB)

    Yao, Lawrence [Diagnostic Radiology Department, National Institutes of Health, Building 10, Room 1C640, 10 Center Drive, MSC 1182, MD 20892-1182, Bethesda (United States); Stanczak, Jeffrey [Fairfax Radiological Consultants, PC, 2722 Merrilee Drive, Suite 230, VA 22031, Fairfax (United States); Boutin, Robert D. [MedTel International, 1430 Spring Hill Road, State 500, VA 22102, Mclean (United States)

    2004-05-01

    MRI detects subchondral marrow findings in painful knees which bear resemblance to spontaneous osteonecrosis of the knee (SONK). Gathering evidence suggests that the primary or predominant pathogenesis of these lesions is physical stress. This study analyzes the patient characteristics and meniscal pathology associated with these lesions - herein referred to as ''presumptive subarticular stress related'' (PSSR) lesions. All patients were scanned using a standardized imaging protocol. The criterion for a PSSR lesion was a subchondral marrow edema pattern encompassing a more focal, low-signal zone adjacent to or contiguous with the subchondral cortex. Patients were identified using an electronic database search of cases reported by one experienced musculoskeletal radiologist. Twenty-five PSSR lesions were identified among 1,948 MRI evaluations of the knee. Twenty-one PSSR lesions occurred in the medial compartment, and four occurred in the lateral compartment. There was no sex predilection. Patients with PSSR lesions were older than other patients undergoing MRI evaluation (mean 66 years versus 52 years, P<0.001). Meniscal tears occurred more commonly in cases with PSSR lesions than in the group as a whole (76% versus 45%, P<0.001). Radial and posterior root tears were more common in knees with PSSR lesions than in other knees with meniscal tears (53% versus 26%, P<0.01). PSSR lesions are associated with meniscal tears and, more specifically, with meniscal tear patterns that dramatically increase contact forces across the knee joint. This observation supports the hypothesis that mechanical stress is important in the pathogenesis of these subarticular lesions that are detected by MRI. (orig.)

  7. Clinical examination, MRI and arthroscopy in meniscal and ligamentous knee Injuries – a prospective study

    Directory of Open Access Journals (Sweden)

    Bastawrous SS

    2008-05-01

    Full Text Available Abstract Data from 565 knee arthroscopies performed by two experienced knee surgeons between 2002 and 2005 for degenerative joint disorders, ligament injuries, loose body removals, lateral release of the patellar retinaculum, plica division, and adhesiolysis was prospectively collected. A subset of 109 patients from the above group who sequentially had clinical examination, MRI and arthroscopy for suspected meniscal and ligament injuries were considered for the present study and the data was reviewed. Patients with previous menisectomies, knee ligament repairs or reconstructions and knee arthroscopies were excluded from the study. Patients were categorised into three groups on objective clinical assessment: Those who were positive for either meniscal or cruciate ligament injury [group 1]; both meniscal and cruciate ligament injury [group 2] and those with highly suggestive symptoms and with negative clinical signs [group 3]. MRI was requested for confirmation of diagnosis and for additional information in all these patients. Two experienced radiologists reported MRI films. Clinical and MRI findings were compared with Arthroscopy as the gold standard. A thorough clinical examination performed by a skilled examiner more accurately correlated at Arthroscopy. MRI added no information in group 1 patients, valuable information in group 2 and was equivocal in group 3 patients. A negative MRI did not prevent an arthroscopy. In this study, specificity, positive and negative predictive values were more favourable for clinical examination though MRI was more sensitive for meniscal injuries. The use of MRI as a supplemental tool in the management of meniscal and ligament injuries should be highly individualised by an experienced surgeon.

  8. Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo; Lee, Jae Gue; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee Univ., Seoul (Korea, Republic of)

    2004-02-01

    Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion.

  9. Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark

    DEFF Research Database (Denmark)

    Hare, Kristoffer Borbjerg; Vinther, Jesper Høeg; Lohmander, L Stefan;

    2015-01-01

    of these procedures may differ from region to region. SETTING: We included data on all patients who underwent an arthroscopic meniscal procedure performed in the public or private sector in Denmark. PARTICIPANTS: Data were retrieved from the Danish National Patient Register on patients who underwent arthroscopic...... for public and private procedures for each region. RESULTS: Incidence of meniscal procedures increased at private and at public hospitals. The private sector accounted for the largest relative and absolute increase, rising from an incidence of 1 in 2000 to 98 in 2011. In 2011, the incidence of meniscal...... procedures was three times higher in the Capital Region than in Region Zealand. CONCLUSIONS: Our study identified a large increase in the use of meniscal procedures in the public and private sector in Denmark. The increase was particularly conspicuous in the private sector as its proportion of procedures...

  10. Diagnostic accuracy of magnetic resonance imaging for meniscal tears in dogs affected with naturally occuring cranial cruciate ligament rupture.

    Science.gov (United States)

    Blond, Laurent; Thrall, Donald E; Roe, Simon C; Chailleux, Nadege; Robertson, Ian D

    2008-01-01

    A stifle magnetic resonance (MR) imaging protocol was developed based on the appearance of the cruciate ligaments and menisci in normal dogs. Proton density images were subjectively considered to have the highest likelihood of detecting a meniscal lesion. Following this initial evaluation, the accuracy of high-field MR imaging to detect meniscal tears in dogs was evaluated in 11 dogs suffering from naturally occurring cranial cruciate ligament rupture. Dogs underwent MR imaging of the affected stifle before surgery. MR imaging and surgical findings were assessed independently, and then compared. Five tears of the medial meniscus were correctly diagnosed with MR imaging and 19 normal menisci were accurately characterized as such, based on MR images. In one medial meniscus, changes consistent with meniscal degeneration were seen on MR images but this was not seen at surgery. With regard to the lateral meniscus, one false positive diagnosis of a tear was made and this likely represented a normal variation. One other lateral meniscus had changes consistent with meniscal degeneration but, as with the similar lesion seen in the medial meniscus, this was not confirmed surgically. The global sensitivity of MR imaging for the diagnosis of a meniscal tear was 100% and the specificity was 94%. High-field MR imaging is a reliable method to diagnose meniscal tears preoperatively and this may be useful in selecting the surgical approach to clinically abnormal joints and may decrease the need for arthrotomy.

  11. Diagnostic value of high-resolution CT and MR compared with standard procedures in meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Schuler, M.; Naegele, M.; Lienemann, A.; Muench, O.; Siuda, S.; Hahn, D.; Lissner, J.

    1987-04-01

    The knees of 20 patients with evidence of meniscal tears were examined via high-resolution computed tomography (HRCT); 10 of these were studied by MRI. The HRCT study was performed directly after double-contrast arthrography (AG). For comparison with HRCT, slice orientation for MRI examination was in transverse view; gradient echo sequences using the FISP technique were applied instead of spin echo sequences. All results were correlated to the arthroscopy (AS) findings. In 95% of the cases AG and AS results agreed, HRCT/AS in 85% and MRI/AS in 70%. In certain cases HRCT provided additional information which influenced appropriate surgical treament. MRI is a noninvasive nonionising method but gives a less exact documentation of the lesion than AG and HRCT. The gradient echo mode is superior to the SE mode in respect of outlining meniscal structures, at least in transverse view.

  12. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje

    2016-01-01

    months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. CONCLUSION......OBJECTIVE: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN: Randomised controlled superiority trial. SETTING: Orthopaedic departments at two public hospitals and two physiotherapy...... clinics in Norway. PARTICIPANTS: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS: 12 week supervised exercise therapy alone or arthroscopic partial...

  13. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje;

    2016-01-01

    clinics in Norway. PARTICIPANTS: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS: 12 week supervised exercise therapy alone or arthroscopic partial......OBJECTIVE: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN: Randomised controlled superiority trial. SETTING: Orthopaedic departments at two public hospitals and two physiotherapy...... months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. CONCLUSION...

  14. Potential use of mesenchymal stem cells in human meniscal repair: current insights

    Science.gov (United States)

    Pak, Jaewoo; Lee, Jung Hun; Park, Kwang Seung; Jeon, Jeong Ho; Lee, Sang Hee

    2017-01-01

    The menisci of the human knee play an important role in maintaining normal functions to provide stability and nutrition to the articular cartilage, and to absorb shock. Once injured, these important structures have very limited natural healing potential. Unfortunately, the traditional arthroscopic meniscectomy performed on these damaged menisci may predispose the joint toward early development of osteoarthritis. Although a very limited number of studies are available, mesenchymal stem cells (MSCs) have been investigated as an alternative therapeutic modality to repair human knee meniscal tears. This review summarizes the results of published applications of MSCs in human patients, which showed that the patients who received MSCs (autologous adipose tissue-derived stem cells or culture-expanded bone marrow-derived stem cells) presented symptomatic improvements, along with magnetic resonance imaging evidences of the meniscal repair. PMID:28356779

  15. Development of a Micronized Meniscus Extracellular Matrix Scaffold for Potential Augmentation of Meniscal Repair and Regeneration.

    Science.gov (United States)

    Monibi, Farrah A; Bozynski, Chantelle C; Kuroki, Keiichi; Stoker, Aaron M; Pfeiffer, Ferris M; Sherman, Seth L; Cook, James L

    2016-12-01

    Decellularized scaffolds composed of extracellular matrix (ECM) hold promise for repair and regeneration of the meniscus, given the potential for ECM-based biomaterials to aid in stem cell recruitment, infiltration, and differentiation. The objectives of this study were to decellularize canine menisci to fabricate a micronized, ECM-derived scaffold and to determine the cytocompatibility and repair potential of the scaffold ex vivo. Menisci were decellularized with a combination of physical agitation and chemical treatments. For scaffold fabrication, decellularized menisci were cryoground into a powder and the size and morphology of the ECM particles were evaluated using scanning electron microscopy. Histologic and biochemical analyses of the scaffold confirmed effective decellularization with loss of proteoglycan from the tissue but no significant reduction in collagen content. When washed effectively, the decellularized scaffold was cytocompatible to meniscal fibrochondrocytes, synoviocytes, and whole meniscal tissue based on the resazurin reduction assay and histologic evaluation. In an ex vivo model for meniscal repair, radial tears were augmented with the scaffold delivered with platelet-rich plasma as a carrier, and compared to nonaugmented (standard-of-care) suture techniques. Histologically, there was no evidence of cellular migration or proliferation noted in any of the untreated or standard-of-care treatment groups after 40 days of culture. Conversely, cellular infiltration and proliferation were noted in scaffold-augmented repairs. These data suggest the potential for the scaffold to promote cellular survival, migration, and proliferation ex vivo. Further investigations are necessary to examine the potential for the scaffold to induce cellular differentiation and functional meniscal fibrochondrogenesis.

  16. Tissue engineering for total meniscal substitution : Animal study in sheep model

    OpenAIRE

    Kon, Elizaveta; Chiari, Catharina; Marcacci, Maurilio; Delcogliano, Marco; Donald M Salter; Martin, Ivan; Ambrosio, Luigi; Fini, Milena; Tschon, Matilde; Tognana, Enrico; Plasenzotti, Roberto; Nehrer, Stefan

    2008-01-01

    Objective: The aim of the study was to investigate the use of a novel hyaluronic acid/polycaprolactone material for meniscal tissue engineering and to evaluate the tissue regeneration after the augmentation of the implant with expanded autologous chondrocytes. Two different surgical implantation techniques in a sheep model were evaluated. Methods: Twenty-four skeletally mature sheep were treated with total medial meniscus replacements, while two meniscectomies served as empty controls. The an...

  17. Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions.

    Science.gov (United States)

    Lelario, M; Ciuffreda, P; Lupo, P; Bristogiannis, C; Vinci, R; Stoppino, L P; De Filippo, M; Macarini, L

    2013-08-01

    To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.

  18. Correlation Between MRI and Ultrasonographic Findings in Meniscal Injuries of the Knee.

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Sasani

    2009-01-01

    Full Text Available "nIntroduction: The purpose of this study was to evaluate ability of ultrasonography in the diagnosis of injuries of the knee menisci including tear, intrasubstance degeneration (ISD and cyst. "nMaterials and Methods: This study included ultrasound examination of knee joints of 100 patients after MR imaging, who were referred by clinicians without informing us about their symptoms and physical examinations. Then ultrasonographic results were correlated with MRI findings. "nResults: The 23 meniscal tear diagnosis made in MR examination in different segments of menisci and 19 (82.6% cases were diagnosed sonographically and the rest were reported as ISD (13% and normal (4.4%. Among the 69 cases in which MR examination interpreted as ISD in different segments, 66.7% were reported as ISD and others were diagnosed as meniscal tear (10% and normal(23% by sonography. There was a significant correlation between ultrasound and MR findings in meniscal tears (82.6% and relatively significant in ISD(66.7%. "nConclusion: Ultrasonographic study of the menisci is an inexpensive, noninvasive, easily available and reliable imaging modality.   

  19. Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery

    DEFF Research Database (Denmark)

    Tornbjerg, Simon Maretti; Nissen, Nis; Englund, Martin;

    2016-01-01

    BACKGROUND: The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal...... the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification...... of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies. RESULTS...

  20. ¿El síndrome meniscal, consecuencia de la retracción miosfacial de los isquiotibiales?

    OpenAIRE

    Tristan, Roberto

    2014-01-01

    Objetivo: Evaluar la incidencia de la retracción miofascial de los isquiotibiales sobre el síndrome meniscal de rodilla. Material y Métodos: En el presente trabajo se ha realizado un tipo de investigación descriptiva, el diseño es de tipo no experimental transversal y la muestra fue no probabilística, realizando un relevamiento de datos a 51 pacientes de 18 a 45 años con síndrome meniscal de rodilla que se encuentran en el periodo de rehabilitación de esta afección en una Cl...

  1. A novel quantitative approach for evaluating contact mechanics of meniscal replacements.

    Science.gov (United States)

    Linder-Ganz, E; Elsner, J J; Danino, A; Guilak, F; Shterling, A

    2010-02-01

    One of the functions of the meniscus is to distribute contact forces over the articular surfaces by increasing the joint contact areas. It is widely accepted that total/partial loss of the meniscus increases the risk of joint degeneration. A short-term method for evaluating whether degenerative arthritis can be prevented or not would be to determine if the peak pressure and contact area coverage of the tibial plateau (TP) in the knee are restored at the time of implantation. Although several published studies already utilized TP contact pressure measurements as an indicator for biomechanical performance of allograft menisci, there is a paucity of a quantitative method for evaluation of these parameters in situ with a single effective parameter. In the present study, we developed such a method and used it to assess the load distribution ability of various meniscal implant configurations in human cadaveric knees (n=3). Contact pressures under the intact meniscus were measured under compression (1200 N, 0 deg flexion). Next, total meniscectomy was performed and the protocol was repeated with meniscal implants. Resultant pressure maps were evaluated for the peak pressure value, total contact area, and its distribution pattern, all with respect to the natural meniscus output. Two other measures--implant-dislocation and implant-impingement on the ligaments--were also considered. If any of these occurred, the score was zeroed. The total implant score was based on an adjusted calculation of the aforementioned measures, where the natural meniscus score was always 100. Laboratory experiments demonstrated a good correlation between qualitative and quantitative evaluations of the same pressure map outputs, especially in cases where there were contradicting indications between different parameters. Overall, the proposed approach provides a novel, validated method for quantitative assessment of the biomechanical performance of meniscal implants, which can be used in various

  2. Clinical knee findings in floor layers with focus on meniscal status

    Directory of Open Access Journals (Sweden)

    Jensen Lilli

    2008-10-01

    Full Text Available Abstract Background The aim of this study was to examine the prevalence of self-reported and clinical knee morbidity among floor layers compared to a group of graphic designers, with special attention to meniscal status. Methods We obtained information about knee complaints by questionnaire and conducted a bilateral clinical and radiographic knee examination in 134 male floor layers and 120 male graphic designers. After the exclusion of subjects with reports of earlier knee injuries the odds ratio (OR with 95% confidence intervals (CI of knee complaints and clinical findings were computed among floor layers compared to graphic designers, using logistic regression. Estimates were adjusted for effects of body mass index, age and knee straining sports. Using radiographic evaluations, we conducted side-specific sensitivity analyses regarding clinical signs of meniscal lesions after the exclusion of participants with tibiofemoral (TF osteoarthritis (OA. Results Reports of knee pain (OR = 2.7, 95% CI = 1.5–4.6, pain during stair walking (OR = 2.2, 95% CI = 1.3–3.9 and symptoms of catching of the knee joint (OR = 2.9, 95% CI = 1.4–5.7 were more prevalent among floor layers compared to graphic designers. Additionally, significant more floor layers than graphic designers had clinical signs suggesting possible meniscal lesions: a positive McMurray test (OR = 2.4, 95% CI = 1.1–5.0 and TF joint line tenderness (OR = 5.4, 95% CI = 2.4–12.0. Excluding floor layers (n = 22 and graphic designers (n = 15 with radiographic TF OA did not alter this trend between the two study groups: a positive McMurray test (OR = 2.2, 95% CI = 1.0–4.9, TF joint line tenderness (OR = 5.0, 95% CI = 2.0–12.5. Conclusion Results indicate that floor layers have a high prevalence of both self-reported and clinical knee morbidity. Clinical knee findings suggesting possible meniscal lesions were significant more prevalent among floor layers compared to a group of low

  3. Evaluación de desenlace: trasplante meniscal versus segunda meniscectomía

    OpenAIRE

    Manrique Otero, Diana Marcela; Moncaleano Ruiz, Viviana; Peña Cruz, Nancy Tatiana; Ramírez Trujillo, Paula; Romero Mora, Jaime Alberto

    2016-01-01

    Introducción: El incremento de pacientes sintomáticos de rodilla y la osteoartrosis en jóvenes con limitadas posibilidades terapéuticas después de una meniscectomía, genera la búsqueda de alternativas terapéuticas. A pesar que es poco utilizado en Colombia, el trasplante meniscal es una propuesta para el manejo sintomático. Según cifras norteamericanas, se practican entre 700.000 a 1.500.000 artroscopias de rodilla anualmente, el 50% termina en meniscectomía y de este un 40% persiste...

  4. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan

    2017-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA......-77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy...

  5. Effect of Knee Extensor Strength on Incident Radiographic and Symptomatic Knee Osteoarthritis in Individuals with Meniscal Pathology

    DEFF Research Database (Denmark)

    Thorlund, Jonas B; Felson, David T; Segal, Neil A

    2016-01-01

    OBJECTIVE: High knee extensor strength may be important to protect against development of knee osteoarthritis (OA) in populations at elevated risk, such as individuals with meniscal pathology. We investigated the extent to which high knee extensor muscle strength was associated with a decreased r...

  6. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis.

    NARCIS (Netherlands)

    Scholten, R.J.P.M.; Devillé, W.L.J.M.; Opstelten, W.; Bijl, D.; Plas, C.G. van der; Bouter, L.M.

    2001-01-01

    OBJECTIVE. Our systematic review summarizes the evidence about the accuracy of physical diagnostic tests for assessing meniscal lesions of the knee. SEARCH STRATEGY. We performed a literature search of MEDLINE (1966-1999) and EMBASE 1988- 1999) with additional reference tracking. SELECTION CRITERIA

  7. Prótese meniscal de polímero bioabsorvível: estudo em coelhos Bioresorbable polymeric meniscal prosthesis: study in rabbits

    Directory of Open Access Journals (Sweden)

    Tulio Pereira Cardoso

    2010-06-01

    Full Text Available OBJETIVO: Obter o crescimento de um neomenisco por entre as porosidades da prótese com objetivo de proteger a cartilagem articular do joelho. MÉTODOS: Foram operados 70 joelhos de 35 coelhos Nova Zelândia com idades entre cinco e sete meses, pesando entre dois e 3,8 quilogramas, sendo 22 machos e 13 fêmeas. Submetidos no mesmo tempo cirúrgico à meniscectomia medial nos dois joelhos, em um lado foi implantada prótese meniscal de polímero bioabsorvível composta por 70% de poli (dioxanona e 30% de poli (L-ácido láctico. Realizada eutanásia com diferentes tempos pós-implante. Os côndilos femorais mediais e o neomenisco foram submetidos à análise histológica, observando-se a degradação e absorção da prótese, o crescimento de tecido meniscal na mesma, e o grau de degradação da cartilagem articular dos côndilos femorais, medido pelo histograma. RESULTADOS: Os dados obtidos avaliaram o crescimento de tecido histologicamente semelhante ao menisco normal, com absorção gradual da prótese e a porcentagem de condrócitos no lado controle e no lado com implante da prótese. CONCLUSÕES: Ocorreu crescimento de tecido por entre os poros da prótese com características histológicas semelhantes a do menisco normal de coelho. A cartilagem articular dos côndilos femorais no lado com implante da prótese apresenta maior número de condrócitos em todas as suas camadas.OBJECTIVE: To induce the ingrowth of a neomeniscus between the pores of the prosthesis in order to protect the articular cartilage of the knee. METHODS: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms. 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during the same time of surgery, having a bioresorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer implanted in one side. They were submitted to euthanasia after

  8. Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament.

    Science.gov (United States)

    von Lewinski, Gabriela; Milachowski, Klaus A; Weismeier, Karl; Kohn, Dieter; Wirth, Carl Joachim

    2007-09-01

    The purpose of this study was to determine the objective and subjective long-term outcomes of the first free meniscal allograft transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial meniscal transplantation with a deep frozen meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging. The Lysholm-score ranged between 21 and 97 points of 100 maximal available points. Corresponding to this the total KOOS ranged between 28.4 and 91.1%. The results of the IKDC-score were evaluated as nearly normal (B) (n = 2), abnormal (C) (n = 2) and severely abnormal (D) (n = 1). The radiological evaluation according to the Kellgren-Lawrence classification showed an increase of the degenerative changes between one and four grades. The radiological results revealed clear degenerative changes with long-term follow-up after meniscal allograft transplantation even though some patients did relatively well regarding the subjective and clinical results in the 20-year follow-up examination in comparison with the literature. Despite these relative clear results the question if medial meniscal transplantation can protect against development of arthritis cannot definitely be answered because in this first case series some aspects of meniscus transplantation that have not been considered which turned out to be of importance during the last 20 years. Furthermore, it has to be taken into account that all patients revealed a cartilage damage at the time of surgery and an ACL reconstruction was performed in addition. Nevertheless from biomechanical point of view it might be taken into consideration to combine the medial meniscus transplantation at least

  9. Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation

    Science.gov (United States)

    Ogura, Takahiro; Bryant, Tim; Minas, Tom

    2016-01-01

    Background: Treating articular cartilage defects and meniscal deficiency is challenging. Although some short- to mid-term follow-up studies report good clinical outcomes after concurrent autologous chondrocyte implantation (ACI) and meniscal allograft transplantation (MAT), longer follow-up is needed. Purpose: To evaluate mid- to long-term outcomes after combined ACI with MAT. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of prospectively gathered data from patients who had undergone ACI with MAT between 1999 and 2013. A single surgeon treated 18 patients for symptomatic full-thickness chondral defects with meniscal deficiency. One patient was lost to follow-up. Thus, 17 patients (18 knees; mean age, 31.7 years) were evaluated over a mean 7.9-year follow-up (range, 2-16 years). A mean 1.8 lesions per knee were treated over a total surface area of 7.6 cm2 (range, 2.3-21 cm2) per knee. Seventeen lateral and 1 medial MATs were performed. Survival was analyzed using the Kaplan-Meier method. The modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, and Short Form–36 were used to evaluate clinical outcomes. Patients also self-reported knee function and satisfaction. Standard radiographs were scored for Kellgren-Lawrence (K-L) grade. Results: Both 5- and 10-year survival rates were 75%. Outcomes for 6 knees were considered failures. Of the 6 failures, 4 knees were converted to arthroplasty and the other 2 knees underwent biological revision surgery. Of the 12 successfully operated knees, all clinical measures significantly improved postoperatively. Ten patients representing 11 of the 12 knees rated outcomes for their knees as good or excellent, and 1 rated their outcome as fair. Eight patients representing 9 of the 12 knees were satisfied with the procedure. There was no significant osteoarthritis progression based on K-L grading from preoperatively to a

  10. Fast presurgical magnetic resonance imaging of meniscal tears and concurrent subchondral bone marrow lesions. Study of dogs with naturally occurring cranial cruciate ligament rupture.

    Science.gov (United States)

    Olive, J; d'Anjou, M-A; Cabassu, J; Chailleux, N; Blond, L

    2014-01-01

    Meniscal tears and subchondral bone marrow lesions have both been described in dogs with cranial cruciate ligament rupture, but their possible concurrence has not been evaluated. In a population of 14 dogs exhibiting signs of stifle pain with surgically confirmed cranial cruciate ligament rupture, a short presurgical 1.5T magnetic resonance (MR) imaging protocol including dorsal proton density, dorsal T1-weighted gradient recalled echo, and sagittal fat-saturated dual echo sequences was tested to further investigate these features and illustrate meniscal tears. Interobserver agreement for detection of medial meniscal tears (k=0.83) and bone marrow lesions (k=0.87) was excellent. Consensus MR reading allowed detection of nine out of 12 surgically confirmed medial meniscal tears and there was no false positive. All dogs had cruciate ligament enthesis-related bone marrow lesions in the tibia, femur or both bones. Additionally, among the 12 dogs with confirmed medial meniscal tears, subchondral bone marrow lesions were present in the caudomedial (9 dogs) and caudoaxial (11 dogs) regions of the tibial plateau, resulting in odds ratios (13.6, p=0.12, and 38.3, p=0.04, respectively) that had large confidence intervals due to the small group size of this study. The other two dogs had neither tibial bone marrow lesions in these locations nor medial meniscal tears. These encouraging preliminary results warrant further investigation using this clinically realistic preoperative MR protocol. As direct diagnosis of meniscal tears remained challenging in dogs even with high-field MR, identification of associated signs such as subchondral bone marrow lesions might indirectly allow suspicion of an otherwise unrecognized meniscal tear.

  11. Meniscal and cruciate ligaments tears diagnosed with MR imaging versus arthroscopy; Uszkodzenie lakotek i wiazadel krzyzowych w stawie kolanowym w badaniu MR i artroskopii

    Energy Technology Data Exchange (ETDEWEB)

    Ziemianski, A.; Kruczynski, J.; Bruszewski, J. [Akademia Medyczna, Poznan (Poland)

    1993-12-31

    MR studies of knee joints in 37 patients were performed. The clinical diagnostics was traumatic lesions of menisci or cruciate ligaments. Arthroscopy of the knee joint was performed in 21 patients. MR showed meniscal lesion in 25 patients and anterior cruciate ligament (ACL) lesions in 18 patients. Arthroscopy showed meniscal lesions in 16 of 21 patients and ACL lesions in 11 of 21 patients. MR correlated with arthroscopy in 16 of examined menisci and 15 of 21 examined ACL. (author).

  12. Novel organ-slice culturing system to simulate meniscal repair: Proof of concept using a synovium-based pool of meniscoprogenitor cells.

    Science.gov (United States)

    Hunziker, Ernst B; Lippuner, Kurt; Keel, Marius J B; Shintani, Nahoko

    2016-09-01

    Meniscal injuries can occur secondary to trauma or be instigated by the changes in knee-joint function that are associated with aging, osteo- and rheumatoid arthritis, disturbances in gait, and obesity. Sixty percent of persons over 50 years of age manifest signs of meniscal pathology. The surgical and arthroscopic measures that are currently implemented to treat meniscal deficiencies bring only transient relief from pain and effect but a temporary improvement in joint function. Although tissue-engineering-based approaches to meniscal repair are now being pursued, an appropriate in-vitro model has not been conceived. The aim of this study was to develop an organ-slice culturing system to simulate the repair of human meniscal lesions in vitro. The model consists of a ring of bovine meniscus enclosing a chamber that represents the defect and reproduces its sequestered physiological microenvironment. The defect, which is closed with a porous membrane, is filled with fragments of synovial tissue, as a source of meniscoprogenitor cells, and a fibrin-embedded, calcium-phosphate-entrapped depot of the meniscogenic agents BMP-2 and TGF-β1. After culturing for 2 to 6 weeks, the constructs were evaluated histochemically and histomorphometrically, as well as immunohistochemically, for the apoptotic marker caspase 3 and collagen types I and II. Under the defined conditions, the fragments of synovium underwent differentiation into meniscal tissue, which bonded with the parent meniscal wall. Both the parent and the neoformed meniscal tissue survived the duration of the culturing period without significant cell losses. The concept on which the in-vitro system is based was thus validated. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1588-1596, 2016.

  13. [Evaluation of meniscal morphology and relation between the diagnostic findings of magnetic resonance imaging and arthroscopy in lesions of the knee].

    Science.gov (United States)

    Esparragoza-Montero, Ricardo; Rodriguez-Diaz, José; Lanier-Dominguez, Julio; Molero-Campos, María; Puccia-Scimonello, Marianela

    2009-03-01

    Magnetic resonance imaging (MRI) is useful in the diagnosis of meniscal lesions of the knee. The purpose of this study was to relate the findings of MRI and arthroscopy and to evaluate the morphology of the menisci with tears. 39 patients of both genders were included, whose age range was 13 to 74 years old (mean: 42.6 years), with and without a history of trauma, who underwent MRI and arthroscopy of the knee, due to symptoms of articular lesion. The images of magnetic resonances were analyzed independently by two specialists prior to the arthroscopy. The measurements of the medial and lateral menisci were made in each meniscal horn with sagital images in protonic density and fat-suppression. MRI detected 8 cases of tear of the lateral meniscus of the 11 catalogued by arthroscopy, and 11 cases of tears of the medial meniscus of the 13 catalogued by arthroscopy. The sensibility and specificity of MRI for the lateral meniscal tears were 72% and 100%, and for the medial tears were 85% and 89%. The meniscal tears were localized mainly in the posterior horn. The dimensions of the posterior horn of the lateral meniscus were larger in disrupted menisci (height, 7.1 +/- 1.3 mm vs. 6.1 +/- 0.7 mm, p meniscal tear produces morphological changes, particularly in the posterior horn of the lateral meniscus. Magnetic resonance constitutes the imaging technique of choice for the diagnosis of the meniscal tears.

  14. Enhancement of meniscal repair in the avascular zone using connective tissue growth factor in a rabbit model

    Institute of Scientific and Technical Information of China (English)

    HE Wei; LIU Yu-jie; WANG Zhi-gang; GUO Zi-kuan; WANG Ming-xin; WANG Ning

    2011-01-01

    Background Connective tissue growth factor (CTGF) is a secreted protein containing several domains that mediate interactions with growth factors,integrins and extracellular matrix components.CTGF plays an important role in extracellutar matrix production by its ability to mediate collagen deposition during wound healing.CTGF also induces neovascularization in vitro,suggesting a role in angiogenesis in vivo.We herein evaluated whether CTGF was required for extracellular matrix synthesis of meniscal fibrochondrocytes and/or angiogenesis during the repair of meniscal tears.Methods Meniscal fibrochondrocytes were isolated from the inner-1/2 of rabbit meniscus by trypsin collagenase treatment and further treated with 100 ng/ml CTGF in vitro.Characterization of fibrochondrocytes was identified by flow cytometry analyzing CD31,CD44,CD45 and CD105,and was further tested by type Ⅱ collagen immunocytochemistry.Changes in gene expression of meniscal fibrochondrocytes were monitored by quantitative real-time polymerase chain reaction.Histological sections prepared from a 3-mm portion of a longitudinal tearing defect in the middle of the rabbit meniscus were subjected to fluorescence-immunohistochemistry analysis at 1,4 and 10 weeks following surgical treatment with 1.5 μg of CTGF/fibrin-glue composites.Results Quantitative RT-PCR assay showed that types Ⅰ and Ⅱ collagen and vascular endothelial growth factor mRNA expression in the 100 ng/ml CTGF group were remarkably enhanced as compared to levels in the no-dose group at 14 days ((2.38±0.63) fold,(2.96±0.87) fold,(2.14±0.56) fold,respectively).Likewise,fluorescence-immunohistochemical analysis revealed that in the group implanted with CTGF-fibrin glue,types Ⅰ and Ⅱ collagen,as well as the capillaries,completely filled the defect by 10 weeks,postoperatively.In contrast,only soft tissue repair occurred when PBS-fibrin glue was implanted.Conclusions These findings suggest that CTGF can significantly promote

  15. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management.

    LENUS (Irish Health Repository)

    2012-02-01

    Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.

  16. Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Wing P. [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); Taipei Medical University-Wan Fang Hospital, Department of Radiology, Taipei (China); Huang, Guo-Shu [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Hsu, Shu-Mei [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); National Taiwan University, Department of Public Health, Taipei (China); Chang, Yue-Cune [Tamkang University, Department of Mathematics, Taipei County (China); Ho, Wei-Pin [Taipei Medical University-Wan Fang Hospital, Department of Orthopedic Surgery, Taipei (China)

    2008-10-15

    The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis. A total of 140 patients who had knee osteoarthritis and underwent primary total knee replacement (TKR) surgery, with unicompartmental medial tibiofemoral JSN (grade 1 or greater) and normal lateral compartments, were recruited. Polytomous logistic regression was used to assess the relationship between JSN and risk factors. All patients with JSN were categorized as grade 1 (n=14, 10.0%), grade 2 (n=64, 45.7%), or grade 3 (n=62, 44.3%). Women presented with indications for a TKR at a younger age than men (mean age, 69 vs 73 years, P<0.05). There were 123 (87.9%) meniscal tears and 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures; 115 of 134 (85.8%) patients had moderate to severe cartilage erosion. A higher grade of JSN was correlated with a higher frequency of meniscal tears [odds ratio (OR) 6.00, 95% CI 1.29-27.96 for grade 2 vs grade 1 JSN] and duration of knee pain (OR 1.25, 95% CI 1.01-1.53 for grade 3 vs grade 1 JSN). A higher grade of JSN was not correlated with a higher frequency of ACL rupture or articular cartilage erosion. A higher grade of JSN is associated with a higher frequency of meniscal tears and long duration of knee pain in patients with knee osteoarthritis. (orig.)

  17. Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries.

    Science.gov (United States)

    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Amato, Cirino; Denaro, Vincenzo; Maffulli, Nicola

    2010-10-01

    In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes.

  18. One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the Meniscal Viper Repair System

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    Ochiai Satoshi

    2011-08-01

    Full Text Available Abstract Background Principles for the treatment of tibial intercondylar eminence fracture are early reduction and stable fixation. Numerous ways to treatment of this fracture have been invented. We designed a simple, low-invasive, and arthroscopic surgical strategy for tibial intercondylar eminence fracture utilizing the Meniscal Viper Repair System used for arthroscopic meniscal suture. Methods We studied 5 patients, who underwent arthroscopic suture fixation that we modified. The present technique utilized the Meniscal Viper Repair System for arthroscopic suture of the meniscus. With one handling, a high-strength ultra-high molecular weight polyethylene(UHMWPE suture can be passed through the anterior cruciate ligament (ACL and the loops for suture retrieval placed at both sides of ACL. Surgical results were evaluated by the presence or absence of bone union on plain radiographs, postoperative range of motion of the knee joint, the side-to-side differences measured by Telos SE, and Lysholm scores. Results The reduced position achieved after surgery was maintained and good function was obtained in all cases. The mean distance of tibia anterior displacement and assessment by Lysholm score showed good surgical results. Conclusion This method simplified the conventional arthroscopic suture fixation and increased its precision, and was applicable to Type II fractures that could be reduced, as well as surgically indicated Types III and IV. The present series suggested that our surgical approach was a useful surgical intervention for tibial intercondylar eminence fracture.

  19. Fibrochondrogenic potential of synoviocytes from osteoarthritic and normal joints cultured as tensioned bioscaffolds for meniscal tissue engineering in dogs

    Directory of Open Access Journals (Sweden)

    Jennifer J. Warnock

    2014-09-01

    Full Text Available Meniscal tears are a common cause of stifle lameness in dogs. Use of autologous synoviocytes from the affected stifle is an attractive cell source for tissue engineering replacement fibrocartilage. However, the diseased state of these cells may impede in vitro fibrocartilage formation. Synoviocytes from 12 osteoarthritic (“oaTSB” and 6 normal joints (“nTSB” were cultured as tensioned bioscaffolds and compared for their ability to synthesize fibrocartilage sheets. Gene expression of collagens type I and II were higher and expression of interleukin-6 was lower in oaTSB versus nTSB. Compared with nTSB, oaTSB had more glycosaminoglycan and alpha smooth muscle staining and less collagen I and II staining on histologic analysis, whereas collagen and glycosaminoglycan quantities were similar. In conclusion, osteoarthritic joint—origin synoviocytes can produce extracellular matrix components of meniscal fibrocartilage at similar levels to normal joint—origin synoviocytes, which makes them a potential cell source for canine meniscal tissue engineering.

  20. Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sampson, M.J. [Department of Radiology Sports Surgery Clinic, Santry Demesne, Dublin (Ireland)], E-mail: allymattsampson@hotmail.com; Jackson, M.P.; Moran, C.J.; Moran, R. [Department of Orthopaedics, Sports Surgery Clinic, Santry Demesne, Dublin (Ireland); Eustace, S.J. [Department of Radiology Sports Surgery Clinic, Santry Demesne, Dublin (Ireland); Shine, S. [Department of Radiology, Cappagh Hospital, Finglas, Dublin (Ireland)

    2008-10-15

    Aim: To assess the accuracy of 3 T magnetic resonance imaging (MRI) in the evaluation of meniscal and anterior cruciate ligament (ACL) injury. Materials and methods: Sixty-one consecutive patients were identified who were referred for evaluation of suspected intra-articular pathology with a 3 T MRI and who, subsequently, underwent an arthroscopic procedure of the knee were included for the study. Two musculoskeletal radiologists interpreted the images. The sensitivity, specificity, positive predictive value, and negative predictive value were then calculated for the MRI versus the arthroscopic findings as a reference standard. Results: The sensitivity and specificity for the overall detection of meniscal tears in this study was 84 and 93%, respectively. The results for the medial meniscus separately were 91 and 93% and for the lateral 77 and 93%. The evaluation of ACL integrity was 100% sensitive and specific. The meniscal tear type was correctly identified in 75% of cases and its location in 94%. Conclusion: This study demonstrates good results of 3 T MRI in the evaluation of the injured knee. Caution should still be given to the interpretation on MRI of a lateral meniscus tear, and it is suggested that the standard diagnostic criteria of high signal reaching the articular surface on two consecutive image sections be adhered to even at these higher field strengths.

  1. 半月板切除与半月板修复临床效果比较——Meta分析%Comparison of meniscal repair with meniscectomy in treatment of meniscal tears: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    徐才祺; 赵金忠

    2013-01-01

    目的 通过回顾已发表文献中关于半月板切除术与半月板修复术短期及长期临床效果的比较,判断哪种术式有更好的临床效果.方法 在Medline、Embase及OVID数据库中检索关于“半月板切除”与“半月板修复”比较的随机、半随机及观察性临床研究文献并纳入本荟萃分析,根据国际膝关节评分委员会(IKDC)评分、Lysholm膝关节评分及Tegner活动评分评价临床效果.结果 共有7项研究入组,1项为随机前瞻性研究,6项为回顾性研究.Lysholm膝关节评分及Tegner活动评分评价显示,半月板修复术与半月板切除术相比有明显优势,差异有统计学意义(P=0.01);但在IKDC评分上,两者并无明显差异(P=0.48).结论 半月板修复术相对半月板切除有更好的长期临床效果以及更好的活动能力.%Objective To review published articles that compared meniscal repair with meniscectomy for short- or long-term outcomes and to determine which procedure leads to a better clinical outcome. Methods A search was performed in the Medline. Embase and OVID databases. All randomized, quasi-randomized, and observational clinical trials that reported the outcome of meniscal repair and meniscectomy were included in our meta-analysis. The outcomes were evaluated according to the International Knee Documentation Committee (IKDC) Score. Lysholm knee score and Tegner activity scale. Results Seven studies were included in this meta-analysis, one of which was a randomized prospective study, six were retrospective studies. There was a statistically significant difference in favor of meniscal repair for Lysholm knee score and Tegner activity scale ( P = 0. 01 ). However, meniscal repair had no significant difference in IKDC Score compared with meniscectomy (P = 0. 48). Conclusions Meniscal repairs have better long-term patient-reported outcomes and better activity levels than meniscectomy.

  2. Meniscal Allograft Transplantation Does Not Prevent or Delay Progression of Knee Osteoarthritis.

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    Catherine Van Der Straeten

    Full Text Available Meniscal tears are common knee injuries. Meniscal allograft transplantation (MAT has been advocated to alleviate symptoms and delay osteoarthritis (OA after meniscectomy. We investigated (1 the long-term outcome of MAT as a treatment of symptomatic meniscectomy, (2 most important factors affecting survivorship and (3 OA progression.From 1989 till 2013, 329 MAT were performed in 313 patients. Clinical and radiographic results and MAT survival were evaluated retrospectively. Failure was defined as conversion to knee arthroplasty (KA or total removal of the MAT.Mean age at surgery was 33 years (15-57; 60% were males. No-to-mild cartilage damage was found in 156 cases, moderate-to-severe damage in 130. Simultaneous procedures in 118 patients included cartilage procedures, osteotomy or ACL-reconstruction. At a mean follow-up of 6.8 years (0.2-24.3years, 5 patients were deceased and 48 lost (14.6%, 186 MAT were in situ (56.5% whilst 90 (27.4% had been removed, including 63 converted to a KA (19.2%. Cumulative allograft survivorship was 15.1% (95% CI:13.9-16.3 at 24.0 years. In patients <35 years at surgery, survival was significantly better (24.1% compared to ≥35 years (8.0% (p = 0.017. In knees with no-to-mild cartilage damage more allografts survived (43.0% compared to moderate-to-severe damage (6.6% (p = 0.003. Simultaneous osteotomy significantly deteriorated survival (0% at 24.0 years (p = 0.010. 61% of patients underwent at least one additional surgery (1-11 for clinical symptoms after MAT. Consecutive radiographs showed significant OA progression at a mean of 3.8 years (p<0.0001. Incremental Kellgren-Lawrence grade was +1,1 grade per 1000 days (2,7yrs.MAT did not delay or prevent tibiofemoral OA progression. 19.2% were converted to a knee prosthesis at a mean of 10.3 years. Patients younger than 35 with no-to-mild cartilage damage may benefit from MAT for relief of symptoms (survivorship 51.9% at 20.2 years, but patients and healthcare payers

  3. Biomedical-grade, high mannuronic acid content (BioMVM) alginate enhances the proteoglycan production of primary human meniscal fibrochondrocytes in a 3-D microenvironment

    Science.gov (United States)

    Rey-Rico, Ana; Klich, Angelique; Cucchiarini, Magali; Madry, Henning

    2016-01-01

    Alginates are important hydrogels for meniscus tissue engineering as they support the meniscal fibrochondrocyte phenotype and proteoglycan production, the extracellular matrix (ECM) component chiefly responsible for its viscoelastic properties. Here, we systematically evaluated four biomedical- and two nonbiomedical-grade alginates for their capacity to provide the best three-dimensional (3-D) microenvironment and to support proteoglycan synthesis of encapsulated human meniscal fibrochondrocytes in vitro. Biomedical-grade, high mannuronic acid alginate spheres (BioLVM, BioMVM) were the most uniform in size, indicating an effect of the purity of alginate on the shape of the spheres. Interestingly, the purity of alginates did not affect cell viability. Of note, only fibrochondrocytes encapsulated in BioMVM alginate produced and retained significant amounts of proteoglycans. Following transplantation in an explant culture model, the alginate spheres containing fibrochondrocytes remained in close proximity with the meniscal tissue adjacent to the defect. The results reveal a promising role of BioMVM alginate to enhance the proteoglycan production of primary human meniscal fibrochondrocytes in a 3-D hydrogel microenvironment. These findings have significant implications for cell-based translational studies aiming at restoring lost meniscal tissue in regions containing high amounts of proteoglycans. PMID:27302206

  4. AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT “SQUEEZE” TECHNIQUE

    Science.gov (United States)

    Richmond, Amy; Sanchez, Belinda; Stevenson, Valerie; Baker, Russell T.; May, James; Nasypany, Alan; Reordan, Don

    2016-01-01

    ABSTRACT Background Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) “Squeeze” technique in physically active participants who presented with clinical symptoms of meniscal tears. Description of Cases The MC “Squeeze” technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population. The Numeric Pain Rating Scale (NRS), the Patient Specific Functional Scale (PSFS), the Disability in the Physically Active (DPA) Scale, and the Knee injury and Osteoarthritis Outcomes Score (KOOS) were administered to assess participant pain level and function. Outcomes Statistically significant improvements were found on cumulative NRS (p ≤ 0.001), current NRS (p ≤ 0.002), PSFS (p ≤ 0.003), DPA (p ≤ 0.019), and KOOS (p ≤ 0.002) scores across all five participants. All participants exceeded the minimal clinically important difference (MCID) on the first treatment and reported an NRS score and current pain score of one point or less at discharge. The MC “Squeeze” technique produced statistically and clinically significant changes across all outcome measures in all five participants. Discussion The use of the MC “Squeeze” technique in this case series indicated positive outcomes in five participants who presented with meniscal tear symptoms. Of importance to the athletic population, each of the participants continued to engage in sport activity as tolerated unless otherwise required during the treatment period. The outcomes reported in this case series exceed those reported when using traditional conservative therapy and the return to play timelines for meniscal tears treated with partial meniscectomies. Levels of Evidence Level 4 PMID:27525181

  5. Knee function and knee muscle strength in middle-aged patients with degenerative meniscal tears eligible for arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Stensrud, Silje; Risberg, May Arna; Roos, Ewa M.

    2014-01-01

    -sectional study. METHODS: Eighty-two participants with MRI verified degenerative meniscal tear (35% women, mean age 49 years) answered the Knee injury and Osteoarthritis Outcome Score (KOOS) and were tested for isokinetic knee muscle strength and lower extremity performance (one-leg hop for distance, 6 m timed...... with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (p10% differences between the injured and the non-injured leg....

  6. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery; MRT des Kniegelenks nach Kreuzband- und Meniskusoperationen

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    Woertler, K. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Inst. fuer Roentgendiagnostik

    2009-03-15

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)

  7. MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears

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    Lance, Valentin; Heilmeier, Ursula R.; Joseph, Gabby B.; Steinbach, Lynne; Link, Thomas M. [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Ma, Benjamin [University of California, Department of Orthopedic Surgery and Sports Medicine, San Francisco (United States)

    2014-11-16

    The purpose of our study was (1) to analyze the flap tear location, direction of displacement and size on magnetic resonance (MR) imaging, (2) to describe associated knee abnormalities including presence of effusion, synovitis, bone marrow edema pattern or ligamentous tear, and (3) to assess clinical findings found with flap tears, including the pain score, and determine differences between operative and nonoperative groups. A retrospective radiology database search over the last 3 years identified 238 patients with flap tears, of which ultimately 58 with isolated flap tears were included after exclusion of patients with other significant knee internal derangement, severe degenerative change or prior surgery. MR studies of the knee were analyzed by two radiologists. Imaging characteristics were correlated with associated knee abnormalities and clinical findings. Statistical analysis employed linear and logistic regression models. Inter- and intrareader reliability was calculated. The medial meniscus was the most common site of flap tears (52/60, 87 %), with inferior displacement (47/60, 78 %). The degree of tibial cartilage loss had a positive correlation with the visual analog pain scale (p = 0.03). Patients who underwent arthroscopy were younger than those who did not (p = 0.01) and more likely to have a positive clinical McMurray test (p = 0.01). Medially and inferiorly displaced flap tears are the most common tear pattern. Those undergoing arthroscopy are more likely to have positive meniscal signs on clinical examination. A greater degree of cartilage loss involving the tibia on MR imaging was associated with increasing visual analog pain scores. (orig.)

  8. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review

    Directory of Open Access Journals (Sweden)

    Aline Mizusaki Imoto

    Full Text Available CONTEXT AND OBJECTIVE: Electrical stimulation (ES is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING: Systematic review at the Brazilian Cochrane Center. METHODS: We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12, Medline (Medical Analysis and Retrieval System Online via PubMed (1966 to December 2010, Embase (Excerpta Medica database, 1980 to December 2010, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010, and PEDro (Physiotherapy Evidence Database, 1929 to December 2010. The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS: Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95% confidence interval, CI: -39.92 to -25.48; n = 56 and in functional outcomes (MD -7; -12.78 to -1.22; n = 43 six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION: There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery

  9. Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees

    Science.gov (United States)

    Gupta, Ravi; Masih, Gladson David; Chander, Gaurav; Bachhal, Vikas

    2016-01-01

    Background: Despite improvements in instability after anterior cruciate ligament (ACL) reconstruction, associated intraarticular injuries remain a major cause of concern and important prognostic factor for long term results as it may lead to osteoarthritis. Delay in ACL reconstruction has been in variably linked to increase in these injuries but there is lack of consensus regarding optimal timing of reconstruction. The goal of this study was to investigate delay in surgery and other factors, associated with intraarticular injuries in ACL deficient knees. Materials and Methods: A total of 438 patients (42 females; 396 males) enrolled for this prospective observational study. The average age of patients was 26.43 (range 17–51 years) years with a mean surgical delay of 78.91 (range 1 week - 18 years) weeks after injury. We analyzed the factors of age, sex, surgical delay, instability, and level of activity for possible association with intraarticular injuries. Results: Medial meniscus injuries had a significant association with surgical delay (P = 0.000) after a delay of 6 months. Lateral meniscus injuries had a significant association with degree of instability (P = 0.001). Medial-sided articular injuries were significantly affected by age (0.005) with an odds ratio (OR) of 1.048 (95% confidence interval [CI] of 1.014–1.082) reflecting 4.8% rise in incidence with each year. Lateral-sided injuries were associated with female sex (P = 0.018) with OR of 2.846 (95% CI of 1.200–6.752). The level of activity failed to reveal any significant associations. Conclusion: Surgical delay predicts an increase in medial meniscal and lateral articular injuries justifying early rather than delayed reconstruction in ACL deficient knees. Increasing age is positively related to intraarticular injuries while females are more susceptible to lateral articular injuries. PMID:27746491

  10. T1-weighted vs. short-TE-long-TR images. Usefulness for knee MR examinations of ligament and meniscal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Hideho; Wada, Mitsuyoshi; Shiotani, Seiji [Tsukuba Medical Center Hospital, Ibaraki (Japan); Niitsu, Mamoru; Itai, Yuji

    2000-11-01

    The purpose of this study was to compare short-TE-long-TR images with T1-weighed images in knee MR examinations. Sagittal MR images of the knee were obtained in 31 patients with knee pain. T1-weighted images were obtained by the spin-echo technique (TR/TE =350/15), and short-TE-long-TR images by fast spin-echo (TR/TE =1300/15) with an echo-train length of 5. Contrast-to-noise-ratios (CNRs) of the anterior cruciate ligament and synovial space, meniscus and articular cartilage, and meniscal lesion and normal meniscus were compared between short-TE-long-TR images and T1-weighted images. On each of the three examinations, short-TE-long-TR images provided significantly higher CNRs than T1-weighted images. It was concluded that short-TE-long-TR images can be a useful alternative to T1-weighted images in evaluating the anterior cruciate ligament and meniscal lesions. (author)

  11. Meniscal repair in vivo using human chondrocyte-seeded PLGA mesh scaffold pretreated with platelet-rich plasma.

    Science.gov (United States)

    Kwak, Hong Suk; Nam, Jinwoo; Lee, Ji-Hye; Kim, Hee Joong; Yoo, Jeong Joon

    2017-02-01

    The objective of this study was to test the hypothesis that platelet-rich plasma (PRP) pretreatment on a poly-lactic-co-glycolic acid (PLGA) mesh scaffold enhances the healing capacity of the meniscus with human chondrocyte-seeded scaffolds in vivo, even when the seeded number of cells was reduced from 10 million to one million. A flexible PLGA mesh scaffold was pretreated with PRP using a centrifugal technique. One million human articular chondrocytes were seeded onto the scaffold by dynamic oscillation. After 7 days, scaffolds were placed between human meniscal discs and were implanted subcutaneously in nude mice for 6 weeks (n = 16/group). Fluorescence microscopy demonstrated uniform attachment of the chondrocytes throughout the scaffolds 24 h following seeding. Cell attachment analysis revealed a significantly increased number of chondrocytes on PRP-pretreated than non-treated scaffolds (p network at 24 h and day 7 of culture. Of the 16 constructs containing PRP-pretreated scaffolds implanted in mice, six menisci healed completely, nine healed incompletely and one did not heal. Histological results from the 16 control constructs containing non-treated scaffolds revealed that none had healed completely, four healed incompletely and 12 did not heal. The histological outcome between the groups was significantly different (p mesh scaffolds demonstrate increased cell attachment and enhance the healing capacity of meniscus with a reduced number of seeding cells in a meniscal repair mouse model. Copyright © 2014 John Wiley & Sons, Ltd.

  12. EFFECTIVENESS OF OPEN KINEMATIC CHAIN EXERCISES VERSUS CLOSED KINEMATIC CHAIN EXERCISES OF KNEE IN MENISCAL INSTABILITY ATHLETES

    Directory of Open Access Journals (Sweden)

    M.Seshagirirao

    2016-02-01

    Full Text Available Background and Purpose: The most common form of meniscal injury is mechanical failure of the tissue due to degeneration or trauma resulting in a tear. In a recent study by Shaji et al (2013 states that OKC and CKC are used often in clinical settings to treat patient’s lower extremity injuries. No study is there on effect of OKC and CKC on strength and stability of knee in meniscal instability. Materials and Methods: Thirty athletes were randomly selected into two groups of fifteen each based on inclusion and exclusion criteria and were given OKC exercises in one group, CKC exercises in another for one month. Pre-treatment and post-treatment values of hamstrings and quadriceps muscle strength and knee function score were measured and analysed statistically. Results: Results showed that P value is < 0.0001 for strength in hamstrings (OKC extremely significant and P value is 0.0080 for quadriceps (OKC very significant and P value is 0.0004 for stability in both groups is extremely significant. Conclusion: OKC and CKC exercises both were effective in improving knee strength and stability, but in OKC strength improvement is better than CKC and in CKC stability is better improved.

  13. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  14. A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears.

    Science.gov (United States)

    Wei, Li-Cheng; Gao, Shu-Guang; Xu, Mai; Jiang, Wei; Tian, Jian; Lei, Guang-Hua

    2012-08-01

    The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.

  15. Development and Characterization of UHMWPE Fiber-Reinforced Hydrogels For Meniscal Replacement

    Science.gov (United States)

    Holloway, Julianne Leigh

    Meniscal tears are the most common orthopedic injuries to the human body. The current treatment of choice, however, is a partial meniscectomy that leads to osteoarthritis proportional to the amount of tissue removed. As a result, there is a significant clinical need to develop materials capable of restoring the biomechanical contact stress distribution to the knee after meniscectomy and preventing the onset of osteoarthritis. In this work, a fiber-reinforced hydrogel-based synthetic meniscus was developed that allows for tailoring of the mechanical properties and molding of the implant to match the size, shape, and property distribution of the native tissue. Physically cross-linked poly(vinyl alcohol) (PVA) hydrogels were reinforced with ultrahigh molecular weight polyethylene (UHMWPE) fibers and characterized in compression (0.1-0.8 MPa) and tension (0.1-250 MPa) showing fine control over mechanical properties within the range of the human meniscus. Morphology and crystallinity analysis of PVA hydrogels showed increases in crystallinity and PVA densification, or phase separation, with freeze-thaw cycles. A comparison of freeze-thawed and aged, physically cross-linked hydrogels provided insight on both crystallinity and phase separation as mechanisms for PVA gelation. Results indicated both mechanisms independently contributed to hydrogel modulus for freeze-thawed hydrogels. In vitro swelling studies were performed using osmotic solutions to replicate the swelling pressure present in the knee. Minimal swelling was observed for hydrogels with a PVA concentration of 30-35 wt%, independently of hydrogel freeze-thaw cycles. This allows for independent tailoring of hydrogel modulus and pore structure using freeze-thaw cycles and swelling behavior using polymer concentration to match a wide range of properties needed for various soft tissue applications. The UHMWPE-PVA interface was identified as a significant weakness. To improve interfacial adhesion, a novel

  16. Value of Fat-Suppressed Proton-Density-Weighted Turbo Spin-Echo Sequences in Detecting Meniscal Lesions: Comparison with Arthroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, F.K.W.; Schaefer, P.J.; Brossmann, J.; Frahm, C.; Hilgert, R.E.; Heller, M.; Jahnke, T. [Univ. Hospital of Schleswig-Holstein, Kiel (Germany). Dept. of Diagnostic Radiology

    2006-07-15

    Purpose: To evaluate fat-suppressed (FS) proton-density-weighted (PDw) turbo spin-echo (TSE) magnetic resonance imaging (MRI) compared to arthroscopy in the detection of meniscal lesions. Material and Methods: In a prospective study, 31 knee joints were imaged on a 1.5T MR scanner before arthroscopy using the following sequences: (a) coronal and sagittal FS-PDw TSE (TR/TE: 4009/15 ms); (b) coronal T1w SE (TR/TE: 722/20 ms), and sagittal PDw TSE (TR/TE: 3800/15 ms). Other imaging parameters were: slice thickness 3 mm, FOV 160 mm, matrix 256x256. A total of 186 meniscal regions (62 menisci; anterior horn, body, posterior horn) were evaluated. Standard of reference was arthroscopy. Sensitivity, specificity, negative predictive value (npv), positive predictive value (ppv), and accuracy were calculated. Results: Arthroscopically, meniscal lesions were detected in 55/186 segments (35 medial and 20 lateral meniscal lesions). Sensitivity, specificity, npv, ppv, and accuracy for combination of coronal and sagittal FS PDw TSE were 91.4%, 98.3%, 95%, 97%, and 93.5% for the medial meniscus, and 90%, 98.6%, 97.3%, 94.7%, and 96.8% for the lateral. The results were comparable to the combination of coronal T1w SE and sagittal PDw TSE for the medial (88.6%, 98.3%, 93.4%, 96.9%, 91.4%) and the lateral (90%, 95.9%, 97.2%, 85.7%, 92.5%) meniscus. Conclusion: FS PDw TSE-MR sequences are an excellent alternative for the detection of meniscal lesions in comparison with diagnostic arthroscopy.

  17. The effect of decellularized meniscal extracellular matrix on meniscal fibrochondrocytes%脱细胞半月板细胞外基质对半月板细胞的影响

    Institute of Scientific and Technical Information of China (English)

    郭维民; 刘舒云; 高钺; 黄靖香; 彭江; 汪爱媛; 王玉; 卢世璧; 郭全义

    2015-01-01

    Objective We explore the effect of porcine decellularized meniscal extracellular matrix (dMECM) on the proliferation, cell activity and redifferentiation of the rabbit passaged meniscal fibrochondrocytes. Methods The novel dMECM biomaterial was prepared using waterproof pulverization and differential centrifugation approach. CCK-8 was used to quantitatively evaluate the cell proliferation of dMECM. The rabbit inner meniscus fibrochondrocytes (P3) were seeded in the dMECM modified growth surface in order to compare with the untreated growth surface (control group). The cell activity was observed by live/dead staining after 7, 14 d culture, the GAG and collagen content werer determined according to kits, and RT-PCR analysis was used to evaluate mRNA expression level of collagens. Results CCK-8 results demonstrated cells proliferation capacity in dMECM group was significantly more potent than that in the control group at 3, 6 d (P Conclusion dMECM enhances the cellular proliferation, viability and redifferentiation of the rabbit passaged meniscal fibrochondrocytes, which shows that dMECM may be one of the ideal candidate biomaterial for meniscal tissue engineering applications in future.%目的探讨脱细胞半月板细胞外基质(dMECM)对传代半月板细胞增殖、细胞活性以及细胞表型的影响。  方法用 CCK-8法检测 dMECM 对半月板细胞增殖的影响;将 P3代的内侧半月板纤维软骨细胞种植在 dMECM修饰盖玻片上,以未修饰盖玻片为对照,体外培养7、14 d后进行细胞活性检测,糖胺多糖、胶原分泌含量测定并用RT-PCR 检测半月板细胞特异性基因 mRNA 表达变化。  结果 CCK-8结果证实,与对照组比较,生长在 dMECM修饰盖玻片上的 P3代兔半月板纤维软骨细胞具有更好的细胞增殖特性(P  结论 dMECM 可以很好地促进半月板纤维软骨细胞的增殖、分化以及细胞活性的维持,可能是未来半月板组织工程领

  18. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Wojtys, Edward [University of Michigan, Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States); University of Michigan Sports Medicine Program, Department of MedSport, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States)

    2007-05-15

    We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear. (orig.)

  19. Medial meniscal posterior root/horn radial tears correlate with cartilage degeneration detected by T1ρ relaxation mapping

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Kenji, E-mail: Kenji-am@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Hashimoto, Sanshiro, E-mail: info@msorc.jp [Minami-Shinjuku Orthopaedic Rehabilitation Clinic, 2-16-7 Yoyogi, Shibuya-ku, Tokyo 151-0053 (Japan); Nakamura, Hiroshi, E-mail: nakamura@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Mori, Atsushi, E-mail: atsu@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Sato, Akiko, E-mail: akiko-sato@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Majima, Tokifumi, E-mail: tkmajima@iuhw.ac.jp [Department of Orthopaedic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasu-shiobara, Tochigi 329-2763 (Japan); Takai, Shinro, E-mail: takai-snr@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan)

    2015-06-15

    Highlights: • Posterior radial tears in medial meniscus associate T1ρ values of cartilage. • Posterior radial tears relate to cartilage degeneration even in early-stage osteoarthritis. • Abnormalities in meniscus on MRI are useful for screening early-stage osteoarthritis. - Abstract: Objective: This study aimed to identify factors on routine pulse sequence MRI associated with cartilage degeneration observed on T1ρ relaxation mapping. Materials and methods: This study included 137 subjects with knee pain. T1ρ values were measured in the regions of interest on the surface layer of the cartilage on mid-coronal images of the femorotibial joint. Assessment of cartilage, subchondral bone, meniscus and ligaments was performed using routine pulse sequence MRI. Radiographic evaluation for osteoarthritis was also performed. Results: Multiple regression analysis revealed posterior root/horn tears to be independent factors increasing the T1ρ values of the cartilage in the medial compartment of the femorotibial joint. Even when adjusted for radiographically defined early-stage osteoarthritis, medial posterior meniscal radial tears significantly increased the T1ρ values. Conclusions: This study showed that posterior root/horn radial tears in the medial meniscus are particularly important MRI findings associated with cartilage degeneration observed on T1ρ relaxation mapping. Morphological factors of the medial meniscus on MRI provide findings useful for screening early-stage osteoarthritis.

  20. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal; Chung, Jin-Wook; Kang, Heung-Sik; Hong, Sung-Hwan; Choi, Ja-Young [Seoul National University, Seoul (Korea, Republic of); Kim, Ho-Sung; Kim, Seok-Jung; Kim, Hyung-Ho [Aeromedical Center, Seoul (Korea, Republic of)

    2004-03-15

    To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. Thirty-eight consecutive patients sho underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3%-96.7%, respectively and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3%-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

  1. 前交叉韧带损伤合并半月板损伤的研究进展%Research progress on anterior cruciate ligament lesions with concurrent meniscal tears

    Institute of Scientific and Technical Information of China (English)

    唐聪; 黄长明; 范华强

    2015-01-01

    Anterior cruciate ligament ( ACL ) lesions are common sports injuries in the knee joint, and ACL reconstruction is widely used in the treatment of ACL lesions. However, the patients with ACL lesions often have other associated injuries, among which meniscal tears are the most common. In recent years, arthroscopic doctors pay more and more attention to the combined injuries and carry out a lot of experimental and clinical studies. In this paper, the relationship between meniscal tears and ACL lesions and treatment progress on the combined injuries are summarized.

  2. Worth replacing a loss of medial meniscal tissue with a polyurethane substitute (Actifit®) when performing a valgus tibial osteotomy addition

    Science.gov (United States)

    Gelber, Pablo E.; Isart, Anna; Erquicia, Juan I.; Tey, Marc; Pelfort, Xavier; Abat, Ferran; Monllau, Juan Carlos

    2015-01-01

    Introduction: The addition tibial valgus osteotomy (ovat) is a common treatment of symptomatic genu varus. This frequently is accompanied by considerable loss of medial meniscal tissue. The aim was to evaluate, in the context of performing a ovat, restoring the functional impact of this lack of medial meniscal tissue with Actifit® compared with the simple meniscectomy. Material and Methods: Sixty patients with symptomatic genu varo operated with ovat were studied prospectively. In 30 patients we have left a medial meniscal defect> 25 mm (M) and in 30 a medial Actifit® was implanted(A). The evaluations were performed using Womet, IKDC, Kujala, EVA and satisfaction (0-4). Results: Both groups were statistically comparable preoperatively, including follow-up time (31.2 months; range, 24-47.5; p = 0.35). 53.4 ± 8.4 Womet improved and 42.4 ± 17.2 points in M and A (p = 0.002), improved IKDC 56.7 ± 12 and 50.3 ± 15.6 points in M and A (p = 0.107), 50.4 ± 14.7 Kujala improved to 38.9 ± 21.6 points M and A (p = 0.02) and VAS decreased 6.9 ± 2.1 and 4.7 ± 2.8 points in M and A (p = 0.006). The satisfaction was 3.3 ± 0.8 and 3.3 ± 1 in M and A (p = 0.84). Conclusions: The symptomatic genu varus treated with OVAT associated to medial meniscectomy led, compared to when it was associated with the implantation of a medial Actifit®, to a marked improvement in most of the scales tested. There was no difference in the degree of satisfaction. Based on short-term results of this study, restitution replacement with polyurethane substitute can not be recommended to perform a ovat.

  3. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

    Science.gov (United States)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje; Ranstam, Jonas; Engebretsen, Lars; Roos, Ewa M

    2016-01-01

    Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7–59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised

  4. Chronic anterior cruciate ligament tears and associated meniscal and traumatic cartilage lesions: evaluation with morphological sequences at 3.0 T

    Energy Technology Data Exchange (ETDEWEB)

    Vlychou, Marianna; Fezoulidis, Ioannis V. [University Hospital of Larissa, Department of Radiology, Medical School of Thessaly, Larissa (Greece); Hantes, Michalis; Michalitsis, Sotirios; Malizos, Konstantinos [University Hospital of Larissa, Department of Orthopaedic Surgery, Medical School of Thessaly, Larissa (Greece); Tsezou, Aspasia [University Hospital of Larissa, Department of Molecular Genetics and Cytogenetics, Medical School of Thessaly, Larissa (Greece)

    2011-06-15

    To investigate the diagnostic efficacy of morphological sequences at 3.0 T MR imaging in detecting anterior cruciate ligament (ACL), meniscal pathology and traumatic cartilage legions in young patients with chronic deficient anterior cruciate ligament knees. This prospective study included 43 patients (39 male) between the age of 15 and 37 years (mean age 22.6 years) with a history of knee injury sustained at least 3 months prior to the decision to repair a torn ACL. All patients underwent a 3.0 T MR scan with the same standard protocol, including intermediate-weighted and three-dimensional spoiled gradient-recalled T1-weighted sequences with fat saturation and subsequently surgical reconstruction of the ACL, along with meniscal and cartilage repair, when necessary. All ACL tears were correctly interpreted by 3.0 T MR images. The sensitivity of the MR scans regarding tears of the medial meniscus was 93.7%, the specificity 92.6%, the positive predictive value 88.2% and the negative predictive value 95.8%. The sensitivity of the MR scans regarding tears of lateral meniscus was 85.7%, the specificity was 93.1%, the positive predictive value 85.7% and the negative predictive value 93.1%. With regard to the grading of the cartilage lesions, Cohen's kappa coefficient indicated moderate agreement for grade I and II cartilage lesions (0.5), substantial agreement for grade III and IV cartilage lesions (0.70 and 0.66) and substantial agreement for normal regions (0.75). Regarding location of the cartilage lesions, Cohen's kappa coefficient varied between almost perfect agreement in the lateral femoral condyle and no agreement in the trochlea. In the setting of chronic ACL deficiency, MR imaging at 3.0 T achieves satisfactory diagnostic performance regarding meniscal and ligamentous pathology. In the detection of cartilage lesions MRI is less successful. (orig.)

  5. Dynamic Alterations in Microarchitecture, Mineralization and Mechanical Property of Subchondral Bone in Rat Medial Meniscal Tear Model of Osteoarthritis

    Directory of Open Access Journals (Sweden)

    De-Gang Yu

    2015-01-01

    Full Text Available Background: The properties of subchondral bone influence the integrity of articular cartilage in the pathogenesis of osteoarthritis (OA. However, the characteristics of subchondral bone alterations remain unresolved. The present study aimed to observe the dynamic alterations in the microarchitecture, mineralization, and mechanical properties of subchondral bone during the progression of OA. Methods: A medial meniscal tear (MMT operation was performed in 128 adult Sprague Dawley rats to induce OA. At 2, 4, 8, and 12 weeks following the MMT operation, cartilage degeneration was evaluated using toluidine blue O staining, whereas changes in the microarchitecture indices and tissue mineral density (TMD, mineral-to-collagen ratio, and intrinsic mechanical properties of subchondral bone plates (BPs and trabecular bones (Tbs were measured using micro-computed tomography scanning, confocal Raman microspectroscopy and nanoindentation testing, respectively. Results: Cartilage degeneration occurred and worsened progressively from 2 to 12 weeks after OA induction. Microarchitecture analysis revealed that the subchondral bone shifted from bone resorption early (reduced trabecular BV/TV, trabecular number, connectivity density and trabecular thickness [Tb.Th], and increased trabecular spacing (Tb.Sp at 2 and 4 weeks to bone accretion late (increased BV/TV, Tb.Th and thickness of subchondral bone plate, and reduced Tb.Sp at 8 and 12 weeks. The TMD of both the BP and Tb displayed no significant changes at 2 and 4 weeks but decreased at 8 and 12 weeks. The mineral-to-collagen ratio showed a significant decrease from 4 weeks for the Tb and from 8 weeks for the BP after OA induction. Both the elastic modulus and hardness of the Tb showed a significant decrease from 4 weeks after OA induction. The BP showed a significant decrease in its elastic modulus from 8 weeks and its hardness from 4 weeks. Conclusion: The microarchitecture, mineralization and mechanical

  6. Evaluation of knee meniscus lesions using MRI - a comparative study of pulse sequences; Avaliacao da lesao meniscal por meio de ressonancia magnetica do joelho - estudo comparativo das sequencias

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Artur da Rocha C.; Vilela, Sonia de Aguiar; Turrini, Elisabeth; Lederman, Henrique M. [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Escola Paulista de Medicina. Dept. de Diagnostico por Imagem

    1997-05-01

    The frequency of knee disability after injuries has become higher, in this context meniscal lesions keep an important role. This study evaluated 34 MR exams using 1.5-T system (Signa; GE). In this group 26 had 4 sequences (5 acquisitions); 2 coronal (T1, MPGR), 3 sagittal (T1, T2, proton density). The aim of this study was to evaluate the MR pulse sequence`s reproducibility and observer variability. Two readers (A and B) reviewed the exams using the same criteria. The reader A reviewed all sequences for each patient; the reader B reviewed the individual sequences at random on two separate occasions, 6 months apart. The signal expression of meniscal lesion is more evident with T1 (short TR/short TE) sagittal; however, in this sequence the results were less consistent. The sagittal proton density (long TR/short TE) was very close to be the idea sequence: had good concordance among the readings of readers A and B. Kappa concordance test showed best result for sagittal proton density images (Kw = 0.84). (author) 47 refs., 17 figs., 2 tabs.

  7. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears*

    Science.gov (United States)

    Chagas-Neto, Francisco Abaeté; Nogueira-Barbosa, Marcello Henrique; Lorenzato, Mário Müller; Salim, Rodrigo; Kfuri-Junior, Maurício; Crema, Michel Daoud

    2016-01-01

    Objective To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition. PMID:27141127

  8. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears

    Directory of Open Access Journals (Sweden)

    Francisco Abaeté Chagas-Neto

    2016-04-01

    Full Text Available Abstract Objective: To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE magnetic resonance imaging (MRI technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods: Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results: For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively and specificity (80% and 85%, respectively. For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively and specificity (68% and 71%, respectively. In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively and specificity (82% and 92%, respectively. There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion: The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

  9. Relationship between years in the trade and the development of radiographic knee osteoarthritis and MRI-detected meniscal tears and bursitis in floor layers. A cross-sectional study of a historical cohort

    DEFF Research Database (Denmark)

    Jensen, Lilli Kirkeskov; Rytter, Søren; Marott, Jacob Louis

    2012-01-01

    An increased risk of developing knee disorders including radiographic knee osteoarthritis (OA) have been shown among workers with kneeling working demands. There may also be a dose-related association between duration of employment in occupations with kneeling work and development of radiographic...... knee OA and magnetic resonance imaging (MRI)-detected meniscal tears and bursitis....

  10. Dynamic Alterations in Microarchitecture, Mineralization and Mechanical Property of Subchondral Bone in Rat Medial Meniscal Tear Model of Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    De-Gang Yu; Shao-Bo Nie; Feng-Xiang Liu; Chuan-Long Wu; Bo Tian; Wen-Gang Wang; Xiao-Qing Wang

    2015-01-01

    Background:The properties of subchondral bone influence the integrity of articular cartilage in the pathogenesis of osteoarthritis (OA).However,the characteristics of subchondral bone alterations remain unresolved.The present study aimed to observe the dynamic alterations in the microarchitecture,mineralization,and mechanical properties of subchondral bone during the progression of OA.Methods:A medial meniscal tear (MMT) operation was performed in 128 adult Sprague Dawley rats to induce OA.At 2,4,8,and 12 weeks following the MMT operation,cartilage degeneration was evaluated using toluidine blue O staining,whereas changes in the microarchitecture indices and tissue mineral density (TMD),mineral-to-collagen ratio,and intrinsic mechanical properties of subchondral bone plates (BPs) and trabecular bones (Tbs) were measured using micro-computed tomography scanning,confocal Raman microspectroscopy and nanoindentation testing,respectively.Results:Cartilage degeneration occurred and worsened progressively from 2 to 12 weeks after OA induction.Microarchitecture analysis revealed that the subchondral bone shifted from bone resorption early (reduced trabecular BV/TV,trabecular number,connectivity density and trabecular thickness [Tb.Th],and increased trabecular spacing (Tb.Sp) at 2 and 4 weeks) to bone accretion late (increased BV/TV,Tb.Th and thickness of subchondral bone plate,and reduced Tb.Sp at 8 and 12 weeks).The TMD of both the BP and Tb displayed no significant changes at 2 and 4 weeks but decreased at 8 and 12 weeks.The mineral-to-collagen ratio showed a significant decrease from 4 weeks for the Tb and from 8 weeks for the BP after OA induction.Both the elastic modulus and hardness of the Tb showed a significant decrease from 4 weeks after OA induction.The BP showed a significant decrease in its elastic modulus from 8 weeks and its hardness from 4 weeks.Conclusion:The microarchitecture,mineralization and mechanical properties of subchondral bone changed in a time

  11. Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Elena Losina

    Full Text Available Arthroscopic partial meniscectomy (APM is extensively used to relieve pain in patients with symptomatic meniscal tear (MT and knee osteoarthritis (OA. Recent studies have failed to show the superiority of APM compared to other treatments. We aim to examine whether existing evidence is sufficient to reject use of APM as a cost-effective treatment for MT+OA.We built a patient-level microsimulation using Monte Carlo methods and evaluated three strategies: Physical therapy ('PT' alone; PT followed by APM if subjects continued to experience pain ('Delayed APM'; and 'Immediate APM'. Our subject population was US adults with symptomatic MT and knee OA over a 10 year time horizon. We assessed treatment outcomes using societal costs, quality-adjusted life years (QALYs, and calculated incremental cost-effectiveness ratios (ICERs, incorporating productivity costs as a sensitivity analysis. We also conducted a value-of-information analysis using probabilistic sensitivity analyses.Calculated ICERs were estimated to be $12,900/QALY for Delayed APM as compared to PT and $103,200/QALY for Immediate APM as compared to Delayed APM. In sensitivity analyses, inclusion of time costs made Delayed APM cost-saving as compared to PT. Improving efficacy of Delayed APM led to higher incremental costs and lower incremental effectiveness of Immediate APM in comparison to Delayed APM. Probabilistic sensitivity analyses indicated that PT had 3.0% probability of being cost-effective at a willingness-to-pay (WTP threshold of $50,000/QALY. Delayed APM was cost effective 57.7% of the time at WTP = $50,000/QALY and 50.2% at WTP = $100,000/QALY. The probability of Immediate APM being cost-effective did not exceed 50% unless WTP exceeded $103,000/QALY.We conclude that current cost-effectiveness evidence does not support unqualified rejection of either Immediate or Delayed APM for the treatment of MT+OA. The amount to which society would be willing to pay for additional information

  12. Thickness of the Meniscal Lamellar Layer: Correlation with Indentation Stiffness and Comparison of Normal and Abnormally Thick Layers by Using Multiparametric Ultrashort Echo Time MR Imaging.

    Science.gov (United States)

    Choi, Ja-Young; Biswas, Reni; Bae, Won C; Healey, Robert; Im, Michael; Statum, Sheronda; Chang, Eric Y; Du, Jiang; Bydder, Graeme M; D'Lima, Darryl; Chung, Christine B

    2016-07-01

    Purpose To determine the relationship between lamellar layer thickness on ultrashort echo time (UTE) magnetic resonance (MR) images and indentation stiffness of human menisci and to compare quantitative MR imaging values between two groups with normal and abnormally thick lamellar layers. Materials and Methods This was a HIPAA-compliant, institutional review board-approved study. Nine meniscal pieces were obtained from seven donors without gross meniscal pathologic results (mean age, 57.4 years ± 14.5 [standard deviation]). UTE MR imaging and T2, UTE T2*, and UTE T1ρ mapping were performed. The presence of abnormal lamellar layer thickening was determined and thicknesses were measured. Indentation testing was performed. Correlation between the thickness and indentation stiffness was assessed, and mean quantitative MR imaging values were compared between the groups. Results Thirteen normal lamellar layers had mean thickness of 232 μm ± 85 and indentation peak force of 1.37 g ± 0.87. Four abnormally thick lamellar layers showed mean thickness of 353.14 μm ± 98.36 and peak force 0.72 g ± 0.31. In most cases, normal thicknesses showed highly positive correlation with the indentation peak force (r = 0.493-0.912; P thickness in two abnormal lamellar layers showed highly negative correlation (r = -0.90, P thick lamellar layers were increased compared with values in normal lamellar layers, although only the UTE T2* value showed significant difference (P = .010). Conclusion Variation of lamellar layer thickness in normal human menisci was evident on two-dimensional UTE images. In normal lamellar layers, thickness is highly and positively correlated with surface indentation stiffness. UTE T2* values may be used to differentiate between normal and abnormally thickened lamellar layers. (©) RSNA, 2016.

  13. Probabilistic Approach for Determining the Material Properties of Meniscal Attachments In Vivo Using Magnetic Resonance Imaging and a Finite Element Model.

    Science.gov (United States)

    Kang, Kyoung-Tak; Kim, Sung-Hwan; Son, Juhyun; Lee, Young Han; Chun, Heoung-Jae

    2015-12-01

    The material properties of in vivo meniscal attachments were evaluated using a probabilistic finite element (FE) model and magnetic resonance imaging (MRI). MRI scans of five subjects were collected at full extension and 30°, 60°, and 90° flexion. One subject with radiographic evidence of no knee injury and four subjects with Kellgren-Lawrence score of 1 or 2 (two each) were recruited. Isovoxel sagittal three-dimensional cube sequences of the knee were acquired in extension and flexion. Menisci movement in flexion was investigated using sensitivity analysis based on the Monte Carlo method in order to generate a subject-specific FE model to evaluate significant factors. The material properties of horn attachment in the five-subject FE model were optimized to minimize the differences between meniscal movements in the FE model and MR images in flexion. We found no significant difference between normal and patient knees in flexion with regard to movement of anterior, posterior, medial, and lateral menisci or changes in height morphology. At 90° flexion, menisci movement was primarily influenced by posterior horn stiffness, followed by anterior horn stiffness, the transverse ligament, and posterior cruciate ligament. The optimized material properties model predictions for menisci motion were more accurate than the initial material properties model. The results of this approach suggest that the material properties of horn attachment, which affects the mobile characteristics of menisci, could be determined in vivo. Thus, this study establishes a basis for a future design method of attachment for tissue-engineered replacement menisci.

  14. Efficacy of zoledronic acid in treatment of teoarthritis is dependent on the disease progression stage in rat medial meniscal tear model

    Institute of Scientific and Technical Information of China (English)

    De-gang YU; Shen LIU; Zhen-an ZHU; Bo YU; Yuan-qing MAO; Xin ZHAO; Xiao-qing WANG; Hui-feng DING; Lei CAO; Guang-wang LIU; Shao-bo NIE

    2012-01-01

    Aim:To investigate whether the stage of osteoarthritis (OA) progression influenced the efficacy of the third-generation bisphosphonate zoledronic acid in a rat medial meniscal tear model.Methods:Medial meniscal tear (MMT) was surgically induced in adult male Sprague Dawley rats.Zoledronic acid (ZOL,100 μg/kg,sc,twice a week) was administered starting immediately,early (from 4 weeks) or late (from 8 weeks) after OA induction.The degeneration of articular cartilage was evaluated with toluidine blue O staining.Subchondral bone remodeling was evaluated with X-ray micro-CT scanning.Joint pain was measured with respect to weight-bearing asymmetry.Calcitonin gene-related peptide (CGRP) expression in dorsal root ganglia (DRGs) was examined using immunofluorescence analysis.The afferent neurons in DRGs innervating the joint were identified by retrograde labeling with fluorogold.Results:Progressive cartilage loss was observed during 12 weeks after OA induction.Subchondral bone remodeling manifested as increased bone resorption at early stage (4 weeks),but as increased bone accretion at advanced stages (8 weeks).Immediately and early ZOL administration significantly improved subchondral microstructural parameters,attenuated cartilage degeneration,reduced weight-bearing asymmetry and CGRP expression,whereas the late ZOL administration had no significant effects.Conclusion:The stage of OA progression influences the efficacy of ZOL in treating joint degeneration and pain.To obtain the maximum efficacy,bisphosphonate treatment should be initiated in rat with early stages of OA pathogenesis.

  15. Meniscal allograft transplantation

    Science.gov (United States)

    ... You will likely be able to move the knee right after surgery. Doing so helps prevent stiffness. Pain is usually managed with medicines. Physical therapy can help you regain the motion and strength ...

  16. 关节镜下Meniscal Fastener缝合修复半月板体部纵行撕裂的疗效分析

    Institute of Scientific and Technical Information of China (English)

    于川东; 于庆巍; 左建林; 朱玉辉

    2011-01-01

    目的研究关节镜下Meniscal Fastener(DePuy Mitck)缝合半月板体部红一白交界区、红区(peripheral)及半月板、滑膜缘(menisco—synovial)撕裂损伤的疗效并做出统计学分析。方法通过一组使用Meniscal Fastener(DePuy Mitek)进行半月板修复前后得到的临床数据资料进行回顾性分析研究。中日联谊医院2009年4月—2010年2月明确诊断为半月板撕裂损伤的患者中进行筛选,以符合纳入标准的7例患者为研究对象。7例半月板损伤患者,男5例,女2例;年龄12~28岁,平均20.8岁;左膝4例,右膝3例;内侧半月板损伤6例,外侧半月板损伤1例;损伤均位于半月板体部,半月板滑膜缘损伤1例,红区损伤4例,红一白交界区损伤2例;病程1~7周,平均27.6天。每例患者手术前后均进行国际上认可的Lysholm和Tegner膝关节功能评分,每例患者术前数据和术后数据进行自身的统计学比较分析。结果所有病例术后均无早期并发症发生。所有患者术后均获得随访,随访时间12.2~21.6(17.1±3.5)个月。截至写稿时,所有随访患者膝关节稳定,膝关节疼痛、绞索等症状消失,8周后关节活动度全面恢复。Lysholm评分由术前的(47.00±8.72)分增加到术后的(91.71±3.68)分,差异有显著性(t=12.73,P〈0.05);Tegner评分由术前的(2.86±0.69)分增加到术后的(8.43±0.79)分,差异有显著性(t=13.00,P〈0.05)。疗效优6例,占85.71%;良1例,占14.29%;总优良率为100%。结论关节镜下Meniscal Fastener(DePuy Mitck)缝合修复半月板体部撕裂损伤手术成功率高,术中和术后风险小,临床长期治疗疗效需要进一步观察。

  17. A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-li; XU Hu; FAN Hong-bin; MENG Cheng-fei; CHEN Hui; CAO Shi-lei

    2008-01-01

    Objective: To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the clinical results.Methods : From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray films were undertaken to detect the bony healing of avulsed fragment.Results: The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1±15.2 (ranging from 10 to 56) preoperatively to 97.5 ±3.7 (ranging from 91 to 100) postoperatively on average in 12-54 months follow up ( mean 23 months). The statistically significant difference was shown in Student's t test (t = 18. 483, P = 3. 100 × 10 -11 , P < 0. 01). Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively.Conclusion : This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.

  18. Evolução funcional da reparação do menisco por implante absorvível Functional evolution of meniscal repair using absorbable implants

    Directory of Open Access Journals (Sweden)

    Waldo Lino Júnior

    2009-04-01

    Full Text Available OBJETIVO: Avaliar a evolução funcional dos joelhos submetidos à reparação da ruptura longitudinal do menisco com o implante absorvível flecha (arrow. MÉTODOS: Entre junho de 1997 e fevereiro de 2001, 23 pacientes com idade média de 26 anos foram avaliados. O seguimento médio foi de quatro meses (45-96. Realizaram-se 19 reparações mediais e quatro laterais. Os pacientes foram avaliados no pré e no pós-operatório quanto à função, de acordo com a escala de Lysholm e, no pós-operatório, pelo IKDC. RESULTADOS: Para melhor compreensão, os 23 indivíduos tratados foram divididos em três grupos. Vinte e um apresentaram lesão do ligamento cruzado anterior e 11 foram submetidos à reconstrução ligamentar (grupo I, com resultados considerados satisfatórios. Dez dos 21 pacientes com lesão do LCA não foram submetidos à reconstrução ligamentar (grupo II, dos quais cinco evoluíram satisfatoriamente, sem necessidade de reconstrução ligamentar, cinco, com queixa de instabilidade e foram submetidos à reconstrução ligamentar. Quatro desses pacientes apresentaram o menisco íntegro e uma ruptura do menisco medial. Dois apresentaram LCA intacto (grupo III, um evoluiu satisfatoriamente e outro apresentou ruptura do menisco lateral. De acordo com a escala de Lysholm, a média pré-operatória foi de 57,53 e a média pós-operatória, de 86,95, representando melhora estatisticamente significativa (Wilcoxon p OBJECTIVE: To evaluate the functional evolution of knees after repair of longitudinal meniscal rupture with absorbable arrow implant. METHODS: Between June 1997 and February 2001, 23 patients with a mean age of 26.3 years were evaluated. The mean follow-up time was 72.87 months (45-96. We performed 19 medial and 4 lateral meniscal repairs. The patients were pre- and postoperatively evaluated regarding joint function according to the Lysholm scale, and, postoperatively, according to IKDC. RESULTS: For better understanding, the 23

  19. MRI of the knee: how do field strength and radiologist's experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

    Energy Technology Data Exchange (ETDEWEB)

    Krampla, W.; Roesel, M.; Svoboda, K.; Nachbagauer, A.; Gschwantler, M.; Hruby, W. [Donauspital, Radiology Department, Vienna (Austria)

    2009-06-15

    Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist's experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength. (orig.)

  20. Arthroscopic repair of meniscal injury with Fast-fix system%Fast-fix系统修复半月板损伤临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    唐恒涛; 赵亮; 燕华; 金大地; 苏训同

    2012-01-01

    [ Objective ] To evaluate the effect of the arthroscopic repair of the meniscal injury with the Fast-fix system. [ Method ] From July 2007 to June 2009, totally 2S4 cases of meniscus injury were treated with Fast-fix system under arthroscope and 96 cases were followed up successfully. There were 58 males and 38 females,aged from 12 to 46(mean 24.3) years. The course was 3 days - 1 year (mean 43.5 days)from injury to treatment. Forty-six right and fifty left knees were involved. They were located in ante-homer (n = 12), body (n = 46) and post-horner (n = 38). The lesion were in the red ( n = 32 ) , red white ( n = 42) and while (n = 22) region, respectively. All inside were used in 56 cases, outside in were used in 8 cases and inside out was used in 32 cases. Generally ,1-3 sutures were used for each patient. The hospital stay was 3-14 days( mean 8 days). The clinical cure criteria of menical injury included no lock.no pain.no swell and negative McMurray test. [Result] All the patients were followed-up.Lysholm rating system was used to determine the function of the knee and the level of activity of the patients. After operation, all the patients were clinically cured. The effects of surgery were satisfactory. The preoperative Lysholm score was 45.10 ±12.55 and the postoperative Lysholm score was 82.34± 10.50,and there was significant difference (t =3. 25,P <0.01). [Conclusion]The Fast-fix system is an efficient,safe and effective suture instrument for meniscal repair.%[目的]评价Fast-fix系统修复半月板损伤的临床疗效.[方法]自2007年7月~2009年6月,关节镜辅助下用Fast-fix系统治疗半月板损伤患者254例,96例患者得到随访.男58例,女38例,年龄12~46岁,平均24.3岁.病程3d~1年,平均43.5 d.右膝46例,左膝50例;前角损伤12例,体部撕裂46例,后角撕裂38例;红区损伤32例,红白区损伤42例,白区损伤(延长红白区)22例.All-inside缝合56例,Outside-in缝合8例,Inside-Out缝合32

  1. 定量T2-mapping评价半月板退变与膝关节骨性关节炎的相关性%Evaluation on the relationship between meniscal degeneration and osteoarthritis with T2-mapping

    Institute of Scientific and Technical Information of China (English)

    曹明明; 张军

    2012-01-01

    目的 利用定量T2-mapping评价半月板退变与膝关节骨性关节炎(OA)之间的关系.方法 收集85例OA患者患者(114个膝关节)行常规MR扫描、多回波自旋回波序列T2-mapping及膝站立位DR检查.对半月板损伤进行定性分级后,将患者分为病例组(半月板退变组,58例)和对照组(非半月板退变组,27例),分析两组关节软骨T2值的差异性,并验证半月板退变与软骨T2值的相关性.结果 ①病例组的软骨T2值(51.42±4.13)ms高于对照组(43.27±3.85)ms(P<0.05);②两组OA患者中内侧软骨单元的T2值均高于外侧软骨单元(P=0.009);③68.29%(84/123)的半月板损伤发生于内侧半月板的前角或后角;④半月板损伤级别与软骨T2值呈正相关(r=0.34);⑤病例组中30.08%(37/123)半月板退变处所对应的软骨单元T2值高于未发生退变处的软骨单元T2值.结论 T2-mapping评价半月板退变与OA之间呈正相关.%To assess the relationship between meniscal degeneration and osteoarthritis (OA) with T2-map-ping. Methods Totally 85 patients with OA underwent multi-echo spin echo sequence for T2-mapping and routine conventional MR sequences and standing knee radiographs for the severity of OA. Then patients divided into case group (58 cases) and control group (27 cases). The difference of T2 values in 2 groups was analyzed, as well as the correlation between the degeneration of the meniscus and cartilage T2 values of cartilage. Results ① T2 value of cartilage in case group ([51. 42±4.13]ms) was significant higher than that in control group ([43. 27±3. 85]ms, P<0. 05); ②T2 values of medial compartment in 2 groups were higher than that in the lateral one (P=0. 009); ③There were 68. 29% (84/123) meniscal lesions in anterior or posterior horn of the medial meniscus; ④There was positive correlation between the Stoller scores and the T2 values of cartilage (r=0. 34) ; ⑤T2 values of meniscal degeneration in cartilage compartment in 30

  2. A combination of biomolecules enhances expression of E-cadherin and peroxisome proliferator-activated receptor gene leading to increased cell proliferation in primary human meniscal cells: an in vitro study.

    Science.gov (United States)

    Pillai, Mamatha M; Elakkiya, V; Gopinathan, J; Sabarinath, C; Shanthakumari, S; Sahanand, K Santosh; Dinakar Rai, B K; Bhattacharyya, Amitava; Selvakumar, R

    2016-10-01

    The present study investigates the impact of biomolecules (biotin, glucose, chondroitin sulphate, proline) as supplement, (individual and in combination) on primary human meniscus cell proliferation. Primary human meniscus cells isolated from patients undergoing meniscectomy were maintained in Dulbecco's Modified Eagle's Medium (DMEM). The isolated cells were treated with above mentioned biomolecules as individual (0-100 µg/ml) and in combinations, as a supplement to DMEM. Based on the individual biomolecule study, a unique combination of biomolecules (UCM) was finalized using one way ANOVA analysis. With the addition of UCM as supplement to DMEM, meniscal cells reached 100 % confluency within 4 days in 60 mm culture plate; whereas the cells in medium devoid of UCM, required 36 days for reaching confluency. The impact of UCM on cell viability, doubling time, histology, gene expression, biomarkers expression, extra cellular matrix synthesis, meniscus cell proliferation with respect to passages and donor's age were investigated. The gene expression studies for E-cadherin and peroxisome proliferator-activated receptor (PPAR∆) using RT-qPCR and immunohistochemical analysis for Ki67, CD34 and Vimentin confirmed that UCM has significant impact on cell proliferation. The extracellular collagen and glycosaminoglycan secretion in cells supplemented with UCM were found to increase by 31 and 37 fold respectively, when compared to control on the 4th day. The cell doubling time was reduced significantly when supplemented with UCM. The addition of UCM showed positive influence on different passages and age groups. Hence, this optimized UCM can be used as an effective supplement for meniscal tissue engineering.

  3. Analysis on Correlated Factors of Meniscal Healing after Suture with FasT-Fix Repairing%FasT-Fix修复半月板撕裂的愈合相关因素分析

    Institute of Scientific and Technical Information of China (English)

    赵程锦; 薛亮; 赵建宁

    2016-01-01

    Objective:The FasT-Fix device is a safe and efficient choice for all-inside meniscal repair. However, the correlated factors for meniscal healing are still controversial. Methods:All the paitents with me-niscal injury, admitted in our department from January 2014 to March 2015 as objects. The patients received arthroscopic meniscal repaire via FasT-Fix, under spinal anesthesia. The patients were followed up 6 months after the procedure. Physical examination and MRI were performed to detect the healing of the meniscus. The results were recorded according to different gender, age, BMI, disease course, history of trauma, injury clas-sification and post-operative immobilization. Results: A total of 133 cases. With the follow-up, 110 cases, had no clinical symptoms or no injury signal with MRI, were detected as meniscal healing (82.7%). The sta-tistical comparison showed that gender, age, O’ Conner classification, post-operative immobilization did not influence meniscal healing. While patients with BMI over 25kg/m2 , disease course longer than 6 weeks and patients without definite trauma history had lower healing rate. Conclusions:Patient with BMI over 25kg/m2, disease course longer than 6 weeks and unclear trauma history has negtive effects on menical healing after FasT-Fix repair.%目的::Fast-Fix半月板缝合系统是一种安全、有效的全关节腔内半月板缝合技术,目前对于半月板缝合术后的愈合影响因素仍不清楚。方法:2014年1月至2015年3月就诊于我科的半月板损伤患者,经关节镜探查证实为体后或后角的红区、红-白区损伤,在腰麻下行FasT-Fix 半月板缝合术。患者于术后6个月进行门诊随访,由手术医生根据Barrett标准进行体格检查;同时行膝关节MRI检查,观察缝合部位MRI表现。分别记录不同性别、年龄(≤45岁,>45岁)、BMI(≤25,>25)、病程(≤6周,>6周)、是否有外伤史、撕裂类型( O’ Connor分型)、术后制动时间(≤4

  4. 半月板运动性损伤的组织工程修复:国际研究趋势与未来%Tissue-engineered repair of exercise-induced meniscal injury: International research trends and future

    Institute of Scientific and Technical Information of China (English)

    杨小宁

    2012-01-01

    BACKGROUND: The depth study of disciplines, such as tissue engineering, genetic engineering, biomechanics and materials science, provides a new approach for the treatment of meniscal injuries.OBJECTIVE: To multivariately analyze the literatures on the tissue-engineered repair of exercise-induced meniscal injury through Scopus database and to summarize the application progress of tissue-engineered repair of exercise-induced meniscal injury.METHODS: A retrieval was performed for the literature of the tissue-engineered repair of exercise-induced meniscal injury, using the key words of "meniscus, sports injuries, tissue engineering, repair" between January 2002 and December 2011 in Scopus database. The retrieval results were analyzed, and the trends were described in words and graphics.RESULTS AND CONCLUSION: A total of 245 literatures on the issue-engineered repair of exercise-induced meniscal injury were retrieved in Scopus database, in which most of paper were published as original articles. Eight articles were identified as classic literatures. The overall number of literature had an upward trend from 2002 to 2011. United States and England published more literature than other countries, which play an important role in the field of tissue-engineered repair of exercise-induced meniscal injury. Most of literatures were published from Rice University, University of Pennsylvania, and Radboud University Nijmegen Medical Centre. Biomaterials published most papers in this field (n=15, 6.12%). This paper provides a valuable reference for researchers to understand the overview and present situation of this field.%背景:骨组织工程学、基因工程、生物力学以及材料学等学科研究的深入,为半月板损伤的治疗提供了新途径.目的:利用Scopus数据库文献检索和深度分析功能,对于半月板运动损伤的组织工程修复的文献资料趋势进行多层次探讨分析,总结半月板运动损伤的组织工程修复的应用进展.

  5. Anatomical basis of adult meniscal sports injury%成人半月板运动损伤的解剖学基础

    Institute of Scientific and Technical Information of China (English)

    刘卫华; 辛文勇; 王伦安; 李鑫; 刘亚国; 马大军

    2006-01-01

    BACKGROUND: There have been some foreign studies on the general anatomy of meniscus, while domestic materials about adult normal meniscus are few.OBJECTIVE: To measure the various data of adult meniscus, so as to provide anatomical basis for clinical meniscal sport injury.DESIGN: Repetitive measurement design.SETTING: Department of Scientific Research, Chengdu Medical College.MATERIALS: This experiment was carried out in the Laboratory of Local Anatomy, Department of Human Anatomy, Chengdu Medical College during September 2003 to September 2005. Totally 94 adult knee joint samples, without any diseases were harvested from 94 patients, including 48 male and 46 female.METHODS: Skin of knee joint, subcutaneous tissue and muscle were removed. Tendon of musculus quadriceps fexoris was cut above the whirbone. Articular capsule was open, and incisions were made and prolonged to the posterior wall of articular capsule. Anterior and posterior cruciate ligaments were exposed and cut near the starting point of anterior cruciate ligaments. Fat pad of articular capsule was carefully cleaned. Various data of adult medial and lateral meniscus before and after ex vivo were measured up and down.MAIN OUTCOME MEASURES: Measurement before ex vivo: ① The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel of medial meniscus. ②The largest sagittal diameter, the length of outer arc, the largest transverse diameter, aperture length ( distance between anterior and posterior angel border of lateral meniscus), the width of anterior angle, caudomedial part and posterior angle of the lateral meniscus. Measurement after exvivo: ①The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel as well as the thickness of lateral border, center and free edge of anterior angle, caudomedial part and posterior angel of medial meniscus. ② The largest sagittal diameter

  6. 关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术%Both the medial and lateral meniscal allograft transplantation following the anterior cruciate ligament reconstruction by arthroscopic surgical technique

    Institute of Scientific and Technical Information of China (English)

    章亚东; 侯树勋; 张轶超; 罗殿中; 衷鸿宾; 张洪

    2011-01-01

    Objective To discuss the minimal invasive arthroscopic surgery technique and clinical results of both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction with double bundles and bone tunnels.Methods In August 2008 a minimal invasive surgery of both the medial and lateral meniscal allograft transplantation following anterior cruciate ligament reconstruction was preformed for 1 case with both the medial and lateral menicectomy by arthroscopic surgery.The method of two bone plugs attached on tibial plateau was employed for medial meniscal allograft transplantation and the technique the bridge in slot for lateral meniscal allograft transplantation.The VAS,Lysholm score and IKDC rating were recorded before and after operation.The stability of knee was assessed by Lachman test,drawer sign and pivot shift test.Results The patient was followed up 26 month after the operations.The degrees of knee flexion,extension and function of walk were normal.The Lachman test,drawer sign and pivot shift test were nearly normal.The VAS after operation was 2 points lower than that before operation.The Lysholm score post-operation was 20 points higher than pre-operation.The IKDC became B degree in late following-up from C degree before the operation.MRI revealed anterior cruciate ligament graft was continuous and the meniscal allograft was normal shape on year 1 after the operation.The posterior horn of medial meniscal allograft and anterior corner of lateral meniscal allograft showed slightly shrunk.The second-look arthroscopy showed that the healing occurring between meniscal allograft and the capsule and meniscal allograft was normal shape on month 18 after the operation.The anterior horn of medial and lateral meniscus was slightly worn.Conclusions Both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction in appropriately selected patients with the medial and lateral meniscus

  7. Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees

    Science.gov (United States)

    Sabatini, L.; Schirò, M.; Atzori, F.; Ferrero, G.; Massè, A.

    2016-01-01

    INTRODUCTION Isolated patellofemoral (PF) arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR). The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. MATERIALS AND METHODS From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients), and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs) after surgery in our patients. RESULTS We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. DISCUSSION AND CONCLUSION We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients. PMID:27891054

  8. Perisurgical and intra-rehabilitative salivary steroid hormone profiles in bicompartmental arthroplasty.

    Science.gov (United States)

    Perego, S; Grasso, D; Bodini, B D; Cavaiani, F; De Santis, C; Ursino, N; Pelosi, C; Banfi, G; Lombardi, G

    2015-01-01

    Sex hormones play a role in pain perception, a key variable in evaluating the progression and treatment of osteoarthritis. The aim of this study was to determine the relationship between salivary concentrations of four steroid hormones and functional/clinical outcomes after hip and knee arthroplasty. Saliva samples were collected from 24 otherwise healthy patients with osteoarthritis before surgery, on admission to rehabilitation, and at hospital discharge. Salivary concentrations of testosterone, 17β-estradiol, dehydroepiandrosterone (DHEA), and cortisol were immunoassayed. Changes in hormone levels were compared with clinical outcomes, as assessed by functional independence measure (FIM®), Barthel Index (BI), and visual analog scale for pain (VAS) scores. Changes in testosterone levels were significantly inversely correlated with VAS (r= -0.53, p=0.043) and FIM® and BI scores in all patients (r= -0.30, p= 0.043, and r= -0.35, p=0.031, respectively). The testosterone to cortisol ratio was inversely correlated with BI scores in all patients (r= -0.30, p=0.040), and in the men (r= -0.55, p=0.005) and the women (r= -0.28, p=0.042) when analyzed separately. Changes in salivary testosterone concentrations closely correlated with clinical outcome measurements for total hip and knee arthroplasty. Clinical outcome after arthroplasty was generally better among the men.

  9. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000.

    Science.gov (United States)

    Furnes, Ove; Espehaug, Birgitte; Lie, Stein Atle; Vollset, Stein Emil; Engesaeter, Lars Birger; Havelin, Leif Ivar

    2002-04-01

    We studied primary total knee replacements (TKRs), reported to the Norwegian Arthroplasty Register, operated on between 1994 and 2000. A Cox multiple regression model was used to evaluate differences in survival among the prosthesis brands, their types of fixation, and whether or not the patella was resurfaced. In Norway in 1999, the incidence of knee prosthesis operations was 35 per 100,000 inhabitants. Cement was used as fixation in 87% of the knees, 10% were hybrid and 2% uncemented implants. Bicompartmental (not resurfaced patella) prostheses were used in 65% of the knees. With all revisions as endpoint, no statistically significant differences in the 5-year survival were found among the cemented tricompartmental prostheses brands: AGC 97% (n 279), Duracon 99% (n 101), Genesis I 95% (n 654), Kinemax 98% (n 213) and Tricon 96% (n 454). The bicompartmental LCS prostheses had a 5-year survival of 97% (n 476). The type of meniscal bearing in LCS knees had no effect on survival. Survival with revision for all causes as endpoint showed no differences among types of fixation, or bi- or tricompartmental prostheses. Pain alone was the commonest reason for revision of cemented bicompartmental prostheses. The risk of revision because of pain was 5.7 times higher (p < 0.001) in cemented bicompartmental prostheses than cemented tricompartmental ones, but the revisions mainly involved insertion of a patellar component. In tricompartmental prostheses the risk of revision because of infection was 2.5 times higher than in bicompartmental ones (p = 0.03). Young age (< 60) and the sequelae after a fracture increased the risk of revision. The 5-year survival of the 6 most used cemented tricompartmental knee prostheses brands varied between 95% and 99%, but the differences were not statistically significant. There were more revisions because of pain in bicompartmental than in tricompartmental knees. In tricompartmental knees, however, there were more revisions because of an

  10. 关节镜下半月板成形术治疗膝关节半月板损伤的疗效观察%Effects of arthroscopic meniscus-plasty on meniscal lesions

    Institute of Scientific and Technical Information of China (English)

    温利波

    2016-01-01

    目的:探讨关节镜下半月板成形术治疗膝关节半月板损伤的临床疗效。方法回顾性分析80例膝关节半月板损伤患者的临床资料,根据手术方式的不同将其分为观察组和对照组。其中,观察组共有37例,行半月板成形术治疗,对照组43例,行半月板切除术治疗。应用 Ikeuchi 评价标准对末次随访时的膝关节功能进行评价;分别于术前、术后2周及末次随访时,应用 Lysholm 和 IKDC 评分表评价患者膝功能恢复情况。结果观察组膝关节功能优良率为86.5%,对照组为62.8%,两组优良率差异有统计学意义(χ2=5.768,P =0.016)。治疗前,两组患者的 Lysholm 和 IKDC 评分差异无统计学意义[(63.4±10.8)分比(61.7±9.5)分,P >0.05;(54.6±7.5)分比(55.1±8.3)分,P >0.05];治疗后2周时,两组患者的 Lysholm 评分[(92.5±5.9)分比(90.4±6.6)分]和 IKDC 评分[(85.4±9.2)分比(83.6±9.8)分]均较前明显升高(t =14.383、16.269、15.784、14.552,均 P <0.05),但两组之间的差异无统计学意义(P >0.05);末次随访时,对照组的 Lysholm 评分(78.5±8.2)分和 IKDC 评分(75.5±7.9)分均较治疗后2周时明显下降(t =7.413、4.220,均 P <0.05),观察组两指标[(89.9±8.3)分和(82.7±7.3)]评分均未见明显变化(P >0.05),两组之间的差异有统计学意义(t =6.165、4.029,均 P <0.05)。结论半月板成形术和半月板切除术治疗半月板损伤的近期疗效相当,但半月板成形术的远期效果更佳,是治疗半月板损伤的优先选择。%Objective To analyze the therapeutic effect of arthroscopic meniscus -plasty in the treatment of meniscal lesions.Methods Patients admitted to our hospital′s department of orthopedics were reviewed,and they were divided

  11. 同种异体半月板移植61例的中期疗效观察%Midterm follow-up of meniscal allograft transplantation:61 cases report

    Institute of Scientific and Technical Information of China (English)

    张新涛; 江小成; 尤田; 张洪雷; 黄伟; 白露; 陈鹏; 张文涛

    2016-01-01

    目的:探讨同种异体半月板移植手术( MAT)的中期疗效。方法北京大学深圳医院运动医学科自2007年1月至2013年12月共进行了73例MAT手术,排除了术后时间不到半年及失访的患者,共有61例(65侧)患者获得半年以上随访并纳入研究。平均随访时间31.0个月(6~80个月),平均年龄32.3岁。外侧半月板移植56例,内侧半月板移植9例;合并前交叉韧带损伤13例;同时行内、外侧半月板移植3例。使用视觉模拟评分( VAS)、国际膝关节文献委员会评分( IKDC)、Lysholm评分、Tegner活动评分、磁共振( MRI)进行术前评估和术后随访,资料采用配对t检验进行对比。结果患者术后随访时在VAS疼痛评分、IKDC评分、Lysholm评分改善程度方面差异有统计学意义(P<0.05);关节活动度、Tegner评分差异无统计学意义(P>0.05)。询问患者如果再次出现相同病情是否愿意接受此手术治疗,42例(68.9%)表示愿意接受手术,15例(24.6%)表示“考虑”,4例(6.5%)拒绝接受此手术。 MRI随访示移植物均与关节囊愈合。结论半月板移植物可以与关节囊达到满意愈合,MAT手术可以有效缓解半月板缺损患者的疼痛和改善膝关节功能,是治疗半月板缺失后出现早期临床症状患者的有效手段。%Objective To investigate the midterm clinical results of arthroscopic meniscal allograft transplantation( MAT).Methods From January 2007 to December 2013, 73 consecutive patients underwent MAT in the department of sports medicine ,Peking University Shenzhen Hospital ,and 61 patients (36 men and 25 women) with a mean age of 32.3 years were followed up for more than six months and were enrolled in this study .The mean followe-up time was 31.0 months ( 6 -80 months ); 56 cases underwent lateral MAT , nine medial MAT; 13 cases combined ACL injury .There were three patients underwent the

  12. 关节镜外侧半月板下入路技术用于外侧半月板前角层裂下层的切除%Arthroscopic Resection of the Inferior Leaf of the Anterior Horn through Sub-meniscal Route for Horizontal Tear of the Lateral Meniscus

    Institute of Scientific and Technical Information of China (English)

    闫辉; 崔国庆; 敖英芳

    2012-01-01

    Objective To evaluate the efficacy of arthroscopic partial meniseectomy via sub-meniscal route for unstable inferior leaf of the anterior horn in horizontal tear of the lateral meniscus. Methods Between January 2008 and December 2010, 10 patients with horizontal tear in the anterior horn of the lateral meniscus underwent arthroscopic partial meniscectomy through submeniscal route. Three routes, anteromedial, anterolateral, and sub-meniscal route, were employed in our patients. An arthroscope was placed via an anteromedial route, and then the superior leaf of the anterior horn was averted by a probe through the anterolateral route for a better visualization of the lesion. Finally the inferior leaf of the anterior horn was excised with a punch through the sub-meniscal route. Results No postoperative complications occurred in our patients. They were followed up for 12 -45 months with a mean of 18.9 months, during which, 9 patients had the pain in the knee joints disappeared completely, and the other occasionally had the knee joint pain after doing sports. The flexion range of the knee joints recovered to a normal range in all the 10 patients, and the Lysholm score increased from 68.7 ± 12. 9 preoperation to 94. 4 ±5.7 ( paired t test, t=7.79, P = 0.00). Conclusion Sub-meniscal route provides a safe and effective alternative for resection of the interior leaf of the anterior horn for horizontal tear of the lateral meniscus.%目的 探讨关节镜外侧半月板下入路切除外侧半月板前角下层的效果. 方法 2008年1月~2010年12月,对10例外侧半月板前角层裂采用关节镜外侧半月板下入路切除外侧半月板前角层裂中不稳定的下层.采用3个入路:膝前外侧入路,前内侧入路及外侧半月板下入路.自前内侧入路置入关节镜观察;经前外侧入路使用探沟翻转层裂上层,并尽可能显露下层;经外侧半月板下入路使用直头Punch(篮钳)切除半月板前角层裂的下层. 结果

  13. 关节镜下 FasT-Fix 缝合器修补半月板的五年随访报告%Arthroscopic meniscal repair with FasT-Fix suture device:a ifve-year follow-up report

    Institute of Scientific and Technical Information of China (English)

    张颉鸿; 符培亮; 吴宇黎; 祝云利; 钱齐荣; 吴海山

    2015-01-01

    目的:评价半月板撕裂患者关节镜下 FasT-Fix 缝合器修补术后5年的临床疗效。方法对2006年8月至2009年10月接受关节镜下 FasT-Fix 缝合器修补半月板撕裂手术的患者进行回顾性分析。本研究共纳入28例(32个撕裂的半月板),男20例,女8例,年龄13~48岁,平均26.2岁。病程2周至2年,平均6个月。撕裂类型均为纵裂,撕裂部位位于红区10个半月板(31.3%),红白区22个半月板(68.7%)。12例合并前交叉韧带( anterior cruciate ligament,ACL )损伤(44%)。根据 Barrett 标准评价半月板临床愈合情况,并用 IKDC、Lysholm、Tegner 评分评估膝关节功能改善情况。结果随访50~78个月,平均63.4个月。临床愈合率为84.4%(27/32),愈合失败5个的半月板,术后2~5年出现症状,平均3.5年。IKDC 评分:术前(43.4±16.8)分,术后(80.7±15.7)分;Lysholm 评分:术前(41.2±14.1)分,术后(83.7±22.1)分;Tegner 评分:术前(3.1±1.4)分,术后(6.2±1.6)分,差异均有统计学意义(P<0.05)。结论 FasT-Fix 修补半月板安全有效,术后5年临床疗效良好。%Objective To evaluate the 5-year clinical results of FasT-Fix suture device in arthroscopic meniscal repair.Methods Clinical results of 28 patients with 32 meniscal tears who underwent meniscal repair using the FasT-Fix device from August 2006 to October 2009 were retrospectively analyzed. There were 20 males and 8 females, whose mean age was 26.2 years old ( range: 13-48 years ). The average period from injury to surgery was 6 months ( range: 0.5 to 24 months ). All the meniscal tears belonged to peripheral longitudinal tears. The lesions were in the red / red zone (n=10, 31.3% ) and red / white zone (n=22, 68.7% ). Twelve patients ( 44% ) received the treatment of meniscal repair combined with anterior cruciate ligament ( ACL ) reconstruction. Clinical healing of the meniscus was assessed by Barrett’s criteria and the improvement of

  14. Osteoarthritis of the knee after meniscal resection

    DEFF Research Database (Denmark)

    Paradowski, P T; Lohmander, L S; Englund, M

    2016-01-01

    OBJECTIVE: To determine prevalence, incidence and progression of radiographic knee osteoarthritis (OA) in a cohort of subjects with previous meniscectomy. METHODS: We assessed 221 subjects (177 men and 44 women) with weight bearing knee radiography twice (assessment A and B) with a follow-up time...

  15. Ring-shaped lateral meniscus with hypoplasic anterior cruciate ligament.

    Science.gov (United States)

    Esteves, Cátia; Castro, Ricardo; Cadilha, Rui; Raposo, Frederico; Melão, Lina

    2015-12-01

    Knee joint lesions can be solitary or occur concomitantly with other lower limb abnormalities. Ring-shaped lateral meniscus (RSM) and hypoplasic anterior cruciate ligament (ACL) are two rare malformations. The therapeutic management of such abnormalities is not consensual, and highly depends on clinical symptomatology. We report a case of a 25-year-old girl with progressive knee pain whose MRI demonstrated a continuous segment of lateral meniscus situated along the medial aspect of the lateral compartment, continuous with the otherwise normal-appearing lateral meniscus, compatible with an RSM. This anatomic variant can be mistaken by a displaced meniscal fragment, like a bucket-handle tear, a central tear of a discoid meniscus, or incomplete discoid meniscus, as previously reported. Her MRI examination also showed a thinned ACL with anomalous lateral course. This abnormality may be mistaken for an ACL rupture and/or a meniscofemoral ligament with agenesis of ACL. Multiple images in different planes as well as following the course of meniscal and ligaments are critical clues to avoid misdiagnosis. As a result, the diagnosis of an RSM along with hypoplasic ACL with abnormal attachment was assumed based on MRI and confirmed during arthroscopy. The patient was treated conservatively with clinical outcome improvement.

  16. 关节镜下全关节内FasT-Fix技术缝合修复半月板损伤36例%Arthroscopic repair of meniscal tears by FasT-Fix technique: a report of 36 cases

    Institute of Scientific and Technical Information of China (English)

    王予彬; 王惠芳; 朱文辉; 崔芳; 袁锋; 卢亮宇; 孙文琳

    2008-01-01

    Objective To assess clinical outcomes of FasT-Fix technique in repair of meniscal injury under arthroscope. Methods A total of 36 cases (37 knees) of mensical tears were repaired with FasF-Fix technique. There were 26 males and 10 females, at mean age of 26 years (14-51 years). Eighteen meniscal tears were located in zone Ⅱ, 16 in zone Ⅲ and 3 in zone Ⅳ. The average length of the tear was 2.2 cm (1.0-3.0 cm). Results There were no any signs of early complications after sur gery. All cases were followed up For 6-26 months (mean 16 months). According to Lysholm scoring scale system ,the average score of operated knees was increased from preoperative 44.13+12.56 to postopera tive 80.24+12.67 (P<0.01). After operation, all the patients could move the knee joint at normal range, except for one case who had a limitation of 20 degree flexion, with no pain or interlocking symptom. All cases returned to original work and/or could continue sports game. Conclusion The FasT-Fix technique is a simple, safe and effective method for repair of properly selected meniscal tears.%目的 探讨关节镜下用FasT-Fix技术全关节内缝合修复半月板损伤的临床应用效果,评价其临床意义.方法 关节镜下用FasT-Fix技术全关节内缝合修复36例患者37个半月板损伤,其中男26例,女10例;年龄14-51岁,平均26岁.半月板损伤分区:Ⅱ区18例,Ⅲ区16例,Ⅳ区3例.撕裂长度平均为2.2 cm(1.0-3.0 cm).结果 所有患者术后均无早期并发症发生.随访时间6-26个月,平均16个月,除1侧膝关节屈曲受限20°外,其余膝关节伸屈功能正常,无疼痛及交锁症状.所有患者均恢复原工作、生活、运动.Lysholm评分:术前(44.13+12.56)分,术后(80.24+12.67)分(P<0.01).结论 对于合适的半月板损伤患者,FasT-Fix缝合系统是一种简便、快速、安全、有效的全关节内缝合方法.

  17. Arthroscopic partial medial meniscectomy

    Directory of Open Access Journals (Sweden)

    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  18. A prospective and comparative study of either physiotherapy along or accompanied arthroscopic surgery for degenerative meniscal tears%退行性半月板撕裂患者理疗与关节镜下手术疗效的前瞻性比较研究

    Institute of Scientific and Technical Information of China (English)

    付东; 单连成; 蔡郑东; 李国东

    2014-01-01

    to physical therapy accompanied by arthroscopic surgery in the treatment of degenerative meniscal tears.Methods A total of 40 patients of more than 50 years old were diagnosed as meniscal tears based on Magnetic Resonance Imaging ( MRI ), and then were divided into 2 treatment groups. The patients in the physical therapy accompanied by arthroscopic surgery group (n=20 ) received arthroscopic surgery and then postoperative physical therapy, and the patients in the physical therapy group (n=20 ) received physical therapy alone. The differences in the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) were compared between the 2 groups at 6, 12 and 24 months after the treatment.Results At 6 months after the treatment, the pain, sports and entertainment, daily activities and KOOS scores both in the physical therapy accompanied by arthroscopic surgery group and in the physical therapy group were obviously improved when compared with the preoperative scores, and the differences between them were statistically signiifcant. In the physical therapy group, the pain scores was improved from 46.35 points to 40.10 points (P0.05 ).Conclusions During the 2-year follow-up, no statistically signiifcant differences are found in the functional improvement or pain relief between the 2 groups. Physical therapy should be considered as the preferred treatment choice for degenerative meniscal tears.

  19. Meniscal Tear Film Fluid Dynamics Near Marx’s Line

    KAUST Repository

    Zubkov, V. S.

    2013-07-03

    Extensive studies have explored the dynamics of the ocular surface fluid, though theoretical investigations are typically limited to the use of the lubrication approximation, which is not guaranteed to be uniformly valid a-priori throughout the tear meniscus. However, resolving tear film behaviour within the meniscus and especially its apices is required to characterise the flow dynamics where the tear film is especially thin, and thus most susceptible to evaporatively induced hyperosmolarity and subsequent epithelial damage. Hence, we have explored the accuracy of the standard lubrication approximation for the tear film by explicit comparisons with the 2D Navier-Stokes model, considering both stationary and moving eyelids. Our results demonstrate that the lubrication model is qualitatively accurate except in the vicinity of the eyelids. In particular, and in contrast to lubrication theory, the solution of the full Navier-Stokes equations predict a distinct absence of fluid flow, and thus convective mixing in the region adjacent to the tear film contact line. These observations not only support emergent hypotheses concerning the formation of Marx\\'s line, a region of epithelial cell staining adjacent to the contact line on the eyelid, but also enhance our understanding of the pathophysiological consequences of the flow profile near the tear film contact line. © 2013 Society for Mathematical Biology.

  20. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Brauer, Charlotte; Pedersen, Ellen Bøtker

    2016-01-01

    of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar...

  1. Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells

    Science.gov (United States)

    2015-09-01

    signature gene Lox, an enzyme responsible for collagen cross-links in the musculoskeletal system. In addition, cells from young and aged mice expressed...relatively steady levels of biglycan and Collagen type I, but COMP (Cartilage Oligomeric Matrix Protein) levels appeared to decrease at 6 months. This...Lu c, Ling Qin d, Christine Ortiz e, Alan J. Grodzinsky f,g,h, Vicki Rosen b, Lin Han a,n a School of Biomedical Engineering, Science, and Health

  2. Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells

    Science.gov (United States)

    2014-09-01

    School of Dental Medicine. In support of this research, Ashira Gendelman received a Harvard Scholarship in Medicine for summer 2014. 10...Faculty, Georg-August-University, 37075 Goettingen, Germany 3Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA 4Co-first...Rodkey, W.G. (2005). Tissue-engineered collagen meniscus implants : 5- to 6-year feasibility study results. Arthroscopy 21, 515–525. Steinert, A.F

  3. Arthroscopic Meniscal Repair: “Modified Outside-In Technique”

    Directory of Open Access Journals (Sweden)

    Sohrab Keyhani

    2015-04-01

     Clinical success was achieved in 61 patients (92.4% and 5 candidates required meniscectomy (7.6%. IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6  postoperatively (P

  4. Localized form of pigmented villonodular synovitis of the knee: the meniscal mime.

    Science.gov (United States)

    Bouguennec, N; Meyer, A; Graveleau, N

    2014-04-01

    The localized form of pigmented villonodular synovitis of the knee is a rare condition with non-specific symptoms. This makes diagnosis especially difficult when the meniscus is affected. A full assessment with several imaging modalities can help support the preoperative diagnosis. But in the case reported here, the full clinical and paraclinical assessment (X-rays, CT arthrography and MRI) was wrong--the localized form of pigmented villonodular synovitis had mimicked a lateral meniscus injury and was only detected during arthroscopy. The lesion was excised surgically and the diagnosis was confirmed through postoperative histopathology.

  5. Cell-Based Meniscal Repair Using an Aligned Bioactive Nanofibrous Sheath

    Science.gov (United States)

    2016-07-01

    Rocky S. Tuan, PhD CONTRACTING ORGANIZATION: University of Pittsburgh Pittsburgh, PA 15213 REPORT DATE: July 2016 TYPE OF REPORT: Annual...NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER University of Pittsburgh, 450...improve the quality of life. Examples include: • data or databases; • biospecimen collections; • audio or video products; • software ; • models

  6. Canine stifle stability following cranial cruciate ligament transection and medial meniscal release

    DEFF Research Database (Denmark)

    Jensen, Tanja Vedel; Kristiansen, Signe Søndergaard; Jensen, Bente Rona;

    Introduction: The patellar tendon angle (PTA), describing the relationship of the patellar tendon to the tibial plateau, is biomechanically significant for canine stifle stability. The crossover point, at which the cranial cruciate ligament (CrCL) becomes the primary stifle stabilizer, has been p...

  7. Magnetic resonance imaging for the diagnosis of chondral, meniscal and cruciate ligaments injuries of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Karam, Francisco Consoli; Fridmann, Marcos William; Arbo, Rodrigo Di Mare; Vieira, Jose Francisco [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine]. E-mail: franciscokaram@terra.com.br; Silva, Jefferson Luis Braga da; Pires, Luiz Antonio Simoes [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine. Hospital Sao Lucas; Abreu, Armando; Abreu, Marcelo [Hospital Mae de Deus, Porto Alegre, RS (Brazil). Servico de Radiologia

    2007-05-15

    Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) of the knee. Materials and methods: Seventy-two patients have been submitted to MRI previously to arthroscopy of the knee performed by a single surgeon and utilized as a comparative standard method. Sensitivity, specificity, values of likelihood and rate of interobserver agreement have been evaluated. Results: The kappa agreement coefficient between MRI and arthroscopy was very good for lesions in the anterior cruciate ligament (0.84), good for lateral meniscus (0.75), reasonable for medial meniscus (0.50) and poor for chondral lesions (< 0.50). MRI has demonstrated high sensitivity for tears in the anterior cruciate ligament (94%) and in the medial meniscus (92%), good sensitivity for lesions in the lateral meniscus (80%), and low sensitivity for lesions in all of the chondral zones (< 50%), while the specificity has been excellent for all the chondral, and ligamentous structures, besides the lateral menisci analyzed (more than 97%), and reasonable (65%) for the medial meniscus. Conclusion: MRI is an useful tool in the clinical diagnosis of intra-articular knee lesions, as already demonstrated by similar results reported both in the Brazilian and international literature. (author)

  8. Meniscal repair by fibrocartilage in the dog : Characterization of the repair tissue and the role of vascularity

    NARCIS (Netherlands)

    Veth, RPH; Jansen, HWB; Nielsen, HKL; deGroot, JH; Pennings, AJ; Kuijer, R

    1996-01-01

    Lesions in the avascular part of 20 canine menisci were repaired by implantation of a porous polyurethane. Seven menisci were not repaired and served as controls. The repair tissue was characterized by biochemical and immunological analysis. The role of vascularity in healing was studied by perfusio

  9. Time-dependent loss of mitochondrial function precedes progressive histologic cartilage degeneration in a rabbit meniscal destabilization model.

    Science.gov (United States)

    Goetz, Jessica E; Coleman, Mitchell C; Fredericks, Douglas C; Petersen, Emily; Martin, James A; McKinley, Todd O; Tochigi, Yuki

    2017-03-01

    The goals of this work were to characterize progression of osteoarthritic cartilage degeneration in a rabbit medial meniscus destabilization (MMD) model and then to use the model to identify pre-histologic disruptions in chondrocyte metabolism under chronically elevated joint contact stresses in vivo. To characterize PTOA progression, 24 rabbits received either MMD or sham surgery. Limb loading was analyzed preoperatively and at regular postoperative intervals using a Tekscan pressure-sensitive walkway. Animals were euthanized 8 (n = 8 MMD; n = 8 sham) or 26 weeks (n = 8 MMD) postoperatively for histological cartilage evaluation by an objective, semi-automated Mankin scoring routine. To examine pre-histologic pathology, MMD was performed on an additional 20 rabbits, euthanized 1 (n = 9) or 4 weeks (n = 10) postoperatively. Chondrocytes were harvested fresh for measurement of mitochondrial function, an intracellular indicator of pathology after mechanical injury. Both MMD and sham surgery caused slight decreases in limb loading which returned to preoperative levels after 2 weeks. Histologically apparent cartilage damage progressed from 8 to 26 weeks after MMD. Changes in chondrocyte respiration were variable at 1 week, but by 4 weeks postoperatively chondrocyte mitochondrial function was significantly reduced. Many human injuries that lead to PTOA are relatively mild, and the cell-level mechanisms leading to disease remain unclear. We have documented PTOA progression in an animal model of subtle joint injury under continued use, and demonstrated that this model provides a realistic environment for investigation of multi-stage cellular pathology that develops prior to overt tissue degeneration and which could be targeted for disease modifying treatments. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:590-599, 2017.

  10. Anatomía descriptiva meniscal de la rodilla, mediante el estudio con resonancia magnética

    OpenAIRE

    Carbajo Botella, Mª Luisa; Palomino Cortés, Miguel Ángel

    2004-01-01

    El conocimiento de la anatomía es una de las bases sobre las que se sustentan los éxitos de la medicina actual, y quizá la idea expuesta por Petit M.A. hace casi dos siglos exprese mejor que ninguna otra el valor de esta parte de la ciencia " La anatomía es la antorcha del médico y debe alumbrar sus primeros pasos". Actualmente nos encontramos en un periodo revolucionario en el campo del diagnóstico. Los nuevos procedimientos de diagnóstico por imagen nos proporcionan información que super...

  11. Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears.

    Science.gov (United States)

    Adams, William B

    2004-10-01

    Overuse injuries of the knee, particularly those of the extensor mechanism and iliotibial band, are commonplace in primary care and musculoskeletal practices. Effective treatment requires identification of all pertinent biomechanical factors contributing to overload and implementing measures to correct them.

  12. 膝关节镜治疗半月板损伤10年回顾%Arthroscopic Treatment of Meniscal Lesions-10 Years Review

    Institute of Scientific and Technical Information of China (English)

    黄迅悟; 常青; 白一冰; 关长勇; 胡明; 孙继桐

    2003-01-01

    目的:探讨膝关节半月板损伤的临床特点及关节镜诊疗技术.方法:回顾1991年6月~2001年6月应用关节镜治疗、50岁以下患者半月板损伤378例,统计患者性别、年龄、职业、损伤侧别、损伤类型、治疗方法.术前及术后1年用Lysholm-Ⅱ评分评定膝关节功能.结果:261例半月板损伤获得随访,半月板部分切除组103例,优良率79.67%,半月板全切组62例,优良率76.39%,半月板缝合组56例,优良率84.85%.结论:膝关节半月板损伤多发生在青年男性,外侧半月板病损率远远高于内侧半月板,关节镜下半月板损伤的治疗应针对不同损伤类型采取不同治疗方法,尽可能保留半月板.

  13. Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: an RSA study in human cadaver knees.

    NARCIS (Netherlands)

    Tienen, T.G. van; Buma, P.; Scholten, J.G.; Kampen, A. van; Veth, R.P.H.; Verdonschot, N.J.J.

    2005-01-01

    The objective of this study was to validate an in vitro human cadaver knee-joint model for the evaluation of the meniscal movement during knee-joint flexion. The question was whether our model showed comparable meniscal displacements to those found in earlier meniscal movement studies in vivo. Furth

  14. Evaluation of biexponential relaxation processes by magnetic resonance imaging. A phantom study

    DEFF Research Database (Denmark)

    Kjaer, L; Thomsen, C; Larsson, H B;

    1988-01-01

    .5 tesla (T). Measurements were performed on a phantom of bicompartmental perspex boxes with combinations of different CuSO4 concentrations. T1 determination was based on a 12-points partial saturation inversion recovery pulse sequence. T2 determination was provided by a multiple spin echo sequence with 32...

  15. 儿童膝关节半月板病变的磁共振影像诊断%MRI diagnosis for meniscal lesions of the knees in children

    Institute of Scientific and Technical Information of China (English)

    王秋艳; 张忠阳; 朱锦勇; 薛建平; 朱礼华; 彭海腾

    2004-01-01

    目的:探讨儿童半月板病变的磁共振表现.材料与方法:回顾性分析48例儿童半月板病变的MRI资料,并与关节腔镜对照.MRI检查扫描序列为冠状面、矢状面的SE T1WI、FFE T2WI,必要时行横断面PDWI.结果:盘状半月板34例,半月板变性3例,半月板撕裂11例,其中2例伴半月板囊肿.34例共36个盘状半月板包括凹面镜样20个,后角肥大型9个,薄片型6个和不完全型1个.MRI诊断儿童盘状半月板的正确率为83%,半月板撕裂的正确率为82%.结论:MRI是检测儿童膝关节半月板病变有效的无创性技术.

  16. 大骨节病患者半月板损伤的原因探讨%To investigate the cause of meniscal lesion of patients suffering from Kashin-Beck Disease

    Institute of Scientific and Technical Information of China (English)

    凌鸣; 易智; 雷海军; 常彦海; 罗振群

    2002-01-01

    目的分析大骨节病患者半月板损伤的原因,为预防和治疗提供理论依据.方法膝关节镜下对31例大骨节病患者半月板及关节软骨的形态进行观察.结果 31例患者62侧半月板中,7例14侧半月板光滑完好,24例患者的13侧半月板毛糙,在损伤的20侧半月板中,1侧为盘状软骨撕裂,另19侧半月板形态似毛刺样.结论大骨节病患者半月板损伤与大骨节病本身无关,与膝关节活动时裸露骨对半月板的机械性摩擦有关.

  17. Delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM) in patients with knee osteoarthritis: relation with meniscal degeneration on conventional MRI, reproducibility, and correlation with dGEMRIC

    Energy Technology Data Exchange (ETDEWEB)

    Tiel, Jasper van [University Medical Center, Department of Orthopaedic Surgery, Erasmus MC, Rotterdam (Netherlands); University Medical Center, Department of Radiology, Erasmus MC, P.O. Box 2040, Rotterdam (Netherlands); Kotek, Gyula; Krestin, Gabriel P.; Oei, Edwin H.G. [University Medical Center, Department of Radiology, Erasmus MC, P.O. Box 2040, Rotterdam (Netherlands); Reijman, Max; Bos, Pieter K.; Verhaar, Jan A.N. [University Medical Center, Department of Orthopaedic Surgery, Erasmus MC, Rotterdam (Netherlands); Bron, Esther E.; Klein, Stefan [University Medical Center, Department of Radiology, Erasmus MC, P.O. Box 2040, Rotterdam (Netherlands); University Medical Center, Department of Medical Informatics, Erasmus MC, Rotterdam (Netherlands); Weinans, Harrie [University Medical Center, Department of Orthopaedic Surgery, Erasmus MC, Rotterdam (Netherlands); Delft University of Technology, Department of Biomechanical Engineering, Delft (Netherlands); University Medical Center, Department of Orthopaedic Surgery, Utrecht (Netherlands); University Medical Center, Department of Rheumatology, Utrecht (Netherlands)

    2014-09-15

    To assess (1) whether normal and degenerated menisci exhibit different T1{sub GD} on delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM), (2) the reproducibility of dGEMRIM and (3) the correlation between meniscus and cartilage T1{sub GD} in knee osteoarthritis (OA) patients. In 17 OA patients who underwent dGEMRIM twice within 7 days, meniscus and cartilage T1{sub GD} was calculated. Meniscus pathology was evaluated on conventional MRI. T1{sub GD} in normal and degenerated menisci were compared using a Student's t-test. Reproducibility was assessed using ICCs. Pearson's correlation was calculated between meniscus and cartilage T1{sub GD}. A trend towards lower T1{sub GD} in degenerated menisci (mean: 402 ms; 95 % CI: 359-444 ms) compared to normal menisci (mean: 448 ms; 95 % CI: 423-473 ms) was observed (p = 0.05). Meniscus T1{sub GD} ICCs were 0.85-0.90. The correlation between meniscus and cartilage T1{sub GD} was moderate in the lateral (r = 0.52-0.75) and strong in the medial compartment (r = 0.78-0.94). Our results show that degenerated menisci have a clear trend towards lower T1{sub GD} compared to normal menisci. Since these results are highly reproducible, meniscus degeneration may be assessed within one delayed gadolinium-enhanced MRI simultaneously with cartilage. The strong correlation between meniscus and cartilage T1{sub GD} suggests concomitant degeneration in both tissues in OA, but also suggests that dGEMRIC may not be regarded entirely as sulphated glycosaminoglycan specific. (orig.)

  18. Uso de células madre pluripotenciales extraídas de grasa y del plasma rico en plaquetas como potenciadores en sutura meniscal. Estudio en un modelo de menisco de conejo

    OpenAIRE

    2009-01-01

    Las lesiones meniscales son un lesión frecuente en nuestra práctica clínica. El tratamiento más utilizado en la meniscectomía parcial. La meniscectomía parcial o total favorece la aparición de cambios degenerativos precoces en la articulación de la rodilla. Varios estudios han demostrado la capacidad de reparación de lesiones meniscales que se sitúan en zona periférica vascularizada, por contra de las lesiones localizadas en zona avascular que presenta bajas tasas de reparación. Diversos estu...

  19. Advances in combining gene therapy with cell and tissue engineering-based approaches to enhance healing of the meniscus.

    Science.gov (United States)

    Cucchiarini, M; McNulty, A L; Mauck, R L; Setton, L A; Guilak, F; Madry, H

    2016-08-01

    Meniscal lesions are common problems in orthopaedic surgery and sports medicine, and injury or loss of the meniscus accelerates the onset of knee osteoarthritis (OA). Despite a variety of therapeutic options in the clinics, there is a critical need for improved treatments to enhance meniscal repair. In this regard, combining gene-, cell-, and tissue engineering-based approaches is an attractive strategy to generate novel, effective therapies to treat meniscal lesions. In the present work, we provide an overview of the tools currently available to improve meniscal repair and discuss the progress and remaining challenges for potential future translation in patients.

  20. The distribution and elimination of Bothrops erythromelas venom labeled with {sup 131} I after intravenous injection in mice

    Energy Technology Data Exchange (ETDEWEB)

    Rocha, M.L. [Pernambuco Univ., Recife, PE (Brazil). Dept. de Zoologia]. E-mail: rocha@cascavel.uefs.br

    1999-07-01

    Pharmacokinetic studies can be used to study the systemic effects of snake venoms and to develop standard serotherapy protocols for envenomation. Bothrops erythromelas is probably responsible for most of the snakebite in Pernambuco. The objective of this study was to investigate the pharmacokinetics of B. erythromelas venom (BeV) in mice, and to evaluate the efficacy of bothropic antivenom. BeV showed bicompartmental distribution in the blood of the experimental animals. (author)

  1. Concomitant injuries of anterior cruciate ligament and meniscus

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2016-01-01

    Full Text Available 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.

  2. Imaging the post-operative meniscus

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni P. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom)]. E-mail: andoni.toms@nnuh.nhs.uk; White, Lawrence M. [Department of Medical Imaging, University of Toronto, Mount Sinai Hospital and the University Health Network, 600 University Avenue, Toronto, Ont., M5G 1X5 (Canada); Marshall, Thomas J. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom); Donell, Simon T. [Institute of Health, University of East Anglia, Norwich, Norfolk NR4 7TJ (United Kingdom)

    2005-05-01

    Considerable developments have occurred in meniscal surgery, and consequently in the imaging of post-operative menisci, over the last 15 years. A drive to preserve meniscal physiologic function for as long as possible, in order to delay osteoarthrosis, has resulted in limited partial meniscectomies, meniscal repairs and meniscal transplants. Each of these techniques affects the imaging appearance of the meniscus, reducing the accuracy of conventional MRI in predicting recurrent tears. The specificity of conventional MRI can be improved by employing at least two T2-weighted sequences, but this still leaves a shortfall in sensitivity. In an attempt to increase the diagnostic accuracy of cross-sectional imaging, MR arthrography (MRA) and CT arthrography (CTA), have been applied to the post-operative meniscus. Sensitivities and specificities for these two techniques approach 90% in predicting recurrent meniscal tears. In the setting of clinical symptoms and gross meniscal deficiency, meniscal allografts are being transplanted with increasing frequency. In these transplants meniscal degeneration, fragmentation and separation are common findings, but the role of imaging in the management of these patients has not yet been well defined. This review explores the imaging techniques available for the evaluation of the post-operative meniscus, their strengths and weaknesses, and the reasons that they may find a place in a rational strategy for imaging of the symptomatic post-operative knee.

  3. Loaded versus unloaded magnetic resonance imaging (MRI of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rina Patel

    2016-01-01

    Conclusion: Our study demonstrated that medial meniscal extrusion significantly increased during loading, specifically in those low KL scores (0 and 1 and in KL score of 3. Loaded MRI may more accurately determine the extent of medial meniscal extrusion in particular in those with no to minimal OA.

  4. Releasing the circumferential fixation of the medial meniscus does not affect its kinematics

    NARCIS (Netherlands)

    Vrancken, A.C.T.; Tienen, van T.G.; Hannink, G.; Janssen, D.; Verdonschot, N.J.J.; Buma, P.

    2014-01-01

    Background Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical beh

  5. Intra-articular Implantation of Mesenchymal Stem Cells, Part 2

    Science.gov (United States)

    Kraeutler, Matthew J.; Mitchell, Justin J.; Chahla, Jorge; McCarty, Eric C.; Pascual-Garrido, Cecilia

    2017-01-01

    Knee osteoarthritis (OA) after partial or total meniscectomy is a prevalent issue that patients must face. Various methods of replacing meniscal tissue have been studied to avoid this progression, including meniscal allograft transplantation, meniscal scaffolds, and synthetic meniscus replacement. Studies have shown that meniscal scaffolds may improve symptoms but have not been shown to prevent progression of OA. Recently, mesenchymal stem cells (MSCs) have been proposed as a possible biological therapy for meniscal regeneration. Several animal studies and 1 human study have evaluated the effect of transplanting MSCs into the knee joint after partial meniscectomy. The purpose of this review was to assess the outcomes of intra-articular transplantation of MSCs on meniscal regeneration in animals and humans after partial meniscectomy. Limited results from animal studies suggest that there is some potential for intra-articular injection of MSCs for the regeneration of meniscal tissue. However, further studies are necessary to determine the quality of regenerated meniscal tissue through histological and biomechanical testing. PMID:28203596

  6. Tribosupplementation with Lubricin in Prevention of Post-Traumatic Arthritis

    Science.gov (United States)

    2015-12-01

    produced under pre-GMP conditions. The meniscal injury model involved destabilization of the medial menisco -tibial ligament. We are disclosing results...underwent DMM by excising a 5 mm full-thickness section of the anterior meniscal horn attached to the menisco -tibial ligament. Note that one animal

  7. A novel method for fabrication of biodegradable scaffolds with high compression moduli

    NARCIS (Netherlands)

    DeGroot, JH; Kuijper, HW; Pennings, AJ

    1997-01-01

    It has been previously shown that, when used for meniscal reconstruction, porous copoly(L-lactide/epsilon-caprolactone) implants enhanced healing of meniscal lesions owing to their excellent adhesive properties. However, it appeared that the materials had an insufficient compression modulus to accom

  8. Crowned odontoid process and osteoarthrosis of the anterior atlantoaxial joint

    Energy Technology Data Exchange (ETDEWEB)

    Skaane, P.; Klott, K.J.

    1981-01-01

    Crowned odontoid process and osteoarthrosis of the anterior atlantoaxial joint. The so-called peridentale aureole ( crowned odontoid ), a horseshoelike calcification around the odontoid process, can occasionally be shown on transbuccal views of the occipito-atlantoaxial region, but is commonly only seen on a.p. tomography in patients with osteoarthrosis of the anterior atlantoxial joint. Tomographic examinations reveal that these irregular horseshoe-like calcifications around the odontoid peg represent mainly the osteophyte formation on the superior border of the anterior arch of the atlas. These calcifications are often surrounding a smaller calcification on the tip of the odontoid peg sometimes with a bucket-handle appearance corresponding to the ostephyte formation on the odontoid process. The peridentale aureole or crowned odontoid process is easily overlooked unless tomography is performed, and misinterpretations are possible if the radiologist is not familiar with this appearance of osteoarthrosis and some other joint diseases of the anterior atlantoaxial joint.

  9. A new genus of aplodontid rodent (Mammalia, Rodentia) from the late Oligocene of northern Junggar Basin, China.

    Science.gov (United States)

    Bi, Shundong; Meng, Jin; McLean, Sarah; Wu, Wenyu; Ni, Xijun; Ye, Jie

    2013-01-01

    A new genus and species of aplodontid rodent, Proansomys dureensis, from the late Oligocene of the northern Junggar Basin of China is described. The new genus is referred to as Ansomyinae because the ectoloph on the upper cheek teeth, although not fully crested, has attained the same characteristic bucket-handle-shaped configuration as other members of the subfamily. It represents the earliest record of the subfamily yet discovered in Asia and is more plesiomorphic than species of the genus Ansomys in having a partly crested ectoloph, a lower degree of lophodonty, and less complex tooth basins (lacking accessory lophules). Proansomys has transitional features between Prosciurus and Ansomys, suggesting that the Ansomyinae derived from a group of aplodontids related to Prosciurus, as did other advanced aplodontid rodents. This provides new light on the paleobiogeography of the Ansomyinae.

  10. Traumatic knee extension deficit (the locked knee)

    DEFF Research Database (Denmark)

    Helmark, I C; Neergaard, K; Krogsgaard, M R

    2007-01-01

    In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted...... of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. Following MRI and surgery, standardized forms were filled out, attempting to objectify the findings. The orthopaedic surgeon was not aware of the MRI result prior to surgery......, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one...

  11. A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis

    Directory of Open Access Journals (Sweden)

    Nicolas Lefevre

    2016-01-01

    Full Text Available The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a differential diagnosis such as osteoarthritis. Ultrasound is rarely used as a diagnostic tool for meniscal pathologies and its accuracy is operator-dependent. CT arthrography with multiplanar reconstructions can detect meniscus tears that are not visible on MRI. This technique is also useful in case of MRI contraindications, in postoperative assessment of meniscal sutures and the condition of cartilage covering the articular surfaces. MRI is the most accurate and less invasive method for diagnosing meniscal lesions. MRI allows confirming and characterizing the meniscal lesion, the type, the extension, its association with a cyst, the meniscal extrusion, and assessing cartilage and subchondral bone. New 3D-MRI in three dimensions with isotropic resolution allows the creation of multiplanar reformatted images to obtain from an acquisition in one sectional plane reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears.

  12. 3D MRI volume sizing of knee meniscus cartilage.

    Science.gov (United States)

    Stone, K R; Stoller, D W; Irving, S G; Elmquist, C; Gildengorin, G

    1994-12-01

    Meniscal replacement by allograft and meniscal regeneration through collagen meniscal scaffolds have been recently reported. To evaluate the effectiveness of a replaced or regrown meniscal cartilage, a method for measuring the size and function of the regenerated tissue in vivo is required. To solve this problem, we developed and evaluated a magnetic resonance imaging (MRI) technique to measure the volume of meniscal tissues. Twenty-one intact fresh cadaver knees were evaluated and scanned with MRI for meniscal volume sizing. The sizing sequence was repeated six times for each of 21 lateral and 12 medial menisci. The menisci were then excised and measured by water volume displacement. Each volume displacement measurement was repeated six times. The MRI technique employed to measure the volume of the menisci was shown to correspond to that of the standard measure of volume and was just as precise. However, the MRI technique consistently underestimated the actual volume. The average of the coefficient of variation for lateral volumes was 0.04 and 0.05 for the water and the MRI measurements, respectively. For medial measurements it was 0.04 and 0.06. The correlation for the lateral menisci was r = 0.45 (p = 0.04) and for the medial menisci it was r = 0.57 (p = 0.05). We conclude that 3D MRI is precise and repeatable but not accurate when used to measure meniscal volume in vivo and therefore may only be useful for evaluating changes in meniscal allografts and meniscal regeneration templates over time.

  13. Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011

    DEFF Research Database (Denmark)

    Thorlund, Jonas B; Hare, Kristoffer B; Lohmander, Stefan

    2014-01-01

    Background - Arthroscopic meniscal surgery is the most common orthopedic procedure, and the incidence has increased in Denmark over the last 10 years. Concomitantly, several randomized controlled trials have shown no benefit of arthroscopic procedures including arthroscopic partial meniscectomy i...

  14. The acutely ACL injured knee assessed by MRI

    DEFF Research Database (Denmark)

    Frobell, R B; Roos, H P; Roos, E M;

    2008-01-01

    OBJECTIVES: To map by magnetic resonance imaging (MRI) and quantitative MRI (qMRI) concomitant fractures and meniscal injuries, and location and volume of traumatic bone marrow lesions (BMLs) in the acutely anterior cruciate ligament (ACL) injured knee. To relate BML location and volume to cortical...... depression fractures, meniscal injuries and patient characteristics. METHODS: One hundred and twenty-one subjects (26% women, mean age 26 years) with an ACL rupture to a previously un-injured knee were studied using a 1.5T MR imager within 3 weeks from trauma. Meniscal injuries and fractures were classified...... depression fracture, but no associations were found between meniscal tears and BML volume or fractures. Older age at injury was associated with smaller BML volumes (PACL injured knees had a cortical depression fracture, which was associated with larger BML volumes...

  15. Review: Modelling of meniscus of knee joint during soccer kicking

    Science.gov (United States)

    Azrul Hisham Mohd Adib, Mohd; Firdaus Jaafar, Mohd

    2013-12-01

    Knee is a part of the body that located between thigh and shank is one of the most complicated and largest joints in the human body. The common injuries that occur are ligaments, meniscus or bone fracture. During soccer games, the knee is the most critical part that will easily injure due to the shock from an external impact. Torn meniscus is one of the effects. This study will investigate the effect towards the meniscus within the knee joint during soccer ball kicking. We conduct a literary review of 14 journals that discuss the general view of meniscus and also soccer kicking. The selected topics for this review paper are meniscal function, meniscal movement, meniscal tears and also instep kick. As a finding, statistics show that most meniscal tears (73%) occurred in athletes who were soccer players, basketball players or skiers. The tear is frequently happening at the medial side rather than lateral side with a percentage of 70%.

  16. Comprehensive selection of reference genes for expression studies in meniscus injury using quantitative real-time PCR.

    Science.gov (United States)

    Leal, Mariana Ferreira; Arliani, Gustavo Gonçalves; Astur, Diego Costa; Franciozi, Carlos Eduardo; Debieux, Pedro; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2016-06-10

    The meniscus plays critical roles in the knee function. Meniscal tears can lead to knee osteoarthritis. Gene expression analysis may be a useful tool for understanding meniscus tears, and reverse-transcription quantitative polymerase chain reaction (RT-qPCR) has become an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. We evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1 and TBP) using meniscus samples of (1) 19 patients with isolated meniscal tears, (2) 20 patients with meniscal tears and combined anterior cruciate ligament injury (ACL), and (3) 11 controls without meniscal tears. The stability of the candidate reference genes was determined using the NormFinder, geNorm, BestKeeper DataAssist and RefFinder software packages and comparative ΔCt method. Overall, HPRT1 was the best single reference gene. However, GenEx software demonstrated that two or more reference genes should be used for gene expression normalization, which was confirmed when we evaluated TGFβR1 expression using several reference gene combinations. HPRT1+TBP was the most frequently identified pair from the analysis of samples of (1) meniscal tear samples of patients with a concomitant ACL tears, (2) all meniscal tears, and (3) all samples. HPRT1+GAPDH was the most frequently identified pair from the analysis of samples of isolated meniscal tear samples and controls. In the analysis involving only controls, GAPDH+18S was the most frequently identified pair. In the analysis of only isolated meniscal tear samples and in the analysis of meniscal tear samples of patients with concomitant ACL tears and controls, both HPRT1+TBP and HPRT1+GAPDH were identified as suitable pairs. If the gene expression study aims to compare non-injured meniscus, isolated meniscal tears and meniscal tears of patients with ACL tears as three independent groups, the trio of HPRT1+TBP+GAPDH is the most suitable

  17. Meniscectomy: indications, procedure, outcomes, and rehabilitation

    Directory of Open Access Journals (Sweden)

    Anetzberger H

    2013-12-01

    Full Text Available Hermann Anetzberger,1 Christof Birkenmaier,2 Stephan Lorenz3 1Orthopädische Gemeinschaftspraxis am OEZ, Munich, Germany; 2Department of Orthopedics, Ludwig-Maximilian-University Munich, Munich, Germany; 3Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany Abstract: Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human knee's menisci in relation to surgical indications, surgical techniques, rehabilitation, and outcomes. In order to identify the relevant literature, we performed a PubMed search for the years ranging from 1980–2013 using the following search terms: meniscus; biomechanical function; meniscectomy; meniscal repair; and clinical outcome. The meniscus helps to distribute the forces between the tibial and femoral articular cartilage layers in a load-sharing capacity. Meniscus damage or meniscectomy intuitively leads to an overloading of the cartilage and, hence, to the development of osteoarthrosis. Precise knowledge of meniscal shape and function, of the type of injury, of surgical techniques, as well as of postsurgical rehabilitative care are of decisive importance for an individually-adjusted treatment strategy. Other underlying coexisting knee pathologies also need to be considered. The diagnosis of a meniscal injury is based upon clinical history, physical examination, and imaging studies. The treatment of a meniscal lesion includes conservative, as well as operative, procedures. The goals of surgery are to reduce pain and disability, as well as to preserve meniscal function without causing additional cartilage damage. The resection of meniscal tissue should be restricted to as much as is necessary, and as little as is reasonably possible. Postoperative rehabilitation serves the purpose of improving functional deficits and pain, as well as of restoring a good range of

  18. Association of a hi-tech with a bio-tech technique in the treatment of early osteoarthritis of the knee: a case report

    OpenAIRE

    UBOLDI, FRANCESCO MATTIA; FERRUA, PAOLO; PARENTE, ANDREA; Pasqualotto, Stefano; Berruto, Massimo

    2016-01-01

    Meniscal replacement to treat early osteoarthritis of the knee after meniscectomy may be accompanied by other surgical procedures to treat factors predisposing to a negative intervention outcome. Overload of the medial compartment in slight varus can be reduced by applying the new KineSpring system, which can promote the best possible outcome of a biodegradable meniscal scaffold implantation, without producing biomechanical and anatomical alterations of the joint. This is the first case repor...

  19. Evaluation of Midterm Clinical Results of All inside Suture Technique in Meniscus Repair

    Directory of Open Access Journals (Sweden)

    Murat Gül

    2015-03-01

    Full Text Available Aim: The aim of this study was to evaluate the functional outcomes of arthroscopic all-inside meniscal repair at an average 5-year follow-up. Methods: Thirty-two patients (29 males 3 females; 19 right knees, 13 left knees, who underwent arthroscopic all-inside meniscal repair, were included in the study. Clinical examination and magnetic resonance imaging were the main diagnostic tools. The mean age of the patients was 28 years (23-41 years. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. Preoperative and postoperative functional knee scores of the patients were assessed by modified Marshall functional knee scores in their last follow-up. Results: The mean follow-up period was 58 months (range 49- 81. Marshall knee scores in the last follow-up were found to be excellent in 23 patients, good - in 8 patients, and moderate in 1 patient. ACL reconstruction was performed in the same session in 12 patients with meniscal injury associated with ACL tear. A statistically significant functional improvement was detected in patients with meniscal repair after 5 years. Conclusion: This study showed that all-inside meniscal repair technique is an easy and reliable method for the treatment of meniscus tears. (The Medical Bulletin of Haseki 2015; 53:47-51

  20. A ressonância magnética para o diagnóstico das lesões condrais, meniscais e dos ligamentos cruzados do joelho Magnetic resonance imaging for diagnosis of the chondral, meniscal and cruciate ligaments injuries of the knee

    Directory of Open Access Journals (Sweden)

    Francisco Consoli Karam

    2007-06-01

    Full Text Available OBJETIVO: Avaliar o valor diagnóstico da ressonância magnética (RM do joelho. MATERIAIS E MÉTODOS: Setenta e dois pacientes foram submetidos a RM previamente à artroscopia do joelho realizada por um único cirurgião e considerada como método padrão. Verificou-se a sensibilidade, a especificidade, os valores de verossimilhança e a concordância entre o radiologista e o ortopedista em classificar as lesões. RESULTADOS: O coeficiente de concordância kappa entre a RM e a artroscopia, em classificar as lesões, foi muito bom para lesões de ligamento cruzado anterior (0,84, bom para o menisco lateral (0,75, razoável para o menisco medial (0,50 e baixo para lesões condrais (menor que 0,50. A RM mostrou ter alta sensibilidade para rupturas de ligamento cruzado anterior (94% e menisco medial (92%, boa sensibilidade para lesões de menisco lateral (80% e baixa sensibilidade para lesões em todas as zonas condrais (menor que 50%, enquanto a especificidade foi excelente para todas as estruturas condrais, ligamentares e para o menisco lateral estudadas (maior que 97% e razoável para o menisco medial (65%. CONCLUSÃO: A RM é uma ferramenta útil para subsidiar o diagnóstico clínico de lesões intra-articulares do joelho, como já foi mostrado em resultados semelhantes encontrados na literatura produzida no Brasil e no exterior.OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI of the knee. MATERIALS AND METHODS: Seventy-two patients have been submitted to MRI previously to arthroscopy of the knee performed by a single surgeon and utilized as a comparative standard method. Sensitivity, specificity, values of likelihood and rate of interobserver agreement have been evaluated. RESULTS: The kappa agreement coefficient between MRI and arthroscopy was very good for lesions in the anterior cruciate ligament (0.84, good for lateral meniscus (0.75, reasonable for medial meniscus (0.50 and poor for chondral lesions (< 0.50. MRI has demonstrated high sensitivity for tears in the anterior cruciate ligament (94% and in the medial meniscus (92%, good sensitivity for lesions in the lateral meniscus (80%, and low sensitivity for lesions in all of the chondral zones (< 50%, while the specificity has been excellent for all the chondral, and ligamentous structures, besides the lateral menisci analyzed (more than 97%, and reasonable (65% for the medial meniscus. CONCLUSION: MRI is a useful tool in the clinical diagnosis of intra-articular knee lesions, as already demonstrated by similar results reported both in the Brazilian and international literature.

  1. Kinematic change of the meniscus and the tibiofemoral joint space in asymptomatic volunteers using a wide bore 3T closed MRI system

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eugene; Kim, Yeo Ju; Kim, Mi Young; Cho, Soon Gu [Inha University Hospital, Department of Radiology, Choong-gu, Incheon (Korea, Republic of); Cha, Jang Gyu [Soonchunhyang University Hospital, Department of Radiology, Bucheon (Korea, Republic of); Lee, Dae Hyung [Inha University Hospital, Clinical Trail Center, Incheon (Korea, Republic of); Kim, Ryuh Sup [Inha University Hospital, Department of Orthopedic Surgery, Incheon (Korea, Republic of)

    2015-10-15

    To evaluate kinematic changes in menisci and tibiofemoral joint spaces in extension and flexion using asymptomatic volunteers using a wide-bore 3-T closed MRI system. Twenty-two knees from asymptomatic volunteers were examined in knee extension and flexion using a 3-T MRI (sagittal 2D FSE T2-weighted sequence and sagittal 3D isotropic FSE proton density-weighted cube sequence). The meniscal positions, meniscal floating and flounce were evaluated. The widths of the medial and lateral tibiofemoral joint spaces and coronal tibiofemoral angles were measured. In the anteroposterior direction, meniscal extrusion was most frequently seen in the anterior horn of the medial menisci (100 %) in extensions (maximum 6.04 mm). Most of the menisci moved significantly to the posterior side from extension to flexion. The anteroposterior meniscal movement was the greatest for the anterior horn of the medial meniscus and least for the posterior horn of the medial meniscus. In the mediolateral direction, meniscal extrusion was seen in 52 % of the medial menisci in extensions (maximum 1.91 mm) and 29 % of lateral menisci in flexions (maximum 2.36 mm). From the extension to flexion, all medial and lateral menisci moved significantly to the lateral side. Meniscal floating was frequently observed in the posterior horn of medial menisci in extension. Meniscal flounce was frequently seen in lateral menisci in flexion with a widened lateral tibiofemoral joint space gap. The coronal tibiofemoral angle showed medial wedging in flexion, but not in extension. Wide-bore 3-T closed MRI revealed significant kinematic changes in the menisci and tibiofemoral joint spaces in asymptomatic volunteers. (orig.)

  2. Platelet-Rich Plasma Increases the Levels of Catabolic Molecules and Cellular Dedifferentiation in the Meniscus of a Rabbit Model.

    Science.gov (United States)

    Lee, Hye-Rim; Shon, Oog-Jin; Park, Se-Il; Kim, Han-Jun; Kim, Sukyoung; Ahn, Myun-Whan; Do, Sun Hee

    2016-01-16

    Despite the susceptibility to frequent intrinsic and extrinsic injuries, especially in the inner zone, the meniscus does not heal spontaneously owing to its poor vascularity. In this study, the effect of platelet-rich plasma (PRP), containing various growth factors, on meniscal mechanisms was examined under normal and post-traumatic inflammatory conditions. Isolated primary meniscal cells of New Zealand white (NZW) rabbits were incubated for 3, 10, 14 and 21 days with PRP(-), 10% PRP (PRP(+)), IL(+) or IL(+)PRP(+). The meniscal cells were collected and examined using reverse-transcription polymerase chain reaction (RT-PCR). Culture media were examined by immunoblot analyses for matrix metalloproteinases (MMP) catabolic molecules. PRP containing growth factors improved the cellular viability of meniscal cells in a concentration-dependent manner at Days 1, 4 and 7. However, based on RT-PCR, meniscal cells demonstrated dedifferentiation, along with an increase in type I collagen in the PRP(+) and in IL(+)PRP(+). In PRP(+), the aggrecan expression levels were lower than in the PRP(-) until Day 21. The protein levels of MMP-1 and MMP-3 were higher in each PRP group, i.e., PRP(+) and IL(+)PRP(+), at each culture time. A reproducible 2-mm circular defect on the meniscus of NZW rabbit was used to implant fibrin glue (control) or PRP in vivo. After eight weeks, the lesions in the control and PRP groups were occupied with fibrous tissue, but not with meniscal cells. This study shows that PRP treatment of the meniscus results in an increase of catabolic molecules, especially those related to IL-1α-induced inflammation, and that PRP treatment for an in vivo meniscus injury accelerates fibrosis, instead of meniscal cartilage.

  3. Platelet-Rich Plasma Increases the Levels of Catabolic Molecules and Cellular Dedifferentiation in the Meniscus of a Rabbit Model

    Directory of Open Access Journals (Sweden)

    Hye-Rim Lee

    2016-01-01

    Full Text Available Despite the susceptibility to frequent intrinsic and extrinsic injuries, especially in the inner zone, the meniscus does not heal spontaneously owing to its poor vascularity. In this study, the effect of platelet-rich plasma (PRP, containing various growth factors, on meniscal mechanisms was examined under normal and post-traumatic inflammatory conditions. Isolated primary meniscal cells of New Zealand white (NZW rabbits were incubated for 3, 10, 14 and 21 days with PRP(−, 10% PRP (PRP(+, IL(+ or IL(+PRP(+. The meniscal cells were collected and examined using reverse-transcription polymerase chain reaction (RT-PCR. Culture media were examined by immunoblot analyses for matrix metalloproteinases (MMP catabolic molecules. PRP containing growth factors improved the cellular viability of meniscal cells in a concentration-dependent manner at Days 1, 4 and 7. However, based on RT-PCR, meniscal cells demonstrated dedifferentiation, along with an increase in type I collagen in the PRP(+ and in IL(+PRP(+. In PRP(+, the aggrecan expression levels were lower than in the PRP(− until Day 21. The protein levels of MMP-1 and MMP-3 were higher in each PRP group, i.e., PRP(+ and IL(+PRP(+, at each culture time. A reproducible 2-mm circular defect on the meniscus of NZW rabbit was used to implant fibrin glue (control or PRP in vivo. After eight weeks, the lesions in the control and PRP groups were occupied with fibrous tissue, but not with meniscal cells. This study shows that PRP treatment of the meniscus results in an increase of catabolic molecules, especially those related to IL-1α-induced inflammation, and that PRP treatment for an in vivo meniscus injury accelerates fibrosis, instead of meniscal cartilage.

  4. Whole meniscus regeneration using polymer scaffolds loaded with fibrochondrocytes

    Institute of Scientific and Technical Information of China (English)

    LU Hua-ding; CAI Dao-zhang; WU Gang; WANG Kun; SHI De-hai

    2011-01-01

    Objective: To study the feasibility of regenerating a whole menisci using poly-(3- hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) scaffolds loaded with meniscal cells in rabbits undergoing total meniscectomy, and to explore its protective effect on cartilage degeneration. Methods: A solvent casting and particulate leaching technique was employed to fabricate biodegradable PHBV scaffolds into a meniscal shape. The proliferated meniscal cells were seeded onto the polymer scaffolds, transplanted into rabbit knee joints whose lateral menisci had been removed. Eight to 18 weeks after transplantation, the regenerated neomenisci were evaluated by gross and histological observations. Cartilage degeneration was assessed by Mankin score. Results: Eighteen weeks after transplantation, the implants formed neomenisci. Hematoxylin and eosin (HE) staining of the neomenisci sections revealed regeneration of fibrocartilage. Type Ⅰ collagen in the neomenisci was also proved similar to normal meniscal tissue by immunohistochemical analysis and Sirius scarlet trinitrophenol staining. Articular cartilage degeneration was observed 8 weeks after implantation. It was less severe as compared with that in total meniscectomy controls and no further degeneration was observed at 18 weeks. At that time, the regenerated neomenisci strongly resembled normal meniscal fibrocartilage in gross and histological appearance, and its mechanical property was also close to that of normal meniscus. Conclusions: The present study demonstrates the feasibility of tissue-engineering a whole meniscal structure in total meniscectomy rabbit models using biodegradable PHBV scaffolds together with cultured allogeneic meniscal cells. Cartilage degeneration is decreased. But long-term in vivo investigations on the histological structure and cartilage degeneration of the neomenisci regenerated by this method are still necessary to determine the clinical potential of this tissue engineering avenue.

  5. MRI of menisci repaired with bioabsorbable arrows

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Antti O.T.; Kiuru, Martti; Koskinen, Seppo K. [Helsinki University Hospital - Radiology, Helsinki (Finland); Tielinen, Laura; Lindahl, Jan; Hirvensalo, Eero [Helsinki University Hospital - Traumatology, Helsinki (Finland)

    2006-07-15

    To analyze with conventional magnetic resonance imaging (MRI) the signal appearance of menisci repaired with bioabsorbable arrows. Forty-four patients with 47 meniscal tears treated with bioabsorbable arrows underwent follow-up conventional MRI examination. The time interval between the surgery and MRI varied from 5 to 67 months (mean 26 months). Twenty-six patients also had concurrent repair of torn anterior cruciate ligament. The following grades were used to classify meniscal signal intensity: (a) G0; low signal intensity on all sequences and regular configuration in every plane, (b) G1; increased signal intensity within the meniscus, not extending to the meniscal surface, (c) G2; increased signal intensity linear in shape, which may or may not communicate with the capsular margin of the meniscus, without extending to the meniscal surface, and (d) G3; increased signal intensity extending to the meniscal surface. Thirteen menisci (27.5%) had normal signal intensity, 13 menisci (27.5%) Grade 1 signal intensity, 9 menisci (19%) Grade 2 signal intensity and 12 menisci (26%) Grade 3 signal intensity. The time difference between operation and MRI was statistically significant between the G0 (36 months) and G3 groups (14 months; P=0.0288). There was no statistical significance in different grades between medial and lateral meniscus or between patients with operated or intact ACL. On physical examination sixteen patients reported slight symptoms, seen evenly in each group. (orig.)

  6. MRI of cystic collection of the three joint; Les collections kystiques du genou en IRM

    Energy Technology Data Exchange (ETDEWEB)

    Boutry, N.; Cotten, A.; Dewatre, F.; Chastanet, P.; Gougeon, F. [Hopital R. Salengro, C.H.U., 59 - Lille (France)

    1997-09-01

    We present the main MR features of cystic lesions around the knee joint. Popliteal cysts are the most frequently seen. The usually result from extrusion of joint fluid into the gastrocnemio-semimembranosus bursa but they can have an atypical location or extension. They are most often due to a meniscal, ligamentous, degenerative or inflammatory joint disease responsible for a chronic joint effusion. Meniscal cysts are always associated with a horizontal tear. Medial meniscal cysts are larger and can extend far from the joint. Bursitis occur as a result of inflammation or infection of a bursa. Their location is stereotyped and they do not communicate with the knee joint. Ganglion cysts or ganglia are benign cystic lesions which can affect peri-articular tissues as well as subchondral bone or cruciate ligaments. MRI is now a simple and noninvasive way of obtaining etiologic diagnosis and guiding therapy. (authors). 46 refs.

  7. [Dynamic examination technique in meniscus sonography].

    Science.gov (United States)

    Füsting, M; Casser, H R

    1991-03-01

    The aim of this study was to introduce an improved dynamic examination technique for sonographic assessment of the menisci, a technique that takes into account the special anatomy and function of the knee joint. The dynamic examination technique was used together with a 7.5 mhz sector transducer fitted with a water or PVC pad attachment when the area around the anterior horn and the pars intermedia was being scanned. Misinterpretation as a result of confusing reflections from a tear with the Hoffa fatty pad, popliteal tendon or popliteal groove can be largely avoided owing to the better sonoanatomic imaging and orientation. Diagnosing lesions of the meniscus from echogenic torn surfaces has also become easier thanks to dynamic examination. 60 patients with, for the most part, chronic knee-joint complaints were selected. A comparison of sonographic and arthroscopic findings demonstrated that large percentages of tears in the meniscus can be detected (76.7%) or ruled out (90.0%), and that recent longitudinal tears, flap and non-luxated bucket-handle tears can be considered to be "ideal" tear shapes. Because of its high specificity, sonography of the meniscus presents itself as a suitable method when lesions have to be ruled out, especially in recent knee injuries where clinical findings are unclear. On the other hand, if there are sure indications of a tear, sonography of the meniscus makes it possible to introduce therapeutic measures immediately and thereby to avoid any possible secondary damage.

  8. Three-Tesla magnetic resonance imaging of the meniscus of the knee: What about equivocal errors?

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Vanhoenacker, Filip M.; Gielen, Jan L.; Parizel, Paul M. (Dept. of Radiology, Univ. Hospital Antwerp and Univ. of Antwerp, Antwerp (Edegem) (Belgium)), e-mail: pieter.van.dyck@uza.be; Dossche, Lieven (Dept. of Orthopedics, Univ. Hospital Antwerp and Univ. of Antwerp, Antwerp (Edegem) (Belgium)); Weyler, Joost (Dept. of Epidemiology and Social Medicine, Univ. of Antwerp, Antwerp (Wilrijk) (Belgium))

    2010-04-15

    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

  9. Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: an RSA study in human cadaver knees.

    Science.gov (United States)

    Tienen, T G; Buma, P; Scholten, J G F; van Kampen, A; Veth, R P H; Verdonschot, N

    2005-05-01

    The objective of this study was to validate an in vitro human cadaver knee-joint model for the evaluation of the meniscal movement during knee-joint flexion. The question was whether our model showed comparable meniscal displacements to those found in earlier meniscal movement studies in vivo. Furthermore, we determined the influence of tibial torque on the meniscal displacement during knee-joint flexion. Three tantalum beads were inserted in the medial meniscus of six human-cadaver joints. The knee joints were placed and loaded in a loading apparatus, and the movements of the beads were determined by means of RSA during knee-joint flexion and extension with and without internal tibial (IT) and external tibial (ET) torque. During flexion without tibial torque, all menisci moved in posterior and lateral direction. The anterior horn showed significantly greater excursions than the posterior horn in both posterior and lateral direction. Internal tibial torque caused an anterior displacement of the pathway on the tibial plateau. External tibial torque caused a posterior displacement of the pathway. External tibial torque restricted the meniscal displacement during the first 30 degrees of knee-joint flexion. The displacements of the meniscus in this experiment were similar to the displacements described in the in vivo MRI studies. Furthermore, the application of tibial torque confirmed the relative immobility of the posterior horn of the meniscus. During external tibial torque, the posterior displacement of the pathway on the tibial plateau during the first 30 degrees of flexion might be restricted by the attached knee-joint capsule or the femoral condyle. This model revealed representative meniscal displacements during simple knee-joint flexion and also during the outer limits of passive knee-joint motion.

  10. MRI of the internal derangement of temporomandibular joint: Comparison with arthrographic and operation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Hye; Kim, Dong Ik; Kim, Hyung Gon; Suh, Jung Ho; Jung, Tae Sub [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1993-07-15

    We retrospectively reviewed the MRI findings of 100 temporomandibular joints in 78 patients who had complained temporomandibular joint dysfunction. MRI findings were classified according to Wilke's staging criteria. And these findings were compared with arthographic findings in 22 joint and surgical findings in 44 joints. According to Wilke's staging, they were classified into 6 stages of abnormality: stage 0 (33 cases), stage I (19 cases), stage II (10 cases), stage III (18 cases), stage IV (6 cases), stage V (14 cases). Among the 22 cases in which arthography and MRI were done, both studies were well correlated in 10 joints. In 7 joints, MRI was superior to arthography, which correctly demonstrated the meniscal displacement in 2 joints and meniscal deformity in 5 joints. In 5 joints, arthography was superior to MR, which demonstrated the perforation (1 joint), adhesion (2 joints) and recapture of meniscus (2 joints). Compared with surgical findings, MRI correctly demonstrated the displacement of meniscus in all 44 joints. However, in case of the 10 meniscal perforation, MRI demonstrated the meniscal discontinuity in only 4 joints. Retrospective MR findings in 10 proven cases were the defect in posterior attachment in 4, far anterior meniscal displacement without recapture in 8, condylar spur in 4, and close bone to bone contact in 1. In conclusion, MRI as a primary diagnostic modality of temporomandibular joint derangement, is superior for the grading of displacement and deformity of meniscus but inferior for the evaluation of perforation, adhesion and recapture of meniscus to conventional arthrography. In case of the suspected meniscal perforation, arthrographic correlation is recommended preoperatively.

  11. Forward lunge knee biomechanics before and after partial meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Nielsen, Jonas Høberg; Holsgaard-Larsen, Anders

    2015-01-01

    partial meniscectomy (APM) on knee joint mechanics. The purpose of this study was to evaluate changes in knee joint biomechanics during a forward lunge in patients with a suspected degenerative meniscal tear from before to three months after APM. METHODS: Twenty-two patients (35-55years old......) with a suspected degenerative medial meniscal tear participated in this study. Three dimensional knee biomechanics were assessed on the injured and contralateral leg before and three months after APM. The visual analogue scale was used to assess knee pain and the Knee Injury Osteoarthritis Outcome Score was used...

  12. Change perspective to increase diagnostic accuracy of ultrasonography in calcium pyrophosphate dihydrate deposition disease! A new approach: the axial scan of the meniscus

    Directory of Open Access Journals (Sweden)

    G. Filippou

    2015-03-01

    Full Text Available Ultrasonography (US is a relevant tool in the study of calcium pyrophosphate dihydrate (CPP deposition disease. However, differential diagnosis of hyperechoic deposits within the fibrocartilage can be difficult; moreover, US study is limited by the need of an adequate acoustic window. We describe a US scanning technique that offers a new viewpoint in the study of knee meniscal structure: a longitudinal scan performed according to the long axis of meniscus. This technique proves to be particularly useful for the identification of CPP deposition, but could also improve the US diagnostic utility and accuracy in other meniscal pathologies.

  13. Benefícios da acupuntura no pós-operatório das cirurgias artroscópicas no joelho

    OpenAIRE

    Saidah, Rassen

    2001-01-01

    O presente estudo teve a finalidade de avaliar a eficácia da acunputura no pós-operatório das cirurgias artroscópicas no joelho utilizando - se a técnica "ao oposto" da medicina tradicional chinesa. As 36 gonalgias estudadas foram distribuídas conforme a patologia encontrada nas artroscópicas cirúrgicas: 50,0% tinham lesão do menisco medial isolada, 19,44% tinham lesão meniscal associada à artrose de joelho, 11,11% tinham lesão meniscal lateral associada à artrose de joelho, 8,33% tinham lesã...

  14. Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty.

    Science.gov (United States)

    Lo, JiaHsuan; Müller, Otto; Dilger, Torsten; Wülker, Nikolaus; Wünschel, Markus

    2011-12-01

    This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior-posterior translation, valgus-varus, and internal-external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provided functional ligamentous structures, bicruciate-retaining BKA is a biomechanically attractive treatment for joint degenerative disease.

  15. Fabrication and characterization of anisotropic nanofiber scaffolds for advanced drug delivery systems

    Directory of Open Access Journals (Sweden)

    Jalani G

    2014-05-01

    Full Text Available Ghulam Jalani,* Chan Woo Jung,* Jae Sang Lee, Dong Woo Lim Department of Bionano Engineering, College of Engineering Sciences, Hanyang University, Education Research Industry Cluster at Ansan Campus, Ansan, South Korea*These authors contributed equally to this workAbstract: Stimuli-responsive, polymer-based nanostructures with anisotropic compartments are of great interest as advanced materials because they are capable of switching their shape via environmentally-triggered conformational changes, while maintaining discrete compartments. In this study, a new class of stimuli-responsive, anisotropic nanofiber scaffolds with physically and chemically distinct compartments was prepared via electrohydrodynamic cojetting with side-by-side needle geometry. These nanofibers have a thermally responsive, physically-crosslinked compartment, and a chemically-crosslinked compartment at the nanoscale. The thermally responsive compartment is composed of physically crosslinkable poly(N-isopropylacrylamide poly(NIPAM copolymers, and poly(NIPAM-co-stearyl acrylate poly(NIPAM-co-SA, while the thermally-unresponsive compartment is composed of polyethylene glycol dimethacrylates. The two distinct compartments were physically crosslinked by the hydrophobic interaction of the stearyl chains of poly(NIPAM-co-SA or chemically stabilized via ultraviolet irradiation, and were swollen in physiologically relevant buffers due to their hydrophilic polymer networks. Bicompartmental nanofibers with the physically-crosslinked network of the poly(NIPAM-co-SA compartment showed a thermally-triggered shape change due to thermally-induced aggregation of poly(NIPAM-co-SA. Furthermore, when bovine serum albumin and dexamethasone phosphate were separately loaded into each compartment, the bicompartmental nanofibers with anisotropic actuation exhibited decoupled, controlled release profiles of both drugs in response to a temperature. A new class of multicompartmental nanofibers could be

  16. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K;

    2012-01-01

    and the bone bruise volume of the lateral femoral condyle. Patients with bone bruise of the medial tibia and patients with meniscal lesions had more pain. It is suggested that pain and decreased function after acute ACL injury most likely is related to soft tissue and cartilage injury and not to bone bruise....

  17. Knee extensor muscle strength in middle-aged and older individuals undergoing arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Hall, Michelle; Juhl, Carsten B; Lund, Hans

    2015-01-01

    OBJECTIVE: People with meniscal tears are at high risk to develop or progress knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these individuals. The purpose of this systematic review and meta-analysis was to investigate knee exte...

  18. Technical note: easy graft passage without posterior portals in PCL reconstruction.

    NARCIS (Netherlands)

    Broek, C.M. van den; Tienen, T.G. van; Defoort, K.C.; Wymenga, A.B.

    2012-01-01

    Graft passage during arthroscopically assisted, single-bundle transtibial PCL reconstruction is a technically demanding surgical procedure. We propose the use of a so called Deschamps clamp, originally designed for cerclage wire transport, in combination with a meniscal repair needle with an eye. Th

  19. Prosthetic replacement of the medial meniscus in cadaveric knees: does the prosthesis mimic the functional behavior of the native meniscus?

    NARCIS (Netherlands)

    Tienen, T.G. van; Verdonschot, N.J.J.; Heijkants, R.G.J.C.; Buma, P.; Scholten, J.G.; Kampen, A. van; Veth, R.P.H.

    2004-01-01

    Meniscus replacement by a polymer meniscus prosthesis in dogs resulted in generation of new meniscal tissue. HYPOTHESIS: Optimal functioning of the prosthesis would involve realistic deformation and motion patterns of the prosthesis during knee joint motion. STUDY DESIGN: Controlled laboratory study

  20. Prosthetic replacement of the medial meniscus in cadaveric knees - Does the prosthesis mimic the functional behavior of the native meniscus?

    NARCIS (Netherlands)

    Tienen, TG; Verdonschot, N; Heijkants, RGJC; Buma, R; Scholten, JGF; van Kampen, A; Veth, RPH

    2004-01-01

    Meniscus replacement by a polymer meniscus prosthesis in dogs resulted in generation of new meniscal tissue. Hypothesis: Optimal functioning of the prosthesis would involve realistic deformation and motion patterns of the prosthesis during knee joint motion. Study Design: Controlled laboratory study

  1. Arthroscopic management of mucoid degeneration of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Chirag H Chudasama

    2012-01-01

    Conclusions: Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty.

  2. Osteonecrosis of the knee following arthroscopic meniscectomy; Osteoenecrosis de rodilla tras meniscectomia artrosocpica

    Energy Technology Data Exchange (ETDEWEB)

    Dobado, M. C.; Mota, J.; Roca, M. [Instituto Clinico Corachan. Barcelona (Spain)

    2000-07-01

    Primary osteonecrosis of the knee is characterized by acute onset of pain in elderly individuals who present no risk factors. Osteonecrosis following arthroscopic surgery for meniscal repair is a rare occurrence, the etiology of which remains to be determined. The authors present the magnetic resonance findings in a new case and a review of the related literature. (Author) 7 refs.

  3. Solvent-free fabrication of micro-porous polyurethane amide and polyurethane-urea scaffolds for repair and replacement of the knee-joint meniscus

    NARCIS (Netherlands)

    Spaans, C.J; Belgraver, V.W.; Rienstra, O.; de Groot, J.H; Veth, R.P.H.; Penning, J.P

    2000-01-01

    New porous polyurethane urea and polyurethane amide scaffolds for meniscal reconstruction have been developed in a solvent-free process. As soft segments, copolymers of 50/50 L-lactide/epsilon-caprolactone have been used. After terminating the soft segment with diisocyanates, chain extension was per

  4. Enhanced boundary lubrication properties of engineered menisci by lubricin localization with insulin-like growth factor I treatment.

    Science.gov (United States)

    Bonnevie, Edward D; Puetzer, Jennifer L; Bonassar, Lawrence J

    2014-06-27

    In this study we analyzed the effects of IGF-I on the boundary lubricating ability of engineered meniscal tissue using a high density collagen gel seeded with meniscal fibrochondrocytes. Biochemical, histological, immunohistochemical, and tribological analyses were carried out to determine a construct's ability to functionally localize lubricin. Our study revealed that supplementation with IGF-I enhanced both the proliferation of cells within the construct as well as enhanced the anabolic activity of the seeded cells. Growth factor supplementation also facilitated the localization of ECM constituents (i.e. fibronectin and type II collagen) near the tissue surface that are important for the localization of lubricin, a boundary lubricant. Consequently, we found localized lubricin in the constructs supplemented with IGF-I. Tribologically, we demonstrated that lubricin serves as a boundary lubricant adsorbed to native meniscal surfaces. Lubricin removal from the native meniscus surface increased boundary friction coefficient by 40%. For the engineered constructs, the lubricin localization facilitated by growth factor supplementation also reduced friction coefficient by a similar margin, but similar results were not evident in control constructs. This study demonstrates that the use of growth factors in meniscal tissue engineering can enhance tribological properties by facilitating the localization of boundary lubricants at the surface of engineered tissue.

  5. A Computer-Aided Type-II Fuzzy Image Processing for Diagnosis of Meniscus Tear.

    Science.gov (United States)

    Zarandi, M H Fazel; Khadangi, A; Karimi, F; Turksen, I B

    2016-12-01

    Meniscal tear is one of the prevalent knee disorders among young athletes and the aging population, and requires correct diagnosis and surgical intervention, if necessary. Not only the errors followed by human intervention but also the obstacles of manual meniscal tear detection highlight the need for automatic detection techniques. This paper presents a type-2 fuzzy expert system for meniscal tear diagnosis using PD magnetic resonance images (MRI). The scheme of the proposed type-2 fuzzy image processing model is composed of three distinct modules: Pre-processing, Segmentation, and Classification. λ-nhancement algorithm is used to perform the pre-processing step. For the segmentation step, first, Interval Type-2 Fuzzy C-Means (IT2FCM) is applied to the images, outputs of which are then employed by Interval Type-2 Possibilistic C-Means (IT2PCM) to perform post-processes. Second stage concludes with re-estimation of "η" value to enhance IT2PCM. Finally, a Perceptron neural network with two hidden layers is used for Classification stage. The results of the proposed type-2 expert system have been compared with a well-known segmentation algorithm, approving the superiority of the proposed system in meniscal tear recognition.

  6. Clinics in diagnostic imaging (40). Iliotibial band syndrome.

    Science.gov (United States)

    Hodge, J C

    1999-08-01

    A 51-year-old male cyclist presented with a mass over the lateral portion of his knee. MR scans showed a cystic collection deep to the iliotibial band (ITB). Diagnosis of the ITB syndrome and its differentiation from other cause of painful lateral knee masses, such as meniscal cyst, lateral collateral ligament injury and Segond fracture, are discussed.

  7. Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study

    DEFF Research Database (Denmark)

    Jensen, Lilli Kirkeskov; Rytter, Søren; Bonde, Jens Peter

    2012-01-01

    Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling...

  8. Expression of collagen type I in unaltered and osteoarthritic menisci of knee joint

    Directory of Open Access Journals (Sweden)

    Sladojević Igor

    2016-01-01

    Full Text Available Introduction. Knee osteoarthritis is a progressive degenerative disease which affects meniscal tissue. The aim of this study was to determine the differences in collagen type I expression in macroscopically unaltered and osteoarthritic menisci, and correlate the expression with the grade of macroscopic damage, age and body mass index of patients, preoperative condition of anterior cruciate ligament, angulation and knee contracture. Material and Methods. The control group consisted of 10 macroscopically unaltered menisci, while the experimental group had 35 osteoarthritic menisci. Besides macroscopic grading of meniscal damage, the analysis of collagen type I expression was determined by immunohistochemical staining with the corresponding antibody using semiquantitative scale scores and quantitative parameters: intensity of expression and stained area size. Results. The results of semiquantitative evaluation showed a statistically significant decrease in collagen type I expression in osteoarthritic menisci, which correlated with an increase in macroscopic damage grade. The results of quantitative evaluation did not show a statistically significant decrease in the expression. In posterior meniscal horns, a more intense collagen type I expression was seen in the women, as well as a positive correlation of quantitatively evaluated expression with body mass index. Collagen type I expression in the anterior horns was significantly lower in varus alignment. Conclusion. In the semiquantitative evaluation, collagen type I expression in osteoarthritic menisci was significantly lower compared to macroscopically unchanged menisci. The decrease in the expression level correlates with the increase in the grade of macroscopic meniscal damage. There was no statistically significant difference in the quantitative evaluation of expression.

  9. Degeneration, inflammation, regeneration, and pain/disability in dogs following destabilization or articular cartilage grooving of the stifle joint

    NARCIS (Netherlands)

    Frost-Christensen, L.N.; Mastbergen, S.C.; Vianen, M.E.; Hartog, A.; Groot, J. de; Voorhout, G.; Wees, A.M.C. van; Lafeber, F.P.J.G.; Hazewinkel, H.A.W.

    2008-01-01

    Objective: The most used model for joint instability is the canine anterior cruciate ligament transection (ACLT)-model. The ACLT-model can be extended with a medial meniscectomy (MX) (i.e., ACLT-MX-model) to avoid unintentional, and with that variable, meniscal damage. The present study compares the

  10. Baker cyst

    Science.gov (United States)

    Popliteal cyst; Bulge-knee ... A Baker cyst is caused by swelling in the knee. The swelling is due to an increase in the fluid that ... squeezes into the back of the knee. Baker cyst commonly occurs with: A tear in the meniscal ...

  11. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  12. Prevalence of knee abnormalities in patients with osteoarthritis and anterior cruciate ligament injury identified with peripheral magnetic resonance imaging: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Wu, H. [McMaster Univ., Dept. of Medical Sciences, Hamilton, Ontario (Canada)]. E-mail: wuh5@mcmaster.ca; Webber, C. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Radiology, Hamilton, Ontario (Canada); Fuentes, C.O. [Hamilton Health Sciences, Dept. of Radiology, Hamilton, Ontario (Canada); Benson, R.; Beattie, K. [McMaster Univ., Dept. of Medical Sciences, Hamilton, Ontario (Canada); Adachi, J.D.; Xie, X. [McMaster Univ., Dept. of Medical Sciences, Hamilton, Ontario (Canada); Jabbari, F. [Hamilton Health Sciences, Hamilton, Ontario (Canada); Levy, D.R. [McMaster Univ., Sports Medicine, Dept. of Family Medicine and Dept. of Medicine, Hamilton, Ontario (Canada)

    2007-06-15

    To assess, with a peripheral magnetic resonance imaging system (pMRI), the prevalence of bony and soft tissue abnormalities in the knee joints of normal subjects, osteoarthritis (OA) patients, and individuals who have suffered an anterior cruciate ligament (ACL) rupture; and 2) to compare the prevalence among groups. Magnetic resonance (MR) images of 28 healthy, 32 OA, and 26 ACL damaged knees were acquired with a 1.0-T pMRI system. Two radiologists grade the presence and severity of 9 MR image features: cartilage degeneration, osteophytes, subchondral cyst, bone marrow edema, meniscal abnormality, ligament integrity, loose bodies, popliteal cysts, and joint effusion. Ten of 28 healthy (35.7%), 24 of 26 ACL (92.3%), and all OA knees (100%) showed prevalent cartilage defects; 5 healthy (17.9%), 20 ACL (76.9%), and all OA knees (100%) had osteophytes; and 9 normal (32.1%), 21 ACL (80.8%), and 29 OA knees (90.6%) had meniscal abnormalities. One-half of the knees in the OA group (16 of 32, 50%) had subchondral cysts, and almost one-half had bone marrow edema (15 of 32, 46.9%). These features were not common in the ACL group (7.7%, and 11.5%, respectively) and were not observed in healthy knees. The OA group had the most severe cartilage defects, osteophytes, bone marrow edema, subchondral cysts, and meniscal abnormalities; the ACL group showed more severe cartilage defects, osteophytes, and meniscal abnormalities than did normal subjects. The results suggest that knees that have sustained ACL damage have OA-like features, most subjects (19 of 26, 73.1%) could be identified as in the early stage of OA. The prominent abnormalities present in ACL-damaged knees are cartilage defects, osteophytes, and meniscal abnormalities. (author)

  13. SLAP lesions: a treatment algorithm.

    Science.gov (United States)

    Brockmeyer, Matthias; Tompkins, Marc; Kohn, Dieter M; Lorbach, Olaf

    2016-02-01

    Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. If conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions has been described in the literature particularly for young athletes. However, the results in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. In this population, tenotomy or tenodesis of the biceps tendon is a viable alternative to SLAP repairs in order to improve clinical outcomes. The present article introduces a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors' clinical experience. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. Moreover, normal variations and degenerative changes in the SLAP complex have to be distinguished from "true" SLAP lesions in order to improve results and avoid overtreatment. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50 % of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.

  14. Comparison of Medial and Lateral Meniscus Root Tears.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Koo

    Full Text Available The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs and twenty patients had lateral meniscus root tears (LMRTs. Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8 in the MMRT group and 0.9mm (range, -1.9 to 3.4 in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years and 30 years (range: 14-62 years in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001, and between an ACL tear and LMRT (p<0.0001. A history of trauma was significantly common in LMRT (p<0.0001. LMRT patients were significantly younger than MMRT patients (p<0.0001. Kellgren-Lawrence (K-L grade differed significantly between MMRT and LMRT group (p<0.0001. Meniscal extrusion is

  15. Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Jensen Lilli

    2012-09-01

    Full Text Available Abstract Background Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA, meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. Methods Data on the Knee injury and Osteoarthritis Outcome Score (KOOS were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. Results Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9 and 2.04 (95% CI 0.77-5.5, respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. Conclusions The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the

  16. Transient superficial peroneal nerve palsy after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Majed Alrowaili

    2016-06-01

    Full Text Available A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  17. Transient Superficial Peroneal Nerve Palsy After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Alrowaili, Majed

    2016-04-26

    A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  18. 3D geometry analysis of the medial meniscus--a statistical shape modeling approach.

    Science.gov (United States)

    Vrancken, A C T; Crijns, S P M; Ploegmakers, M J M; O'Kane, C; van Tienen, T G; Janssen, D; Buma, P; Verdonschot, N

    2014-10-01

    The geometry-dependent functioning of the meniscus indicates that detailed knowledge on 3D meniscus geometry and its inter-subject variation is essential to design well functioning anatomically shaped meniscus replacements. Therefore, the aim of this study was to quantify 3D meniscus geometry and to determine whether variation in medial meniscus geometry is size- or shape-driven. Also we performed a cluster analysis to identify distinct morphological groups of medial menisci and assessed whether meniscal geometry is gender-dependent. A statistical shape model was created, containing the meniscus geometries of 35 subjects (20 females, 15 males) that were obtained from MR images. A principal component analysis was performed to determine the most important modes of geometry variation and the characteristic changes per principal component were evaluated. Each meniscus from the original dataset was then reconstructed as a linear combination of principal components. This allowed the comparison of male and female menisci, and a cluster analysis to determine distinct morphological meniscus groups. Of the variation in medial meniscus geometry, 53.8% was found to be due to primarily size-related differences and 29.6% due to shape differences. Shape changes were most prominent in the cross-sectional plane, rather than in the transverse plane. Significant differences between male and female menisci were only found for principal component 1, which predominantly reflected size differences. The cluster analysis resulted in four clusters, yet these clusters represented two statistically different meniscal shapes, as differences between cluster 1, 2 and 4 were only present for principal component 1. This study illustrates that differences in meniscal geometry cannot be explained by scaling only, but that different meniscal shapes can be distinguished. Functional analysis, e.g. through finite element modeling, is required to assess whether these distinct shapes actually influence

  19. Meniskus dikiş teknikleri primer stabilitelerinin biyomekanik değerlendirilmesi

    OpenAIRE

    Asik, Mehmet; Sener, Nadir; Durmaz, Hayati; Kocaoglu, Mehmet; Goksan, Alp

    2004-01-01

    The importance of menisci to the knee has become more clearly delineated in recent years by biomechanical studies and by long term follow up of meniscectomy cases. Functional significance of the menisci has led to a more conservative therapeutic approach to lesions of the meniscus and furthermore lots of open and arthroscopic suturing techniques have been identified. The aim of this study was to measure and compare the primary stability of five different meniscal suturing techniques. The tech...

  20. Compressive cyclic ratcheting and fatigue of synthetic, soft biomedical polymers in solution.

    Science.gov (United States)

    Miller, Andrew T; Safranski, David L; Smith, Kathryn E; Guldberg, Robert E; Gall, Ken

    2016-02-01

    The use of soft, synthetic materials for the replacement of soft, load-bearing tissues has been largely unsuccessful due to a lack of materials with sufficient fatigue and wear properties, as well as a lack of fundamental understanding on the relationship between material structure and behavior under cyclic loads. In this study, we investigated the response of several soft, biomedical polymers to cyclic compressive stresses under aqueous conditions and utilized dynamic mechanical analysis and differential scanning calorimetry to evaluate the role of thermo-mechanical transitions on such behavior. Studied materials include: polycarbonate urethane, polydimethylsiloxane, four acrylate copolymers with systematically varied thermo-mechanical transitions, as well as bovine meniscal tissue for comparison. Materials showed compressive moduli between 2.3 and 1900MPa, with polycarbonate urethane (27.3MPa) matching closest to meniscal tissue (37.0MPa), and also demonstrated a variety of thermo-mechanical transition behaviors. Cyclic testing resulted in distinct fatigue-life curves, with failure defined as either classic fatigue fracture or a defined increased in maximum strain due to ratcheting. Our study found that polymers with sufficient dissipation mechanisms at the testing temperature, as evidenced by tan delta values, were generally tougher than those with less dissipation and exhibited ratcheting rather than fatigue fracture much like meniscal tissue. Strain recovery tests indicated that, for some toughened polymers, the residual strain following our cyclic loading protocol could be fully recovered. The similarity in ratcheting behavior, and lack of fatigue fracture, between the meniscal tissue and toughened polymers indicates that such polymers may have potential as artificial soft tissue.

  1. CRUCIATE LIGAMENT RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    A. V. Korolev

    2016-01-01

    Full Text Available Purpose: To evaluate long-term results of meniscal repair during arthroscopic ACL reconstruction.Materials and methods: 45 patients who underwent meniscal repair during arthroscopic ACL reconstruction between 2007 and 2013 by the same surgeon were included in the study. In total, fifty meniscus were repaired (26 medial and 24 lateral. Procedures included use of one up to four Fast-Fix implants (Smith & Nephew. In five cases both medial and lateral meniscus were repaired. Cincinnati, IKDC and Lysholm scales were used for long-term outcome analysis.Results: 19 male and 26 female patients were included in the study aging from 15 to 59 years (mean age 33,2±1,5. Median time from injury to surgical procedure was zero months (ranging zero to one. Mean time from surgery to scale analysis was 55,9±3 months (ranged 20-102. Median Cincinnati score was 97 (ranged 90-100, with excellent results in 93% of cases (43 patients and good results in 7% (3 patients. Median IKDC score was 90,8 (ranged 86,2-95,4, with excellent outcomes in 51% of cases (23 patients, good in 33% (15 patients and satisfactory in 16% (7 patients. Median Lysholm score was 95 (ranged 90-100, with excellent outcomes in 76% of cases (34 patients and good in 24% (11 patients. Authors identified no statistical differences when comparing survey results in age, sex and time from trauma to surgery.Conclusions: Results of the present study match the data from orthopedic literature that prove meniscal repair as a safe and efficient procedure with good and excellent outcomes. All-inside meniscal repair can be used irrespectively of patients' age and is efficient even in case of delayed procedures.

  2. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  3. Editorial Commentary: Iliotibial Band Allograft Shows Promise for Arthroscopic Hip Labral Reconstruction.

    Science.gov (United States)

    Rossi, Michael J

    2016-01-01

    Arthroscopic hip labral reconstruction using iliotibial band allograft in a modified front-to-back technique results in improved outcomes after 2-year follow-up. The authors' reasoning for reconstruction are reminiscent of similar arguments for restoring hoop stresses in knee meniscal surgery. Results are comparable to reported outcomes of labral repair, and allograft is particularly indicated for severe labral damage when repair is not possible. Don't miss the related technical note with video in Arthroscopy Techniques.

  4. DIAGNOSTIC ACCURACY OF CLINICAL AND MAGNETIC RESONANCE IN KNEE MENISCI AND LIGAMENTOUS INJURIES

    Directory of Open Access Journals (Sweden)

    Nilesh

    2016-03-01

    Full Text Available OBJECTIVE The purpose of this study was to evaluate the reliability of clinical diagnosis compared to MRI findings in ligamentous and meniscal injuries with respect to arthroscopic confirmation as a gold standard. METHODS 485 patients with knee injuries were prospectively assessed by clinical evaluation and magnetic resonance imaging and correlated after therapeutic arthroscopy. The overall accuracy, clinically productive values of sensitivity and specificity was derived. The actual value of the test with respect to positive predictive and negative predictive value was also derived, taking arthroscopic findings as confirmatory. The overall partial and total agreement among the clinical, MRI and arthroscopy was documented. RESULTS The overall accuracy for clinical examination was 85, 92, 100 and 100 and accuracy for MRI was 90, 97, 97 and 97 for detecting medial meniscus, lateral meniscus, ACL and PCL tears respectively. Clinically lateral meniscus tears are difficult to diagnose clinically with negative predictive value (90 whereas ACL injuries do not need MRI for diagnosis as evident by a high negative predictive value (100 of clinical examination. Total agreement with the clinical findings confirmed by arthroscopy was 64.40% which was relatively high as compared to total agreement of MRI findings which was only 31.50%. We found similar total agreement versus total disagreement of both clinical and MRI to be only 2.74% indicating very high accuracy in clinical diagnosis of meniscal and ligamentous injuries combined. CONCLUSION The clinical evaluation alone is sufficient to diagnose meniscal and ACL/PCL pathologies and MRI should be considered only as a powerful negative diagnostic tool. The arthroscopy decision should not be heavily dependent on MRI for ligamentous injuries but reverse is true for meniscal lesions. MR evaluation functions as a powerful negative diagnostic tool to rule out doubtful and complex knee injuries.

  5. Lesiones del ligamento cruzado anterior. Nuevas opciones de tratamiento mediante ingenier??a de tejidos

    OpenAIRE

    Bol??var Arroyo, V??ctor; Raya Villarraso, Ana; Garrido-G??mez, Juan

    2014-01-01

    Las lesiones del ligamento cruzado anterior (LCA) constituyen una causa frecuente de lesiones en poblaci??n joven. Al tratarse de una estructura intraarticular, el ligamento cruzado lesionado no cicatriza de forma similar al de otros ligamentos extraarticulares, de forma que entre los cabos de ruptura no se interpone el co??gulo de fibrina que aparece en las fases iniciales de la cicatrizaci??n. La ruptura del LCA conlleva la aparici??n de inestabilidad de rodilla, da??o meniscal ...

  6. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  7. Meniscectomy: indications, procedure, outcomes, and rehabilitation

    OpenAIRE

    2013-01-01

    Hermann Anetzberger,1 Christof Birkenmaier,2 Stephan Lorenz3 1Orthopädische Gemeinschaftspraxis am OEZ, Munich, Germany; 2Department of Orthopedics, Ludwig-Maximilian-University Munich, Munich, Germany; 3Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany Abstract: Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human kn...

  8. Patellofemoral Arthralgia, Overuse Syndromes of the Knee, and Chondromalacia Patella

    OpenAIRE

    1985-01-01

    Patellofemoral arthralgia is a very common syndrome affecting athletes. Most often, examination fails to define true pathology. Conservative treatment, an active exercise program, and sports may be undertaken without harm to the knee. The patellofemoral arthralgia syndrome must be differentiated from true chondromalacia patella, where there is actual degeneration of the patella's articular cartilage, and from other sources of internal derangement such as meniscal disease or osteochondral lesi...

  9. Temporomandibular joint: true sagittal computed tomography with meniscus visualization

    Energy Technology Data Exchange (ETDEWEB)

    Sartorix, D.J.; Neumann, C.H.; Riley, R.W.

    1984-01-01

    Accessory patient support equipment was constructed that allows patient positioning for true sagittal projection of the temporomandibular joint using a GE 8800 CT/T scanner. Range of motion abnormalities, osseous alterations of the mandibular condyle and temporal bone, joint-space narrowing, and meniscal configuration may be demonstrated. The technique has potential advantages over other CT projections and sagittal reconstruction for evaluation of temporomandibular joint dysfunction.

  10. Magnetic resonance diagnosis of posterior horn tears of the lateral meniscus using a thin axial plane: the zip sign - a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Savoye, P.Y.; Ravey, J.N.; Dubois, C.; Barbier, L.P.; Ferretti, G. [CHU Grenoble, Clinique Universitaire de Radiologie et d' Imagerie Medicale, B.P 217, Grenoble Cedex 09 (France); Courvoisier, A.; Saragaglia, D. [CHU Grenoble, Clinique Universitaire de Chirurgie Orthopedique et Traumatologique, Grenoble (France)

    2011-01-15

    The ''zip'' sign is a newly described form of meniscal tear progressing from the distal insertion of menisco-femoral ligaments (MFLs) through the lateral meniscal wall; the tear occurs during anterior cruciate ligament (ACL) rupture. The purpose of this study was to evaluate the zip sign on knee MRI within the context of ACL injuries. From a series of 261 MR examinations for acute knee injury, we selected 97 patients with both MR and arthroscopic data for a retrospective blinded review. The zip sign was defined on axial thin MR sections as a straight line from the distal insertion of MFLs in association with five sagittal images lateral to the posterior cruciate ligament (PCL) where the MFLs were identified. Sensitivity and specificity in detecting lateral meniscal tears before and after having defined the zip sign were calculated. Sensitivity in detecting the tears of the posterior horn of the lateral meniscus (PHLM) reached 87.5% (CI 0.68-0.97) after zip sign criteria were defined. The zip sign has excellent inter-observer agreement, K > 0.90. The zip sign indicates a lesion at the insertion site of MFLs into the PHLM on thin axial images associated with sagittal MR sections that may improve MR sensitivity in detecting PHLM tears. (orig.)

  11. Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis

    Science.gov (United States)

    Podlipská, Jana; Koski, Juhani M.; Kaukinen, Päivi; Haapea, Marianne; Tervonen, Osmo; Arokoski, Jari P.; Saarakkala, Simo

    2017-01-01

    The aetiology of knee pain in osteoarthritis (OA) is heterogeneous and its relationship with structural changes and function is unclear. Our goal was to determine the prevalence of wide-area scanned ultrasound-defined knee OA structural features and their association with pain and functional impairment in 79 symptomatic and 63 asymptomatic subjects. All subjects underwent ultrasound knee wide-area scanning and the severity of articular cartilage degeneration, the presence and size of osteophytes, and meniscal extrusion were evaluated. Subjects filled in a self-administrated questionnaire on present knee pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on clinical symptoms and function over the past week. Cartilage changes were the most prevalent followed by lateral meniscal extrusion, osteophytes and medial meniscal extrusion. The global femoral cartilage grade associated strongly with pain and the WOMAC index. Site-specifically, early medial cartilage changes and thinning in sulcus and lateral site were associated with symptoms. The presence of femoral lateral osteophytes was also associated with both outcomes. Using the novel wide-area ultrasound scanning technique, we were able to confirm the negative impact of femoral cartilage OA changes on clinical symptoms. Presence, not necessarily size, of lateral femoral osteophytes was also associated with increased pain and disability. PMID:28295049

  12. FUNCTIONAL OUTCOME OF ARTHROSCOPICALLY ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PATELLAR BTB GRAFT: A PROSPECTIVE STUDY OF 45 CASES

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : In today’s world high velocity road traffic accidents, sports activities and increased fitness awareness, ACL injuries is a common clinical problem. Once upon a time ACL rupture led to a relatively safe existence and was thought to be of less significance. Now with improved knee kinematics and clinical skills, it has been established that post ACL injury, the prevalence of clinically significant meniscal damage increases with time and is associated with increasing disability and arthrosis. Ligament reconstruction has not been shown to prevent arthrosis, but studies show that it appears to reduce the risk of subsequent meniscal injury and improve anteroposterior knee motion and facilitates return to high level sporting activities. As surgical techniques like Arthroscopy improve the ability to tackle complex problems, complex decisions regarding Meniscal repair and transplantation, Cartilage repair and regeneration are now commonplace, as are decisions regarding the need for Osteotomies in Arthritically unstable knees. Arthroscopic reconstruction of the Anterior Cruciate Ligament with patellar bone - tendon - bone graft is minimally invasive and is relatively quick and simple to perform, although attention to detail as required for good results. Thus arthroscopy helps in diagnosis and treatment of internal derangement and on extra articular reconstruction.

  13. Disposition of human recombinant lubricin in naive rats and in a rat model of post-traumatic arthritis after intra-articular or intravenous administration.

    Science.gov (United States)

    Vugmeyster, Yulia; Wang, Qin; Xu, Xin; Harrold, John; Daugusta, Daren; Li, Jian; Zollner, Richard; Flannery, Carl R; Rivera-Bermúdez, Moisés A

    2012-03-01

    We have recently demonstrated that intra-articular (IA) administration of human recombinant lubricin, LUB:1, significantly inhibited cartilage degeneration and pain in the rat meniscal tear model of post-traumatic arthritis. In this report, we show that after a single IA injection to naïve rats and rats that underwent unilateral meniscal tear, [(125)I]LUB:1 had a tri-phasic disposition profile, with the alpha, beta, and gamma half-life estimates of 4.5 h, 1.5 days, and 2.1 weeks, respectively. We hypothesize that the terminal phase kinetics was related to [(125)I]LUB:1 binding to its ligands. [(125)I]LUB:1 was detected on articular cartilage surfaces as long as 28 days after single IA injection. Micro-autoradiography analysis suggested that [(125)I]LUB:1 tended to localize to damaged joint surfaces in rats with meniscal tear. After a single intravenous (IV) dose to rats, [(125)I]LUB:1 was eliminated rapidly from the systemic circulation, with a mean total body clearance of 154 mL/h/kg and a mean elimination half-life (t (1/2)) of 6.7 h. Overall, LUB:1 has met a desired disposition profile of a potential therapeutic intended for an IA administration: target tissue (knee) retention and fast elimination from the systemic circulation after a single IA or IV dose.

  14. Knee joint examinations by magnetic resonance imaging: The correlation of pathology, age, and sex

    Directory of Open Access Journals (Sweden)

    Serhat Avcu

    2010-01-01

    Full Text Available Aims: The aim of our study was to investigate the incidence and coexistence of multiple knee joint pathologies and the distribution of knee joint pathologies according to age and sex. Patients and Methods: A retrospective analysis was performed using the clinical data of patients evaluated with magnetic resonance imaging (MRI of the knee joint. Data from 308 patients examined between August 2002 and July 2003 were included into this study. A Pearson correlation analysis was performed to examine the relationship between the pathological findings and the age and sex of the patients. Results: The ages of the patients ranged between 1 and 74 years (mean: 43.3 years. Age was significantly correlated with meniscal degeneration and tears, medial collateral ligament degeneration, parameniscal cyst, and chondromalacia patellae. There was a significant correlation between male gender and anterior cruciate ligament injury. Meniscal injury was significantly correlated with bursitis, as well as medial collateral ligament injury. Bone bruise was significantly correlated with medial collateral ligament injury, lateral collateral ligament injury, Baker′s cyst, and anterior cruciate ligament injury. Chondromalacia patellae was significantly correlated with anterior cruciate ligament injury, patellae alta, and osteochondral lesion. Bursitis (in 53.2% of the patients followed by grade-II meniscal degeneration (in 43% of the patients were the most common knee pathologies observed by MRI. Conclusions: MRI findings of select knee pathologies are significantly correlated with each other and the age and sex of the patient.

  15. Knee joint examinations by magnetic resonance imaging: The correlation of pathology, age, and sex

    Directory of Open Access Journals (Sweden)

    Serhat Avcu

    2010-04-01

    Full Text Available Aims: The aim of our study was to investigate the incidence and coexistence of multiple knee joint pathologies and the distribution of knee joint pathologies according to age and sex. Patients and Methods: A retrospective analysis was performed using the clinical data of patients evaluated with magnetic resonance imaging (MRI of the knee joint. Data from 308 patients examined between August 2002 and July 2003 were included into this study. A Pearson correlation analysis was performed to examine the relationship between the pathological findings and the age and sex of the patients. Results: The ages of the patients ranged between 1 and 74 years (mean: 43.3 years. Age was significantly correlated with meniscal degeneration and tears, medial collateral ligament degeneration, parameniscal cyst, and chondromalacia patellae. There was a significant correlation between male gender and anterior cruciate ligament injury. Meniscal injury was significantly correlated with bursitis, as well as medial collateral ligament injury. Bone bruise was significantly correlated with medial collateral ligament injury, lateral collateral ligament injury, Baker’s cyst, and anterior cruciate ligament injury. Chondromalacia patellae was significantly correlated with anterior cruciate ligament injury, patellae alta, and osteochondral lesion. Bursitis (in 53.2% of the patients followed by grade-II meniscal degeneration (in 43% of the patients were the most common knee pathologies observed by MRI. Conclusions: MRI findings of select knee pathologies are significantly correlated with each other and the age and sex of the patient.

  16. Microfluidic conceived drug loaded Janus particles in side-by-side capillaries device.

    Science.gov (United States)

    Khan, Ikram Ullah; Serra, Christophe A; Anton, Nicolas; Li, Xiang; Akasov, Roman; Messaddeq, Nadia; Kraus, Isabelle; Vandamme, Thierry F

    2014-10-01

    A side-by-side capillaries microfluidic device was developed to fabricate drug loaded poly(acrylamide)/poly(methyl acrylate) Janus particles in the range of 59-240 μm by UV-assisted free radical polymerization. This system was characterized in terms of continuous and dispersed phases flow rates (Qc/Qd), monomer composition of the two compartments, surfactant nature and concentration, outlet tube diameter and UV intensity. These factors were adequately controlled to get different particle shapes ranging from core-shell to bi-compartmental particles. For the latter, a low surfactant concentration (0.75 wt.%) was necessary when the two dispersed phases were pumped at equal flow rate, while at high surfactant concentration, dispersed phases flow rates have to be changed. FTIR analysis suggested complete polymerization of monomers and cytotoxicity test showed these particles were biocompatible having LD 50 of 9 mg/mL. Both ketoprofen and sodium fluorescein were released in sustained release manner at pH 6.8 by following a diffusion type release mechanism. Drug release was faster for bigger particles and found to result from the irregular distribution of the two phases and indentation on bigger particles as revealed by SEM analysis. In comparison, sodium fluorescein release was slower which was attributed to low encapsulation but could be modified by decreasing crosslinker concentration.

  17. Modeling dynamics of mutants in heterogeneous stem cell niche

    Science.gov (United States)

    Shahriyari, L.; Mahdipour-Shirayeh, A.

    2017-02-01

    Studying the stem cell (SC) niche architecture is a crucial step for investigating the process of oncogenesis and obtaining an effective stem cell therapy for various cancers. Recently, it has been observed that there are two groups of SCs in the SC niche collaborating with each other to maintain tissue homeostasis: border stem cells (BSCs), which are responsible in controlling the number of non-stem cells as well as stem cells, and central stem cells (CeSCs), which regulate the SC niche. Here, we develop a bi-compartmental stochastic model for the SC niche to study the spread of mutants within the niche. The analytic calculations and numeric simulations, which are in perfect agreement, reveal that in order to delay the spread of mutants in the SC niche, a small but non-zero number of SC proliferations must occur in the CeSC compartment. Moreover, the migration of BSCs to CeSCs delays the spread of mutants. Furthermore, the fixation probability of mutants in the SC niche is independent of types of SC division as long as all SCs do not divide fully asymmetrically. Additionally, the progeny of CeSCs have a much higher chance than the progeny of BSCs to take over the entire niche.

  18. Pharmacokinetics of marbofloxacin after single intravenous and repeat oral administration to cats.

    Science.gov (United States)

    Albarellos, G A; Montoya, L; Landoni, M F

    2005-09-01

    The pharmacokinetic properties of marbofloxacin, a third generation fluoroquinolone, were investigated in six cats after single intravenous (IV) and repeat oral (PO) administration at a daily dose of 2 mg/kg. Marbofloxacin serum concentration was analysed by microbiological assay using Klebsiella pneumoniae ATCC 10031 as micro-organism test. Serum marbofloxacin disposition was best described by bicompartmental and mono-compartmental open models with first-order elimination after IV and oral dosing respectively. After IV administration, distribution was rapid (T(1/2(d)) 0.23+/-0.24 h) and wide, as reflected by the steady-state volume of distribution of 1.01+/-0.15 L/kg. Elimination from the body was slow with a body clearance of 0.09+/-0.02 L/h kg and a T(1/2) of 7.98+/-0.57 h. After repeat oral administration, absorption half-life was 0.86+/-1.59 h and T(max) of 1.94+/-2.11 h. Bioavailability was almost complete (99+/-29%) with a peak plasma concentration at the steady-state of 1.97+/-0.61 mug/mL. Drug accumulation was not significant after six oral administrations. Calculation of efficacy predictors showed that marbofloxacin has good therapeutic profile against Gram-negative and Gram-positive bacteria with a MIC(50) value <0.25 microg/mL.

  19. Sulfasalazine unveils a contact-independent HSV-TK/ganciclovir gene therapy bystander effect in malignant gliomas.

    Science.gov (United States)

    Robe, Pierre A; Nguyen-Khac, Minh-Tuan; Lambert, Frederic; Lechanteur, Chantal; Jolois, Olivier; Ernst-Gengoux, Patricia; Rogister, Bernard; Bours, Vincent

    2007-01-01

    The efficacy of HSV-TK/ganciclovir-based gene therapy on malignant gliomas largely relies on the amplitude of the bystander effect. In these experiments, the anti-inflammatory drug Sulfasalazine increased the HSV-TK/ganciclovir bystander effect in C6, 9L and LN18 cells but not in U87 glioma cells. Using bi-compartmental culture devices and conditioned medium transfer experiments, we showed that in C6, 9L and LN18 cells but not in U87 cells, Sulfasalazine also unveiled a new, contact-independent mechanism of HSV-TK/ganciclovir bystander effect. Upon treatment with ganciclovir, human LN18-TK but not U87-TK cells synthetized and released TNF-alpha in the culture medium. Sulfasalazine sensitized glioma cells to the toxic effect of TNF-alpha and enhanced its secretion in LN18-TK cells in response to GCV treatment. The caspase-8 inhibitor Z-IETD-FMK and a blocking antibody to TNF-alpha both inhibited the contact-independent bystander effect in LN18 cells. Taken together, these results suggest that TNF-alpha mediates the contact-independent bystander effect in LN18 cells. The treatment with GCV and/or Sulfasalazine of tumor xenografts consisting of a mix of 98% C6 and 2% C6-TK cells shows that Sulfasalazine is also a potent adjunct to the in vivo treatment of gliomas.

  20. Use of the novel atypical opioid tapentadol in goats (Capra hircus): pharmacokinetics after intravenous, and intramuscular administration.

    Science.gov (United States)

    Lavy, E; Lee, H-K; Mabjeesh, S J; Sabastian, C; Baker, Y; Giorgi, M

    2014-10-01

    The objective of the present study was to assess the pharmacokinetics of the novel atypical drug tapentadol (TAP) after intravenous (I.V.) and intramuscular (I.M.) injections in clinically healthy goats. A 2 × 2 cross-over design study was carried out. Six local adult Nubian nonlactating, nonpregnant female goats, were given 5 mg/kg body weight of TAP by I.V. and I.M. routes. The concentrations of TAP in plasma were evaluated using a validated HPLC method. Transient adverse effects were noticed in some animals, especially after I.V. administration (tremors and ataxia). Three days after drug administration, severe hair loss was also recorded. The plasma concentrations after the two routes of administration were best described by a bi-compartmental model. After I.M. injection, TAP showed a very fast absorption (Tmax  = 0.17 h) and a short half-life (1.29 h). The I.M. bioavailability was quite high, despite being variable (87.8 ± 35.6%). This is the first pharmacokinetic study of TAP in goats but due to its unknown safety profile and efficacy, it is premature to recommend the use of this drug in clinical ovine practice.

  1. Discussing treatment options with a minor: the conflicts related to autonomy, beneficence, and paternalism.

    Science.gov (United States)

    Ross, James R; Capozzi, James D; Matava, Matthew J

    2012-01-04

    A seventeen-year-old male, high-school football player presents to an orthopaedic surgeon because of recurrent right knee pain after having undergone an arthroscopic meniscal repair one year previously. The patient did well initially but now has recurrent medial joint-line pain in the knee, which developed when he planted the right leg to throw a pass during summer training camp. He was evaluated by the team's athletic trainer and by an orthopaedic surgeon, both of whom, on the basis of their physical examination of the boy, believe that he may have sustained a recurrent meniscal tear. A magnetic resonance arthrogram is acquired, which confirms the presence of a large longitudinal tear of the medial meniscus in the "red-red" zone, with no signs of degenerative change, articular cartilage damage, or other ligamentous pathology. The patient had just started summer training camp before his senior year of high-school football, and he is considered to be a potential high-level candidate for a Division-I football scholarship.The orthopaedic surgeon presents the patient and his mother with three treatment options: nonoperative management, arthroscopic partial meniscectomy, and arthroscopic meniscal repair. He also presents the relevant risks and benefits of each choice, including, for meniscectomy, the risk of the future development of osteoarthritis if a large portion of the meniscus were to be excised and, for meniscal repair, the need for an extended (four to six-month) rehabilitation period. Both the patient and his mother are apprised of the limitations of preoperative magnetic resonance imaging (MRI) in determining if a meniscal tear can be repaired1-3. The patient states that, on the basis of his symptoms of pain, intermittent locking, and swelling, he does not believe that he would be able to play football if nonoperative management was chosen. He voices a strong preference for meniscectomy, as this would allow him the most rapid return to play. He states that he

  2. 上方盂唇前后向撕裂的肩关节MR造影评价%Superior labrum anterior-posterior lesions on shoulder MR arthrography

    Institute of Scientific and Technical Information of China (English)

    田春艳; 郑卓肇; 李选; 崔国庆

    2010-01-01

    目的 评价肩关节MR造影对上方盂唇前后向撕裂(SLAP损伤)的诊断价值.方法 由2名影像诊断医师独立回顾分析137例经肩关节镜证实的肩关节造影MR图像,判定有无SLAP损伤,并进行分型.SLAP损伤分4型:Ⅰ型为上盂唇毛糙,Ⅱ型为肱二头肌腱盂唇复合体从关节孟撕裂,Ⅲ型为上盂唇桶柄状撕裂,Ⅳ型为上盂唇桶柄状撕裂并同时累及肱二头肌长头腱.计算肩关节MR造影对SLAP损伤的敏感度、特异度和准确度,以及与肩关节镜分型的符合率.采用Kappa统计计算2名影像诊断医师评价的一致性.结果 137例患者中,肩关节镜证实SLAP损伤59例,包括SLAP损伤Ⅰ型6例(10.2%)、Ⅱ型50例(84.7%)、Ⅲ型3例(5.1%).肩关节MR造影的敏感度、特异度和准确度医师甲分别为86.4%(51/59)、78.2%(61/78)和81.8%(112/137),医师乙分别为88.1%(52/59)、84.6%(66/78)和86.1%(118/137).2名影像诊断医师的评价一致性极好(K=0.796).肩关节MR造影与肩关节镜的分型符合率医师甲为83.1%(49/59),医师乙为79.7%(47/59).结论 肩关节MR造影是评价SLAP损伤比较可靠的影像方法.%Objective To evaluate the diagnostic value of shoulder MR arthrography for superior labral anterior-posterior (SLAP) lesions.Methods A retrospective study was conducted in 137 cases of shoulder MR arthrography confirmed by subsequent shoulder arthroscopy.Two radiologists analyzed all MR examinations independently and the results were compared with those of arthrescopy.The superior labrum was described as normal or torn.In addition, each iabral tear was classified as type Ⅰ-Ⅳ.Type Ⅰ lesions were defined as marked fraying of the articulating surface of the superior labrum; type Ⅱ, avulsion of the labral-bicipital complex from the ghnoid; type Ⅲ, displaced bucket handle tear of the superior labrum; and type Ⅳ, bucket handle tear of the superior labrum with extension into the fibers of the biceps tendon.Sensitivity, specificity

  3. Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans

    Science.gov (United States)

    Ishikawa, Masakazu; Adachi, Nobuo; Yoshikawa, Masahiro; Nakamae, Atsuo; Nakasa, Tomoyuki; Ikuta, Yasunari; Hayashi, Seiju; Deie, Masataka; Ochi, Mitsuo

    2016-01-01

    Background: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. Purpose: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries. Results: MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups. Conclusion: The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries. PMID:27294170

  4. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kosy, Jonathan D.; Mandalia, Vipul I.; Anaspure, Rahul [Royal Devon and Exeter Hospital, Princess Elizabeth Orthopaedic Centre, Exeter (United Kingdom)

    2015-11-15

    The anterolateral ligament (ALL) may limit tibial internal rotation and pivot-shift following anterior cruciate ligament reconstruction. Previous studies, using magnetic resonance imaging (MRI) to identify this structure, have been inconsistent. We aimed to further characterize the anatomy of this ligament with reference to previous work. Institutional Review Board approval was gained and a retrospective study of 154 consecutive 1.5-T MRI studies was performed by a consultant musculoskeletal radiologist. Cases with a lateral compartment or cruciate injury and patients under 16 years were excluded. A total of 100 MRIs (98 patients; 63 males: 35 females; mean age, 45.3 years, range, 16-85 years) were included in the study. The ALL was visualized partially in 94 (94.0 %) of the cases and fully with distinct femoral and tibial fibers in 57 (57.0 %) of the cases. Although the femoral origin was discreet in only 57 (57.0 %) of cases, the tibial insertion (7.64 ± 1.26 mm below the joint-line) and meniscal attachment were demonstrated in all cases where the ligament was seen. Where the femoral origin was not seen, a broad expansion of the ligament was noted. We identified four types of meniscal attachment (complete, central, bipolar, and inferior-only). The thickness of the ALL, at the level of the joint-line, was 1.75 ± 0.57 mm. The ALL is a consistent structure with meniscal and tibial portions identifiable in the majority of MRI studies of the uninjured knee. There is an attachment to the lateral meniscus with anatomical variation described by our subclassification. (orig.)

  5. Development of the Knee Quality of Life (KQoL-26 26-item questionnaire: data quality, reliability, validity and responsiveness

    Directory of Open Access Journals (Sweden)

    Atwell Chris

    2008-07-01

    Full Text Available Abstract Background This article describes the development and validation of a self-reported questionnaire, the KQoL-26, that is based on the views of patients with a suspected ligamentous or meniscal injury of the knee that assesses the impact of their knee problem on the quality of their lives. Methods Patient interviews and focus groups were used to derive questionnaire content. The instrument was assessed for data quality, reliability, validity, and responsiveness using data from a randomised trial and patient survey about general practitioners' use of Magnetic Resonance Imaging for patients with a suspected ligamentous or meniscal injury. Results Interview and focus group data produced a 40-item questionnaire designed for self-completion. 559 trial patients and 323 survey patients responded to the questionnaire. Following principal components analysis and Rasch analysis, 26 items were found to contribute to three scales of knee-related quality of life: physical functioning, activity limitations, and emotional functioning. Item-total correlations ranged from 0.60–0.82. Cronbach's alpha and test retest reliability estimates were 0.91–0.94 and 0.80–0.93 respectively. Hypothesised correlations with the Lysholm Knee Scale, EQ-5D, SF-36 and knee symptom questions were evidence for construct validity. The instrument produced highly significant change scores for 65 trial patients indicating that their knee was a little or somewhat better at six months. The new instrument had higher effect sizes (range 0.86–1.13 and responsiveness statistics (range 1.50–2.13 than the EQ-5D and SF-36. Conclusion The KQoL-26 has good evidence for internal reliability, test-retest reliability, validity and responsiveness, and is recommended for use in randomised trials and other evaluative studies of patients with a suspected ligamentous or meniscal injury.

  6. Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging

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    De Maeseneer, M.; Debaere, C.; Desprechins, B.; Osteaux, M. (Vrije Universiteit Brussel, Jette (Belgium). Dept. of Radiology)

    1999-08-01

    Objective. The purpose of this study was to determine the prevalence of Baker's cysts on MR images in a paediatric orthopaedic population, to investigate the association of Baker's cyst with joint fluid and joint disorders in children, and to compare the MR appearance of Baker's cysts in children with that previously reported in adults. Materials and methods. Reports from 393 MR studies of the knee performed in children aged from 1 to 17 years were retrospectively reviewed for the presence of a Baker's cyst, joint effusion, meniscal tear, anterior cruciate ligament tear, or any other joint disorder. Results. A Baker's cyst was identified in 6.3 % (25/393) of patients. The MR images and clinical charts of patients with a Baker's cyst were reviewed. None of the 25 patients with a Baker's cyst had an associated anterior cruciate ligament tear or meniscal tear. Two patients had osteochondritis dissecans and two others had synovial disease (infection and juvenile rheumatoid arthritis). Joint fluid was demonstrated in 16 % (4/25) of patients with a Baker's cyst. There was no statistically significant association between presence of a Baker's cyst and presence of joint fluid. Conclusions. Baker's cyst is less prevalent in a paediatric orthopaedic population than in an adult population. In children, it seems that Baker's cyst is seldom associated with joint fluid, meniscal tear, or anterior cruciate ligament tear. On MR images, a communication between the Baker's cyst and the joint was not demonstrated in any of the patients. In addition, the presence of debris and cyst leakage was not observed. (orig.) With 4 figs., 1 tab., 11 refs.

  7. COMPARATIVE ANALYSES OF DIAGNOSTIC METHODS IN KNEE INJURIES

    Directory of Open Access Journals (Sweden)

    Džoleva-Tolevska Roza

    2016-03-01

    Full Text Available Objective:This study is analyzing the role and significance of the three diagnostic methods (clinical diagnosis, magnetic resonance imaging (MRI and arthroscopy, in establishing accurate diagnosis in knee injuries. The goal is to determine the diagnostic accuracy of each diagnostic method, using arthroscopy as gold standard. Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using patient’s history and positive clinical tests for meniscal lesions, ACL injury and articular cartilage lesions. All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for making the final diagnosis. Results: We analyzed the results of clinical tests for meniscal, ligamentous and articular cartilage injuries of the patients in both groups. Validity of the clinical tests was compared to the results got from MRI and arthroscopy. Accuracy of clinical diagnosis versus MRI diagnosis for medial(69.6% vs. 68.5% and lateral (84% vs. 82.6%meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of MRI diagnosis for ACL injuries was higher (91.3% vs. 81.4%. Accuracy (85.5% vs. 72.8% of clinical diagnosis versus MRI diagnosis for articular cartilage lesions was better. Conclusion: Affirmation of clinical diagnosis in this study is a result of usage of standard clinical signs and tests which are fundamental in establishing clinical diagnosis of knee injuries. MRI is a diagnostic method which enriches the diagnostic process. Arthroscopy is defined as superior diagnostic method, also a gold standard for comparison of the other two diagnostic methods.

  8. Diagnosis of knee injuries: comparison of the physical examination and magnetic resonance imaging with the findings from arthroscopy

    Directory of Open Access Journals (Sweden)

    Nilton Orlando Júnior

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVES: To ascertain the sensitivity, specificity, accuracy and concordance of the physical examination (PE and magnetic resonance imaging (MRI in comparison with arthroscopy, in diagnosing knee injuries. METHODS: Prospective study on 72 patients, with evaluation and comparison of PE, MRI and arthroscopic findings, to determine the concordance, accuracy, sensitivity and specificity. RESULTS: PE showed sensitivity of 75.00%, specificity of 62.50% and accuracy of 69.44% for medial meniscal (MM lesions, while it showed sensitivity of 47.82%, specificity of 93.87% and accuracy of 79.16% for lateral meniscal (LM lesions. For anterior cruciate ligament (ACL injuries, PE showed sensitivity of 88.67%, specificity of 94.73% and accuracy of 90.27%. For MM lesions, MRI showed sensitivity of 92.50%, specificity of 62.50% and accuracy of 69.44%, while for LM injuries, it showed sensitivity of 65.00%, specificity of 88.46% and accuracy of 81.94%. For ACL injuries, MRI showed sensitivity of 86.79%, specificity of 73.68% and accuracy of 83.33%. For ACL injuries, the best concordance was with PE, while for MM and LM lesions, it was with MRI ( p < 0.001. CONCLUSIONS: Meniscal and ligament injuries can be diagnosed through careful physical examination, while requests for MRI are reserved for complex or doubtful cases. PE and MRI used together have high sensitivity for ACL and MM lesions, while for LM lesions the specificity is higher. Level of evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard.

  9. MR imaging of anterior cruciate ligament tears: is there a gender gap?

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    Fayad, Laura M. [Morgan Department of Radiology and Radiological Science, John Hopkins Medical Institutions, Baltimore, MD (United States); Parellada, J.Antoni; Parker, Laurence; Schweitzer, Mark E. [Department of Radiology, Thomas Jefferson University Hospital, Gibbon Building Suite 3390, 111 South 11th St., 19107-5098, Philadelphia, PA (United States)

    2003-11-01

    Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears. At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16-39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries. The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries. Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries. (orig.)

  10. Cysts and cystic-appearing lesions of the knee: A pictorial essay

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    Nicholas A Telischak

    2014-01-01

    Full Text Available Cysts and cystic-appearing lesions around the knee are common and can be divided into true cysts (synovial cysts, bursae, ganglia, and meniscal cysts and lesions that mimic cysts (hematomas, seromas, abscesses, vascular lesions, and neoplasms. The specific anatomic location of the cystic lesion often permits the correct diagnosis. In difficult cases, identifying a cystic mass in an atypical location and/or visualizing internal solid contrast enhancement on magnetic resonance imaging (MRI should raise concern for a neoplasm and the need for further evaluation and intervention.

  11. Effect of Timing of Surgery in Partially Injured ACLs.

    Science.gov (United States)

    Li, Bin; Bai, Lunhao; Fu, Yonghui; Wang, Guangbin; He, Ming; Wang, Jiashi

    2012-05-01

    The purpose of this study was to explore the optimal timing for surgical intervention of partially injured anterior cruciate ligaments (ACL). Thirty-eight patients were divided into early (n=17) or delayed (n=21) surgery groups based on the interval between injury and surgery. Minimum follow-up was 2 years. The outcome measures used were the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating, range of motion, and arthrometer measurements. The findings of this study indicate that early surgical reconstruction of partially ruptured ACLs did not result in arthrofibrosis but may prevent secondary loosening of the intact bundles and further meniscal and chondral injury.

  12. Estudio comparativo entre resonancia magnética con secuencias convencionales y secuencia spin-echo volumétrica en el diagnóstico de fracturas meniscales de origen traumático. Ecuador 2013 - 2014

    OpenAIRE

    Arellano Arregui, Paulina Jimena; Ortega Coronel, Maria Fernanda

    2015-01-01

    Antecedentes: La incidencia de lesión meniscal es elevada, por lo que el tratamiento de este tipo de lesiones continúa siendo el procedimiento quirúrgico más frecuente de la rodilla. La Resonancia magnética (RM) es un método de imagen que valora adecuadamente las estructuras de la rodilla, aportando significativamente en el diagnóstico de las mismas, la toma de decisiones acerca del tratamiento quirúrgico o conservador, planeamiento preoperatorio y la determinación del pronóstico de la lesi...

  13. Análisis comparativo de la rigidez al desplazamiento antero-posterior de la rodilla canina completa, rodilla con rotura del ligamento cruzado anterior y rodilla reparada con la técnica de avance de la tuberosidad tibial

    OpenAIRE

    Musté Rodríguez, Marta

    2013-01-01

    In canine traumatology, one of the most common knee pathologies is torn cruciate ligament (ACL), the diagnosis and treatment costs were 1.32 billion dollars in the U.S. during 2003. The short-term effects are instability of the knee, osteoarthritis, meniscal injuries, pain and loss of function of the joint. The ACL acts as a joint stabilizer. Its function is to limit anterior displacement of the tibia relative to the femur, internal tibia rotation and hyperextension of the knee. Treating ACL ...

  14. Magnetic resonance analysis of loaded meniscus deformation: a novel technique comparing participants with and without radiographic knee osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    MacLeod, Toran D. [California State University, Department of Physical Therapy, Sacramento, CA (United States); Subburaj, Karupppasamy; Wu, Samuel; Kumar, Deepak; Wyatt, Cory; Souza, Richard B. [University of California, Department of Radiology and Biomedical Imaging, Musculoskeletal and Quantitative Imaging Research Group, San Francisco, CA (United States)

    2015-01-15

    To establish a novel method of quantifying meniscal deformation using loaded MRI. More specifically, the goals were to evaluate the (1) accuracy, (2) inter-rater reliability, (3) intra-rater reliability, and (4) scan-rescan reliability. The secondary purpose of this experiment was to evaluate group differences in meniscal deformation in participants with and without radiographic knee OA. Weight-bearing 3-T MRIs of the knee in full extension and 30 of flexion were processed to create 3D models of meniscal deformation. Accuracy was assessed using a custom-designed phantom. Twenty-one participants either with or without signs of OA were evaluated, and another six participants (14 knees, one subject was scanned twice) underwent repeated imaging to assess scan-rescan reproducibility. Intraclass correlation coefficient (ICC), root-mean squared error (RMSE), and root-mean-square percent coefficient-of-variation (RMS%CV) analyses were performed. Exploratory comparisons were made between those with and without OA to evaluate potential group differences. All variables were found to be accurate with RMSE ranging from 0.08 to 0.35 mm and 5.99 to 14.63 mm{sup 2}. Reproducibility of peak anterior-posterior meniscal deformation was excellent (ICC > 0.821; p < 0.013) with RMS%CV for intra-rater ranging from 0.06 to 1.53 % and 0.17 to 1.97 %, inter-rater ranging from 0.10 to 7.20 % and 3.95 to 18.53 %, and scan-rescan reliability ranging from 1.531 to 7.890 % and 4.894 to 9.142 %, for distance and area metric, respectively. Participants with OA were found to have significantly greater anterior horn movement of both the medial (p = 0.039) and lateral meniscus (p = 0.015), and smaller flexed medial meniscus outer area (p = 0.048) when compared to controls. MRI-based variables of meniscus deformation were found to be valid in participants with and without OA. Significant differences were found between those with and without radiographic OA; further study is warranted. (orig.)

  15. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon. A case report.

    Science.gov (United States)

    Alpantaki, Kaliopi; Papadokostakis, George; Katonis, Pavlos; Hadjpavlou, Alexander

    2004-02-01

    Simultaneous bilateral rupture of the quadriceps tendon has rarely been reported; it generally occurs in association with chronic metabolic disorders, such as chronic renal failure, obesity, diabetes mellitus and secondary hyperparathyroidism. The case presented here was in an 85-year-old man with no known risk factors, who sustained simultaneous and spontaneous rupture of both quadriceps tendons. The patient suffered from spinal stenosis and degenerative changes in the knee menisci. These findings suggest that instability of the knee due to meniscal damage, and quadriceps weakness as a result of spinal stenosis, may have played a significant role in the pathogenesis of this injury.

  16. Resultados da intervenção da Fisioterapia em indivíduos submetidos a meniscectomia

    OpenAIRE

    2014-01-01

    Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-Esqueléticas Enquadramento: A ruptura meniscal do joelho, apresenta uma taxa de ocorrência estimada por ano de 23.8/100000 (Clayton, & Court-Brown’s, 2008). Os tratamentos artroscópicos, a rupturas meniscais, estão entre os mais comuns realizados pelos cirurgiões ortopédicos, consti...

  17. ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIE S

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    Saurabh

    2013-02-01

    Full Text Available ABSTRACT : MRI is an accurate, noninvasive imaging modality for evaluation of knee injuries, and determines the patient management, saving them f rom unnecessary arthroscopy. Our study focuses on the fundamental biomechanical forces und erlying the most common injuries and correlate MRI findings with specific traumatic mecha nisms. We conducted a retrospective study on 138 patients having prior history of knee trauma. The studies evaluated cruciate ligament tears, collateral ligament injuries, chondromalacia patella, bone marrow contusions, joint effusions, tendon tear, meniscal tear and osteoarth ritis.

  18. Arthroscopic and computer-assisted high tibial osteotomy using standard total knee arthroplasty navigation software.

    Science.gov (United States)

    Thompson, Stephen R; Zabtia, Nazar; Weening, Bradley; Zalzal, Paul

    2013-05-01

    Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.

  19. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    Science.gov (United States)

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed.

  20. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

    Energy Technology Data Exchange (ETDEWEB)

    Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-08-31

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre

  1. Diffusion tensor imaging and histology of developing hearts.

    Science.gov (United States)

    Abdullah, Osama M; Seidel, Thomas; Dahl, MarJanna; Gomez, Arnold David; Yiep, Gavin; Cortino, Julia; Sachse, Frank B; Albertine, Kurt H; Hsu, Edward W

    2016-10-01

    Diffusion tensor imaging (DTI) has emerged as a promising method for noninvasive quantification of myocardial microstructure. However, the origin and behavior of DTI measurements during myocardial normal development and remodeling remain poorly understood. In this work, conventional and bicompartmental DTI in addition to three-dimensional histological correlation were performed in a sheep model of myocardial development from third trimester to postnatal 5 months of age. Comparing the earliest time points in the third trimester with the postnatal 5 month group, the scalar transverse diffusivities preferentially increased in both left ventricle (LV) and right ventricle (RV): secondary eigenvalues D2 increased by 54% (LV) and 36% (RV), whereas tertiary eigenvalues D3 increased by 85% (LV) and 67% (RV). The longitudinal diffusivity D1 changes were small, which led to a decrease in fractional anisotropy by 41% (LV) and 33% (RV) in 5 month versus fetal hearts. Histological analysis suggested that myocardial development is associated with hyperplasia in the early stages of the third trimester followed by myocyte growth in the later stages up to 5 months of age (increased average myocyte width by 198%, myocyte length by 128%, and decreased nucleus density by 70% between preterm and postnatal 5 month hearts.) In a few histological samples (N = 6), correlations were observed between DTI longitudinal diffusivity and myocyte length (r = 0.86, P eigenvectors during development changed significantly. Collectively, the findings demonstrate a role for DTI to monitor and quantify myocardial development, and potentially cardiac disease. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Evaluation of various gentamicin dosage regimens in geriatric patients: a simulation study.

    Science.gov (United States)

    Bourguignon, Laurent; Goutelle, Sylvain; De Saint-Martin, Julie Burdin; Maire, Pascal; Ducher, Michel

    2010-02-01

    The aim of this simulation study was to evaluate the ability of three regimens proposed in official French recommendations for gentamicin to hit defined pharmacokinetic (PK) and pharmacodynamic targets in a population of elderly patients. The first drug regimen tested consisted of a loading dose of 1 mg/kg and a maintenance dose weighted by creatininemia, every 8 h. The second regimen consisted of a fixed dose of 1 mg/kg at various intervals of time, calculated from creatinine clearance. The last regimen was a fixed dose of 3 mg/kg once a day. All regimens were for 5 days. We used a bicompartmental PK model and implemented a Monte Carlo simulation to generate a large sample of geriatric subjects. The analysis examined three ranges of creatinine clearance. Simulations showed that for the two regimens using multiple doses per day, neither was able to reach an efficacy level without significant toxicity after 5 days of treatment, regardless of the level of renal function. The use of creatininemia or creatinine clearance to adjust the drug dose did not alter these findings. The once-a-day dosing regimen gave better results both in efficacy and toxicity, except for patients with creatinine clearance lower than 60 mL/min, where the incidence of potential toxicity was above 25%. These results strongly suggest that official French recommendations about aminoglycoside dosage regimens in elderly patients with renal impairment should be updated, and that the frequent need for therapeutic drug monitoring and dosage individualization should be clearly stated.

  3. Sulfur Transfer through an Arbuscular Mycorrhiza1

    Science.gov (United States)

    Allen, James W.; Shachar-Hill, Yair

    2009-01-01

    Despite the importance of sulfur (S) for plant nutrition, the role of the arbuscular mycorrhizal (AM) symbiosis in S uptake has received little attention. To address this issue, 35S-labeling experiments were performed on mycorrhizas of transformed carrot (Daucus carota) roots and Glomus intraradices grown monoxenically on bicompartmental petri dishes. The uptake and transfer of 35SO42− by the fungus and resulting 35S partitioning into different metabolic pools in the host roots was analyzed when altering the sulfate concentration available to roots and supplying the fungal compartment with cysteine (Cys), methionine (Met), or glutathione. Additionally, the uptake, transfer, and partitioning of 35S from the reduced S sources [35S]Cys and [35S]Met was determined. Sulfate was taken up by the fungus and transferred to mycorrhizal roots, increasing root S contents by 25% in a moderate (not growth-limiting) concentration of sulfate. High sulfate levels in the mycorrhizal root compartment halved the uptake of 35SO42− from the fungal compartment. The addition of 1 mm Met, Cys, or glutathione to the fungal compartment reduced the transfer of sulfate by 26%, 45%, and 80%, respectively, over 1 month. Similar quantities of 35S were transferred to mycorrhizal roots whether 35SO42−, [35S]Cys, or [35S]Met was supplied in the fungal compartment. Fungal transcripts for putative S assimilatory genes were identified, indicating the presence of the trans-sulfuration pathway. The suppression of fungal sulfate transfer in the presence of Cys coincided with a reduction in putative sulfate permease and not sulfate adenylyltransferase transcripts, suggesting a role for fungal transcriptional regulation in S transfer to the host. A testable model is proposed describing root S acquisition through the AM symbiosis. PMID:18978070

  4. Microstructural characterization of CPPD and hydroxyapatite crystal depositions on human menisci

    Energy Technology Data Exchange (ETDEWEB)

    Katsamenis, Orestis L. [Bioengineering Research Group, University of Southampton, Southampton, SO17 1BJ (United Kingdom); Department of Materials Science, University of Patras, 26504 Rio, Patras (Greece); Karoutsos, Vagelis [Department of Materials Science, University of Patras, 26504 Rio, Patras (Greece); Kontostanos, Konstantinos; Panagiotopoulos, Elias C. [Department of Orthopaedics, School of Medicine, University of Patras, 26500 Rio, Patras (Greece); Papadaki, Helen [Department of Anatomy-Histology-Embryology, School of Medicine, University of Patras, 26500 Rio, Patras (Greece); Bouropoulos, Nikolaos [Department of Materials Science, University of Patras, 26504 Rio, Patras (Greece); Foundation for Research and Technology, Hellas-Institute of Chemical Engineering and High Temperature Chemical Processes - FORTH/ICE-HT, P.O. Box 1414, GR-26504 Patras (Greece)

    2012-11-15

    Meniscus is a fibrocartilaginous tissue composed mainly of water and a dense elaborate collagen network with a predominantly circumferential alignment. Crystal formation and accumulation on meniscal tissue is frequently observed especially in elderly. In this study, we used X-ray diffraction (XRD), FTIR and FT-Raman for the structural identification of the depositions and Optical microscopy, Scanning Electron microscopy (SEM/EDX) and Atomic Force microscopy (AFM), in order to investigate the structural relationship between the crystal deposits and the collagen fibers of human meniscal tissues. We are reporting on the formation of intercalary ''colonies'' of Calcium Pyrophosphate Dihydrate (CPPD) crystals with two distinct morphologies corresponding to the monoclinic and the triclinic phase, as well as the formation of micro-aggregations composed of nano-crystalline HAP aggregations which are developed along the longitudinal axis of collagen fibers without extensively disturbing the collagens arrangement. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  5. Meniscus repair and regeneration: review on current methods and research potential

    Directory of Open Access Journals (Sweden)

    C Scotti

    2013-01-01

    Full Text Available Meniscus regeneration is an unsolved clinical challenge. Despite the wide acceptance of the degenerative consequences of meniscectomy, no surgical procedure has succeeded to date in regenerating a functional and long-lasting meniscal fibrocartilage. Research proposed a number of experimental approaches encompassing all the typical strategies of regenerative medicine: cell-free scaffolds, gene therapy, intra-articular delivery of progenitor cells, biological glues for enhanced bonding of reparable tears, partial and total tissue engineered meniscus replacement. None of these approaches has been completely successful and can be considered suitable for all patients, as meniscal tears require specific and patient-related treatments depending on the size and type of lesion. Recent advances in cell biology, biomaterial science and bioengineering (e.g., bioreactors have now the potential to drive meniscus regeneration into a series of clinically relevant strategies. In this tutorial paper, the clinical need for meniscus regeneration strategies will be explained, and past and current experimental studies on meniscus regeneration will be reported.

  6. Non-traumatic Thickening of the Anterior Cruciate Ligament

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hyun Jun; Park, Jin Gyoon; Song, Sang Gook [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-08-15

    To describe the magnetic resonance (MR) imaging findings of non-traumatic thickening of the anterior cruciate ligament (ACL) and to evaluate the associated lesions. Between January 2003 and August 2005, 44 knees of 44 patients who had thickened ACLs on MR images and had no history of knee trauma were analyzed retrospectively. The normal thickness of the ACL was measured on axial T2-weighted images of 40 healthy adult knees. The MR imaging findings of the thickened ACLs and associated lesions were analyzed. In 40 cases of healthy knees, the thickness of the proximal ACL was 3-6 mm. In 44 cases of non-traumatic thickening of the ACL, the thickness of the proximal ACL was 8-14 mm. There was an increased signal intensity and ill-defined border in all cases of thickened ACLs, linear low-signal intensity fibers parallel to the long axis of the thickened ACL (celery stalk appearance) in 24 cases, and entrapment in 10 cases. With respect to associated lesions, there was osteoarthritis in 40 cases, meniscal tears in 42 cases, and degeneration of the posterior cruciate ligament in 7 cases. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears

  7. The valuable use of Microsoft Kinect™ sensor 3D kinematic in the rehabilitation process in basketball

    Science.gov (United States)

    Braidot, Ariel; Favaretto, Guillermo; Frisoli, Melisa; Gemignani, Diego; Gumpel, Gustavo; Massuh, Roberto; Rayan, Josefina; Turin, Matías

    2016-04-01

    Subjects who practice sports either as professionals or amateurs, have a high incidence of knee injuries. There are a few publications that show studies from a kinematic point of view of lateral-structure-knee injuries, including meniscal (meniscal tears or chondral injury), without anterior cruciate ligament rupture. The use of standard motion capture systems for measuring outdoors sport is hard to implement due to many operative reasons. Recently released, the Microsoft Kinect™ is a sensor that was developed to track movements for gaming purposes and has seen an increased use in clinical applications. The fact that this device is a simple and portable tool allows the acquisition of data of sport common movements in the field. The development and testing of a set of protocols for 3D kinematic measurement using the Microsoft Kinect™ system is presented in this paper. The 3D kinematic evaluation algorithms were developed from information available and with the use of Microsoft’s Software Development Kit 1.8 (SDK). Along with this, an algorithm for calculating the lower limb joints angles was implemented. Thirty healthy adult volunteers were measured, using five different recording protocols for sport characteristic gestures which involve high knee injury risk in athletes.

  8. Failure strength of repair devices versus meniscus suturing techniques.

    Science.gov (United States)

    Aşík, Mehmet; Sener, Nadir

    2002-01-01

    The purpose of this study was to compare the load to failure of different common suturing techniques with repair devices. Seventy-one calf medial menisci were cut to simulate peripheral longitudinal tears and repaired with one of 13 repair techniques. The two parts of the meniscus were pulled using the Instron tensometer until failure occurred. The techniques and repair devices tested were vertical (0 PDS, 2-0 PDS, 2-0 Ethibond), horizontal (0 PDS, 2-0 PDS, 2-0 Ethibond) suturing, T-fix, Mitek, Clearfix screw, Clearfix dart, Biostinger, S-D-sorb, and Artrex dart. The strongest repair method in our study was the vertical sutures with 0 PDS. In this study the mean failure strength of all meniscal repair devices was lower than that of the vertical and horizontal suturing techniques. All meniscus repair devices except T-fix and in some the Arthrex dart (40% broken up) pulled out of the menisci. Devices which had only horizontally placed barbs had lower mean failure strength. Failure strength of T-fix was similar to horizontal sutures with 2-0 Ethibond and 2-0 PDS. In conclusion, because all meniscal repair devices had inferior results, when such devices are used, postoperative rehabilitation should not be hastened, and their inferior primary stability should be kept in mind.

  9. Magnetic resonance imaging of fresh traumatic injuries of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Ishibashi, Koji; Ojima, Tadao; Sato, Katsumi; Sato, Tetsuro; Komatsu, Tetsuro; Nobuta, Shingo; Inoue, Hisayoshi; Onuma, Hidezi; Murakami, Tadashi (Tohoku Rosai Hospital, Sendai (Japan))

    1993-11-01

    Taking advantages of its water density delineation, MR studies were carried out in 22 patients having traumatic hemarthrosis of the knee within 3 days of the incidents. Because of swelling and severe pain, exact physical examination of an injured knee is very difficult. However, MR imaging is a non-invasive examination that would facilitate morphological diagnosis of soft tissue injuries such as meniscal tears, ligamental tears, and even fracture. In the present studies, MRI findings were compared with those from arthroscopic investigations and MR reimaging more than one month later. The results were confirming most of the MRI findings. Seventeen cases of tears of the anterior cruciate ligaments, 1 case of tear to posterior cruciate ligaments, 2 cases of tear of medial collateral ligaments, 2 cases of tear of lateral collateral ligaments, 4 cases of tears of meniscal and 6 of fractures. False MRI findings were encountered in only two cases: normal cruciate ligament surrounded with hemarthrosis caused by the tear of anterior cruciate ligament, and the tear of the posteior horn of the lateral meniscus musked by hematoma in the burusa of the popliteus tendon. We concluded that MRI can definitely contribute to clinical diagnosis and treatment planning of fresh traumatic knee injuries buried in hemarthrosis. (author).

  10. A prospective study on time to recovery in 254 injured novice runners.

    Directory of Open Access Journals (Sweden)

    Rasmus Oestergaard Nielsen

    Full Text Available Describe the diagnoses and the time to recovery of running-related injuries in novice runners.Prospective cohort study on injured runners.This paper is a secondary data analysis of a 933-person cohort study (DANO-RUN aimed at characterizing risk factors for injury in novice runners. Among those sustaining running-related injuries, the types of injuries and time to recovery is described in the present paper. All injured runners were diagnosed after a thorough clinical examination and then followed prospectively during their recovery. If they recovered completely from injury, time to recovery of each injury was registered.A total of 254 runners were injured. The proportion of runners diagnosed with medial tibial stress syndrome was 15%, 10% for patellofemoral pain, 9% for medial meniscal injury, 7% for Achilles tendinopathy and 5% for plantar fasciitis. Among the 220 runners (87% recovering from their injury, the median time to recovery was 71 days (minimum  = 9 days, maximum  = 617 days.Medial tibial stress syndrome was the most common injury followed by patellofemoral pain, medial meniscal injury and Achilles tendinopathy. Half of the injured runners were unable to run 2×500 meters without pain after 10 weeks. Almost 5% of the injured runners received surgical treatment.

  11. Linear signal hyperintensity adjacent to the subchondral bone plate at the knee on T2-weighted fat-saturated sequences: imaging aspects and association with structural lesions

    Energy Technology Data Exchange (ETDEWEB)

    Gondim Teixeira, Pedro Augusto; Balaj, Clemence [CHU Hopital Central, Service D' Imagerie Guilloz, Nancy (France); Universite de Lorraine, IADI, UMR S 947, Nancy (France); Marie, Beatrice [CHU Hopital Central, Service d' Anatomo-Pathologie, Nancy (France); Lecocq, Sophie; Louis, Matthias; Blum, Alain [CHU Hopital Central, Service D' Imagerie Guilloz, Nancy (France); Braun, Marc [CHU Hopital Central, Service de Neuroradiologie, Nancy (France)

    2014-11-15

    To describe the association between linear T2 signal abnormalities in the subchondral bone and structural knee lesions. MR studies of patients referred for the evaluation of knee pain were retrospectively evaluated and 133 of these patients presented bone marrow edema pattern (BMEP) (study group) and while 61 did not (control group). The presence of linear anomalies of the subchondral bone on T2-weighted fat-saturated sequences was evaluated. The findings were correlated to the presence of structural knee lesions and to the duration of the patient's symptoms. Histologic analysis of a cadaveric specimen was used for anatomic correlation. Linear T2 hyperintensities at the subchondral bone were present in 41 % of patients with BMEP. None of the patients in the control group presented this sign. When a subchondral linear hyperintensity was present, the prevalence of radial or root tears was high and that of horizontal tears was low (71.4 and 4.8 %, respectively). Sixty-nine percent of the patients with a subchondral insufficiency fracture presented a subchondral linear hyperintensity. It was significantly more prevalent in patients with acute or sub-acute symptoms (p < 0.0001). The studied linear T2 hyperintensity is located at the subchondral spongiosa and can be secondary to local or distant joint injuries. Its presence should evoke acute and sub-acute knee injuries. This sign is closely related to subchondral insufficiency fractures and meniscal tears with a compromise in meniscal function. (orig.)

  12. Arthroscopy of the knee without pathological findings.

    Science.gov (United States)

    Schlepckow, P; Weber, M; Hempel, K

    1994-01-01

    From 1983 to 1990, 82 knee arthroscopies (8.2%) carried out in our patients found nothing pathological. Sixty-four percent of these patients were active in sports, but trauma was noted in 32% of the cases only. Football and other ball games, skiing, and track and field athletics were the main causes. Twenty-six percent of the patients had undergone previous surgery in the affected knee. At a mean of 4.6 years postoperatively, clinical and radiological re-assessment was conducted so as to compare our pre- and intraoperative findings with the further course of events. We found that 48.2% of the patients were symptom-free after the diagnostic arthroscopy, 37.5% had persistent discomfort and 14.3% had a recurrence of discomfort after 6 months to 2 years. The objective measurement score (Zarins Rowe score), at 47.5 out of 50 points, was better than the subjective score, at 40 out of 50 points. Our diagnoses had to be changed retrospectively: meniscal lesions were diagnosed too frequently, while chondropathia patellae and instability were often missed. Additionally, complaints could be related to abnormal axis, limited range of motion of the hip or knee, leg length inequality and hypermobility. Being unable to verify a presumed intra-articular lesion arthroscopically is frustrating for both doctor and patient. Our data suggest that meniscal signs should be looked at more critically and emphasise the need for a complete evaluation of the whole locomotor system.

  13. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    Directory of Open Access Journals (Sweden)

    David Simon

    2015-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

  14. Collagene order of articular cartilage by clinical magnetic resonance images and its age dependency

    Energy Technology Data Exchange (ETDEWEB)

    Seidel, P.; Gruender, W. [Inst. of Medical Physics and Biophysics, Univ. of Leipzig (Germany)

    2005-07-01

    The present papers describes a novel method to obtain information on the degree of order of the collagen network of the knee meniscal cartilage by means of a single clinical MRI. Images were obtained from 34 healthy volunteers aged between 6 and 76 years as well as from one patient with clinically-diagnosed arthrosis at the age of 32 and 37 years. A siemens vision (1.5 T) MRT with TR = 750 ms, TE = 50 ms, FoV = 160 mm, and Matrix 512 x 512 was used for this purpose. The MR signal intensities of the cartilage were read out along slices with constant height above the subchondral bone and plotted versus the actual angle to the external magnetic field. The obtained intensity curves were fitted by a model distribution, and the degree of order of the collagen fibers was calculated. For the knee meniscal cartilage, there was an age-dependency of the degree of order and a significant deviation of the volunteer with arthrosis from the normal curve. The results are discussed in view of the arcade model and of a possible use of non-invasive clinical MRT for the detection of early arthrotic changes of cartilage. (orig.)

  15. Pseudodynamic MR imaging of temporomandibular joint disorders

    Energy Technology Data Exchange (ETDEWEB)

    Nakasato, Tatsuhiko; Ehara, Shigeru (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1992-09-01

    Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.5 Tesla MR unit and 8 cm circular planar surface coil. For depiction of each compartment of the meniscus, the optimum sequence was 200/15/2 (TR/TE/excitations) with 50 deg or 60 deg flip angle in gradient refocused acquisition in steady-state (GRASS) sequences. Three contiguous slices on sagittal MR images were routinely obtained at 14-18 different phases of the opening cycle and displayed in closed-loop cine fashion. Internal derangement was observed in 57% of 68 joints. The most common type was anterior meniscal displacement without reduction. Sideway and rotational displacements, observed in 10% each, were noted on both sagittal multislice images and axial reference images. As a pseudodynamic MR technique, jaw movement specifically designed to check bite procedure to adjust splints is useful for detecting the exact time of meniscal redisplacement on the second click. After conservative therapy for arthrosis, pseudodynamic MR provided information on changes in the meniscus and condylar relationship. Pseudodynamic MR with multiple phases is suitable for evaluating subtle motion abnormality of the meniscus and for post-therapeutic monitoring. (author).

  16. Radiologic findings of hemophilic arthropathy of the knee : Focusing on MR imaging and plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Jin; Choi, Jae Young; Cha, Sung Suk; Eun, Choong Kie [Inje Univ., College of Medicine, Pusan (Korea, Republic of); Park, Dong Woo [Hanyang Univ., College of Medicine, Seoul (Korea, Republic of)

    1996-12-01

    To evaluate the characteristic MR findings of hemophilic arthropathy of the knee. Seven keens in six patients with hemophilia (five hemophilia A and one hemophilia B) were retrospectively studied with MR images and plain radiographs. Patients were aged between 2 and 20 years (mean, 11) and all had a clinical history of repeated hemarthrosis. MR images of the knee were analyzed with respect to intra- and extra-articular hemorrhage, the state of synovial tissue, articular cartilage, bone, menisci, and ligaments. Synovial hypertrophy and articular cartilage destruction were revealed in all seven knees ; pannus was found in four, and was seen as low signal intensity on T1-weighted image and high signal intensity on T2-weighted images. All five instances of synovial hypertrophy and pannus were enhanced. Joint effusion, presented in five of seven knees, demonstrated slightly low signal intensity on T1-weighted image and high signal intensity on T2-weighted images, and was associated with peripheral low signal intensity of hemosiderin. Subchondral and marginal erosion was seen in six cases, patellar deformity in three, meniscal damage in four and cruciate ligament damage in one case. MR is superior to radiography in demonstrating chronic repeated hemarthrosis (manifested as thick intra-articular effusion), hemosidering, synovial hypertrophy, erosion or destruction of articular cartilage and bone, and meniscal or cruciate ligament injury of hemophilic arthropathy of the knee. MR is therefore thought to be a useful imaging study for accurate evaluation of hemophilic arthropathy of the knee.

  17. Cell-Based Strategies for Meniscus Tissue Engineering

    Science.gov (United States)

    Niu, Wei; Guo, Weimin; Han, Shufeng; Zhu, Yun; Liu, Shuyun; Guo, Quanyi

    2016-01-01

    Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone. Following a series of studies and clinical trials, tissue engineering is considered a promising prospect for meniscus repair and regeneration. As one of the key factors in tissue engineering, cells are believed to be highly beneficial in generating bionic meniscus structures to replace injured ones in patients. Therefore, cell-based strategies for meniscus tissue engineering play a fundamental role in meniscal regeneration. According to current studies, the main cell-based strategies for meniscus tissue engineering are single cell type strategies; cell coculture strategies also were applied to meniscus tissue engineering. Likewise, on the one side, the zonal recapitulation strategies based on mimicking meniscal differing cells and internal architectures have received wide attentions. On the other side, cell self-assembling strategies without any scaffolds may be a better way to build a bionic meniscus. In this review, we primarily discuss cell seeds for meniscus tissue engineering and their application strategies. We also discuss recent advances and achievements in meniscus repair experiments that further improve our understanding of meniscus tissue engineering. PMID:27274735

  18. MRI findings in renal transplant recipients with hip and knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Donmez, Fuldem Yildirim [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: fuldemyildirim@yahoo.com; Basaran, Ceyla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: ceylab@baskent-ank.edu.tr; Ulu, Esra Meltem Kayahan [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: emkayahanulu@yahoo.com; Uyusur, Arzu [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: arzuuyusur@yahoo.com; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: caglat@baskent-ank.edu.tr; Muhtesem Agildere, A. [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Caddesi 10. sokak no: 45, Bahcelievler 06490, Ankara (Turkey)], E-mail: amuhtesem@superonline.com

    2009-09-15

    Purpose: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. Materials and methods: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. Results: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. Conclusion: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be Second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

  19. Cell-Based Strategies for Meniscus Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Wei Niu

    2016-01-01

    Full Text Available Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone. Following a series of studies and clinical trials, tissue engineering is considered a promising prospect for meniscus repair and regeneration. As one of the key factors in tissue engineering, cells are believed to be highly beneficial in generating bionic meniscus structures to replace injured ones in patients. Therefore, cell-based strategies for meniscus tissue engineering play a fundamental role in meniscal regeneration. According to current studies, the main cell-based strategies for meniscus tissue engineering are single cell type strategies; cell coculture strategies also were applied to meniscus tissue engineering. Likewise, on the one side, the zonal recapitulation strategies based on mimicking meniscal differing cells and internal architectures have received wide attentions. On the other side, cell self-assembling strategies without any scaffolds may be a better way to build a bionic meniscus. In this review, we primarily discuss cell seeds for meniscus tissue engineering and their application strategies. We also discuss recent advances and achievements in meniscus repair experiments that further improve our understanding of meniscus tissue engineering.

  20. Magnetic resonance tomography of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Puig, Stefan; Kuruvilla, Yojena Chittazhathu Kurian; Ebner, Lukas [University Hospital, University of Berne, Department of Interventional, Pediatric and Diagnostic Radiology Inselspital, Berne (Switzerland); Endel, Gottfried [Main Association of Austrian Social Insurance Institutions, Vienna (Austria)

    2015-10-15

    To compare the diagnostic performance of magnetic resonance imaging (MRI) in terms of sensitivity and specificity using a field strength of <1.0 T (T) versus ≥1.5 T for diagnosing or ruling out knee injuries or knee pathologies. The systematic literature research revealed more than 10,000 references, of which 1598 abstracts were reviewed and 87 full-text articles were retrieved. The further selection process resulted in the inclusion of four systematic reviews and six primary studies. No differences could be identified in the diagnostic performance of low- versus high-field MRI for the detection or exclusion of meniscal or cruciate ligament tears. Regarding the detection or grading of cartilage defects and osteoarthritis of the knee, the existing evidence suggests that high-field MRI is tolerably specific but not very sensitive, while there is literally no evidence for low-field MRI because only a few studies with small sample sizes and equivocal findings have been performed. We can recommend the use of low-field strength MRI systems in suspected meniscal or cruciate ligament injuries. This does, however, not apply to the diagnosis and grading of knee cartilage defects and osteoarthritis because of insufficient evidence. (orig.)

  1. MR imaging before arthroscopy in knee joint disorders?

    Energy Technology Data Exchange (ETDEWEB)

    Rappeport, E.D. [Dept. of Diagnostic Radiology, Harlev Hospital, Univ. of Copenhagen (Denmark); Mehta, S. [Stockport Acute Services NHS Trust (United Kingdom); Wieslander, S.B. [Dept. of Diagnostic Radiology, Harlev Hospital, Univ. of Copenhagen (Denmark); Schwarz Lausten, G. [Dept. of Orthopaedic Surgery, Herlev Hospital, Univ. of Copenhagen (Denmark); Thomsen, H.S. [Dept. of Diagnostic Radiology, Harlev Hospital, Univ. of Copenhagen (Denmark)

    1996-09-01

    Purpose: To review the current literature examining the relative merits of arthroscopy and MR imaging of the knee. Material and Methods: All papers comparing MR imaging with arthroscopy published within the last 10 years according to Medline were collected and read. Results: Technology has improved considerably during recent years allowing detailed non-invasive visualization of the knee. In particular, the development of cheaper whole-body and dedicated low-field MR units has opened up for non-invasive inspection of the knee at reasonable cost. Meniscal tears can be detected with accuracy rates of around 90% and rupture of the anterior cruciate ligament with accuracy rates of around 93% compared to arthroscopy. However, arthroscopy is not the ideal gold standard, since it has weak points, e.g. peripheral meniscal tears or osteochondritis without apparent damage to the cartilage. Conclusion: Based on the overwhelming literature it seems safe to conclude that MR examinations of the knee should be performed before arthroscopy is undertaken. (orig.).

  2. Analysis of the unicompartmental knee arthroplasty results

    Directory of Open Access Journals (Sweden)

    S. A. Firsov

    2015-01-01

    Full Text Available In 2012-2014 total 67 unicompartmental arthroplasty surgeries with use of Oxford knee meniscal bearing were performed. The surgeries were performed by a single surgeon. Minimally invasive approach was used. All patients were evaluated clinically, radiographically and with Oxford Knee score scale, Knee Society score scale and functional scale. Obtained data was processed with nonparametric Mann-Whitney-Wilcoxon test. Results were processed using the statistical analysis application package SPSS, version 10.07. Analysis of of mid-term results showed that the average for Oxford Knee score increased from 16.4 (95% CI 9-23 to 41.3 (95% CI 29-47. Average for Knee Society score scale increased from 42.7 (95% CI 31-55 to 88.6 (95% CI 73-100. No occurrence of early postoperative complications have been reported. Statistically significant improvements of knee function in patients after unicompartmental arthroplasty have been observed. Unicompartmental arthroplasty currently can be considered as an advanced treatment option for medial knee joint pathology. Meniscal bearing cemented prostheses such as Oxford III are preferable.

  3. Deformation of articular cartilage during static loading of a knee joint--experimental and finite element analysis.

    Science.gov (United States)

    Halonen, K S; Mononen, M E; Jurvelin, J S; Töyräs, J; Salo, J; Korhonen, R K

    2014-07-18

    Novel conical beam CT-scanners offer high resolution imaging of knee structures with i.a. contrast media, even under weight bearing. With this new technology, we aimed to determine cartilage strains and meniscal movement in a human knee at 0, 1, 5, and 30 min of standing and compare them to the subject-specific 3D finite element (FE) model. The FE model of the volunteer׳s knee, based on the geometry obtained from magnetic resonance images, was created to simulate the creep. The effects of collagen fibril network stiffness, nonfibrillar matrix modulus, permeability and fluid flow boundary conditions on the creep response in cartilage were investigated. In the experiment, 80% of the maximum strain in cartilage developed immediately, after which the cartilage continued to deform slowly until the 30 min time point. Cartilage strains and meniscus movement obtained from the FE model matched adequately with the experimentally measured values. Reducing the fibril network stiffness increased the mean strains substantially, while the creep rate was primarily influenced by an increase in the nonfibrillar matrix modulus. Changing the initial permeability and preventing fluid flow through noncontacting surfaces had a negligible effect on cartilage strains. The present results improve understanding of the mechanisms controlling articular cartilage strains and meniscal movements in a knee joint under physiological static loading. Ultimately a validated model could be used as a noninvasive diagnostic tool to locate cartilage areas at risk for degeneration.

  4. Role of magnetic resonance imaging in the clinical management of the acutely locked knee

    Energy Technology Data Exchange (ETDEWEB)

    McNally, Eugene G.; Nasser, Khalid N.; Dawson, Stewart; Goh, Leslie A. [Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford, OX3 7LD (United Kingdom)

    2002-10-01

    To explore prospectively the hypothesis that MRI of the acutely locked knee can alter surgical decision-making.Design and patients. The study group comprised patients with a clinical diagnosis of knee locking requiring arthroscopy. The decision to carry out arthroscopy was made by an experienced consultant orthopaedic surgeon specialising in trauma and recorded in the patient's notes prior to MRI. Preoperative MRI was carried out using a 1.5 T system. The management was altered from surgical to conservative treatment in 20 (48%) patients on the basis of the MR findings. Arthroscopy was limited to patients with an MR diagnosis of a mechanical block, usually a displaced meniscal tear or loose body. Both patient groups were followed clinically until symptoms resolved.Results. Forty-two patients were entered into the study. MRI identified a mechanical cause for locking in 22 patients (21 avulsion meniscal tears and 1 loose body). All were confirmed at arthroscopy. Twenty patients were changed from operative to non-operative treatment on the basis of the MRI findings. One patient in this group required a delayed arthroscopy for an impinging anterior cruciate ligament stump. The sensitivity/specificity/accuracy of MRI in identifying patients who require arthroscopy was therefore 96%/100%/98% respectively.Conclusion. MRI can successfully segregate patients with a clinical diagnosis of mechanical locking into those who have a true mechanical block and those who can be treated conservatively. MRI should precede arthroscopy in this clinical setting. (orig.)

  5. SLAP lesion of the shoulder. MRI evaluation; La lesione antero-posteriore del labbro glenoideo superiore della spalla. Valutazione con Risonanza Magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Barile, A.; Sabatini, M.; Maffey, M.V.; Di Cesare, E.; Masciocchi, C. [L' Aquila Univ., L' Aquila (Italy). Cattedra di Radiologia

    2000-09-01

    Purpose of this work is to assess MR potentials in the evaluation of superior glenoid labrum disease and possible associated conditions of the rotator cuff and of the anterior mechanism of the shoulder. 51 patients ( age range 18 to 53 years) with a diagnosis of anteroposterior lesion of the superior glenoid labrum were retrospectively evaluated. MR examinations were performed with a 0.2 T permanent magnet and a dedicated coil, using T1- and T2-weighted SE sequences on mostly coronal-oblique planes. Slice thickness was 4 mm. In 8 cases, the examination was completed with intra-articular injection of contrast agent. Twenty-eight patients were submitted to surgery (arthrotomy in 7 cases; arthroscopy in 21 cases). MRI demonstrated 5 cases of superior labrum irregularities at the level of its glenoid insertional portion (type I lesion); 6 cases of detachment of the superior portion of the labrum (type II); 9 cases of bucket handle tear of the superior labrum with involvement of the insertional portion of the long head of the biceps tendon (type III); 8 cases of superior labrum tear extending within the long head of the biceps tendon (type IV). Subsequent surgery always confirmed the presence of associated lesions, while the superior labrum lesion was not confirmed in 3 patients. In 4 cases, surgical findings provided a different classification of the lesion type than MRI. MRI can be a valuable diagnostic technique in type III and IV lesions of the superior glenoid labrum. It often provides important information about the possible presence of associated diseases, especially of the rotator cuff, which are helpful for treatment planning. [Italian] Scopo di questo lavoro e' analizzare le potenzialita' della RM nella valutazione della patologia del cercine glenoideo superiore e delle eventuali lesioni associate della cuffia dei rotatori e della cinghia funzionale anteriore. 51 pazienti (con eta' compresa tra 18 e 53 anni), nei quali era stata posta diagnosi

  6. Arthroscopic capsulolabral reconstruction of the severe superior labrum anterior-posterior lesion with anterior or/and posterior extensive tear%肩关节镜下缝线锚钉修复合并关节盂唇前后延伸撕裂的严重SLAP损伤

    Institute of Scientific and Technical Information of China (English)

    黄华扬; 郑小飞; 张余; 李凭跃; 张涛

    2012-01-01

    Objective To investigate the efficacy of arthroscopic capsulolabral reconstruction of the severe superior labrum anterior posterior (SLAP) lesion with anlerior or/and posterior extensive tear. Methods From 2007 to 2009, 12 shoulders in 12 patients were diagnosed as SLAP lesion with anterior or/ and posterior extensive tear by physical examination, magnetic resonance image and arthroscopy. Seven cases were Type V SLAP lesion described as a superior labral tear confluent with an anterior-inferior labral tear, or Bankarl lesion. Three cases were Type Ⅷ SLAP lesion described as an avulsion of the biceps anchor (type Ⅱ SLAP) with exlensive labral lear posteriorly along the glenoid. Two cases were a new type of SLAP lesion described by us as a bucket-handle tear of superior labrum with extensive labral tear posteriorly along the glenoid with a normal biceps tendon and an intacl biceps anchor, while the avulsed labrum was dislocated. All cases were treated with an arthroscopic capsulolabral reconslruclion. Shoulders were evaluated preoperatively and postoperatively by the American Shoulder and Elbow Surgeons (ASES) scoring system and standard subjective scales for stability, strength, function, and range of motion. Results 12 shoulders were analyzed at a mean follow-up time of 27 months. The mean ASES score improved from 77. 4 lo 94. 3 ( t = 28. 1, P < 0. 05 ). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (t =28.9, P < 0. 05). No shoulder required revision surgery for recurrent instability. All patients were able to return to job. Conclusions Arthroscopic capsulolabral reconstruction is an effective and reliable trealment for glenohumeral instability due to severe complex SLAP lesions. Successful return to sport is a reasonable expectation.%目的 探讨肩关节镜下缝线锚钉修复合并关节盂唇上部从前到后的损伤(SLAP)的疗效.方法 2007年至2009年,结合体格检

  7. MRI in definition of bleeding source, lesion pattern and therapy in haemarthros of the knee; Die MRT beim Haemarthros des Kniegelenks: Bestimmung von Blutungsursachen, Verletzungsmustern und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Bachmann, G. [Abt. Diagnostische Radiologie, Klinikum der Justus-Liebig-Universitaet, Giessen (Germany); Juergensen, I. [Orthopaedische Klinik, Klinikum der Justus-Liebig-Universitaet, Giessen (Germany); Leier, S. [Orthopaedische Klinik, Klinikum der Justus-Liebig-Universitaet, Giessen (Germany); Rauber, K. [Abt. Diagnostische Radiologie, Klinikum der Justus-Liebig-Universitaet, Giessen (Germany)

    1996-09-01

    Patients with haemarthros of the knee were examined by MRI and arthroscopy to identify the bleeding source and to determine surgical or conservative therapy. A prospective study was performed on 120 patients who underwent MRI and arthroscopy, point lesions and bleeding sources were documented separately on a standardised form. Arthroscopy demonstrated a ruptured anterior cruciate ligament in 86%, meniscal tears in 55%, disruption of collateral ligaments in 17%, osteochondral lesions in 5% and tears of capsule or plicae in 13%. Disruption of cruciate ligaments caused haemorrhage in all but three cases. In contrast, only meniscal tears located very adjacent to the meniscal basement had bled. Those types of osteochondral lesions caused haemorrhage characterised on MRI by destruction of the subchondral plate and overlying cartilage. Severe lesions of the knee were diagnosed by MRI in 71% to 100%, slight lesions in 13% to 40% of the cases. Single, combined and bland lesions were accurately diagnosed in MRI which permitted a correct prediction of surgical and conservative therapy in 96% and 80%. Morphological criteria in MRI permit identification of bleeding sources in haemarthros of the knee. Different lesion patterns can be separated for the planning of therapy. (orig.) [Deutsch] Bei gesichertem Haemarthros des Knies wurde geprueft, ob mit der MRT Angaben zur Blutungsursache moeglich sind und die relevanten Verletzungsmuster fuer die folgende konservative oder operative Therapie exakt beschrieben werden koennen. In einer prospektiven Studie wurden 120 Patienten mit akutem Haemarthros des Knies nacheinander mit der MRT und der Arthroskopie untersucht. Alle Laesionen und Blutungsquellen wurden getrennt fuer beide Methoden auf standardisierten Erhebungsboegen fuer die Arthroskopie registriert. Arthroskopisch wurden Rupturen der vorderen Kreuzbaender in 86%, Meniskusrisse in 55%, Rupturen der Kollateralbaender in 17%, subchondrale Laesionen in 5% und Kapsel- bzw

  8. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR.

    Science.gov (United States)

    Leal, Mariana Ferreira; Astur, Diego Costa; Debieux, Pedro; Arliani, Gustavo Gonçalves; Silveira Franciozi, Carlos Eduardo; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.

  9. Anatomical significance of a posterior horn of medial meniscus: the relationship between its radial tear and cartilage degradation of joint surface

    Directory of Open Access Journals (Sweden)

    Kan Akinori

    2010-01-01

    Full Text Available Abstract Background Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Methods Five hundred and forty eight cadaveric knees (290 male and 258 female were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years. The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. Results The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. Conclusions We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior

  10. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR.

    Directory of Open Access Journals (Sweden)

    Mariana Ferreira Leal

    Full Text Available The anterior cruciate ligament (ACL is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1 injured ACL tears and controls, and (2 ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.

  11. “Meniscal” scar as a landmark for the joint line in revision total knee replacement

    Science.gov (United States)

    Khan, Wasim Sardar; Bhamra, Jagmeet; Williams, Rhodri; Morgan-Jones, Rhidian

    2017-01-01

    AIM To determine whether tissue identified at the joint line was actually remnant “meniscal” scar tissue or not. METHODS Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery. Although preoperative radiographic evaluations suggested that the joint line had been altered, intraoperatively there was scar tissue at the level of the recreated joint line. This scar tissue has traditionally been described as meniscal scar, and to identify the origins of this tissue, samples were sent for histological analyses. The tissue samples were stored in formalin, and embedded and sectioned before undergoing histochemical staining. All samples underwent macroscopic and microscopic examination by a histopathologist who was blind to the study aims. The specific features that were examined included tissue organisation, surface and central composition, cellular distribution including histiocytes, nuclear ratio and vasculature. Atypical and malignant features, inflammation and degeneration were specifically looked for. A statistical review of the study was performed by a biomedical statistician. RESULTS The histological findings for the nine patients showing the macroscopic and microscopic findings, and the conclusion are outlined in a Table. The histological analyses were reviewed to determine whether the tissue samples were likely to be meniscal scar tissue. The response was yes (2, 22%), no (6, 67%) and maybe (1, 11%) based on the conclusions. The results were “yes” when on macroscopy, firm cream tissue was identified. In these two “yes” samples, microscopic analyses showed organised fibrous tissue with focal degenerative areas with laminated pattern associated with histiocytes peripherally but no inflammation. The “no” samples were assessed macroscopically and microscopically and were

  12. MRI reporting by radiographers: The construction of an objective structured examination

    Energy Technology Data Exchange (ETDEWEB)

    Piper, K.J. [Allied Health Professions Department, Canterbury Christ Church University, Canterbury, Kent CT1 1QU (United Kingdom)], E-mail: k.j.piper@canterbury.ac.uk; Buscall, K.L. [Allied Health Professions Department, Canterbury Christ Church University, Canterbury, Kent CT1 1QU (United Kingdom)

    2008-05-15

    Purpose: The aim was to construct a bank of general magnetic resonance imaging (MRI) investigations where good agreement was demonstrated between three independent radiological reports. The bank was subsequently to be used to assess radiographers' ability to accurately report at the end of an accredited programme; Postgraduate Certificate (PgC) Clinical Reporting (MRI-General Investigations). Method: Eighty-seven examinations (33 knee, 36 lumbar spine and 18 internal auditory meatus-IAM) were initially reported by two radiologists. Seventy-two of these examinations (25 knee, 29 lumbar spine and 18 IAM) were subsequently reported by a third radiologist. Interobserver agreement was assessed by estimating the total, positive and negative % agreement rates; and by use of the weighted or unweighted kappa values. Knee reports were analysed for meniscal tears, and degenerative meniscus (264 meniscal sites); ligament injury (ACL; PCL; MCI; and LCL; 132 ligament sites); bone bruise; effusion; fracture and/or osteochondral defect. Lumbar spine reports were analysed for disc morphology (bulge, protrusion, extrusion and/or annular tear-180 intervertebral disc levels); degenerative disc disease; Modic endplate changes; cord compression; spinal stenosis; nerve root involvement; vertebral collapse, primary tumour or metastases; and other incidental findings. IAM reports were analysed for acoustic neuroma and vascular loop. Results: Agreement in the knee reports varied mainly between moderate ({kappa} = 0.46) for ligament injury to very good [almost perfect] ({kappa} = 0.86) for meniscal tears, although agreement for degenerative meniscus was only fair ({kappa} = 0.3). Variation in the lumbar spine reports ranged predominantly between moderate ({kappa} = 0.54) for disc bulge/protrusion to fair ({kappa} = 0.32) for Modic endplate changes to good [substantial] ({kappa} = 0.79) for tumour/metastases. Agreement for the presence of acoustic neuroma was very good [almost perfect

  13. Comparison of Kinematics and Tibiofemoral Contact Pressures for Native and Transplanted Lateral Menisci

    Science.gov (United States)

    McCulloch, Patrick C.; Dolce, Donald; Jones, Hugh L.; Gale, Andrea; Hogen, Michael G.; Alder, Jason; Palmer, Jeremiah E.; Noble, Philip C.

    2016-01-01

    Background: Lateral meniscus transplantation is a proven treatment option for the meniscus-deficient knee, yet little is known about meniscal kinematics, strain, and tibiofemoral contact pressure changes after transplantation or the effect of altered root position in lateral meniscus transplantation. Purpose: To compare the native lateral meniscal kinematics, strain, and tibiofemoral contact pressures to a best-case scenario meniscus transplant with perfectly matched size and position and to determine how sensitive these factors are to subtle changes in shape and position by using a nonanatomic meniscus transplant position. Study Design: Controlled laboratory study. Methods: The lateral menisci of 8 cadaveric knees were circumferentially implanted with radiopaque spherical markers. They were mounted to a testing apparatus applying muscle and ground-reaction forces. The meniscus was evaluated at 0°, 30°, 90°, and 115° of knee flexion using Roentgen stereophotogrammetric analysis (RSA), with a pressure sensor affixed to the lateral tibial plateau. Measurements were recorded for 3 states: the native lateral meniscus, an anatomic autograft transplant, and a nonanatomic autograft transplant with an anteriorized posterior root position. Results: After transplantation, there was less posterior displacement in both the anatomic and nonanatomic transplant states compared with the native meniscus, but this was not significant. The largest lateral translation in the native state was 2.38 ± 1.58 mm at the anterolateral region from 0° to 90°, which was increased to 3.28 ± 1.39 mm (P = .25) and 3.12 ± 1.18 mm (P = .30) in the anatomic and nonanatomic transplant states, respectively. Internal deformations of the transplant states were more constrained, suggesting less compliance. The native meniscus distributed load over 223 mm2, while both the anatomic (160 mm2) and nonanatomic (102 mm2) states concentrated pressure anteriorly to the tibial plateau centroid. Conclusion

  14. Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Ding, David; Group, Mars

    2016-01-01

    tunnels before rACLR) were also significant predictors for need for reoperation within 2 years. Patients with grade IV cartilage damage seen during rACLR were 47% less likely to undergo subsequent operations within 2 years. Gender, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. Conclusion: There is a significant reoperation rate following rACLR at two years (10.1%). The most prevalent reoperations involved meniscal procedures. Independent risk factors for subsequent surgery on the ipsilateral knee include ageallograft tissue at the time of rACLR.

  15. The isokinetic study of different surgical procedures for the treatment of patients with arthroscopic knee meniscus%膝半月板损伤后关节镜手术不同术式的等速肌力测试分析

    Institute of Scientific and Technical Information of China (English)

    邵正海; 张玉发; 吕宏; 毕霞; 高亮亮; 刘小垒; 黄鑫凝

    2014-01-01

    目的:回顾性分析关节镜下行半月板缝合修整成型术和射频消融术的疗效差异,以向临床推广合适的术式。方法:对60例膝半月板损伤患者关节镜术后采取半月板缝合修整成型术和射频消融术,采用等速肌力测试比较两组治疗的差异。结果:观察组屈膝60°、120°时膝关节单次最大做功、力矩加速能、屈膝伸肌峰力矩测试和平均做功率均优于对照组,差异有统计学意义(P<0.05)。结论:半月板缝合修整成型术对膝半月板损伤关节镜手术后患者具有较好的改善,能够明显改善患者的预后状况。%Objective:Retrospective analysis of the isokinetic study of different surgical procedures for the treatment of arthroscopic meniscal suture repair angioplasty and radiofrequency ablation for patients with arthroscop-ic knee meniscus ,in order to promote the appropriate surgery methods for clinical treatment .Methods :60 cases of patients with knee meniscus injury were treated by the treatment of arthroscopic meniscal suture repair angioplasty and radiofrequency ablation and the isokinetic treatment were used to compared the difference between the two groups .Results :The knee maximum single acting ,torque acceleration energy ,knee extensor peak torque testing and average power of the observation group were better than those in the control group and all P <0 .05 .Conclu-sion:The treatment of arthroscopic meniscal suture repair angioplasty for the patients can significantly improve the patient's prognosis ,and worthy of clinical application .

  16. MRI VERSUS ARTHROSCOPY: A COMPARISON OF FINDINGS

    Directory of Open Access Journals (Sweden)

    Somashekhara Reddy

    2016-06-01

    Full Text Available The purpose of this study is to correlate the findings of Magnetic Resonance Imaging with Arthroscopy in internal derangements of knee and to assess the sensitivity, specificity and accuracy of Magnetic Resonance Imaging in comparison to Arthroscopy. METHODS AND MATERIALS Fifty six patients with history of suspected internal derangement of knee were evaluated prospectively with MRI and correlated with arthroscopy during a one and half a year period from March 2012 to September 2013.1.5 Tesla MRI machine using a closed extremity coil is used. Sequences used in MRI of the knee include Turbo-spin echo (TSE, FFE (Gradient echo and Short Tau Inversion Recovery (STIR sequences in Axial, Sagittal and Coronal planes using a slice thickness of 3 mm with a 0.3 mm slice gap. Arthroscopy of the knee with standard anteromedial and anterolateral portals with the patient in supine position done in all the cases. RESULTS The diagnostic sensitivity, specificity and accuracy of MRI in detecting cruciate ligament and meniscal injuries as compared to Arthroscopy are as follows: Anterior Cruciate Ligament (ACL: 97.29%, 89.47%, 94.64%; Posterior Cruciate Ligament (PCL: 100%, 100%, 100%; Medial Meniscus (MM: 100%, 93.33%, 98.21% and Lateral Meniscus (LM: 93.10, 92.59, 92.85. Most common lesions found were ACL and Medial Meniscal tears (posterior horn of MM being the most common site. SUMMARY AND CONCLUSION  MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in diagnosing cruciate ligament and meniscal injuries.  MRI should be considered as the first line of investigation in all patients with suspected internal derangements of knee.  MRI being easily available and non-invasive is useful as a pre-operative screening modality, thus improves the quality of diagnostic and therapeutic arthroscopies and further reduces the morbidity.  Arthroscopy is the standard diagnosing tool in all patients with suspected internal

  17. Anterior cruciate ligament tears: MRI versus arthroscopy. Vordere Kreuzbandruptur: MRT versus Arthroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U.; Felix, R. (Strahlenklinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany)); Schauwecker, W.; Dreithaler, B. (Chirurgische Klinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany))

    1992-05-01

    Because of suspected rupture of the anterior cruciate ligament sixteen acute traumatised patients were investigated by MR and arthroscopy. The MR diagnosis of a lesion of the anterior cruciate ligament proved to be correct by arthroscopy in fifteen of sixteen cases. Diagnostic criteria for lesions of the anterior cruciate ligament were: increased signal intensity in T[sub 1]- and T[sub 2] weighted images, increased volume and discontinuity of ligamentous structures. Additional MR findings of meniscal tears were correct in three of four cases laterally and in four of four cases medially. Femoral cartilage lesions were correctly identified by MR in three cases. MR normal findings proved to be correct by arthroscopy in another five cases. (orig.).

  18. 半月板损伤术后康复技能的研究%Study on Rehabilitation Skills of Meniscus Injury after Surgery

    Institute of Scientific and Technical Information of China (English)

    闫虎; 孙远标; 孙力盟; 张秋玲

    2015-01-01

    外伤、退行性病变、炎性疾患等原因所致的半月板损伤的治疗方法包括半月板全切除术、半月板部分切除术、缝合修补术、留置保守处理、异体半月板移植及组织工程,术后及时、准确的康复锻炼对患者肢体功能恢复尤其重要。%The treatment of meniscal injury caused by trauma, degenerative lesions, inflammatory diseases and the like includes total meniscectomy, partial meniscectomy, conservative therapy, allogenic meniscus transplantation and tissue engineering, postoperative, timely and accurate rehabilita-tion exercise of limb function recovery is especially important.

  19. Ho:YAG laser arthroscopy of the knee

    Science.gov (United States)

    Sisto, Domenick J.; Blazina, Martin E.; Hirsh, Linda C.

    1994-09-01

    The HO:YAG laser is a near-contact laser with a capacity to ablate or cut tissues. The ablation function allows the surgeon to remove meniscal tissue, lyse and resect adhesions, melt loose bodies, and dissolve inflamed synovium. The cutting function of the laser is utilized to perform a lateral release or resect torn menisci. The laser can also be utilized to drill holes in Grade IV chondromalacic lesions to initiate a healing response. The laser has been embraced by orthopaedic surgeons because of its shape and versatility. The tip is only 2 mm wide and can be delivered into the tight posterior compartments of the knee with no damaging contact with the articular surfaces. The laser coagulates as it works and bleeding is minimized. The laser can function both as a cutting and ablating tool. The laser can also drill holes into subchondral bone to, hopefully, initiate a healing response.

  20. Large infrapatellar ganglionic cyst of the knee fat pad: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ilias Apostolos

    2011-08-01

    Full Text Available Abstract Introduction Large ganglionic cystic formations arising from the infrapatellar fat pad are quite uncommon and only a few are mentioned in the literature. An open excision in these cases is mandatory. Case presentation We report the case of a large infrapatellar fat pad ganglion in a 37-year-old Greek man with chronic knee discomfort. The ganglionic cyst originated from the infrapatellar fat pad and had no intrasynovial extension. The final diagnosis was determined with magnetic resonance imaging of the knee, and the lesion was treated with surgery. Conclusions These lesions are asymptomatic in most cases but often are misdiagnosed as meniscal or ligamentous lesions of the knee joint. Nowadays, the therapeutic trend for such lesions is arthroscopic excision, but when there is a large ganglion, as in this case report, the treatment should be an open and thorough resection. This report is intended mostly but not exclusively for clinical physicians and radiologists.

  1. Suturing property of tough double network hydrogels for bio-repair materials

    Science.gov (United States)

    Na, Yang Ho; Oh, Hwa Yeon; Ahn, Young Ju; Han, Youngbae

    2015-02-01

    Cartilage and meniscal lesions have limited potential for spontaneous repair. Consequently, much effort has been made to develop methods for repairing such lesions. Double-network (DN) gels are new candidate-materials for repairing such lesions. They exhibit exceptional mechanical strength and toughness in spite of their high water content. In this study, we prepared highly tough DN hydrogels and investigated the mechanical properties related to clinical implant use. The mechanical properties such as Young's modulus and suture tear-out strength were measured for the artificial replacement. The results suggest that the suture property of DN hydrogels can be adjusted by controlling the crosslinking density and monomer concentration. Finite element method was also applied to these DN hydrogels in order to check whether the fracture strength of the material is enough to meet a medical purpose.

  2. Magnetic resonance imaging of knee osteonecrosis: a study of 19 cases

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, Daniel Leme da; Ribeiro, Elisio Jose Salgado; Domingues, Romeu Cortes, E-mail: danielc@predialnet.com.b [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Pires Carvalho, Antonio Carlos [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Faculdade de Medicina

    2010-04-15

    Objective: to describe epidemiological, clinical and magnetic resonance imaging findings of osteonecrosis in the distal femur and proximal tibia. Materials and methods: evaluation of 19 patients (12 women and 7 men), with no previous history of causative factors, with magnetic resonance imaging findings suggestive of osteonecrosis in the tibial plateau or femoral condyle. Results: osteochondral abnormalities were observed in 63.1% of the cases; in 73.6% of them, such abnormality was associated with ipsilateral meniscal lesion. Also, a significant association with bone marrow edema (grade III in 16 cases) was observed. Conclusion: magnetic resonance imaging has demonstrated to be a noninvasive method with good sensitivity in the diagnosis of knee osteonecrosis as well as of associated lesions which are most frequently found in women (63% of cases). (author)

  3. Lineage plasticity and cell biology of fibrocartilage and hyaline cartilage: Its significance in cartilage repair and replacement

    Energy Technology Data Exchange (ETDEWEB)

    Freemont, Anthony J. [Regenerative Medicine Research Group, University of Manchester, England (United Kingdom)]. E-mail: Tony.freemont@man.ac.uk; Hoyland, Judith [Regenerative Medicine Research Group, University of Manchester, England (United Kingdom)

    2006-01-15

    Cartilage repair is a major goal of modern tissue engineering. To produce novel engineered implants requires a knowledge of the basic biology of the tissues that are to be replaced or reproduced. Hyaline articular cartilage and meniscal fibrocartilage are two tissues that have excited attention because of the frequency with which they are damaged. A basic strategy is to re-engineer these tissues ex vivo by stimulating stem cells to differentiate into the cells of the mature tissue capable of producing an intact functional matrix. In this brief review, the sources of cells for tissue engineering cartilage and the culture conditions that have promoted differentiation are discussed within the context of natural cartilage repair. In particular, the role of cell density, cytokines, load, matrices and oxygen tension are discussed.

  4. Strength of different meniscus suturing techniques.

    Science.gov (United States)

    Aşik, M; Sener, N; Akpinar, S; Durmaz, H; Göksan, A

    1997-01-01

    We measured and compared the primary stabilities of five different meniscal suturing techniques. The techniques tested were horizontal mattress, vertical mattress, knot-end, vertical, and vertical loop. Twenty bovine medial menisci were cut to simulate peripheral longitudinal tears and repaired with one of the five suture techniques. Then the two parts of the meniscus were pulled using the Instron Tensometer until failure occurred. Knot-end techniques gave inferior results (mean ultimate failure strength 64 +/- 5 N) compared with the other techniques. Vertical mattress failed at 130 +/- 3 N, vertical loop at 128 +/- 4.5 N, horizontal mattress at 98 +/- 5 N and vertical suturing at 136 +/- 2.7 N. This study shows the superior mechanical characteristic of the vertical suturing technique.

  5. Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

    Directory of Open Access Journals (Sweden)

    Yamakado Kotaro

    2012-02-01

    Full Text Available Abstract A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred.

  6. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques.

    Science.gov (United States)

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-02-18

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.

  7. Treatment of Anterior Cruciate Ligament Injury in Skeletally Immature Patients

    Directory of Open Access Journals (Sweden)

    Joshua L. Hudgens

    2012-01-01

    Full Text Available The incidence of ACL tears is rising in the pediatric and adolescent populations as these individuals succumb to traumatic and nontraumatic athletic injuries. Management of this condition in the skeletally immature patient poses a challenge and is controversial. Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity but provides stability to the knee and allows return of function in most patients. On the other hand, nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage and is difficult from a compliance standpoint in this demographic. For the majority of skeletally immature patients, operative treatment is recommended as it has shown good clinical and functional results with minimal risk of growth disturbance. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies.

  8. Musculoskeletal MR: knee

    Energy Technology Data Exchange (ETDEWEB)

    Staebler, A.; Glaser, C.; Reiser, M. [Dept. of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilian Universitaet Muenchen (Germany)

    2000-02-01

    Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage. (orig.)

  9. Revisión bibliográfica del tratamiento de las lesiones meniscales degenerativas: meniscectomía artroscópica vs. fisioterapia

    OpenAIRE

    Martínez Jiménez, Soraya

    2015-01-01

    Antecedentes: La cirugía artroscópica como tratamiento de la lesión meniscal es la intervención quirúrgica traumatológica más frecuente. Está demostrada su eficacia en las lesiones meniscales traumáticas en pacientes jóvenes pero no está tan clara su indicación en las roturas meniscales degenerativas. Objetivos: El objetivo principal de esta revisión es descubrir cuál es el mejor tratamiento para una lesión de menisco degenerativa, si la intervención quirúrgica por art...

  10. [On evaluating the robot-based experimental system for biomechanical experiment of human knee].

    Science.gov (United States)

    Deng, Guoyong; Tian, Lianfang; Bai, Bo; Sun, Hui

    2010-02-01

    This is a report on how we use the hybrid force-displacement control method to load the human knee and analyze the effect and value of our robot experimental system through the biomechanical experiments of total meniscal resection of human knee. The whole robot control system can load continuously on the specimens, thus overcoming the shortcomings of the traditional loading methods which can only load discretely. In the meantime, by using the robot-based testing system, the force (torque) of the specimens and the spatial position under the force can be measured in real-time, which overcomes the shortcomings caused by the separation of force (torque) measurement from displacement measurement and so greatly improves the measurement accuracy.

  11. A conceptual framework for a sports knee injury performance profile (SKIPP and return to activity criteria (RTAC

    Directory of Open Access Journals (Sweden)

    David Logerstedt

    2015-10-01

    Full Text Available ABSTRACTInjuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.

  12. Estudo comparativo das alterações degenerativas dos meniscos medial e lateral na artrose do joelho em varo

    OpenAIRE

    Alexandre Carneiro Bitar

    2006-01-01

    Na prática clínica, a queixa de dor no joelho em pacientes, a partir da quinta década de vida, é muito freqüente e comumente atribuída à lesão meniscal degenerativa. A relação entre a lesão degenerativa do menisco e a artrose é controversa, assim como a relação do varo e a evolução para artrose do joelho. Foram estudadas as alterações macroscópicas e microscópicas dos meniscos em 21 pacientes com deformidade em varo submetidos a artroplastia total do joelho, decorrente de artrose do joelho. A...

  13. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release.

    Science.gov (United States)

    Atoun, Ehud; Debbi, Ronen; Lubovsky, Omri; Weiler, Andreas; Debbi, Eytan; Rath, Ehud

    2013-02-01

    Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.

  14. Virtual reality simulation of arthroscopy of the knee.

    Science.gov (United States)

    Mabrey, Jay D; Gillogly, Scott D; Kasser, James R; Sweeney, Howard J; Zarins, Bertram; Mevis, Howard; Garrett, William E; Poss, Robert; Cannon, W Dilworth

    2002-01-01

    The virtual reality arthroscopic knee simulator (VR-AKS) consists of a computer platform, a video display, and two force-feedback (haptic) interfaces known as "PHANToMs" that also monitor the position of the instruments in the user's hands. The forces that the user would normally apply to the lower limb during arthroscopy are directed through an instrumented surrogate leg. Proprietary software provides the mathematical representation of the physical world and replicates the visual, mechanical, and behavioral aspects of the knee. This includes moderating the haptic interface and simultaneously executing a collision-detection algorithm that prevents the instruments from moving through "solid" surfaces. Modeling software interacts with this algorithm to send the appropriate images to the video display, including knee pathology such as meniscal tears and chondral defects as well as normal anatomy. Task-oriented programs monitor specific performance such as executing a proper examination of the knee or shaving a torn meniscus.

  15. Platelet Rich Plasma and Knee Surgery

    Directory of Open Access Journals (Sweden)

    Mikel Sánchez

    2014-01-01

    Full Text Available In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon’s goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

  16. Internal derangements of the temporomandibular joint: findings in the pediatric age group

    Energy Technology Data Exchange (ETDEWEB)

    Katzberg, R.W.; Tallents, R.H.; Hayakawa, K.; Miller, T.L.; Goske, M.J.; Wood, B.P.

    1985-01-01

    Findings in 31 pediatric patients with pain and dysfunction of the temporomandibular joint (TMJ) are reported. The average age was 14 years and the average duration of symptoms was 21.4 months. Internal derangements were found in 29 patients (94%) and degenerative arthritis in 13 (42%). In 12 patients (39%), the problem could be traced to an injury to the jaw. Secondary condylar hypoplasia was associated with the meniscal abnormality in 3 patients (10%). Further awareness of internal derangements of the TMJ in the pediatric population should permit greater recognition of their etiology. It is important that threatment be initiated as soon as possible, not only to minimize the development of osseous disease in young adults but also to prevent facial growth deformities.

  17. Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa

    OpenAIRE

    Peccin, Maria Stella; Ciconelli,Rozana; Cohen, Moisés

    2006-01-01

    As doenças do joelho apresentam conseqüências variadas para a função e a qualidade de vida do indivíduo. Para traduzir, validar e verificar as propriedades de medida do questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale" para a língua portuguesa, selecionamos, por conveniência, 50 pacientes (29 homens e 21 mulheres, média de idade 38,7 anos) com lesão de joelho (lesão meniscal, lesão do ligamento cruzado anterior, condromalácia ou artrose). A reprodutibilidade e a con...

  18. Comparative study between the Spin-echo and 3-D fast imaging techniques in the Knee evaluation with magnetic resonance. Estudio comparativo entre las tecnicas de Spin-Eco ecogradiente 3D, en la evaluacion de la rodilla con resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Oleaga Zufiria, L.; Ibaez Zubiarrain, A.; Grande Icaran, J.; Vela Martin, A.C.; Cintora Leon, E.; Grau Garcia, M.; Grande Icaran, D. (Hospital Civil de Bilbao. Servicio de Radiodiagnostico. Bilbao (Spain))

    1993-01-01

    We have carried out a retrospective analysis of the results of magnetic resonance (MR) studies in 20 patients, comparing two different sequences. We compared a 2-D spin-echo (SE2D) sequence with a 3-D fast imaging with steady-state precession (FISP3D) sequence in the attempt to compare the reliability of each in the detection of knee injuries. Arthroscopy was employed as a control technique. Our study revealed no statistically significant difference between the two sequences, although the overall sensitivity for the detection of meniscal lesions was slightly greater with the FISP3D sequence; however, the reliability in the detection of ruptures of the posterior cruciate ligament is less with this sequence than with the SE2D sequence. Both sequences showed very low sensitivity in the detection of hyaline cartilage injuries. (Author) 14 refs.

  19. Ressonância magnética na avaliação das variações anatômicas meniscais e da anatomia ligamentar perimeniscal: potenciais causas de erro de interpretação

    Directory of Open Access Journals (Sweden)

    Marcelo Novelino Simão

    2011-04-01

    Full Text Available O conhecimento adequado das variações anatômicas meniscais e das estruturas perimeniscais é essencial para uma avaliação adequada dos exames de ressonância magnética do joelho, tanto no diagnóstico das lesões meniscais quanto para se evitar uma série de possíveis erros diagnósticos. Este artigo revê variações anatômicas que alteram o tamanho, a forma e a estabilidade meniscais e que incluem os vários tipos de menisco discoide, outras variações morfológicas meniscais menos frequentes e o ossículo meniscal. Também é revisada a anatomia de estruturas perimeniscais, principalmente ligamentares, que incluem os ligamentos meniscocapsulares, intermeniscais, meniscofemorais e extensões meniscoligamentares.

  20. Expression of NGF, Trka and p75 in human cartilage

    Directory of Open Access Journals (Sweden)

    A Gigante

    2009-06-01

    Full Text Available Nerve growth factor (NGF exerts its action through two types of receptor: high-affinity tyrosine kinase A receptor (trkA and low-affinity p75 receptor. NGF has a neurotrophic role in central and peripheral nervous system development, but there is also clear evidence of its involvement in the developing skeleton. The aim of the present immunohistochemical study was to investigate the expression and distribution of NGF, trkA, and p75 in normal cartilaginous tissues from adult subjects: articular and meniscal cartilage of the knee, cartilage from the epiglottis, and intervertebral disc tissue. Detection of NGF mRNA was also performed by in situ hybridization. Immunoreaction for NGF and the two receptors in articular chondrocytes, chondrocyte-like cells of meniscus and annulus fibrosus, and chondrocytes of the epiglottis demonstrated that they are all expressed in hyaline, fibrous and elastic cartilaginous tissues, suggesting that they could be involved in cartilage physio-pathology.

  1. A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees.

    Science.gov (United States)

    Vertullo, Christopher J; Wijenayake, Lahann; Grayson, Jane E

    2016-04-01

    It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation,

  2. Total ankle replacement. Early experiences with STAR prosthesis.

    Science.gov (United States)

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  3. El valor de la exploración clínica y de la resonancia magnética nuclear en el diagnóstico de las lesiones meniscales.

    OpenAIRE

    2002-01-01

    En esta tesis se realiza un estudio comparativo y analítico, que ordena la población del estudio en dos grupos A y B, con el objetivo de la descripción, valoración, análisis, evaluación y comprobación de los datosespecíficos de la valoración de acertada identificación, desarrollo y precisión del método clínico y del método de imágenes de RMN (en adición del método clínico) para realizar el diagnóstico de una posible lesión meniscal (interna y/o externa) aislada o acompañada de otras lesiones ...

  4. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC)

    Science.gov (United States)

    Logerstedt, David; Arundale, Amelia; Lynch, Andrew; Snyder-Mackler, Lynn

    2015-01-01

    Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health. PMID:26537805

  5. [Augmented anterior cruciate ligament replacement with the Kennedy-LAD (ligament augmentation device)--long term outcome].

    Science.gov (United States)

    Riel, K A

    1998-01-01

    The ligament augmentation device (Kennedy-LAD) is used to protect tendon grafts during the posttransplantation decrease in strength in anterior cruciate ligament (acl) reconstructions. The augmentation with the LAD is based on the concept of load sharing. Since 1983 we used the LAD in acl-reconstructions in 856 patients. In 63 cases we had to treat complications like infection (8), recurrent effusions (21), arthrofibrosis (34). The overall results are good with respect to stability, regain of strength and sports activity. In 73 cases resurgery was necessary because of synovitis (7), LAD-rupture due to re-injury (9), fatigue-rupture of the LAD (22), meniscal tears (35), 2.7 +/- 2.3 years (range: 2 months to 10 years) after LAD implantation. Modern techniques in acl reconstruction lead to comparable results without synthetic augmentation. Therefore, we now recommend the use of a LAD only in cases of repeated acl replacement with week tendon grafts, to avoid an allograft.

  6. Development of meniscus substitutes using a mixture of biocompatible polymers and extra cellular matrix components by electrospinning.

    Science.gov (United States)

    López-Calzada, G; Hernandez-Martínez, A R; Cruz-Soto, M; Ramírez-Cardona, M; Rangel, D; Molina, G A; Luna-Barcenas, G; Estevez, M

    2016-04-01

    Despite the significant advances in the meniscus tissue engineering field, it is difficult to recreate the complex structure and organization of the collagenous matrix of the meniscus. In this work, we developed a meniscus prototype to be used as substitute or scaffold for the regeneration of the meniscal matrix, recreating the differential morphology of the meniscus by electrospinning. Synthetic biocompatible polymers were combined with the extracellular matrix component, collagen and used to replicate the meniscus. We studied the correlation between mechanical and structural properties of the polymer blend as a function of collagen concentration. Fibers were collected on a surface of a rapidly rotating precast mold, to accurately replicate each sectional morphology of the meniscus; different electro-tissues were produced. Detailed XRD analyses exhibited structural changes developed by electrospinning. We achieved to integrate all these electro-tissues to form a complete synthetic meniscus. Vascularization tests were performed to assess the potential use of our novel polymeric blend for promising meniscus regeneration.

  7. Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children.

    Science.gov (United States)

    Irha, E; Vrdoljak, J

    2000-01-01

    The aim of this study was to select children with pathological lesions of the intra-articular structures from children with identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment is justified only in acute cases.

  8. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Rennie, W.J. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College London, Institute of Orthopaedics and Musculoskeletal Sciences (United Kingdom)

    2005-07-01

    To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. A retrospective review was performed of the reports of 509 knee MRI studies obtained from July 1998 to June 2004 on 488 patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI studies and case histories of all patients reported to have pes anserine bursitis were reviewed. The management of these patients was also noted. The prevalence of pes anserine bursitis as detected on MRI is 2.5%. The commonest clinical presentation was pain along the medial joint line mimicking a medial meniscal tear. We suggest that an accurate diagnosis of pes anserine bursitis on MRI will help prevent unnecessary arthroscopy and possibly initiate early treatment of the condition. Axial imaging is important in these cases to differentiate the bursa from other medial fluid collections. (orig.)

  9. Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa Specific questionnaire for knee symptoms - the "Lysholm Knee Scoring Scale": translation and validation into Portuguese

    Directory of Open Access Journals (Sweden)

    Maria Stella Peccin

    2006-01-01

    Full Text Available As doenças do joelho apresentam conseqüências variadas para a função e a qualidade de vida do indivíduo. Para traduzir, validar e verificar as propriedades de medida do questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale" para a língua portuguesa, selecionamos, por conveniência, 50 pacientes (29 homens e 21 mulheres, média de idade 38,7 anos com lesão de joelho (lesão meniscal, lesão do ligamento cruzado anterior, condromalácia ou artrose. A reprodutibilidade e a concordância ordinal inter e intra-entrevistador foram excelentes (alfa = 0,9. A concordância nominal inter-entrevistadores foi boa (Kappa = 0,7 e intra-entrevistador, excelente (Kappa = 0,8. No processo de validação, correlacionamos o questionário Lysholm com a escala numérica da dor (r=-0,6; p=0,001 e com o índice de Lequesne (r= -0,8; p=0,001. As correlações entre o Lysholm e a avaliação global da saúde pelo paciente e pelo terapeuta apresentaram-se fracas e não significantes. As correlações entre o questionário Lysholm e o SF-36 foram significantes nos aspectos físicos (r = 0,4; p = 0,04, de dor (r = 0,5; p = 0,001 e de capacidade funcional (r = 0,7; p = 0,0001. Concluímos que a tradução e adaptação cultural do "Lysholm knee scoring scale" para o nosso idioma apresentou reprodutibilidade e validade em pacientes com lesão meniscal, lesão do ligamento cruzado anterior, condromalácia ou artrose do joelho.Knee diseases present variable consequences for an individual’s function and quality of life. For the purposes of translating, validating and checking the measurement properties of the specific questionnaire for knee symptoms - the "Lysholm Knee Scoring Scale" - into Portuguese, we selected, for convenience, 50 patients (29 males and 21 females, mean age = 38.7 years with knee injuries (meniscal injury, anterior cruciate ligament injury, chondromalacia or arthrosis. Reproducibility and ordinal consistency inter- and

  10. A Brief History of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Nikolaos Davarinos

    2014-01-01

    Full Text Available Reconstructions of the anterior cruciate ligament (ACL are among the most frequently performed procedures in knee surgery nowadays. The history of ACL surgery can be traced as far back as the Egyptian times. The early years reflect the efforts to establish a viable, consistently successful reconstruction technique while, during the early 20th century, we witness an increasing awareness of, and interest in, the ligament and its lesions. Finally, we highlight the most important steps in the evolution of the ACL reconstruction surgery by discussing the various techniques spanning the years using not only autologous grafts (fascia lata, meniscal, hamstring, patella tendon, bone-patella tendon-bone, and double bundle grafts but also synthetic ones and allografts.

  11. Health technology assessment of magnetic resonance imaging of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Huysse, W.C.J. [Department of Radiology, Ghent University, De Pintelaan 185, B-9000 Gent (Belgium)], E-mail: Wouter.huysse@ugent.be; Verstraete, K.L. [Department of Radiology, Ghent University, De Pintelaan 185, B-9000 Gent (Belgium)], E-mail: Koenraad.verstraete@ugent.be

    2008-02-15

    A search of the available literature was performed and the role of MR imaging of the knee is discussed. Based on this search the authors concluded that MR has a high sensitivity in detecting any abnormalities in the knee but it does not have the same diagnostic accuracy as a clinical investigation performed by a trained knee specialist when all knee injuries are taken together. It does lead to a decrease in the number of surgical interventions due to its high negative predictive value. For the detection of meniscal injury, MR has the same accuracy as arthroscopy and should be performed in order to avoid unnecessary surgical interventions. A negative MR also obviates further investigation in suspected cartilage damage. This is not true for anterior and posterior cruciate ligament problems where MRI is less accurate than clinical investigation.

  12. Fat-suppressed volume isotropic turbo spin echo acquisition (VISTA) MR imaging in evaluating radial and root tears of the meniscus: Focusing on reader-defined axial reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Daekeon; Lee, Young Han; Kim, Sungjun; Song, Ho-Taek; Suh, Jin-Suck, E-mail: jss@yuhs.ac

    2013-12-01

    Objective: To assess the diagnostic value of fat-suppressed (FS) three-dimensional (3D) volume isotropic turbo spin echo acquisition (VISTA) imaging in detecting radial and root tears of the meniscus, including the reader-defined reformatted axial (RDA) plane. Materials and methods: Twenty-three patients with arthroscopically confirmed radial or root tears of the meniscus underwent magnetic resonance imaging (MRI) with 2D and FS 3D VISTA sequences. MRIs were reviewed independently by two musculoskeletal radiologists blinded to the arthroscopic findings. Sensitivity, specificity, accuracy, and interobserver agreement were calculated for radial and root tears. Both radiologists reported confidence scale for the presence of meniscal tears in 2D axial imaging, 3D axial imaging, and RDA imaging, based on a five-point scale. Wilcoxon's signed rank test was used to compare confidence scale. Results: The sensitivity, specificity, and accuracy of FS 3D VISTA MR imaging versus 2D MR imaging were as follows: 96%, 96%, and 96% versus 91%, 91%, and 91%, respectively in reader 1, and 96%, 96%, and 96% versus 83%, 91%, and 87%, respectively, in reader 2. Interobserver agreement for detecting meniscal tears was excellent (κ = 1) with FS 3D VISTA. The confidence scale was significantly higher for 3D axial images than 2D imaging (p = 0.03) and significantly higher in RDA images than 3D axial image in detecting radial and root tears. Conclusions: FS 3D VISTA had a better diagnostic performance in evaluating radial and root tears of the meniscus. The reader-defined reformatted axial plane obtained from FS 3D VISTA MR imaging is useful in detecting radial and root tears of the meniscus.

  13. MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans

    Energy Technology Data Exchange (ETDEWEB)

    Partezani Helito, Camilo; Pecora, Jose Ricardo; Camanho, Gilberto Luis; Kawamura Demange, Marco [University of Sao Paulo, Faculty of Medicine, Institute of Orthopedics and Traumatology, Knee Surgery Division, Sao Paulo (Brazil); Partezani Helito, Paulo Victor; Pereira Costa, Hugo; Bordalo-Rodrigues, Marcelo [University of Sao Paulo, Faculty of Medicine, Institute of Orthopedics and Traumatology, Musculoskeletal Radiology Department, Sao Paulo (Brazil)

    2014-10-15

    This study evaluated the ability of routine 1.5-T MRI scans to visualize the anterolateral ligament (ALL) and describe its path and anatomic relations with lateral knee structures. Thirty-nine 1.5-T MRI scans of the knee were evaluated. The scans included an MRI knee protocol with T1-weighted sequences, T2-weighted sequences with fat saturation, and proton density (PD)-weighted fast spin-echo sequences. Two radiologists separately reviewed all MRI scans to evaluate interobserver reliability. The ALL was divided into three portions for analyses: femoral, meniscal, and tibial. The path of the ALL was evaluated with regard to known structural parameters previously studied in this region. At least a portion of the ALL was visualized in 38 (97.8 %) cases. The meniscal portion was most visualized (94.8 %), followed by the femoral (89.7 %) and the tibial (79.4 %) portions. The three portions of the ALL were visualized in 28 (71.7 %) patients. The ALL was characterized with greater clarity on the coronal plane and was visualized as a thin, linear structure. The T1-weighted sequences showed a statistically inferior ligament visibility frequency. With regard to the T2 and PD evaluations, although the visualization frequency in PD was higher for the three portions of the ligament, only the femoral portion showed significant values. The ALL can be visualized in routine 1.5-T MRI scans. Although some of the ligament could be depicted in nearly all of the scans (97.4 %), it could only be observed in its entirety in about 71.7 % of the tests. (orig.)

  14. Arthroscopic laser in intra-articular knee cartilage disorders

    Science.gov (United States)

    Nosir, Hany R.; Siebert, Werner E.

    1996-12-01

    Different assemblies have endeavored to develop arthroscopic laser surgery. Various lasers have been tried in the treatment of orthopaedic problems, and the most useful has turned out to be the Hol-YAG laser 2.1 nm which is a near- contact laser. By using the laser as a powerful tool, and cutting back on the power level, one is able to better achieve the desired treatment effect. Clinical studies to evaluating the role of the laser in different arthroscopic knee procedures, comparing to conventional techniques, showed that the overall outcome attains a momentous confidence level which is shifted to the side of the laser versus the conventional for all maneuvers, barring meniscectomy where there is not perceiving disparity between laser versus the conventional. Meniscectomy continues to be one of the most commonly performed orthopaedic procedures. Laser provides a single tool which can ablate and debride meniscal rims with efficiency and safety. Chondroplasty can also be accomplished with ease using defocused laser energy. Both lateral release and soft tissue cermilization benefit from the cutting effect of laser along with its hemostatic effect. Synovial reduction with a defocused laser is also easily accomplished. By one gadget, one can cut, ablate, smooth, coagulate, congeal and with authentic tissue depth control The future of laser arthroscopic surgery lies in its ability to weld or repair tissues. Our research study has shown that laser activated photoactive dyes can produce a molecular bonding of collagen fibers, and therefore a repair 'weld' can be achieved with both meniscal tissues and with articular cartilage lesions.

  15. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Blacksin, M.F.; Zurlo, J.V. [Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark, NJ (United States); Levy, A.S. [Department of Orthopedic Surgery, University of Medicine and Dentistry of New Jersey, University Hospital, Newark, NJ 07103-2426 (United States)

    1998-08-01

    Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee. (orig.) With 4 figs., 2 tabs., 13 refs.

  16. Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty

    Science.gov (United States)

    Hamilton, T. W.; Pandit, H. G.; Lombardi, A. V.; Adams, J. B.; Oosthuizen, C. R.; Clavé, A.; Dodd, C. A. F.; Berend, K. R.; Murray, D. W.

    2016-01-01

    Aims An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre. Patients and Methods Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature. Results The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100). Conclusion The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3–10. PMID:27694509

  17. Osteochondral defect repair using a polyvinyl alcohol-polyacrylic acid (PVA-PAAc) hydrogel.

    Science.gov (United States)

    Bichara, David A; Bodugoz-Sentruk, Hatice; Ling, Doris; Malchau, Erik; Bragdon, Charles R; Muratoglu, Orhun K

    2014-08-01

    Poly(vinyl alcohol) (PVA) hydrogels can be candidates for articular cartilage repair due to their high water content. We synthesized a PVA-poly(acrylic acid) (PAAc) hydrogel formulation and determined its ability to function as a treatment option for condylar osteochondral (OC) defects in a New Zealand white rabbit (NZWR) model for 12 weeks and 24 weeks. In addition to hydrogel OC implants, tensile bar-shaped hydrogels were also implanted subcutaneously to evaluate changes in mechanical properties as a function of in vivo duration. There were no statistically significant differences (p > 0.05) in the water content measured in the OC hydrogel implant that was harvested after 12 weeks and 24 weeks, and non-implanted controls. There were no statistically significant differences (p > 0.05) in the break stress, strain at break or modulus of the tensile bars either between groups. Histological analysis of the OC defect, synovial capsule and fibrous tissue around the tensile bars determined hydrogel biocompatibility. Twelve-week hydrogels were found to be in situ flush with the articular cartilage; meniscal tissue demonstrated an intact surface. Twenty-four week hydrogels protruded from the defect site due to lack of integration with subchondral tissue, causing fibrillation to the meniscal surface. Condylar micro-CT scans ruled out osteolysis and bone cysts of the subchondral bone, and no PVA-PAAc hydrogel contents were found in the synovial fluid. The PVA-PAAc hydrogel was determined to be fully biocompatible, maintained its properties over time, and performed well at the 12 week time point. Physical fixation of the PVA-PAAc hydrogel to the subchondral bone is required to ensure long-term performance of hydrogel plugs for OC defect repair.

  18. Obesity increases the prevalence and severity of focal knee abnormalities diagnosed using 3T MRI in middle-aged subjects - data from the osteoarthritis initiative

    Energy Technology Data Exchange (ETDEWEB)

    Laberge, Marc A.; Baum, Thomas; Virayavanich, Warapat; Nardo, Lorenzo; Link, Thomas M. [University of California San Francisco, Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Nevitt, M.C.; Lynch, J.; McCulloch, C.E. [University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA (United States)

    2012-06-15

    To study the effect of BMI on the prevalence, severity, and 36-month progression of early degenerative changes in the knee by using 3T MRI in middle-aged subjects without radiographic osteoarthritis (OA). We examined baseline and 36-month follow-up MR studies from 137 middle-aged individuals (45-55 years old) with risk factors for knee OA but no radiographic OA from the Osteoarthritis Initiative. Subjects were grouped into three categories: normal BMI (BMI < 25 kg/m{sup 2}, n = 38), overweight (BMI 25-29.9 kg/m{sup 2}, n = 37), and obese (BMI {>=} 30 kg/m{sup 2}, n = 62). Using 3T MRI, cartilage, meniscus, and bone marrow abnormalities were graded using the OA Whole-organ MR Imaging Score (WORMS). The statistical analysis was corrected as necessary for differences in age, sex, and OA risk factors other than BMI. The overall prevalence of lesions was 64% for meniscus and 79% for cartilage (including low grade lesions). At baseline, the prevalence and severity of knee lesions was positively associated with BMI, with a nearly fourfold increase in meniscal tears and more than twofold increase in high-grade cartilage defects in obese individuals relative to normal-weight subjects. Over the 36-month follow-up period, the number of new or worsening cartilage lesions of any grade was significantly higher in obese subjects (p = 0.039), while there was no significant difference in meniscal lesion progression. Obesity was associated with both higher prevalence and severity of early degenerative changes in the knee in middle-aged individuals without radiographic OA and with significantly increased cartilage lesion progression (of any grade) over 36 months. (orig.)

  19. Finite element analysis of a total ankle replacement during the stance phase of gait.

    Science.gov (United States)

    Reggiani, B; Leardini, A; Corazza, F; Taylor, M

    2006-01-01

    Total ankle replacement (TAR) designs have still several important issues to be addressed before the treatment becomes fully acceptable clinically. Very little is known about the performance, in terms of the contact pressures and kinematics of TAR when subjected to daily activities such as level gait. For this purpose, an explicit finite element model of a novel 3-component TAR was developed, which incorporated a previously validated mechanical model of the ankle ligament apparatus. The intermediate mobile polyethylene meniscal bearing was modelled as an elastic-plastic continuum while the articulating surfaces of the tibial and talar metal components as rigid bodies. Overall kinematics, contact pressures and ligament forces were analysed during passive, i.e. virtually unloaded, and active, i.e. stance phase of gait, conditions. Simulation of passive motion predicted similar kinematics as reported previously in an analytical four-bar linkage model. The meniscal bearing was observed to move 5.6 mm posteriorly during the simulated stance and the corresponding antero-posterior displacement of the talar component was 8.3 mm. The predicted pattern and the amount (10.6 degrees ) of internal-external rotation of the ankle complex were found to be in good agreement with corresponding in vivo measurements on normal ankles. A peak contact pressure of 16.8 MPa was observed, with majority of contact pressures below 10 MPa. For most ligaments, reaction forces remain within corresponding physiological ranges. A first realistic representation of the biomechanical behaviour of the human ankle when replaced by prosthetic joints is provided. The applied methodology can potentially be applied to other TAR designs.

  20. Body Mass Index, Modulated by Lateral Posterior Tibial Slope, Predicts ACL Injury Risk

    Science.gov (United States)

    Bojicic, Katherine M.; Beaulieu, Melanie L.; Krieger, Daniel Imaizumi; Ashton-Miller, James A.; Wojtys, Edward M.

    2016-01-01

    Objectives: Intervention strategies to prevent ACL injury rely on increasing knowledge of risk factors. While several modifiable and non-modifiable risk factors for ACL rupture have been identified, the interaction between them remains unknown. The aim of this study was to quantify the relationship between BMI and several knee geometries as potential risk factors for ACL injury. We hypothesized that an increased BMI in the presence of an increased posterior tibial slope or middle cartilage slope would increase risk of ACL injury. We also hypothesized that an increased BMI in the presence of a decreased posterior meniscal height or meniscal bone angle would result in an increased risk of ACL injury. Methods: Sagittal knee MRI files from 76 ACL-injured and 42 non-injured subjects were gathered from the institution’s archive. The PTS, MCS, PMH, and MBA were measured using the circle method and compared with BMI from the subject demographic. Data were analyzed using univariate and multivariate logistical regression. Figure 1 details measurements made for each knee geometry. Results: Univariate analysis of PTS showed increases in PTS significantly increase the odds of ACL tear (p = 0.043, OR =1.12). Univariate analysis of MCS showed increases of MCS significantly increase the odds of ACL tear (p = 0.037, OR = 1.12). Multivariate analysis of PTS and BMI centered around the mean (PTS*cBMI) showed increases of PTS in combination with increases in cBMI significantly increases the odds of ACL rupture (p value = .050, OR = 1.03). Table 1 shows predicted increases in ACL injury risk for combinations of increases in PTS and BMI. Conclusion: An increase in BMI will increase the risk of ACL tear when an increase in lateral posterior tibial slope is present. An increase in lateral posterior tibial slope or lateral middle cartilage slope increases the risk of an ACL tear.

  1. Clinical characteristics of 4355 patients with anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    MEI Yu; AO Ying-fang; WANG Jian-quan; MA Yong; ZHANG Xin; WANG Jia-ning; ZHU Jing-xian

    2013-01-01

    Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs.24.95%,P<0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P<0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle,18.30% double-bundle).Three hundred and forty-five patients (7.92%)were combined with other ligaments injuries,2667 (61.24%) were found with various grades of cartilage lesions,and 3377 (77.54%) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.

  2. FUNCTIONAL OUTCOME OF ACCELERATED REHABILITATION IN ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE PATELLAR TENDON BONE GRAFT A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Hiranyakumar

    2016-03-01

    Full Text Available INTRODUCTION An ideal rehabilitation program post anterior cruciate ligament reconstruction enables an individual to return to pre injury levels at a faster rate with minimal to no risk of reinjury to the graft. Rehabilitation protocols have changed considerably over time in the past. It has become “aggressive”, meaning an intensive rehabilitation which includes greater variety of exercises and sports related training. AIM OF THE STUDY The aim of our study is to assess the outcome of accelerated rehabilitation post anterior cruciate ligament (ACL reconstruction. METHODOLOGY 106 patients were operated by a single surgeon underwent arthroscopic anterior cruciate ligament reconstruction using bone patella tendon bone graft and partial meniscectomy for associated meniscal tear. Patients were put on an accelerated rehabilitation protocol designed in our institute on first post-operative day, under the guidance of a physical therapist in consultation with the operated surgeon. Patients were followed up at 3 weeks, 6 months and 9 months, post onset of rehabilitation, patients were assessed using KT1000 Arthrometer and Lysholm knee scoring system. RESULTS Out of 106 patients, who were selected, 96(91% were males and 10(9% were females. The mean pre-operative Lysholm score was 55.09. Post operatively, while on accelerated rehabilitation program the Lysholm scores were 69.73 at 3 weeks, 89.13 at 6 months and 89.19 at 9 months. In our pre-operative evaluation mean KT 1000 arthrometer score was 10.53 and post-operative at six months was 3.49. At nine months 105 patients had excellent results whereas 1 patient had good result. CONCLUSION Accelerated rehabilitation protocol enables the patient to functionally recover faster to pre injury levels. A rehabilitation protocol for 6 months is sufficient in enabling a patient to get back to pre-injury levels. Functional outcome is the same with or without associated meniscal injuries.

  3. Diagnostic Efficacy in Knee MRI Comparing Conventional Technique and Multiplanar Reconstruction with One-Millimeter FSE PDW Images

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Y.C.; Kim, S.S.; Chung, H.W.; Choe, B.K.; Ahn, J.H. [Dept. of Radiolog y, Kangwon National Univ. School of Medicine, Kangwon-do (Korea)

    2007-10-15

    Background: Magnetic resonance (MR) imaging has proved to be an excellent tool in diagnosing injuries of the cruciate ligaments and menisci. However, multiple planes and sometimes optimal oblique or double-oblique scan planes are needed due to the variability in the positioning of important structures, which means there is a lower throughput and longer scanning time. Purpose: To compare the performance of a 1-mm-thickness fast spin-echo (FSE) proton-density-weighted (PDW) MR imaging technique with multiplanar reconstruction (MPR) in diagnosing tears of the menisci and cruciate ligaments with that of conventional MR imaging. Material and Methods: Twenty-five consecutive patients underwent preoperative conventional and 1-mm-thickness FSE PDW MR imaging with subsequent knee arthroscopic surgery. Two musculoskeletal radiologists evaluated the status of the cruciate ligaments and menisci using two sets of MR images (method A: conventional images including seven sequences, taking 26 min; method B: 1-mm-thickness FSE PDW images with MPR, taking 7 min 20 s). The diagnostic efficacies of both methods for tears of the cruciate ligament and menisci were calculated and compared. Results: Arthroscopic surgery revealed 10 anterior cruciate ligament (ACL) tears, one posterior cruciate ligament (PCL) tear, and 26 meniscal tears. The diagnostic values of both methods were 100% for a cruciate ligament tear. The diagnostic values (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value) for meniscal tears were 90%, 100%, 96%, 100%, and 94% for method A, and 95%, 100%, 98%, 100%, and 97% for method B, respectively. There were no significant differences in the diagnostic values between methods A and B. Conclusion: 1-mm-slice-thickness FSE PDW imaging with MPR showed comparable performance in diagnosing tears of the cruciate ligaments and menisci to conventional sequences but the scan time was much shorter. Therefore, this technique (method B) might

  4. Cinética da fermentação in vitro do capim-Marandu em diferentes idades de corte = In vitro ruminal fermentation kinetics of Marandu grass at different harvest ages

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    Gesiane Moura Neves Rebouças

    2011-07-01

    Full Text Available O objetivo do trabalho foi avaliar os parâmetros da cinética de degradação ruminal da Brachiaria brizantha cv. Marandu, cortadas aos 28, 35 e 54 dias, pela técnica in vitro de produção de gases. Foram realizadas determinações dos teores de matéria seca (MS, matéria orgânica (MO, proteína bruta (PB, extrato etéreo (EE, fibra em detergente neutro corrigida para cinzas e proteína (FDNCP, fibra em detergente ácido (FDA, nitrogênio insolúvel em detergente neutro (NIDN, nitrogênio insolúvel em detergente ácido (NIDA, lignina (LIG, Carboidratos totais (CT, carboidratos não fibrosos (CNF, fração B2 e fração C, respectivamente. Os dados da produção de gases foram ajustados ao modelo logístico bicompartimental. O delineamento utilizado foi inteiramente casualizado. Os dados foram submetidos à análise de variância e regressão, ao nível de 5% de probabilidade.Houve efeito (p The objective of the work was to evaluate ruminal fermentation kinetics parameters of Brachiaria brizantha, harvested at 28, 35 and 54 days, using the semiautomatic in vitro gas production technique. Analyses were carried out for dry matter (DM, organic matter (OM, crude protein (CP, ether extract (EE, neutral detergent fiber corrected for ash and protein (NDFAP, acid detergent fiber (ADF, neutral detergent insoluble nitrogen (NDIN, acid detergent insoluble nitrogen (ADIN, lignin (LIG, total carbohydrates (TC, non-fiber carbohydrates (NFC, fraction B2 and the fraction C, respectively. Thedata of gas production were adjusted to the bicompartmental logistic model. The design used was completely randomized. The data were submitted to analysis of variance and regression, at the level of 5% probability. There was a significant effect (p <0.05, for the variables DM, NDFAP, ADF, NDIN, ADIN, TC, B2, with linear increase as harvest age advanced. For gas production, fraction A was similar between the ages of 28 and 35 days, with 95.75 and 116.8 mL g-1 of DM

  5. Muscle MCT4 Content Is Correlated with the Lactate Removal Ability during Recovery Following All-Out Supramaximal Exercise in Highly-Trained Rowers

    Science.gov (United States)

    Maciejewski, Hugo; Bourdin, Muriel; Féasson, Léonard; Dubouchaud, Hervé; Denis, Christian; Freund, Hubert; Messonnier, Laurent A.

    2016-01-01

    The purpose of this study was to test if the lactate exchange (γ1) and removal (γ2) abilities during recovery following short all-out supramaximal exercise correlate with the muscle content of MCT1 and MCT4, the two isoforms of the monocarboxylate transporters family involved in lactate and H+ co-transport in skeletal muscle. Eighteen lightweight rowers completed a 3-min all-out exercise on rowing ergometer. Blood lactate samples were collected during the subsequent passive recovery to assess an individual blood lactate curve (IBLC). IBLC were fitted to the bi-exponential time function: La(t) = [La](0) + A1(1 − e-γ1t) + A2(1 − e-γ2t) where [La](0) is the blood lactate concentration at exercise completion and the velocity constants γ1 and γ2 denote the lactate exchange and removal abilities, respectively. An application of the bi-compartmental model of lactate distribution space allowed estimation of the lactate removal rate at exercise completion [LRR(0)]. Biopsy of the right vastus lateralis was taken at rest to measure muscle MCT1 and MCT4 content. Fiber type distribution, activity of key enzymes and capillary density (CD) were also assessed. γ1 was correlated with [La](0) (r = −0.54, P < 0.05) but not with MCT1, MCT4 or CD. γ2 and LRR(0) were correlated with MCT4 (r = 0.63, P < 0.01 and r = 0.73, P < 0.001, respectively) but not with MCT1 or cytochrome c oxidase activity. These findings suggest that the lactate exchange ability is highly dependent on the milieu so that the importance of the muscle MCT1 and MCT4 content in γ1 was hidden in the present study. Our results also suggest that during recovery following all-out supramaximal exercise in well-trained rowers, MCT4 might play a significant role in the distribution and delivery of lactate for its subsequent removal. PMID:27375499

  6. 膝关节镜下手术和药物辅助治疗半月板损伤疗效观察

    Institute of Scientific and Technical Information of China (English)

    郑元波; 厉乐泉; 杨胜武; 游逸丰; 苏忠良

    2013-01-01

      Objective To evaluate the efficacy of arthroscopic repair surgery combined intraarticular injection of hyaluronate in treatment of meniscal injury. Methods Twenty two patients with torn meniscus underwent arthroscopic meniscus repair surgery, among them 16 patients were treated with suture from outside to inside and another 6 from inside to outside. Sodi-um hyaluronate was injected intraarticularly after surgery. The patients were fol owed-up with knee arthroscopy or MRI examina-tion;and the efficacy was also evaluated with Lysholm knee score. Results Knee meniscus repair surgery in 22 cases was al successful. Arthroscopic examination in 5 cases during fol ow up indicated meniscal healing well. MRI examinations were per-formed in 17 patients, among whom 15 displayed meniscal healing, 1 was not completely healed and 1 did not heal. The mean postoperative Lysholm scores improved significantly compared to the preoperative scores (P<0.01). In 22 patients the results were excel ent in 14 cases, good in 6 cases, poor or not good in 1 case respectively with a good/excel ent rate of 90.9%(20/22). Conclusion Arthroscopic meniscus repair surgery combined with intraarticular injection of sodium hyaluronate is effective in treat-ment of knee meniscus injury.%  目的探讨膝关节镜下手术修复和术后药物辅助治疗半月板损伤的疗效。方法对22例半月板撕裂的患者行膝关节镜下半月板修复术(其中16例从外到内缝合,6例从内到外缝合),术后给予玻璃酸钠膝关节腔内注射辅助治疗,通过二期膝关节镜和MRI检查、Lysholm膝关节功能评分对治疗效果进行评价。结果22例患者膝关节镜下半月板修复术均取得成功。二期关节镜检查5例,显示半月板愈合良好;MRI复查17例,显示半月板愈合15例,未完全愈合和未愈合各1例;术后Lysholm平均评分较术前明显提高,差异具有统计学意义(P<0.01);疗效优14例,良6例,可1

  7. Sutura de menisco com implantes absorvíveis Meniscus suture with absorbable implants

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    Arnaldo José Hernandez

    2006-01-01

    Full Text Available Os autores avaliam clinicamente 19 pacientes (19 joelhos - 15 meniscos mediais e 5 laterais submetidos à sutura de menisco, utilizando 2 tipos de implantes absorvíveis (ácido polilático Arrow® e Clear fix®. O estudo compõe-se de 15 homens e 4 mulheres com idades entre 16 e 44 anos, com média de 26,8 anos. O tempo de seguimento médio foi de 24 meses, com mínimo de 18 e máximo de 32 meses. A técnica operatória constituiu-se da sutura de um ou ambos os meniscos (1 caso, via artroscópica com Arrow® em 15 pacientes e Clear fix® em 4. Dos 19 indivíduos, 6 foram submetidos à sutura meniscal isolada, 11 associada à reconstrução do LCA e 2 à reconstrução do LCA com osteotomia valgizante da tíbia. Os resultados foram avaliados segundo exame físico incluindo as manobras de Appley e Mc Murray. A avaliação funcional pré e pós-operatória do joelho foi realizada pela escala de Lysholm modificada. Todos os pacientes tiveram suas manobras meniscais negativadas no pós-operatório. A pontuação média pré-operatória segundo a escala de Lysholm foi de 39,8 subindo para 91,5 no pós-operatório. Os autores concluem que a sutura de menisco, utilizando implantes absorvíveis, tem se mostrado eficiente até o momento, e que tecnicamente ela é mais simples que a sutura convencional.The authors clinically assessed 19 patients (19 knees - 15 medial meniscus and 5 lateral meniscus submitted to meniscus suture using 2 kinds of absorbable implants (polylactic acid Arrow® and Clear fix®. The study is composed of 15 males and 4 females, ages ranging 16 - 44 years old (average = 26.8 years old. The mean follow-up time was 24 months, ranging from 18 to 32 months, at most. The surgical technique was constituted of a suture in one or both meniscus (1 case, through arthroscopy with Arrow® in 15 patients and Clear fix® in 4. From the 19 individuals, 6 were submitted to isolated meniscal suture, 11 combined to ACL reconstruction and 2 to ACL

  8. Medial meniscus transplantation using cyanoacrylate in rabbits Transplante de menisco medial utilizando cianoacrilato em coelhos

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    Leandro José Reckers

    2006-04-01

    Full Text Available PURPOSE: To evaluate meniscal transplantation using as fixation method a synthetic glue derived from cyanoacrylate acid. METHODS: Twenty rabbits were used, of which 10 for autologous transplantation and 10 for homologous transplantation. For the autologous transplantation the meniscus was removed, and then transplanted in the same animal, using the synthetic glue. For the homologous transplantation, the study was divided into two stages: 1- Removal of the meniscus which was maintained at a temperature of 73ºC. 2- Use of cyanoacrylate acid-derived surgical adhesive for meniscal retransplantation in a different rabbit 30 days after the transplant. RESULTS: Due to complications, euthanasia had to be anticipated to the 15th day in the homologous group and to the 18th day in the autologous group. Macroscopically, knees submitted to transplantation presented whitish secretions from the surgical incision up to deep planes. Necrosis was observed in both groups. Statistical analysis has shown that mild (p=0.043 and moderate (p=0.001 complications emerged in a significantly earlier way in the homologous group, where euthanasia was also performed earlier (p=0,005. CONCLUSION: Synthetic surgical adhesives derived from cyanoacrylate acid promoted cortical to medullary bone necrosis bone in both groups.OBJETIVO: Avaliar macroscópica e histologicamente o transplante meniscal, utilizando-se a cola sintética derivada do ácido cianoacrilato como método de fixação. MÉTODOS: Foram utilizados 20 coelhos, tendo 10 realizado transplante autólogo e 10, homólogo. Para o transplante autólogo, o menisco foi retirado e em seguida transplantado no mesmo animal, sendo fixado com a cola sintética. Para o transplante homólogo o estudo foi dividido em duas etapas: 1- retirada do menisco e manutenção a uma temperatura de 73°C negativos. 2- Utilização do adesivo cirúrgico derivado do ácido cianoacrilato para reimplantar num coelho diferente 30 dias após o

  9. Use of acupuncture after arthroscopic knee surgery and its relationship to pain, physical activity and need of walking aid Acupuntura em relação a dor, atividade física e a necessidade de apoio para a marcha, no pós-operatório das cirurgias artroscópicas no joelho

    Directory of Open Access Journals (Sweden)

    Rassen Saidah

    2003-01-01

    Full Text Available The purpose of this study was to evaluate the efficacy of Acupuncture in the postoperative arthroscopic knee surgery, using "The Opposite Side" technique from the Traditional Chinese Medicine. The 36 pain in the knee were grouped according to the disorders found during the arthroscopic surgery: 50% with isolated lesion of the medial meniscus, 19.44% with lesion of the medial meniscus associated to knee arthrosis ,11.11% with lesion of lateral meniscus associated to knee arthrosis, 8.33% with isolated lesion of lateral meniscus of the knee, 2.77% lesion of both isolated meniscus, 2.77%with lesion of both isolated meniscus, 2.77% with chrondomalacia patella, and 2.77% were free body carrier. Group I, 18 patients (Acupuncture were submitted to 20 acupuncture session. Contralateral points of acupuncture were performed in the injured knee. Group II, 18 patients (Physiotherapy were submitted to 20 physiotherapy sessions under the administration of nonsteroidal anti-inflammatory agents. The non-parametrical analysis of the results showed that either the subjective data (pain intensity, difficulty in walking, in crouching, on going upstairs/downstairs, on running, on using some support walking presented good results in the majority of the studied parameters. Although, the results of the treatment were similar, the acupuncture showed better results since it presented earlier improvement than the physiotherapy.O presente estudo teve a finalidade de avaliar a eficácia da Acupuntura no pós-operatório das cirurgias artroscópicas no joelho utilizando-se a técnica "ao oposto" da Medicina Tradicional Chinesa. Os 36 pacientes portadores de gonalgias foram distribuídos conforme a patologia encontrada nas artroscopias cirúrgicas: 50,0% tinham lesão do menisco medial isolada, 19,44% lesão meniscal medial associada à artrose de joelho, 11,11% lesão meniscal lateral associada à artrose de joelho, 8,33% lesão meniscal lateral isolada de joelho, 2

  10. 镜下缝线锚钉修复肩关节上盂唇前后向合并前后延伸损伤的疗效分析%Arthroscopic capsulolabral reconstruction of severe superior labrum anterior posterior lesions plus anterior or/and posterior extensive tear

    Institute of Scientific and Technical Information of China (English)

    黄华扬; 郑小飞; 李凭跃; 张余; 沈洪园; 张涛; 徐亮; 王庆

    2011-01-01

    Objective To investigate the efficacy of arthroscopic capsulolabral reconstruction of severe superior labrum anterior posterior (SLAP) lesions plus anterior or/and posterior extensive tear.Methods From March 2007 to April 2009,12 patients (12 shoulders) were diagnosed with SLAP lesions plus anterior or/and posterior extensive tear by physical examination,magnetic resonance imaging and arthroscopy.They were 7 men and 5 women,aged from 18 to 40 years (average,28.7 years).Seven cases of SLAP lesion were of Type V (a superior labral tear plus an anterior-inferior labral tear,or Bankart lesion),3 cases were of Type Ⅷ (an avulsion of the biceps anchor plus extensive labral tear posteriorly along the glenoid),and 2 cases were a new type (a bucket-handle tear of superior labrum plus extensive labral tear posteriorly along the glenoid with a normal biceps tendon and an intact biceps anchor while the avulsed labrum dislocated to the glenoid neck).All were treated with an arthroscopic capsulolabral reconstruction.Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons (ASES)scoring system,visual analog scale (VAS) and Constant-Murley scoring system for stability,strength,function,and range of motion.Results All the patients were followed up for an average of 17 months (from 11 to 22 months ).Their mean ASES score improved from 77.4 ± 3.7 to 94.3 ± 2.6 ( P < 0.05).Their mean VAS score improved from 7.2 ± 1.4 to 1.2 ± 0.6 ( P < 0.05).Their mean Constant-Murley score improved from 78.1 ±4.6 to 93.9 ± 3.7 ( P < 0.05).There were significant improvements in ranges of motion ( P <0.05).No shoulder required revision surgery for recurrent instability.All patients were able to return to sports.Conclusion Since it is difficult to diagnose severe SLAP lesions plus anterior or/and posterior extensive tear,arthroscopy can offer accurate diagnosis to facilitate timely and minimally invasive reconstruction of the lesions

  11. Causes and effects of medial meniscus extrusion in patients with knee osteoarthritis%膝关节骨关节炎内侧半月板突出的临床意义

    Institute of Scientific and Technical Information of China (English)

    王植; 孟祥虹; 锁咏梅; 王林森; 赵力

    2013-01-01

    目的 探讨膝关节骨关节炎患者内侧半月板突出的病因及影响.方法 选取2011年1月至2012年3月诊断为膝关节退行性骨关节炎并经MRI确认有内侧半月板突出的60例患者为半月板突出组,无突出的60例为对照组.在MRI上测量内侧半月板突出距离、胫股角,分析突出组胫股角与突出距离的相关性,比较两组膝内翻、内侧半月板及胫股关节软骨损伤的发生率,分析内侧半月板突出对半月板损伤、膝内翻对半月板突出的影响.结果 突出组:半月板突出距离平均(8.30±1.79) mm;60例有膝内翻,胫股角平均179.0°±2.2°;内侧半月板损伤发生率:前角50.0% (30/60),体部93.3% (56/60),后角93.3% (56/60);内侧半月板后角根部撕裂14例,发生率23.3%(14/60);胫股内侧关节软骨退变发生率:胫骨内侧平台100%(60/60),股骨内髁100%(60/60);胫股角与内侧半月板突出距离呈负相关.对照组:内侧半月板超出胫骨内侧平台边缘的距离平均(0.57±0.80) mm;4例膝内翻;内侧半月板损伤发生率:前角0,体部16.7%(10/60),后角70.0% (42/60);无内侧半月板后角根部撕裂;胫股内侧关节软骨退变发生率:胫骨内侧平台26.7%(16/60),股骨内髁30.0% (18/60).半月板突出组与对照组半月板损伤比值比为6.0、膝内翻例数比值比为15.0.半月板突出组内侧半月板各部位及胫股内侧关节软骨损伤的发生率和严重程度高于对照组.结论 膝内翻可能是内侧半月板突出的原因之一,内侧半月板突出显著增加半月板损伤的发生率,其对膝胫股内侧关节骨关节炎的发生、发展有重要影响.%Objective To investigate causes and effects of medial meniscus extrusion in patients with knee osteoarthritis.Methods A total of 120 patients diagnosed as knee osteoarthritis between January 2011 and March 2012 were enrolled in this study,including 60 patients with medial meniscal extrusion

  12. Epinephrine enhanced double contrast knee arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Mun; Choi, Byung Ihn [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

    1981-12-15

    It is well known that double contrast knee arthrography is useful in diagnosis of meniscal lesion and other knee pathology. But intra-articular structures become less well delineated shortly after injection into the knee joint with water soluble contrast media because of rapid absorption and dilution of the injected media. This limits the time when sharply detailed arthrograms are obtained and precludes repeat delayed arthrogram without reinjection of contrast media. In order to overcome this major disadvantage, the authors used epinephrine which has vasoconstrictive effect and is expected to reduce fluid movement across the synovial membrane temporarily. The authors attempted to compare epinephrine enhanced double contrast arthrographic group, epinephrine (+) group, to the double contrast arthrographic group without epinephrine, epinephrine (-) group, by statistical evaluation. Each group consisted of 35 cases and 7 lateral films of knee joint were taken sequentially 2, 6, 10, 15, 20, 30, and 60 minutes after injection of contrast media, and were assessed by 5 certified radiologist. The results were as follows: 1. The differences of mean score of quality between epinephrine (+) group and epinephrine (-) group was statistically significant at every time interval (p value<0.01 at 2 minutes, p<0.001 at all other time interval). Epinephrine (+) group was superior to the epinephrine (-) group in quality of film. 2. Numbers of cases above score of 2 which was considered to be of diagnostic quality in evaluating meniscal lesions were larger in epinephrine (+) group than epinephrine (-) group at every time interval. And the differences between two groups was highly significant statistically (p,0.001). 3. Only 43% of cases was above score of 2 at 10 minutes in epinephrine (-) group, but 97% at 10 minutes and 80% at 20 minutes respectively in epinephrine (+) group. Therefore duration for adequate study of arthrogram is prolonged more than two times epinephrine (+) group. 4

  13. 组织工程半月板研究进展%RESEARCH PROGRESS IN TISSUE ENGINEERED MENISCUS

    Institute of Scientific and Technical Information of China (English)

    李尚福; 戎利民

    2013-01-01

    Objective To elucidate the latest research progress and application of tissue engineered meniscus. Methods The literature concerning the advance in tissue engineered meniscus was extensively reviewed, then closely-related issues including seed cells, scaffolds, and bioreactors were analyzed. Results With more and more attention being paid to meniscus tissue engineering, different approaches and strategies for seed cells, scaffolds, and bioreactors have contributed to the generation of meniscal constructs, which are capable of restoring meniscal lesions to some extent, but translating successes in basic science research to clinical application is still limited. Conclusion More research for the optimal combination of the appropriate cell source, the scaffold type, and the proper physical and chemical factors for the stimulation of cells differentiation into tissue with optimal phenotypes in tissue engineered meniscus is still in needed, but the overall future looks promising.%目的 对使用组织工程技术构建半月板的研究进展及其应用情况进行综述. 方法 广泛查阅近年来通过组织工程构建半月板的相关文献,分别从种子细胞、支架材料及生物反应器3个方面进行分析总结. 结果 组织工程半月板越来越受到人们的重视,近年来对种子细胞、支架材料及生物反应器的研究均取得了可喜进展,但研究成果真正应用于临床尚需努力. 结论 寻求更加有效的构建方法仍然是组织工程半月板的研究热点,随着对种子细胞、支架材料及生物反应器认识的不断深入,必将会构建出更接近于人体的组织工程半月板.

  14. Clinical Application and Curative Effect of Plasma Blade Combined Arthroscopic Surgery on Meniscus Lesions of 38 Cases%等离子刀联合关节镜治疗膝半月板损伤38例临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    张勇; 朱昊; 蒋定华; 黄立新; 孙树金; 董天华

    2015-01-01

    ObjectiveTo investigate the clinical application and curative effect of plasma blade combined arthroscopic surgery on meniscus lesions.Methods The data of surgical treatment in 38 patients with meniscal injury in 41 knees were retrospectively analyzed. The proper surgical procedures were selected respectively according to the injury position and the type of lesions. Lysholm score system was applied and the scores of pre- and post-operation were compared, all patients were followed up over 2 years.ResultsThese 38 patients with meniscal injury in 41 knees were conifrmed by arthroscopic surgery. All the surgeries were successful with no serious complications. All the patients were followed up for over 24 months. Their symptoms completely disappeared in 26 knees, improved in 13 knees in comparison with preoperative status. The effect in 2 knees was not satisfying. The excellent and good rate of the post-operative function was 95.12%.ConclusionThe meniscus injury cured under the combination of plasma blade and arthroscopic surgery is of the advantages of intuitive and accurate checking, simple procedures, less trauma, faster recovery, and the effect is more ideal.%目的:探讨应用等离子刀联合关节镜微创手术治疗半月板损伤的临床疗效。方法回顾性收集分析38例41膝半月板损伤患者的临床资料,根据半月板损伤部位及损伤类型,选择相应的关节镜手术方式予以治疗。术后2年以上随访观察,以Lysholm膝关节评分系统评价治疗效果。结果患者38例41膝半月板损伤术中均得到确诊。手术均获成功,未见严重并发症。术后2年随访,无失访病例。症状完全消失26膝,比术前好转13膝,效果一般2膝。优良率为95.12%。结论应用等离子刀联合关节镜治疗半月板损伤具有操作简便、创伤小、疗效确切、术后恢复快的特点。

  15. Correlation between body mass index and chondral lesions in isolated medial meniscus tears

    Directory of Open Access Journals (Sweden)

    Barak Haviv

    2015-01-01

    Full Text Available Background:Chondral lesions of the knee are commonly found during arthroscopic partial meniscectomy. The literature advises against arthroscopic medial meniscectomy in the presence of advanced chondral derangement because of unfavorable outcome. Recent studies have shown an association between obesity and chondropathy in patients with meniscal tears. The aim of this study was to assess whether body mass index (BMI correlates with the severity of chondral lesions in patients with isolated medial meniscus tears (i.e. without ligamentous or lateral meniscal injury. Materials and Methods: 837 knee arthroscopies were performed in a regional referral center of arthroscopic surgery between January 2011 and December 2012. Of these 168 (109 males, 59 females patients with no axial knee deformity and no radiological signs of osteoarthritis who have had arthroscopic debridement for isolated torn medial meniscus were included in the study. The correlation between different demographic factors and the level of chondral damage reported at surgery was evaluated. The mean age of patient was 50 years (range 13-82 years and an average BMI was 28.2 kg/m [2] (range17.5-42.5 kg/m [2] . Results: Overall, regression analysis showed both age and BMI to be linearly correlated to chondral score (r = 0.53, P < 0.04; however, there were no advanced chondral lesions found in patients younger than 40 years of age and all severe lesions were at age 50 years or more. Therefore, further analysis was performed for age subgroups: patients were grouped as younger than 40, between the age of 40 and 50 (middle age and older than 50 years. The BMI was linearly correlated to the severity of chondral score exclusively in the middle aged group (i.e. 40-50 years old. There was no correlation between activity level and chondral damage. Women had worse chondral lesions than men in all age groups. Conclusion: Higher BMI in middle aged patients with isolated medial meniscus tears and

  16. Epinephrine inhanced double contrast knee arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Mun; Choi, Byung Ihn [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

    1981-09-15

    It is well known that double contrast knee arthrography is useful in diagnosis of meniscal lesions and other knee pathology. But intra-articular structures become less well delineated shortly after injection into the knee joint with water soluble contrast media because of rapid absorption and dilution of the injected media. This limits the time when sharply detailed arthrograms are obtainable and precludes repeat delayed arthrogram without reinjection of contrast media. In order to overcome this major disadvantage, the authors used epinephrine which has vasoconstrictive effect and is expected to reduce fluid movement across the synovial membrane temporarily. The authors attempted to compare epinephrine inhanced double contrast arthrographic group, epinephrine(+) group, to the double contrast arthrographic group without epinephrine, epinephrine(-) group, by statistical evaluation. Each group consisted of 35 cases and 7 lateral films of knee joint were taken sequentially 2, 6, 10, 15, 20, 30, and 60 minutes after injection of contrast media, and were assessed by 5 certified radiologists. The results were as follows: 1. The difference of mean score of quality between epinephrine(+) group and epinephrine(-) group was statistically significant at every time interval ({rho} value < 0.01 at 2 minutes, {rho} < 0.001 at all other time intervals). Epinephrine(+) group was superior to the epinephrine(-) group in quality of film. 2. Numbers of cases above score of 2 which was considered to be of diagnostic quality in evaluating meniscal lesions were larger in epinephrine(+) group than epinephrine(-) group at every time interval. And the difference between two groups was highly significant statistically ({rho} < 0.001). 3. Only 43% of cases was above score of 2 at 10 minutes in epinephrine(-) group, but 97% at 10 minutes and 80% at 20 minutes respectively in epinephrine(+) group. Therefore duration for adequate study of arthrogram is prolonged more than two times in epinephrine

  17. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Scher, Courtney [Michigan State University Osteopathic Radiology Residency, Henry Ford Macomb Hospital, Warren, MI (United States); Craig, Joseph [Department of Radiology, Henry Ford Hospital, Detroit, MI (United States); Nelson, Fred [Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI (United States)

    2008-07-15

    The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28-75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p=0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p<0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p<0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p<0.001). However, the BME results were still significant after accounting for the age difference. Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern. (orig.)

  18. Knee injuries and Alpine skiing. Treatment and rehabilitation.

    Science.gov (United States)

    Paletta, G A; Warren, R F

    1994-06-01

    Alpine skiing is an increasingly popular recreational sport worldwide. While the overall injury rate has declined and the pattern of injury changed over the years, the incidence of knee injuries has not changed substantially and accounts for 20 to 30% of all alpine skiing injuries. Medial collateral ligament (MCL) injuries are the most common in skiing, accounting for 15 to 20% of all skiing injuries and 60% of knee injuries in skiers. Tears are commonly isolated, but may occur in association with other ligamentous injuries. Associated meniscal pathology is rare. Isolated MCL injuries are treated nonoperatively with a programme of initial immobilisation, early range-of-motion, and isometric quadriceps strengthening exercises. When full range of motion is achieved, a programme of progressive resistance exercises, isokinetic and closed chain exercises, and functional rehabilitation is instituted. Good results with return to skiing can be expected in most cases. Isolated lateral collateral ligament (LCL) injuries are rare in skiers. There is usually associated cruciate or arcuate ligament complex. Careful physical examination is essential to rule out associated ligament injuries and more complex instability patterns. In the rare case of isolated LCL injury, a similar approach to isolated MCL injury should be instituted. Anterior cruciate ligament (ACL) injuries have become increasingly common in skiers. This may reflect a true increase in the incidence or an improved awareness and ability to diagnose ACL injury. Physical examination and arthrometric analysis are important in assessing the integrity of the ACL. Radiographic and magnetic resonance imaging (MRI) evaluation may be helpful in assessing associated meniscal pathology. Treatment of the ACL-deficient knee is usually surgical. However, prior to reconstruction, a programme aimed at reducing effusion and regaining a full, pain-free range of motion is recommended. Surgical reconstruction is usually with the

  19. THE FUNCTIONAL OUTCOME OF MANAGEMENT OF SCHATZKER TYPE II AND III TIBIAL PLATEAU FRACTURES TREATED WITH INDIRECT ELEVATION, PERCUTANEOUS FIXATION AND BONE GRAFTING

    Directory of Open Access Journals (Sweden)

    Sheshagiri

    2016-02-01

    Full Text Available INTRODUCTION Damage to the joint is more extensive in tibia plateau fractures than the roentgenograms Indicate. It may be associated with soft tissue trauma, ligament injuries (4-33% medial Collateral ligament being the most common, meniscal injuries (20%, lateral collateral Ligament injury (3%, peroneal nerve injuries (3%. Posttraumatic arthritis is associated with residual instability or axial malalignment rather than joint depression. So we use minimally invasive approach to the depressed tibial plateau fractures (Schatzker type II & III. MATERIALS AND METHODS 32 patients were studied. They were followed up for maximum of 3yrs and a minimum of 1.5yrs with an average of 2.2yrs. Inclusion criteria included those patients with an age group between 20yrs and 60yrs, joint depression more than 3mm. Patients with open fracture, severe osteoporotic bones and with radiographic evidence of osteoarthritis are excluded from the study. CT was done in all patients. Mean age group was 28.8yrs and 19(76% were males; the mean articular depression was 11.32 mm measured in CT. Pre-op evaluation includes x-rays of the knee, stress x-rays if needed, and CT was done with 2mm limited cuts. Cancellous Bone graft was taken from opposite tibia through a 3-4cm long incision made below the tibial tuberosity over the medial aspect of the tibia. Cortical window was made in the affected limb, just enough to introduce the punch, and its position was confirmed under c-arm and depressed fragment was elevated with punch and reduction was held with k wires in subarticular plane and later two cannulated cancellous screws was introduced and the defect packed with bone grafts, Post-operatively all patients were immobilized with plaster of Paris (POP for 3 weeks and then mobilized. RESULTS The mean duration of the follow up was 2.2yrs. Results were excellent in 21 patients (84%, good 3(12% and fair in 1 patients (4% according to anatomic and functional criteria by Hohl and Luck

  20. Ressonância magnética da osteonecrose do joelho: estudo de 19 casos Magnetic resonance imaging of knee osteonecrosis: a study of 19 cases

    Directory of Open Access Journals (Sweden)

    Daniel Leme da Cunha

    2010-04-01

    Full Text Available OBJETIVO: Descrever os achados epidemiológicos, clínicos e de ressonância magnética da osteonecrose das porções distal do fêmur e proximal da tíbia. MATERIAIS E MÉTODOS: Avaliação de 19 pacientes (12 mulheres e 7 homens, sem história prévia de fatores causais, com achados à ressonância magnética sugestivos de osteonecrose do platô tibial ou côndilo femoral. RESULTADOS: Verificou-se a presença de anormalidades osteocondrais em 63,1% dos casos e em 73,6% destes houve associação com lesão meniscal ipsilateral. Houve também importante associação com edema na medular óssea em correspondência (grau III em 16 casos. CONCLUSÃO: A ressonância magnética demonstrou ser um método não invasivo com boa sensibilidade no diagnóstico da osteonecrose do joelho, bem como das lesões associadas, sendo mais frequente nas mulheres (63% dos casos.OBJECTIVE: To describe epidemiological, clinical and magnetic resonance imaging findings of osteonecrosis in the distal femur and proximal tibia. MATERIALS AND METHODS: Evaluation of 19 patients (12 women and 7 men, with no previous history of causative factors, with magnetic resonance imaging findings suggestive of osteonecrosis in the tibial plateau or femoral condyle. RESULTS: Osteochondral abnormalities were observed in 63.1% of the cases; in 73.6% of them, such abnormality was associated with ipsilateral meniscal lesion. Also, a significant association with bone marrow edema (grade III in 16 cases was observed. CONCLUSION: Magnetic resonance imaging has demonstrated to be a noninvasive method with good sensitivity in the diagnosis of knee osteonecrosis as well as of associated lesions which are most frequently found in women (63% of cases.

  1. Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium); Shahabpour, Maryam; Milants, Annemieke; Ridder, Filip de; Mey, Johan de [Universitair Ziekenhuis Brussel, Department of Radiology, Jette, Brussels (Belgium); Lenchik, Leon [Wake Forest University, Department of Radiology, Winston-Salem, NC (United States); Cattrysse, Erik [Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium)

    2014-06-15

    The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 x 170; matrix, 424 x 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 x 105; matrix, 200 x 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to

  2. 关节镜下应用全内和外内缝合法治疗半月板损伤的临床研究%The Study of Using All-inside and Outside-in Suturing Technique to Treat Meniscus Tears Under Arthroscope

    Institute of Scientific and Technical Information of China (English)

    杨镇; 张明宇; 郑江; 张宪; 金善汝; 周伟; 刘阳; 张亮

    2013-01-01

    Objective To study the effects of the suturing meniscal tears using all-inside and outside-in technique under the arthroscope. Methods 63 cases of meniscal tears were sutured under arthroscope,using outside-inside technique to treat anterior angle、antero-body and medio-body of meniscus,and using all-inside technique to treat posterior angle、postero-body of meniscus. Results All patients were followed up for 6 to 12 months,the rate of symptomless for knee was 93%. According to Lysholm scoring scale system,the average score of operated knees inceresed from (42. 23 ± 5. 5 ) to (91. 35 ± 2. 72) after operation(P<0. 01). Conclusion The technique has the advantages of little damage and high healing rate.%目的 评价膝关节镜下应用全内和外内缝合法治疗半月板损伤的手术治疗效果.方法 63例半月板撕裂伤患者在关节镜下进行半月板缝合术,对前角及体前、中部损伤采用由外向内缝合法,对后角及体后部损伤采用全内半月板缝合方法.结果 全部病例经12~18个月随访,膝关节无症状率达93%.本组Lysholm膝关节功能评分术前(42.23±5.56)分,术后6个月提高到(91.35±2.72)分,两者比较差异有统计学意义(P<0.01).结论 关节镜下半月板缝合术具有损伤小及愈合率高等优点.

  3. Preparation and test of type Ⅰ collagen-glycosaminoglycan (GAG) template%Ⅰ型胶原-糖胺聚糖模板的制备与检测

    Institute of Scientific and Technical Information of China (English)

    徐青镭; 吴海山; 周维江; 赵定麟

    2001-01-01

    Objective: To synthesize the collagen-GAG template and to evaluate its feasibility to be used as the MSCs vehicle for meniscal tissue engineering. Methods: The collagen-GAG template was synthesized from rat tail type Ⅰ collagen and GAG using Yannas method. Then the post-stimulated MSCs by bFGF and TGF-β1 were added in. The MSCs-enriched collagen sponges were cultured in vitro, two weeks later the histological and ultrastructure detection was performed. Results: The histological and ultrastructure of the collagen-GAG template remained intact after 2 weeks' culture, and the MSCs in it remained viable. Conclusion: The collagen-GAG template synthesized in this experiment is suitable for the meniscal tissue engineering reconstruction as the vehicle for MSCs seed cells.%目的:制备胶原-糖胺聚糖模板,并检测其作为半月板组织工程重建的相关种子细胞载体的可行性。方法:采用Yannas法以大鼠尾作为原料提取Ⅰ型胶原,加入糖胺聚糖后冻干成为Ⅰ型胶原-糖胺聚糖模板,体外加入经碱性成纤维细胞生长因子(bFGF)和转化生长因子-β1(TGF-β1)协同刺激后的兔骨髓间充质干细胞培养2周后,行组织学及电镜检测。结果:培养2周后所制备的胶原-糖胺聚糖模板显微及超微结构保持良好,对骨髓间充质干细胞无毒害作用。结论:本实验方法所制备的胶原-糖胺聚糖模板适合用作半月板组织工程重建的种子细胞生物载体。

  4. Magneto-structural variety of new 3d-4f-4(5)d heterotrimetallic complexes.

    Science.gov (United States)

    Visinescu, Diana; Alexandru, Maria-Gabriela; Madalan, Augustin M; Pichon, Céline; Duhayon, Carine; Sutter, Jean-Pascal; Andruh, Marius

    2015-10-14

    Three families of heterotrimetallic chains (type 1-type 3), with different topologies, have been obtained by reacting the 3d-4f complexes, [{Cu(L(1))}xLn(NO3)3] with x = 1 or 2, formed in situ by the reaction of Schiff-base bi-compartmental [Cu(II)(L(1))] complexes and lanthanide(iii) salts, with (NHBu3)3[M(CN)8] (M = Mo(V), W(V)). For type 1 series of compounds, 1-D coordination polymers, with the general formula [{Cu2(valpn)2Ln}{M(CN)8}]·nH2O·mCH3CN (where H2valpn = 1,3-propanediylbis(2-iminomethylene-6-methoxy-phenol), result from the association of trinuclear {CuLn(III)} moieties and [M(V)(CN)8](3-) anions acting as tri-connecting spacers [Ln = La (1), Ce (2), Eu (3), Tb (4), Ho (5), M = Mo; Ln = Tb (6), Ho (7), M = W; m = 0, n = 1.5 (7) and 2 (1-4, 6); n = 1, m = 1 (5)]. The type 2 family has the general formula [{Cu(valdp)Ln(H2O)4}{M(CN)8}]·2H2O·CH3CN (where H2valdp = 1,2-propanediylbis(2-iminomethylene-6-methoxy-phenol)) and also consists of heterotrimetallic chains involving binuclear {Cu(II)Ln(III)} units linked to [M(CN)8](3-) anions coordinating through two cyano groups [Ln = Gd (8), Tb (9), Dy (10); M = Mo; Ln = La (11), Gd (12), Tb (13), Dy (14); M = W]. With large Ln(III) ions (La(III) and Pr(III)), the type 3 family of heterotrimetallic compounds are assembled: [{Cu2(valdp)2Ln(H2O)4}{Mo(CN)8}]·nCH3OH·mCH3CN, n, m = 0, Ln = La (15); n = m = 1, Pr (16), in which the trinuclear {CuLn(III)} nodes are connected to [Mo(V)(CN)8](3-) anions that act as tetra-connecting spacers. For Tb(III) derivatives of the type 1 (compounds 4 and 6), the DC magnetic properties indicate a predominant ferromagnetic Cu(II)-Tb(III) interaction, while the AC magnetic susceptibility (in the presence of a static magnetic field, HDC = 3000 Oe) emphasize the slow relaxation of the magnetization (Ueff/kB = 20.55 K and τ0 = 5.5 × 10(-7) s for compound 4, Ueff/kBT = 15.1 K and τ0 = 1.5 × 10(-7) s for compound 6). A predominant ferromagnetic Cu(II)-Ln(III) interaction was

  5. Population pharmacokinetics and pharmacodynamics of hydroxyurea in sickle cell anemia patients, a basis for optimizing the dosing regimen

    Directory of Open Access Journals (Sweden)

    Galactéros Frédéric

    2011-05-01

    Full Text Available Abstract Background Hydroxyurea (HU is the first approved pharmacological treatment of sickle cell anemia (SCA. The objectives of this study were to develop population pharmacokinetic(PK-pharmacodynamic(PD models for HU in order to characterize the exposure-efficacy relationships and their variability, compare two dosing regimens by simulations and develop some recommendations for monitoring the treatment. Methods The models were built using population modelling software NONMEM VII based on data from two clinical studies of SCA adult patients receiving 500-2000 mg of HU once daily. Fetal hemoglobin percentage (HbF% and mean corpuscular volume (MCV were used as biomarkers for response. A sequential modelling approach was applied. Models were evaluated using simulation-based techniques. Comparisons of two dosing regimens were performed by simulating 10000 patients in each arm during 12 months. Results The PK profiles were described by a bicompartmental model. The median (and interindividual coefficient of variation (CV of clearance was 11.6 L/h (30%, the central volume was 45.3 L (35%. PK steady-state was reached in about 35 days. For a given dosing regimen, HU exposure varied approximately fivefold among patients. The dynamics of HbF% and MCV were described by turnover models with inhibition of elimination of response. In the studied range of drug exposures, the effect of HU on HbF% was at its maximum (median Imax was 0.57, CV was 27%; the effect on MCV was close to its maximum, with median value of 0.14 and CV of 49%. Simulations showed that 95% of the steady-state levels of HbF% and MCV need 26 months and 3 months to be reached, respectively. The CV of the steady-state value of HbF% was about 7 times larger than that of MCV. Simulations with two different dosing regimens showed that continuous dosing led to a stronger HbF% increase in some patients. Conclusions The high variability of response to HU was related in part to pharmacokinetics and

  6. Cinética da fermentação in vitro do capim-Marandu em diferentes idades de corte - doi: 10.4025/actascianimsci.v33i3.9462 In vitro ruminal fermentation kinetics of Marandu grass at different harvest ages - doi: 10.4025/actascianimsci.v33i3.9462

    Directory of Open Access Journals (Sweden)

    Mauro Pereira de Figueiredo

    2011-06-01

    Full Text Available O objetivo do trabalho foi avaliar os parâmetros da cinética de degradação ruminal da Brachiaria brizantha cv. Marandu, cortadas aos 28, 35 e 54 dias, pela técnica in vitro de produção de gases. Foram realizadas determinações dos teores de matéria seca (MS, matéria orgânica (MO, proteína bruta (PB, extrato etéreo (EE, fibra em detergente neutro corrigida para cinzas e proteína (FDNCP, fibra em detergente ácido (FDA, nitrogênio insolúvel em detergente neutro (NIDN, nitrogênio insolúvel em detergente ácido (NIDA, lignina (LIG, Carboidratos totais (CT, carboidratos não fibrosos (CNF, fração B2 e fração C, respectivamente. Os dados da produção de gases foram ajustados ao modelo logístico bicompartimental. O delineamento utilizado foi inteiramente casualizado. Os dados foram submetidos à análise de variância e regressão, ao nível de 5% de probabilidade. Houve efeito (p CP, FDA, NIDN, NIDA, CT, B2, com aumento linear à medida que avançou a idade de corte. Para a produção de gases a fração A foi semelhante entre as idades de 28 e 35 dias, com 95,75 e 116,8 mL 1g-1 de MS, respectivamente. A idade recomendada para obtenção do melhor valor nutricional do Brachiaria brizantha cv. Marandu foi aos 28 dias.The objective of the work was to evaluate ruminal fermentation kinetics parameters of Brachiaria brizantha, harvested at 28, 35 and 54 days, using the semiautomatic in vitro gas production technique. Analyses were carried out for dry matter (DM, organic matter (OM, crude protein (CP, ether extract (EE, neutral detergent fiber corrected for ash and protein (NDFAP, acid detergent fiber (ADF, neutral detergent insoluble nitrogen (NDIN, acid detergent insoluble nitrogen (ADIN, lignin (LIG, total carbohydrates (TC, non-fiber carbohydrates (NFC, fraction B2 and the fraction C, respectively. The data of gas production were adjusted to the bicompartmental logistic model. The design used was completely randomized. The data

  7. Uranium hetero-bimetallic complexes: synthesis, structure and magnetic properties; Complexes heterobimetalliques de l'uranium: synthese, structure et proprietes magnetiques

    Energy Technology Data Exchange (ETDEWEB)

    Le Borgne, Th

    2000-10-04

    The aim of this thesis is to synthesize molecular complexes with uranium and transition metal ions in close proximity, to determine the nature of the magnetic interaction between them. We decided to use Schiff bases as assembling ligands, which are unusual for uranium (IV). Although the simplest Schiff bases, such as H{sub 2}Salen, lead to ligand exchange reactions, the bi-compartmental Schiff base H{sub 4}L{sup 6} (bis(3-hydroxy-salicylidene) - 2,2-dimethyl-propylene) allows the crystal structure determination of the complex [L{sup 6}Cu(pyr)]U[L{sup 6}Cu].2pyr, obtained by reaction of the metallo-ligand H{sub 2}L{sup 6}Cu with U(acac){sub 4}. In this manner, the complexes [L{sup 6}Co(pyr)]{sub 2}U and [L{sup 6}Ni(pyr)]{sub 2}U.pyr were also isolated, as well as the compounds in which the paramagnetic ions have been exchanged by the diamagnetic ions Zn{sup II}, Zr{sup IV} and Th{sup IV}': [L{sup 6}Zn(pyr)]{sub 2}U, [L{sup 6}Cu]{sub 2}Zr and [L{sup 6}Cu(pyr)]Th[L{sup 6}Cu].2pyr. These complexes are the first which involve three metallic centres assembling by the means of a hexa-dentate Schiff base. The crystalline structures show, for all these complexes, the outstanding orthogonal arrangement of the two fragments L{sup 6}M around the central atom which is in a dodecahedral environment of eight oxygen atoms of two Schiff bases. The syntheses of the isostructural complexes Cu2{sup II} and Zn{sub 2}U in which the uranium (IV) ion is close, in the first one, to the paramagnetic ion Cu{sup II} and, in the second one, to the diamagnetic ion Zn{sup II}, has allowed the use of the empiric method to determine the nature of the magnetic interaction between an f element and a transition metal. The comparison of the magnetic behaviour of two complexes Cu{sub 2}U and Zn{sub 2}U, expressed by the variation of {chi}T vs T, reveals the ferromagnetic interaction in the heart of the triad Cu-U-Cu. The magnetic behaviour of the complexes Cu{sub 2}Th et Cu{sub 2}Zr which does not

  8. MR imaging of the knee using fat suppression technique: a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Jin Suck; Kim, Mi Hye; Cho, Jae Hyun; Park, Chang Yun; Lee, Yeon Hee [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo [Inje University College of Medicine, Kimhae (Korea, Republic of)

    1994-03-15

    The purpose of this study is to evaluate the usefulness of fat suppression technique for MR imaging of the knee. Twenty-eight knees of 26 patients were imaged at a 1.5 T MR system. Sagittal and coronal T2-weighted spin echo imaged (SET2) and sagittal fat suppression SET2(FSSE) were obtained in all cases. We used a chemical shift imaging method for fat suppression. We compared FSSE with SET2 in terms of the conspicuity of lesions of menisci, cruciate ligaments, cartilage, bone and soft tissue of the knee. Meniscal lesions were detected on FSSE and SET2 as well. FSSE depicted the lesion more conspicuously in 6 cases. For the depiction of ACL tear, SET2 was superior to FSSE in 5 cases. FSSE was better for the visualization of the normal structure of cartilage and it also depicted the cartilaginous lesions more conspicuously in 3 cases. Though bone bruise could be detected on both techniques, FSSE was better. FSSE could provide the improved delineation of menisci, cartilage, bone bruise and other soft tissues except the injuries of anterior cruciate ligament. Although FSSE is a reliable method, it can not replace SET2. It may be used as a complemental method in the imaging of the knee.

  9. Timing of surgery in anterior cruciate ligament-injured knees.

    Science.gov (United States)

    Shelbourne, K D; Patel, D V

    1995-01-01

    Despite recent advances in the surgical techniques of anterior cruciate ligament (ACL) reconstruction in the past two decades, there is no consensus of opinion as to the ideal timing for ACL surgery. Based on the evolution of management of patients with ACL injuries over the period 1982-1994, we have found that various factors need to be considered in order to provide the best possible long-term result to the patient with minimal or no complications. In this review, we discuss the perioperative factors that one must consider to determine optimum timing for ACL surgery. Factors such as mental preparation of the patient; school, work, family, and social schedules; preoperative condition of the knee [i.e., minimal or no swelling, good strength, good leg control, and full range of motion (ROM) including full hyperextension]; and associated ligamentous and/or meniscal injuries must be considered before undertaking ACL surgery. With careful consideration of the above-mentioned factors and with our preoperative and postoperative rehabilitation program, we have been able to obtain predictable, successful, long-term results following ACL reconstruction in our athletic population. We emphasize that every patient should be treated on his or her own merit, and treatment decisions must be individualized.

  10. Pseudodynamic imaging of the temporomandibular joint: SE versus GE sequences

    Energy Technology Data Exchange (ETDEWEB)

    Masui, Takayuki; Isoda, Haruo; Mochizuki, Takao [Hamamatsu Univ. School of Medicine, Hamamatsu City (Japan)] [and others

    1996-05-01

    Pseudodynamic MR imaging of the temporomandibular joints (TMJs) has been used for the evaluation of the functional aspects of the TMJs. To evaluate the value of T1-weighted spin-echo (SE) and gradient-echo (GE) techniques, both techniques were performed in 9 asymptomatic (mean 25.7 years, 22-32 years), and 25 symptomatic (mean 44.9 years, 20-71 years) subjects with signs and symptoms of internal derangement or osteoarthrosis of the TMJs. The imaging time for the SE (180 ms / 15 ms / 110{degrees} repetition time / echo time /flip angle) and GE (fast low angle shot; FLASH, 90 ms / 12 ms / 40{degrees}) sequences was 27 and 28 s, respectively. In asymptomatic and symptomatic subjects, the confidence of the identification of the meniscal position was better on SE than GE images (3.6 {+-} 0.6 vs. 2.9 {+-} 0.9, p < 0.01, 3.2 {+-} 0.8 vs. 2.8 {+-} 0.8, p < 0.05), respectively and the sizes of the menisci were bigger on SE than GE images. The delineation of the condylar cortex was better on GE than SE images. For pseudodynamic imaging display of the TMJs, the SE images might be better than GE images to provide the stable recognition of the menisci. 17 refs., 7 figs., 5 tabs.

  11. In Vitro Testing of Scaffolds for Mesenchymal Stem Cell-Based Meniscus Tissue Engineering—Introducing a New Biocompatibility Scoring System

    Directory of Open Access Journals (Sweden)

    Felix P. Achatz

    2016-04-01

    Full Text Available A combination of mesenchymal stem cells (MSCs and scaffolds seems to be a promising approach for meniscus repair. To facilitate the search for an appropriate scaffold material a reliable and objective in vitro testing system is essential. This paper introduces a new scoring for this purpose and analyzes a hyaluronic acid (HA gelatin composite scaffold and a polyurethane scaffold in combination with MSCs for tissue engineering of meniscus. The pore quality and interconnectivity of pores of a HA gelatin composite scaffold and a polyurethane scaffold were analyzed by surface photography and Berliner-Blau-BSA-solution vacuum filling. Further the two scaffold materials were vacuum-filled with human MSCs and analyzed by histology and immunohistochemistry after 21 days in chondrogenic media to determine cell distribution and cell survival as well as proteoglycan production, collagen type I and II content. The polyurethane scaffold showed better results than the hyaluronic acid gelatin composite scaffold, with signs of central necrosis in the HA gelatin composite scaffolds. The polyurethane scaffold showed good porosity, excellent pore interconnectivity, good cell distribution and cell survival, as well as an extensive content of proteoglycans and collagen type II. The polyurethane scaffold seems to be a promising biomaterial for a mesenchymal stem cell-based tissue engineering approach for meniscal repair. The new score could be applied as a new standard for in vitro scaffold testing.

  12. MR imaging findings in early osteoarthritis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Karachalios, Theofilos E-mail: kar@med.uth.gr; Zibis, Aristidis; Papanagiotou, Panagiotis; Karantanas, Apostolos H.; Malizos, Konstantinos N.; Roidis, Nikolaos

    2004-06-01

    Purpose: To carry out a modern diagnostic survey among patients with a clinical and radiological diagnosis of early osteoarthritis of the knee. Materials and methods:A magnetic resonance imaging survey was performed on 70 patients (82 knees) with a mean age of 59 years. (range, 40-71 years) who had chronic knee pain, clinical diagnosis of early osteoarthritis of the knee and conventional knee radiographs classified as 1 and 2 on the Kellgren-Lawrence scale. Results: A variety of different disorders was found; degenerative meniscal lesions with or without ruptures of the anterior cruciate ligament in 70.7% of the knees, osteonecrosis of the femoral and tibial condyles in 9.75%, osteophytes and degenerative articular cartilage lesions in 8.54%, transient osteoporosis in 2.44% and benign neoplasms and cysts in 6.1%. Conclusions: The existence of such a heterogenous group of disorders in these 'early osteoarthritic knees' may explain failures in treatment and it may justify a modern MRI imaging approach to proper diagnosis.

  13. MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined

    Energy Technology Data Exchange (ETDEWEB)

    Ramnath, R. Richard; Kattapuram, Susan V. [Harvard Medical School, Massachusetts General Hospital, Boston (United States)

    2004-10-01

    To investigate the MR characteristics of SONK-like (spontaneous osteonecrosis of the knee) subchondral abnormalities in the adult atraumatic knee and to recategorize these patients into two subgroups: a subacute to chronic process associated with osteoarthritis and an acute process associated with insufficiency fractures. We retrospectively examined the knee MRIs of 39 patients with non-specific interpretations of osteochondral abnormalities. There were a total of 52 subchondral lesions without any known traumatic event and no prior surgery. All lesions evaluated had MR features previously ascribed to SONK. Several MR characteristics were then assessed: presence or absence of a line, size, zonal location, T1 and T2 signal, associated marrow edema, associated ipsilateral meniscal tear, and associated ipsilateral cartilage defects. The abnormalities with linear components (insufficiency fractures) tended to be larger (P<0.01) and were associated with a severe amount of marrow edema (P<0.0001) consistent with an acute process. The non-linear abnormalities were more associated with cartilage defects (P=0.01) and less marrow edema consistent with osteoarthritis and a subacute to chronic process. This association of SONK-like abnormalities with osteoarthritis and insufficiency fractures casts doubt on the validity of the term ''spontaneous osteonecrosis'' as it is currently applied, and further investigation into the separate etiologies of these subchondral marrow lesions is needed. (orig.)

  14. [Material properties of meniscus tissue and the effect of the menisci on the compression behavior of the knee joint].

    Science.gov (United States)

    Kohn, D; Mussack, T; Plitz, W

    1993-01-01

    Specimens of meniscus tissue were taken from different locations of the medial and lateral meniscus. They were tested to failure in the tensometer and force elongation diagrams were recorded. 28 meniscus specimens (14 medial, 14 lateral) gained at autopsy were available for testing. The posterior third of the medial meniscus and the middle third of the lateral meniscus were the strongest and stiffest parts of the meniscus. Yet local differences within one meniscus were only subtle. One clinical significance of these data is, that for replacement of the medial and lateral meniscus the same homogeneous material can be employed. Six tests under compression were carried out using six knee specimens gained at autopsy. Knee compression tests yielded different results after radial cutting of the meniscus, whereas partial meniscectomy had no effect on deformation and hysteresis. These biomechanical results support the concept of partial meniscectomy and preservation of the meniscal periphery. But they cannot be related to the problem of possible degenerative arthritis after partial meniscectomy.

  15. Pseudoaneurysm after arthroscopic procedure in the knee

    Directory of Open Access Journals (Sweden)

    Edmar Stieven Filho

    2015-04-01

    Full Text Available The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%, followed by pulsating tumor (31%, edema of the calf (12% and hemarthrosis (11%. The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.

  16. The MRI appearance of cystic lesions around the knee

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, Catherine L.; McNally, Eugene G. [Department of Radiology, Nuffield Orthopaedic Centre, Windmill Road, OX3 7LD, Headington, Oxford (United Kingdom)

    2004-04-01

    This review presents a comprehensive illustrated overview of the wide variety of cystic lesions around the knee. The aetiology, clinical presentation, MRI appearances and differential diagnosis are discussed. Bursae include those related to the patella as well as pes anserine, tibial collateral ligament, semimembranosus-tibial collateral ligament, iliotibial and fibular collateral ligament-biceps femoris. The anatomical extension, imaging features and clinical significance of meniscal cysts are illustrated. Review of ganglia includes intra-articular, extra-articular, intraosseous and periosteal ganglia, highlighting imaging findings and differential diagnoses. The relationship between proximal tibiofibular joint cysts and intraneural peroneal nerve ganglia is discussed. Intraosseous cystic lesions, including insertional and degenerative cysts, as well as lesions mimicking cysts of the knee are described and illustrated. Knowledge of the location, characteristic appearance and distinguishing features of cystic masses around the knee as well as potential imaging pitfalls such as normal anatomical recesses and atypical cyst contents on MR imaging aids in allowing a specific diagnosis to be made. This will prevent unnecessary additional investigations and determine whether intra-articular surgery or conservative management is appropriate. (orig.)

  17. Ergonomic handle for an arthroscopic cutter.

    Science.gov (United States)

    Tuijthof; van Engelen; Herder; Goossens; Snijders; van Dijk

    2003-03-01

    From an analysis of the routinely performed meniscectomy procedures, it was concluded that a punch with a side-ways steerable tip would improve the reachability of meniscal tissue. This potentially leads to a safer and more efficient meniscectomy. Furthermore, the current scissors handles of arthroscopic punches are ergonomically not sufficient. An ergonomic handle is designed with one lever that enables opening and closing of the instrument tip, and side-ways steering of the instrument tip. The design of the handle complies with ergonomic guidelines that were found in the literature. A model of the instrument tip was added to the new handle for comparison with conventional handles. Experiments were performed with a knee joint model, using objective and subjective criteria. The results show that the concept of a side-ways steerable punch is promising, since faster task times are achieved without increasing the risk of damaging healthy tissue. The current design of the ergonomic handle incorporates two degrees of freedom in an intuitive way, the handle is more comfortable to hold, and easy to control. The external memory capabilities of the new handle could be improved. Further development of this handle and the addition of a sufficient instrument tip and force transmission are recommended.

  18. Glanzmann’s Thrombasthenia Diagnosed following Knee Arthroscopy

    Directory of Open Access Journals (Sweden)

    John E. Zvijac

    2015-01-01

    Full Text Available A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests, and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, the patient underwent a second arthroscopy, during which a hematoma was removed and a synovectomy performed. The patient continued bleeding from the incisions after portals were sutured, and he was admitted to the hospital. A hematologist was consulted and comprehensive platelet aggregation testing revealed previously undiagnosed Glanzmann’s thrombasthenia. The patient began treatment with platelet infusions and desmopressin and progressed to a full recovery. Clinical suspicion for surgical patients with unusual repetitive postoperative bleeding should include previously undetected rare bleeding disorders even in adults.

  19. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures

    Institute of Scientific and Technical Information of China (English)

    DUAN Xiao-jun; YANG Liu; GUO Lin; CHEN Guang-xing; DAI Gang

    2008-01-01

    Objective: To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures.Methods: A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005,including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury.There were 4 cases of type I fracture,12 type II,9 type III,12 type IV and 2 type V according to Schatzker criteria.Firstly,the combined injuries were treated.Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed.Finally,the internal fixation was observed by X-ray equipment.Postoperative management was early motion and delayed weight bearing.Results: All the fractures healed in 3 or 4 months.All patients were followed up for 1 to 5 years after operation.No case had severe complications,such as poor wound healing,infection,osteofascial compartment syndrome and osteoarthritis.According to the Rasmussen scoring system,36 cases obtained excellent or good results and the other 3 cases had moderate clinical results.The average score was 26 ± 3.Conclusions: As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture,arthroscopy has many advantages.It can treat associated intraarticular soft tissue components,visualize the chondral surface reduction,lavage the hematoma and smaller loose fragments,decrease soft tissue dissection,reduce the risk of scarring and promote rapid recovery.

  20. Function of the medial meniscus in force transmission and stability.

    Science.gov (United States)

    Walker, Peter S; Arno, Sally; Bell, Christopher; Salvadore, Gaia; Borukhov, Ilya; Oh, Cheongeun

    2015-06-01

    We studied the combined role of the medial meniscus in distributing load and providing stability. Ten normal knees were loaded in combinations of compressive and shear loading as the knee was flexed over a full range. A digital camera tracked the motion, from which femoral-tibial contacts were determined by computer modelling. Load transmission was determined from the Tekscan for the anterior horn, central body, posterior horn, and the uncovered cartilage in the centre of the meniscus. For the three types of loading; compression only, compression and anterior shear, compression and posterior shear; between 40% and 80% of the total load was transmitted through the meniscus. The overall average was 58%, the remaining 42% being transmitted through the uncovered cartilage. The anterior horn was loaded only up to 30 degrees flexion, but played a role in controlling anterior femoral displacement. The central body was loaded 10-20% which would provide some restraint to medial femoral subluxation. Overall the posterior horn carried the highest percentage of the shear load, especially after 30 degrees flexion when a posterior shear force was applied, where the meniscus was estimated to carry 50% of the shear force. This study added new insights into meniscal function during weight bearing conditions, particularly its role in early flexion, and in transmitting shear forces.

  1. Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy.

    Science.gov (United States)

    Meinig, R P; Holtgrewe, J L; Wiedel, J D; Christie, D B; Kestin, K J

    1988-01-01

    Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 patients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee. Electrocardiogram tracings, blood pressure, and neurologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the following procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Monitoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupivacaine. The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 +/- 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupivacaine is convenient, efficacious, and pharmacologically safe for routine clinical arthroscopy.

  2. Value of scintiscanning using 99mTc-MDP to assess disorders of the knee and ankle joints in orthopedic patients as compared to that of X-ray procedures. Die Wertigkeit der Scintigraphie mit 99m Tc-MDP bei Knie- und Fussgelenksaffektionen des orthopaedischen Krankenguts im Vergleich zur Roentgendiagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Buyer, B.

    1983-10-20

    Relevant analyses were carried out on the basis of the data of 100 patients. The radiopharmaceutical examinations were performed using a scanner two hours after injection of 10 mCi 99mTc-MDP. Following interpretation of the density patterns, the concentration quotients of the scintiscans were calculated to permit a semi-quantitative assessment to be made. As far as arthropathies were concerned, the scintiscans did not contribute much useful information to diagnose patellar chondropathy at an early stage of the disease, nor were they seen to offer any decisive advantages over X-ray examinations in degenerative disorders of the joints. Scintiscanning was also found an unsuitable method to differentiate athritis from arthrosis. Under certain circumstances, joint scintiscanning may have an additional indication in the diagnosis of meniscitis. In rheumatoid arthritis and Sudeck's syndrome the scintiscans were found to be in better agreement with the clinical symptoms than the corresponding X-ray findings. In soft tissue disorders scintiscanning did not appear to be an adequate method to obtain additional diagnostic information. On the other hand, all types of osteopathy caused by inflammation, necrosis, neoplasms or cysts are clearly falling within the domaine of scintiscanning. Foot deformities were invariably seen to be associated with locallised concentration of the tracer substance. Owing to the limited specifity of radiopharmaceutical investigations using 99mTc-MDP, concentional X-ray examinations will indispensable in the vast majority of cases. (TRV).

  3. Fluids of the ocular surface: concepts, functions and physics.

    Science.gov (United States)

    Cher, Ivan

    2012-08-01

    General adoption of the ocular surface (OS) concept has advanced the therapy of the external eye. Fresh physical findings have prompted new concepts; examples taken from each section of the text are: (i) ever-present lipid sealant bridges the palpebral fissure capping the three-dimensional 'OS' sac. The muco-aqueous pool (MAP) is thus enclosed, secluded from atmosphere, evaporation mitigated. Hence, the OS is conceptually, a compartment. The term 'dacruon' (otherwise 'tear film') has been coined for the combined fluids of the OS, viz. lipid film and MAP. (ii) Investigative techniques of physics yield data on (say) surface tension and viscosity, and on functions such as anchorage of dacruon base to the varied mucosae of the OS, lubrication, renovation of intermarginal fluid layers as the eye opens after each blink, and refinement of optics and vision by the fluids attached to the cornea. (iii) Physical events in the opening eye produce the unique 'black line' phenomenon in which capillary force induces subsurface flows into thirsty menisci, bringing about parameniscal dark grooves, pupil-ward of each meniscus. Attenuation of fluorescein in the shallowed fluid gaps behind each groove makes the dye appear unilluminated ('black lines') relative to adjacent full-thickness MAP fluid glowing under cobalt-blue illumination. Isolated from cornea by grooves and gaps, the meniscal fluid cannot pass freely over the cornea. It therefore streams through the menisci to nasolacrimal outflow.

  4. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis.

    Science.gov (United States)

    Smith, Toby O; Jerman, Emma; Easton, Victoria; Bacon, Holly; Armon, Kate; Poland, Fiona; Macgregor, Alex J

    2013-11-01

    Joint proprioceptive deficit is documented in a variety of musculoskeletal conditions including osteoarthritis, ligament and meniscal injuries, and individuals with increased joint hypermobility, such as those with Ehlers-Danlos. No systematic reviews have assessed joint proprioception in people with benign joint hypermobility syndrome (BJHS). This study addresses this to determine whether people with BJHS exhibit reduced joint proprioception, and, if so, whether this is evident in all age groups. The search strategy was conducted on 31st January 2013. The published literature was assessed using the databases: AMED, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library. Unpublished literature and trial registries were assessed including: OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive. All studies comparing the proprioceptive capability of people with and without BJHS were included. Study methodological quality was assessed using the CASP appraisal tool. Meta-analysis techniques were used when study homogeneity permitted. Five studies including 254 people were identified. People with BJHS demonstrated statistically significantly poorer lower limb joint position sense (JPS) (p proprioceptive difference was less clear, with no statistically significant difference between the cohorts for shoulder JPS (p = 0.10), but a statistically significant difference in finger JPS (p proprioceptive capability in those with BJHS (p proprioception is reduced in those with BJHS compared to non-BJHS cohorts, whilst unclear in the upper limb.

  5. FDA regulation of adult stem cell therapies as used in sports medicine.

    Science.gov (United States)

    Chirba, Mary Ann; Sweetapple, Berkley; Hannon, Charles P; Anderson, John A

    2015-02-01

    In sports medicine, adult stem cells are the subject of great interest. Several uses of stem cells are under investigation including cartilage repair, meniscal regeneration, anterior cruciate ligament reconstruction, and tendinopathy. Extensive clinical and basic science research is warranted as stem cell therapies become increasingly common in clinical practice. In the United States, the Food and Drug Administration (FDA) is responsible for regulating the use of stem cells through its "Human Cells, Tissues, and Cellular and Tissue-Based Products" regulations. This report provides a brief overview of FDA regulation of adult stem cells. Several common clinical case scenarios are then presented that highlight how stem cells are currently being used in sports medicine and how current FDA regulations are likely to affect the physicians who use them. In the process, it explains how a variety of factors in sourcing and handling these cells, particularly the extent of cell manipulation, will affect what a physician can and cannot do without first obtaining the FDA's express approval.

  6. Obesity-related juvenile form of cartilage lesions: a new affliction in the knees of morbidly obese children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Widhalm, Harald K.; Marlovits, Stefan; Vecsei, Vilmos [Medical University of Vienna, Center for Joints and Cartilage, Department of Traumatology, Vienna (Austria); Welsch, Goetz H. [Medical University of Vienna, MR Center, Department of Radiology, Vienna (Austria); University Hospital of Erlangen, Department of Trauma Surgery, Erlangen (Germany); Dirisamer, Albert [Medical University of Vienna, Department of Radiology, Vienna (Austria); Neuhold, Andreas [Private Hospital Rudolfinerhaus, Department of Radiology, Vienna (Austria); Griensven, Martijn van [Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna (Austria); Seemann, Rudolf [Medical University of Vienna, Department of Cranio-Maxillofacial and Oral Surgery, Vienna (Austria); Widhalm, Kurt [Medical University of Vienna, Division of Nutrition and Metabolism, Department of Pediatrics, Vienna (Austria)

    2012-03-15

    Overweight and obesity are afflictions that lead to an increased risk of health problems including joint problems. The aim of the study was to assess the condition of articular cartilage in obese adolescent patients suffering from knee pain. MRI of 24 knees of 20 morbidly obese patients, mean age 14.2 years, was performed in an open 1.0 Tesla MR system, where the cartilage, the quality and structure of the menisci, and the presence or absence of surrounding changes was examined. In all patients a cartilage lesion in at least one region of the knee could be detected. Retropatellar cartilage lesions have been found in 19 knees. Ten cartilage lesions grade I, and four lesions grade II have been described in the lateral compartment of the knee, whereas the medial compartment showed in eight cases a grade I, in 13 cases a grade II and in two cases a grade III cartilage lesion. Meniscal changes were assessed in most patients. Morbidly obese children and adolescents show major abnormalities in the articular cartilage of the knee. Whether obesity alone is the causal factor for the development of the pattern of these changes, remains to be seen. (orig.)

  7. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year

    Energy Technology Data Exchange (ETDEWEB)

    Roemer, Frank W. [Boston University School of Medicine, Quantitative Imaging Center, Department of Radiology, Boston, MA (United States); University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Kwoh, C.K. [University of Arizona Arthritis Center and University of Arizona College of Medicine, Tucson, AZ (United States); Hannon, Michael J.; Grago, Jason [University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA (United States); Hunter, David J. [University of Sydney, Department of Rheumatology, Royal North Shore Hospital and Kolling Institute, St Leonards (Australia); Eckstein, Felix [Paracelsus Medical University, Institute of Anatomy, Salzburg (Austria); Boudreau, Robert M. [University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA (United States); Englund, Martin [Lund University, Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund (Sweden); Guermazi, Ali [Boston University School of Medicine, Quantitative Imaging Center, Department of Radiology, Boston, MA (United States)

    2017-01-15

    To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year. We studied 355 knees from the Osteoarthritis Initiative that developed ROA (Kellgren-Lawrence grade ≥ 2), which were matched with control knees. The MR images were assessed using the semi-quantitative MOAKS system. Conditional logistic regression was applied to estimate risk of incident ROA. Logistic regression was used to assess the risk of worsening cartilage damage in knees with partial meniscectomy that developed ROA. In the group with incident ROA, 4.4 % underwent partial meniscectomy during the year prior to the case-defining visit, compared with none of the knees that did not develop ROA. All (n = 31) knees that had partial meniscectomy and 58.9 % (n = 165) of the knees with prevalent meniscal damage developed ROA (OR = 2.51, 95 % CI [1.73, 3.64]). In knees that developed ROA, partial meniscectomy was associated with an increased risk of worsening cartilage damage (OR = 4.51, 95 % CI [1.53, 13.33]). The probability of having had partial meniscectomy was higher in knees that developed ROA. When looking only at knees that developed ROA, partial meniscectomy was associated with greater risk of worsening cartilage damage. (orig.)

  8. Fratura avulsão do planalto tibial medial (Segond reverso Avulsion fracture of the medial tibial plateau (reverse Segond injury

    Directory of Open Access Journals (Sweden)

    Fabio Janson Angelini

    2007-01-01

    Full Text Available Descreve-se neste artigo um padrão de lesão descrito na literatura apenas duas vezes, num total de quatro casos, denominado Segond reverso por apresentar achados clínicos e radiológicos exatamente opostos aos da clássica lesão de Segond. Semelhantemente aos casos previamente descritos, apresentou fratura avulsão do planalto tibial medial, na inserção do ligamento colateral medial profundo, associada a lesão do ligamento cruzado posterior. Assim como em um dos casos prévios, foi constatada lesão do ligamento cruzado anterior. Entretanto, diferiu dos anteriormente relatados por não apresentar lesão do menisco medial.This article reports an injury pattern described only twice in literature, totaling four cases, and referred to as reverse Segond injury for its clinical and radiological findings are precisely opposite to those observed in the classical Segond injury. Similarly to the previously described cases, our case reported avulsion fracture of the medial tibial plateau at the insertion of the deep tibial collateral ligament, associated to posterior cruciate ligament injury. Similarly to one of the previous cases, anterior cruciate ligament injury was found in our case, although it differs from the previous ones because it does not show medial meniscal injury.

  9. Avulsion Fractures of the Knee: Imaging Findings and Clinical Significance

    Directory of Open Access Journals (Sweden)

    Babak Sanei

    2010-05-01

    Full Text Available The knee is an intricate joint with numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to complex injuries after trauma. A variety of avulsion fractures of the knee can occur, including Segond and reverse Segond fractures; avulsions of the anterior and posterior cruciate ligaments; arcuate complex avulsion; iliotibial band avulsion; avulsions of the biceps femoris, semimembranous, and quadriceps tendons; Sinding-Larsen-Johansson syndrome; and Osgood- Schlatter disease. These fractures often have a subtle appearance at conventional radiography, which is typically the first imaging modality performed in these cases. Advanced imaging modalities, particularly magnetic resonance imaging, are helpful and can provide valuable additional information for adequately defining the extent of damage. The onus is on the radiologist to identify the pattern of injury and to understand the substantial underlying damage that it frequently represents. Conveying this information to the referring clinician is crucial and represents the first step toward additional evaluation and probable orthopedic referral. By recognizing the significance of these injuries at initial presentation, radiologists can facilitate appropriate patient work-up and prevent the chronic morbidity associated with delayed treatment.

  10. MR findings in iliotibial band syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, G.; Yamato, M. [Department of Radiology, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi-ken 321-02 (Japan); Tamai, K. [Department of Orthopedic Surgery, Dokkyo University School of Medicine, Tochigi-ken (Japan); Takahashi, J. [Department of Orthopedic Surgery, Shimizu Municipal Hospital, Shimizu (Japan); Uetani, M. [Department of Radiology, Nagasaki University School of Medicine, Nagasaki (Japan)

    1997-09-01

    Objective. To elucidate the MR findings in iliotibial band (ITB) syndrome. Design and patients. The subjects comprised four patients (five knees) with lateral knee pain: two athletes and two non-athletes. One non-athlete was engaged in work requiring repetitive knee movement, and the other suffered from Cushing syndrome and had bilateral abnormalities. All patients were suspected of having a lateral meniscal tear prior to MR examination, but physical examination following provisional MR diagnosis warranted the final diagnosis. MR studies included fast spin echo sagittal imaging, fat-saturated fast spin echo proton density coronal imaging, and T2* radial imaging. Twelve normal volunteers were examined. Results and conclusion. Fat-saturated coronal imaging demonstrated an ill-defined, high-intensity area deep to the ITB. T2* radial imaging showed an identical, but less conspicuous, abnormality. The MR finding suggested soft tissue inflammation and/or edema rather than focal fluid collection in the bursae. The signal alteration predominated in the region beneath the posterior fibers of the ITB, thus supporting the current opinion that the posterior fibers of the ITB are tighter against the lateral femoral epicondyle than the anterior fibers. The ITB itself did not show any signal alteration or increased thickness. (orig.). With 4 figs., 1 tab.

  11. Diagnosis and reconstruction of the human temporomandibular joint after trauma or internal derangement.

    Science.gov (United States)

    Bessette, R W; Katzberg, R; Natiella, J R; Rose, M J

    1985-02-01

    This study reviewed the standardized records of 1100 patients with the symptoms of temporomandibular joint syndrome. Of these patients, only 4.5 percent required surgical intervention. The remaining patients were found to have masticatory muscle spasm and were treated by conservative dental methods. Over half the surgical patients had significant macrotrauma to the jaws in their past history. In addition, electromyographic measurement of the masseteric silent period duration in these patients did not reveal muscle spasm. These factors further serve to differentiate the surgical patient from the patient with myofascial pain dysfunction. The patients selected for surgery demonstrated moderate to severe joint disease and required arthroplasty with partial meniscectomy. A surgical technique is presented demonstrating the reconstruction of the meniscus with silicone implant. This same surgical technique is studied in 10 monkeys, and their joints are examined histologically. The results of surgery reveal that 87 percent of the patients reported improvement 1 year after surgery. In all patients complaining of temporomandibular joint clicking or crepitus, surgery produced complete alleviation of these symptoms. The results of surgery were also associated with a 62 percent increase of jaw opening. Histologic evaluation of the human meniscal resections revealed that in addition to an anatomic displacement of the meniscus, there are also significant cellular changes. These changes consisted of calcification, a decrease in cellularity, hyperemia, and a decrease in elastin content.

  12. Diagnostic Efficiency of MR Imaging of the Knee. Relationship to time Interval between MR and Arthroscopy; Eficacia diagnostica de la RM de rodilla. Relacion con el intervalo de tiempo entre la RM y la artroscopia

    Energy Technology Data Exchange (ETDEWEB)

    Barrera, M. C.; Recondo, J. A.; Aperribay, M.; Gervas, C.; Fernandez, E.; Alustiza, J. M.

    2003-07-01

    To evaluate the efficiency of magnetic resonance (MR) in the diagnosis of knee lesions and how the results are influenced by the time interval between MR and arthroscopy. 248 knees studied by MR were retrospectively analyzed, as well as those which also underwent arthroscopy. Arthroscopy was considered to be the gold standard, MR diagnostic capacity was evaluated for both meniscal and cruciate ligament lesions. Sensitivity, specificity and Kappa index were calculated for the set of all knees included in the study (248), for those in which the time between MR and arthroscopy was less than or equal to three months (134) and for those in which the time between both procedures was less than or equal to one month. Sensitivity, specificity and Kappa index of the MR had global values of 96.5%, 70% and 71%, respectively. When the interval between MR and arthroscopy was less than or equal to three months, sensitivity, specificity and Kappa index were 95.5%, 75% and 72%, respectively. When it was less than or equal to one month, sensitivity was 100%, specificity was 87.5% and Kappa index was 91%. MR is an excellent tool for the diagnosis of knee lesions. Higher MR values of sensitivity, specificity and Kappa index are obtained when the time interval between both procedures is kept to a minimum. (Author) 11 refs.

  13. MR imaging of the temporomandibular joint meniscus; Le menisque de l`ATM en IRM

    Energy Technology Data Exchange (ETDEWEB)

    Pujol, A.; Pharaboz, C. [Hopital des Armees Begin, 94 - Saint-Mande (France); Foucart, J.M.; Carpentier, D.; Pajoni, D. [Paris-7 Univ., 75 (France); Deffrennes, D. [Hopital Lariboisiere, 75 - Paris (France)

    1995-09-01

    The continuing improvement of the MRI`s equipments and softwares led us to a continuous adaptation of the exam technique. We use today a bilateral coil technique, 3 inches in diameter. Four slices are performed for each articulation (4 mm thick) in the true sagittal plane. A fast spin echo, balanced in proton density, for one minute, allows the study of 15 steps inside a full open/close cycle. Oblique coronal cuts are also performed parallel to the long axis of the condyle in a T 1-weighted spin echo sequence in close and half-open positions. The analysis of 350 subjects allows to detail more precisely the meniscal displacement. Beside the classic anterior luxation, the meniscus slips medially, laterally and may rotate. These different situations may be isolated or combined. The dynamic study is specifically useful in the displacement with reduction exams. It enables permits to point out the timing of the disk disturbances: this information may be of great help in therapeutic decisions. (authors). 17 refs., 24 figs.

  14. Retrospective Evaluation Of MRI Findings Of Knee Joint In 255 Patients

    Directory of Open Access Journals (Sweden)

    Ahmet Mete

    2003-03-01

    Full Text Available Retrospective evaluation of knee MRI obtained from 255 cases and to demonstrate most common knee joint pathologies in our region.In our study knee joints of 255 cases who admitted to different clinics of our hospital with various complains of knee between October 1996 and December 1998 were examined in wide spectrum with MRI. Via 1.0 Tesla MRI device and special knee coil in sagittal, coronal and axial plains MRI images were obtained. The number of male and female patients were 173 and 82 and their ages were ranged between 14 and 70, and the mean age was 3413.The most common knee pathologies were intra-articular fluid (%58.04, medial (%46,66 and lateral (%12.55 meniscal injuries, anterior cruciate ligament injury (%17.25 and osteoarthritis (%14.9. The other important lesions were degeneration of medial and lateral meniscus, Baker’s cyst, bursitis, posterior cruciate ligament injury , medial and lateral collateral ligament injuries, synovial hypertrophy, chondromalasia of patella, and contusion.In our images of knee the most common lesions were injuries of meniscus and ligament. Because of being noninvasive technique for knee joint pathologies, capacity of multiplanar imaging, high contrast resolution and chance of detailed anatomic evaluation MR imaging was found to be most appropriate imaging technique for knee joint pathologies.

  15. MR imaging of lipoma arborescens and the associated lesions

    Energy Technology Data Exchange (ETDEWEB)

    Vilanova, J.C.; Barcelo, J.; Villalon, M. [Magnetic Resonance Unit, Ressonancia Girona, Clinica Girona (Spain); Aldoma, J.; Delgado, E. [Centre Diagnostic Pedralbes, Barcelona (Spain); Zapater, I. [Dept. of Radiology, Hospital de Palamos, Palamos, Girona (Spain)

    2003-09-01

    Objective: To describe the typical features of lipoma arborescens on MR imaging with pathologic correlation and to evaluate the associated lesions within the joints. Design and patients: The MR imaging findings of 32 patients with the diagnosis of lipoma arborescens of the knee (n=32) and shoulder (n=1) were reviewed. The diagnosis of lipoma arborescens was confirmed by the histologic findings in 12 cases and the other 21 cases were diagnosed by the characteristic MR imaging features. One patient had bilateral lipoma arborescens of the knee joint. Results: MR imaging showed a typical pattern of villous lipomatous proliferation of the synovium in all cases, as a diffuse pattern in 79% (26/33) of cases and as a dominant mass-like lesion in 21% (7/33) of cases. The associated MR pathology in the knee was (n=32): joint effusion (100%), degenerative changes (87%), meniscal tear (72%), synovial cysts (38%), bone erosions (25%), chondromatosis (13%), patellar subluxation (6%) and discoid meniscus (3%). In all cases except two there was associated pathology of the knee. MR imaging showed an associated rotator cuff tear in the lipoma arborescens of the shoulder. Conclusion: The characteristic MR features of lipoma arborescens allows an accurate diagnosis of this rare lesion, which is almost always associated with other chronic pathology of the joint in the elderly. (orig.)

  16. Acute injury affects lubricin expression in knee menisci: an immunohistochemical study.

    Science.gov (United States)

    Musumeci, Giuseppe; Loreto, Carla; Carnazza, Maria Luisa; Cardile, Venera; Leonardi, Rosalia

    2013-03-01

    The aim of this study was to investigate for the first time lubricin expression in intact menisci and in menisci from patients with recent knee joint injury using histology, immunohistochemistry, Western blotting and gene expression analysis, to provide insights into pathological processes affecting meniscal tissue. Lubricin expression was studied in vivo in 20 patients (14 males and 6 females) with recent joint injury subjected to arthroscopic partial meniscectomy and in vitro in fibroblast-like cells from meniscus tissue to establish whether it is down-regulated following acute traumatic knee injury. The control group consisted of cadaver donors with normal menisci. Histology demonstrated a normal tissue without structural changes in control samples and structural alterations and clefts in injured menisci. Very strong lubricin immunohistochemical staining was observed in intact menisci; in contrast weak staining was seen in injured menisci. Western blot and mRNA expression analysis also demonstrated strong lubricin expression in control cells and a negligible amount of lubricin in injured fibroblast-like cells. Our data provide information concerning the immediate in vivo response to injury of human knee menisci by documenting early changes in the boundary-lubricating ability of synovial fluid and articular cartilage integrity. These findings may provide the biological basis for developing novel medical therapies to be applied before surgical treatment to preserve tissue function and prevent cartilage damage.

  17. Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine.

    Science.gov (United States)

    Lombardi, Nicholas J; Tucker, Bradford; Freedman, Kevin B; Austin, Luke S; Eck, Brandon; Pepe, Matthew; Tjoumakaris, Fotios P

    2016-09-01

    It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [Orthopedics. 2016; 39(5):e944-e949.].

  18. CURENT LANDMARKS IN THE ATHLETES’ RECOVERY WITH MENISCO-LIGAMENTARY INJURIES

    Directory of Open Access Journals (Sweden)

    Corina Predescu

    2009-10-01

    Full Text Available For over 30 years the recovery and reeducation post - surgery protocols are beeing adapted to the progressmade in the field of surgical techniques. The surgical revolution of the meniscal and ligament pathology,determined by the use of the arthroscope was followed by a new approach of the recovery of patients withmeniscectomy with or without associated ligamentoplastyFrom the theoretical point of view, the reeducation has to allow stimulations which would favor thereformation of the colagen fibres in the injured structures. In practice, though, the goal of the recovery processaims at a stable and functional knee, which allows the reintegration of the athlete in the training and competitionactivities as soon as possible, beeing known that the removal from the competitive activities has a negativeimpact all the more powerful if the inactivity is longer..The arthroscopy, through the minimal suffering inflicted, allows a much quicker resumption of activitycompared to the classical meniscectomy. This was, actually, the major argument for using this surgical techniquewith performance athletes, and afterwards in major population.There are many recovery protocols. Some of them are conservatory (24, 69, 89, whilst others are extremelyagressive, accelerated (10, 219, 221. The general opinion tends towards an active reeducation with the fast andcomplete recovery of the extension (170, 175. All aim toward the same thing: the return of the athlete to thecompetition activity as soon as possible, without the risk of a recurrent injury.

  19. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips

    Energy Technology Data Exchange (ETDEWEB)

    Sahin, Guelden [Department of Radiology, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)]. E-mail: gsahin@medicine.ankara.edu.tr; Demirtas, Mehmet [Department of Hand Surgery, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)

    2006-06-15

    Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.

  20. Digital micromirror device projection printing system for meniscus tissue engineering.

    Science.gov (United States)

    Grogan, Shawn P; Chung, Peter H; Soman, Pranav; Chen, Peter; Lotz, Martin K; Chen, Shaochen; D'Lima, Darryl D

    2013-07-01

    Meniscus degeneration due to age or injury can lead to osteoarthritis. Although promising, current cell-based approaches show limited success. Here we present three-dimensional methacrylated gelatin (GelMA) scaffolds patterned via projection stereolithography to emulate the circumferential alignment of cells in native meniscus tissue. Cultured human avascular zone meniscus cells from normal meniscus were seeded on the scaffolds. Cell viability was monitored, and new tissue formation was assessed by gene expression analysis and histology after 2weeks in serum-free culture with transforming growth factor β1 (10ngml(-1)). Light, confocal and scanning electron microscopy were used to observe cell-GelMA interactions. Tensile mechanical testing was performed on unseeded, fresh scaffolds and 2-week-old cell-seeded and unseeded scaffolds. 2-week-old cell-GelMA constructs were implanted into surgically created meniscus defects in an explant organ culture model. No cytotoxic effects were observed 3weeks after implantation, and cells grew and aligned to the patterned GelMA strands. Gene expression profiles and histology indicated promotion of a fibrocartilage-like meniscus phenotype, and scaffold integration with repair tissue was observed in the explant model. We show that micropatterned GelMA scaffolds are non-toxic, produce organized cellular alignment, and promote meniscus-like tissue formation. Prefabrication of GelMA scaffolds with architectures mimicking the meniscus collagen bundle organization shows promise for meniscal repair. Furthermore, the technique presented may be scaled up to repair larger defects.

  1. An arthroscopic technique to treat the iliotibial band syndrome.

    Science.gov (United States)

    Michels, F; Jambou, S; Allard, M; Bousquet, V; Colombet, P; de Lavigne, C

    2009-03-01

    Iliotibial band syndrome (ITBS) is an overuse injury mainly affecting runners. The initial treatment is conservative. Only, in recalcitrant cases surgery is indicated. Several open techniques have been described. The purpose of this study is to evaluate the results of a standardized arthroscopic technique for treatment of a resistant ITBS. Thirty-six athletes with a resistant ITBS were treated with a standardized arthroscopic technique, limited to the resection of lateral synovial recess. Thirty-three patients were available for follow-up (mean 2 years 4 months). Thirty-two patients (34 knees) had good or excellent results. All patients went back to sports after 3 months. In two patients a meniscal lesion was found, which required treatment. One patient with only a fair result had associated cartilage lesions of the femoral condyle. Our results show that arthroscopic treatment of resistant ITBS is a valid option with a consistently good outcome. In addition, this arthroscopic approach allows excluding or treating other intra-articular pathology.

  2. A CLINICAL STUDY ON FUNCTIONAL OUTCOME AFTER COMBINED ARTHROSCOPIC AND FLUOROSCOPIC ASSISTED REDUCTION AND INTERNAL FIXATION OF CLOSED TIBIAL PLATEAU FRACTURES IN ADULTS

    Directory of Open Access Journals (Sweden)

    Bhavani Prasad

    2015-06-01

    Full Text Available BACKGROUND AND INTRODUCTION: Management of tibial plateau fractures had witnessed tremendous improvement in surgical techniques over the past decades. Conservative treatment of these fractures results in consistently poor results. The present literature supports that absolute anatomi cal reduction and stable fixation of peri articular fractures followed by early post - operative rehabilitation is crucial for good results. And if this is achieved by minimal damage to soft tissue the results are much better. In this study it is achieved by arthroscopy and fluoroscopy. MATERIALS AND METHODS: We have conducted a prospective study between September 2009 to august 2013 including 9 patients with tibial plateau fractures treated with combined arthroscopic and fluoroscopic reduction and internal f ixation with or without bone grafting. And then the radiographic and functional evaluation done. RESULTS: According to Hohl’s clinical and radiographic scoring systems 4 patients were assessed excellent, 3 good, 2 fair. According to Rasmussen’s clinical sc oring system 4 patients excellent, 3 good and 2 fair results. CONCLUSION: The use of arthroscopy and fluoroscopy in the management of tibial plateau fractures results in good outcome. It also helped to simultaneously treat the meniscal injuries. But its use is mainly limited to Shatzkar type1, 2, 3, 4

  3. Automating measurement of subtle changes in articular cartilage from MRI of the knee by combining 3D image registration and segmentation

    Science.gov (United States)

    Lynch, John A.; Zaim, Souhil; Zhao, Jenny; Peterfy, Charles G.; Genant, Harry K.

    2001-07-01

    In osteoarthritis, articular cartilage loses integrity and becomes thinned. This usually occurs at sites which bear weight during normal use. Measurement of such loss from MRI scans, requires precise and reproducible techniques, which can overcome the difficulties of patient repositioning within the scanner. In this study, we combine a previously described technique for segmentation of cartilage from MRI of the knee, with a technique for 3D image registration that matches localized regions of interest at followup and baseline. Two patients, who had recently undergone meniscal surgery, and developed lesions during the 12 month followup period were examined. Image registration matched regions of interest (ROI) between baseline and followup, and changes within the cartilage lesions were estimate to be about a 16% reduction in cartilage volume within each ROI. This was more than 5 times the reproducibility of the measurement, but only represented a change of between 1 and 2% in total femoral cartilage volume. Changes in total cartilage volume may be insensitive for quantifying changes in cartilage morphology. A combined used of automated image segmentation, with 3D image registration could be a useful tool for the precise and sensitive measurement of localized changes in cartilage from MRI of the knee.

  4. Assessment of anterior cruciate ligament reconstruction using 3D ultrashort echo-time MR imaging.

    Science.gov (United States)

    Rahmer, Jürgen; Börnert, Peter; Dries, Sebastian P M

    2009-02-01

    This work demonstrates the potential of ultrashort TE (UTE) imaging for visualizing graft material and fixation elements after surgical repair of soft tissue trauma such as ligament or meniscal injury. Three asymptomatic patients with anterior cruciate ligament (ACL) reconstruction using different graft fixation methods were imaged at 1.5T using a 3D UTE sequence. Conventional multislice turbo spin-echo (TSE) measurements were performed for comparison. 3D UTE imaging yields high signal from tendon graft material at isotropic spatial resolution, thus facilitating direct positive contrast graft visualization. Furthermore, metal and biopolymer graft fixation elements are clearly depicted due to the high contrast between the signal-void implants and the graft material. Thus, the ability of UTE MRI to visualize short-T(2) tissues such as tendons, ligaments, or tendon grafts can provide additional information about the status of the graft and its fixation in the situation after cruciate ligament repair. UTE MRI can therefore potentially support diagnosis when problems occur or persist after surgical procedures involving short-T(2) tissues and implants.

  5. Patellofemoral Pain Syndrome in Iranian Female Athletes

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    Hamid Reza Baradaran

    2011-03-01

    Full Text Available Patellofemoral pain syndrome (PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who come to the sports medicine clinic. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatella. Pain increases on ascending and descending stairs and squatting and prolonged sitting. The aim of this study was to evaluate the prevalence of PFPS in Iranian female athletes. 418 female athletes aged 15-35 years were examined in five sports: Soccer (190, volleyball (103, running (42, fencing (45 and rock climbing (38. The athletes who had non- traumatic onset anterior knee pain of at least 3 months that increased in descending and ascending stairs and squatting, had no other causes of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis and arthritis and no history of knee surgery during the one past year were diagnosed as PFPS. 26/190 (13.68 % soccer players, 21/103(20.38 % volleyball players, 7/42 (16.66 % runners, 6/45(13.33 % fencers and 10/38 (26.31% rock climbers had patellofemoral pain. Among the 418 female athletes who were evaluated 70 had PFPS. Rock climbers were the most common athletes with PFPS followed by volleyball players and runners.

  6. Accuracy of Lachman and Anterior Drawer Tests for Anterior Cruciate Ligament Injuries

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    Hadi Makhmalbaf

    2013-12-01

    Full Text Available   Background: The knee joint is prone to injury because of its complexity and weight-bearing function. Anterior cruciate ligament (ACL ruptures happen in young and physically active population and can result in instability, meniscal tears, and articular cartilage damage. The aim of this study is to evaluate the accuracy of Lachman and anterior drawer test in ACL injury in compare with arthroscopy.   Methods: In a descriptive, analytical study from 2009 to 2013, 653 patients who were suspected to ACL rapture were entered the study. Statistical analysis was performed by the usage of SPSS 19.0. Multiple comparison procedure was performed for comparing data between clinical examination and arthroscopic findings and their relation with age and sex. Results: Mean age of patients was 28.3±7.58 years (range from 16 to 68 years. From 428 patients, 41.2% (175 patients were between 26 and 35, 38.8% (165 ones between 15 and 25 and 20% (85 patients over 36 years. 414 patients were male (97.2% and 12 were female (2.8%. Sensitivity of anterior drawer test was 94.4% and sensitivity of Lachman test was 93.5%. Conclusion: The diagnosis and decision to reconstruct ACL injury can be reliably made regard to the anterior drawer and Lachman tests result. The tests did not have privilege to each other. These test accuracy increased considerably under anesthesia especially in women.

  7. Accuracy of Lachman and Anterior Drawer Tests for Anterior Cruciate Ligament Injuries

    Directory of Open Access Journals (Sweden)

    Hadi Makhmalbaf

    2013-12-01

    Full Text Available Background: The knee joint is prone to injury because of its complexity and weight-bearing function. Anterior cruciate ligament (ACL ruptures happen in young and physically active population and can result in instability, meniscal tears, and articular cartilage damage. The aim of this study is to evaluate the accuracy of Lachman and anterior drawer test in ACL injury in compare with arthroscopy.   Methods: In a descriptive, analytical study from 2009 to 2013, 653 patients who were suspected to ACL rapture were entered the study. Statistical analysis was performed by the usage of SPSS 19.0. Multiple comparison procedure was performed for comparing data between clinical examination and arthroscopic findings and their relation with age and sex. Results: Mean age of patients was 28.3±7.58 years (range from 16 to 68 years. From 428 patients, 41.2% (175 patients were between 26 and 35, 38.8% (165 ones between 15 and 25 and 20% (85 patients over 36 years. 414 patients were male (97.2% and 12 were female (2.8%. Sensitivity of anterior drawer test was 94.4% and sensitivity of Lachman test was 93.5%. Conclusion: The diagnosis and decision to reconstruct ACL injury can be reliably made regard to the anterior drawer and Lachman tests result. The tests did not have privilege to each other. These test accuracy increased considerably under anesthesia especially in women.

  8. Another way to think of tears: blood, sweat, and... "dacruon".

    Science.gov (United States)

    Cher, Ivan

    2007-07-01

    Eugene Wolff's 1946 concept of an interpalpebral, trilaminar, preocular tear film does not sit comfortably with more recent scientific observations. A film so defined could exist only in the interblink phase and would exclude unshed retropalpebral fluid. A modern, evidence-based, clinically relevant model is needed, one that includes retropalpebral and meniscal fluids and is applicable throughout the blink cycle. The "ocular surface" (OS) concept combines adjacent discrete epithelia into a single continuous mucosal sheet. This "surface" constitutes an integrated organ. The OS concept has revolutionized the understanding and management of ocular pathology and therapeutics. Further practical advances can be expected once Wolff's trilaminar hypothesis is replaced by a new concept that recognizes a duality: a voluminous muco-aqueous pool extending retropalpebrally, separated always from the atmosphere by its accessory lipid sealant. The neologism "dacruon" (pronounced dacroo-on) is introduced for this composite fluid body. The respective differences between the two components--in their origins, structures, thicknesses, chemistries, motilities, secretion rates, turnovers, functions and manners of disposal--support the duality of the dacruon concept. Adoption of this alternative view of tear structure requires new descriptors to encourage precision and consensus in terminology.

  9. Evaluation of pre-stresses in the menisci of human knee joint using microindentation.

    Science.gov (United States)

    Kwak, Dai Soon; Bae, Ji Yong; Kim, Sung Youb; Jeon, Insu; Lu, Tian Jian

    2014-01-01

    To evaluate the pre-stress in the menisci of a human knee joint, the technique of microindentation was adopted. Five specimens each for lateral and medial menisci attached to the tibia were prepared from the knee joints of Korean cadavers to represent the pre-stress state of the meniscus. To create test specimens for the stress-free state of the meniscus, each meniscus was resected from the tibia and cut into three parts, which were subsequently attached to a metal plate. Indentations were carried out in each meniscus in both the pre-stress state and the stress-free state. The pre-stresses in the menisci were evaluated using the load-versus-depth curves. Compressive pre-stresses were found in the menisci. For each indentation region, the pre-stresses in the medial meniscus were higher than in the lateral meniscus. The highest pre-stress in both the lateral and medial meniscus was found in the posterior regions, while the anterior regions experienced the lowest pre-stress. The obtained pre-stresses can be used for the accurate numerical analysis, the fabrication of artificial menisci, and the diagnosis of meniscal disease progression for human knee joints.

  10. EFFICACY OF SOFT TISSUE APPLICATION, MANUALLY-THERAPEUTICAL TECHNIQUES FOR KNEE ARTHROKINEMATICS RECOVERY COMPLEX IN PATIENTS AFTER ARTHROSCOPIC MENISCECTOMY

    Directory of Open Access Journals (Sweden)

    Kostov Rostislav V

    2015-07-01

    Full Text Available Introduction: In this article we present the final effect of the application of complex soft tissue manually-treatment system for recovery of joint kinematics in patients with moderate and minimal protective period of rehabilitation after arthroscopic meniscectomy. Material and Methods: The study was conducted in 2005-2012 into three medical centers in Bulgaria: Blagoevgrad, Sofia and Pleven. The study included a total of 110 patients divided into three groups (Control and Experimental I and Experimental Group II who studied the effect of topical application of the manual therapeutic techniques compared to traditional rehabilitation methods applied. For testing the efficacy of a treatment approach in the three groups of patients, the results have processed by the method of variational analysis. Results: After analysis of results we find significantly more fully and without residual short violations recovery for all controlled parameters in patients who have implemented comprehensive manually-therapeutic treatment compared with control group patients. Conclusion: Application of adequate physiological and pedagogically grounded complex rehabilitation is required in patients after arthroscopic meniscectomy model with motor deficits in tractable routine rehabilitation. Observations allow us to offer a methodology for implementation in general practice rehabilitation in patients after meniscal ruptures treated by arthroscopic meniscectomy and motor deficits, intractable routine rehabilitation.

  11. Three-tesla imaging of the knee: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Craig, Joseph G.; Blechinger, Joseph; Hearshen, David; Bouffard, J. Antonio; Diamond, Mark; Holsbeeck, Marnix T. van [Henry Ford Hospital, Department of Diagnostic Radiology, Detroit, MI (United States); Go, Lily [Wayne State University School of Medicine, Detroit, MI (United States)

    2005-08-01

    To assess 3-T imaging of the knee. We reviewed 357 3-T magnetic resonance images of the knee obtained using a dedicated knee coil. From 58 patients who had arthroscopy we determined the sensitivity and specificity for anterior cruciate ligament (ACL) tear and medial and lateral meniscal tear. A chemical shift artifact showed prominently at 3 T even after improvements had been made by increasing the bandwidth. For complete ACL tear the sensitivity was 100% (95% confidence interval, CI, 75.30-100.00), and the specificity was 97.9% (95% CI 87.7-99.9). For the medial meniscus the sensitivity was 100.00% (95% CI 90.0-100.00), and the specificity was 83.3%(95% CI 66.6-95.3). For the lateral meniscus the sensitivity was 66.7% (95% CI 38.4-88.2), and the specificity was 97.6% (95% CI 87.1-99.9). In general 3-T imaging allows a favorable display of anatomy and pathology. The lateral meniscus was assessed to be weaker than the other anatomic structures. Three-tesla imaging allows increased signal-to-noise ratio, increased resolution, and faster scanning times. (orig.)

  12. MRI diagnosis of ACL bundle tears: value of oblique axial imaging

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    Ng, Alex W.H.; Griffith, James F.; Hung, Esther H.Y. [Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China); Law, Kan Yip; Yung, Patrick S.H. [Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China)

    2013-02-15

    To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL. (orig.)

  13. Meniscus and ligament injuries; Meniskus- und Bandlaesionen

    Energy Technology Data Exchange (ETDEWEB)

    Glaser, C.; Trumm, C. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie (Germany); Scheidler, J.; Heuck, A. [Radiologisches Zentrum Muenchen, Pasing (Germany)

    2006-01-01

    The knee is one of the major weight-bearing joints and is relatively exposed to trauma. Capsuloligamentous structures are essential to provide joint stability and - in turn - persistent instability bears a risk for osteoarthritis that needs timely and comprehensive diagnosis. Using MRI it may be beneficial to routinely apply (T)SE sequences in all three major planes as a basic protocol and to add additional sequences according to the clinical information available and imaging findings in the basic protocol. Especially fat-suppressed sequences (STIR, T2w/PDw FS TSE) are very useful because they sensitively depict bone marrow edema pattern (BMEP)-like changes. This finding often alerts the reader to - sometimes only discrete - underlying pathologies and may - if found in typical locations - give information about the mechanism of injury and thus lead the radiologist to look for specific concomitant capsuloligamentous, cartilage, and/or meniscal injury. BMEP is quite prominent in contusion injury, whereas often it is but discrete in avulsion lesions. There is extensive literature about the signs, possible pitfalls, and the accuracy of MRI for the diagnosis of specific pathologies such as meniscal tears or cruciate or collateral ligament ruptures. However, combined injuries of more than one structure are frequent and affect the therapeutic approach. Thus, the primary goal of the radiologist is to go beyond the description of any isolated lesion and to give a comprehensive description of (or to reliably exclude) any injury to other structures. A necessary prerequisite to accomplish this is a thorough knowledge of the - in some locations - complex anatomic relationships, pitfalls, and locations where lesions typically occur and where they may be overlooked. (orig.) [German] Das Knie ist vergleichsweise exponiert gegenueber Traumata. Sein Kapsel-Band-Apparat ist ein wesentlicher Faktor fuer die Gelenkstabilitaet. Umgekehrt erhoeht persistierende Instabilitaet das Risiko

  14. 超声及核磁共振在类风湿性关节炎膝关节病变诊断中的应用比较

    Institute of Scientific and Technical Information of China (English)

    陈永刚

    2016-01-01

    Objective To investigate the clinic value of ultrasound(US)in the diagnosis of rheumatoid arthritis of knee compared with the result of magnetic resonance imaging(MRI). Methods This analysis comprised 42 patients suspected of rheumatoid arthritis in our hospital from May 2013 to May 2015,all of whom were further diagnosed with MRI and ultrasound. The consistency of these two results was compared. Results In the diagnosis of arthroedema、synovium thicken、pannus formation and other lesions,the results of MRI and ultrasound had highly consistency,and the Kappa value was 0.929(P<0.05). Correlated with MRI,the sensitivity、specificity、positive predictive value and negative predicated value of ultrasound were 98.75%、83.33%、99.37% and 71.43%, respectively. In addition,the meniscal injury grade of MRI was highly consistent with that of ultrasound,and Kappa value was 0.843(P<0.05). Conclusion Ultrasound could provide good diagnostic assessment to the detection of pathological nature of rheumatoid arthritis and grade of meniscal injury,having important implication in early diagnosis of rheumatoid arthritis of knee.%目的:将超声检查结果与核磁共振检查结果进行比较,评估超声对类风湿性关节炎膝关节病变的临床诊断价值。方法随机选取2013年5月至2015年5月经筛查、诊断疑为类风湿性关节炎的患者42例,并对其进行进一步核磁共振成像以及超声检查,比较分析两者结果的一致性。结果在诊断包括髌上囊积液、滑膜增厚、血管翳形成等类风湿性关节炎病变种类方面,MRI与超声的结果具有高度的一致性, Kappa值为0.929(P<0.05)。以MRI结果作为比较,超声检查结果的灵敏度、特异度、阳性预测值、阴性预测值分别为98.75%、83.33%、99.37%和71.43%。除此之外,两者在诊断膝关节软骨退行性变损害时,结果同样具有较高的一致性,Kappa值为0.843(P<0.05)。结论超声可以为类风

  15. 高分辨率CT关节造影在膝关节病变诊断中的应用%Application of high resolution CT arthrography in the diagnosis of knee joint lesions

    Institute of Scientific and Technical Information of China (English)

    吕永革; 陈智毅; 吴冬; 莫金潮; 专庆春; 侯瑜; 江振华; 贺德行

    2013-01-01

    Objective To explore the value of the high resolution CT arthrography to the diagnosis of knee joint lesions. Methods Fifty patients with suspected knee joint lesion underwent high resolution CT scanning, the raw data were reconstructed with multi-plane techniques, and the lesions were observed from various angles. Results In fifty cases, 32 cases were diagnosed as meniscal injury, demonstrating contrast agent filling in the injured part, 18 cases were diagnosed as articular cartilage injury, demonstrating articular cartilage thinning, rough surface and partial cartilage defect, 12 cases were diagnosed as cruciate ligament injury, demonstrating abnormal density and morphology, contrast infiltration from the injured part, 8 cases were diagnosed as discoid meniscus, demonstrating the meniscus broadening and thickening, 6 cases were diagnosed as meniscal cyst, demonstrating high density in its adjacent meniscus, and 10 cases were diagnosed as popliteal cyst, demonstrating high density saclike shadow in popliteal fossa communicating with knee joint cavity. Conclusion High resolution CT arthrography has a high clinical value to the diagnosis of knee joint lesions, and plays an important reference role in preoperative screening, treatment plan and postoperative assessment.%目的 探讨高分辨率CT关节造影(high resolution CT arthrography,HRCTA)在诊断膝关节病变的应用价值.方法 50例疑诊膝关节病变患者,行HRCTA扫描及多平面重建成像,多角度观察膝关节病变的影像表现.结果 HRCTA诊断半月板损伤32例,表现为损伤部位可见高密度造影剂充填;诊断关节软骨损伤18例,表现为关节面软骨变薄、表面毛糙、部分缺损;诊断交叉韧带损伤12例,表现为密度及形态异常、损伤处造影剂渗入;诊断盘状半月板8例,表现为半月板增宽、增厚;诊断半月板囊肿6例,表现为与半月板相邻的小囊袋状高密度影;诊断腘窝囊肿10例,表现为腘窝内与

  16. Magnetic resonance tomography in the diagnosis of intraarticular tibial plateau fractures: value for fracture classification and spectrum of fracture-associated soft tissue injuries; Die Magnetresonanztomographie in der Diagnostik der intraartikulaeren Tibiakopffraktur: Stellenwert bei der Frakturklassifikation und Spektrum der frakturbegleitenden Weichteilverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Fischbach, R.; Maintz, D.; Zaehringer, M.; Landwehr, P. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Prokop, A. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Unfall-, Hand- und Wiederherstellungschirurgie

    2000-07-01

    Purpose: To compare magnetic resonance imaging (MRI) and X-ray tomography in assessing the type of fracture, degree of comminution and amount of articular surface depression in acute tibial condylar fractures and to describe the associated soft tissue injuries diagnosed with MRI. Method: 27 patients with acute tibial plateau fractures were investigated usig linear X-ray tomography and MRI employing T{sub 1}-weighted and proton density turbo spin echo, STIR, and T{sub 2}-weighted gradient echo images. Fractures were classified according to the AO classification system. The degrees of depression and comminution were measured and soft tissue injuries were recorded. Results: Fractures were classified as type B1 in 7, as B2 in 6, and as B3 in 6 cases by MRI. More complex C-type fractures were diagnosed in 8 cases. MR and X-ray grading were consistent with the exception of two B3 fractures, which were graded as B1 by X-ray tomography. X-ray tomography under-estimated the degree of comminution. 63% of the patients had either meniscal tears or complete ruptures of their cruciate or collateral ligaments. Ten meniscal tears were diagnosed in 9 of 27 patients. Complete tears of the anterior cruciate ligament were seen in 4, and avulsions of the posterior cruciate ligament in 2 patients. Conclusion: MRI allows a detailed assessment of acute tibial plateau fractures and can replace conventional X-ray tomography. The high rate of fracture-associated soft tissue lesions makes MRI an especially valuable tool. (orig.) [German] Ziel: Vergleich der Magnetoresonanztomographie (MRT) und der konventionellen Verwischungstomographie in der Beurteilung von Frakturtyp, Fragmentierung und der Gelenkflaechenimpression sowie Beschreibung der MR-tomographisch diagnostizierten Weichteilverletzungen bei Patienten mit Tibiakopffraktur. Methode: 27 Patienten mit akuten Tibiakopffrakturen wurden mittels linearer Verwischungstomographie und MRT unter Verwendung einer T{sub 1}-gewichteten sowie einer

  17. A Prospective Multi-Center Clinical Trial to Compare Efficiency, Accuracy and Safety Of the VisionScope Imaging System Compared to MRI and Diagnostic Arthroscopy

    Science.gov (United States)

    Xerogeanes, John W.; Safran, Marc R.; Huber, Bryan; Mandelbaum, Bert R.; Robertson, William; Gambardella, Ralph A.

    2014-01-01

    Objectives: Until now, arthroscopic surgery has been the gold standard for the diagnosis of intra-articular pathology. When a patient presents with ongoing pain and/or disability despite non-operative care, MRI is commonly used as a diagnostic modality. To date, there is not a minimally-invasive option that can provide detailed information about the intra-articular pathology of a joint. VisionScope Imaging (VSI) is an office-based diagnostic modality that provides comprehensive real-time images and video of a joint with higher accuracy and reliability compared to static MR images. The purpose of this study was to compare the efficacy, accuracy and safety of VSI compared to MRI and surgical diagnostic arthroscopy. Methods: A prospective, blinded, multi-centered study was performed of all patients who had a routine surgical arthroscopy at one of the six participating clinical sites between July 2012 and May 2013. Patients were consented by the physician investigator at each site. Study inclusion criteria consisted of: suspected meniscal tears or articular cartilage damage. Patients were excluded from the study if they had (1) acute traumatic hemarthoses, (2) concomitant ligament injury, (3) active systemic infection, (4) allergy to silicone or any medication used during the procedure,. All patients had a MRI and a comprehensive physical exam prior to their surgical arthroscopy. Each patient underwent a MRI, VSI exam and surgical diagnostic arthroscopy. The attending physician completed standard forms comparing the VSI exam findings to the diagnostic arthroscopy findings on each patient. Two blinded experts unaffiliated with the study reviewed the VSI and MRI images. The arthroscopy served as the “control” comparison between the VSI and MRI findings. Results: There were 110 patients included in this study. The accuracy, sensitivity and specificity of VSI was equivalent to surgical diagnostic arthroscopy and more accurate than MRI (Table 1). When comparing VSI to

  18. Tratamento fisioterapêutico após reconstrução do ligamento cruzado anterior Physiotherapy after reconstruction of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Maitê Pereira

    2012-12-01

    Full Text Available O objetivo desse estudo foi avaliar se há diferença da evolução na reabilitação dos indivíduos submetidos à reconstrução do LCA através das técnicas osso-tendão patelar-osso ou enxerto quádruplo do semitendíneo e grácil através de uma revisão da literatura. Utilizaram-se as bases de dados eletrônicas: MEDLINE, EMBASE, LILACS, COCHRANE e PEDro. Os critérios de inclusão foram: ensaio clínico randomizado e aleatório com ou sem metanálise; participantes com lesão do LCA associada ou não a lesão meniscal e que foram submetidos à ligamentoplastia e à reabilitação fisioterapêutica; intervenção cirúrgica através das técnicas de reconstrução osso-tendão patelar-osso ou enxerto quádruplo do semitendíneo e grácil; ensaios clínicos que comparem a diferença da evolução na recuperação funcional; estudos publicados nos idiomas: português, inglês e espanhol, no período de 1997 a junho de 2011. Foram encontrados cinco ensaios clínicos que preenchessem os critérios de inclusão. Não foram observadas diferenças clínicas e funcionais entre as técnicas, porém, com recomendação para uma reabilitação menos agressiva e com maior atenção no fortalecimento dos isquiotibiais quando estes são utilizados como enxerto.The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials

  19. Condromatose sinovial Synovial chondromatosis

    Directory of Open Access Journals (Sweden)

    Neylor Pace Lasmar

    2010-01-01

    Full Text Available Paciente masculino, 34 anos de idade, apresentou dor forte em joelho esquerdo associado à incapacidade funcional sem fator desencadeante aparente. Procurou atendimento médico em dezembro de 2006, quando lhe foram prescritos AINES. Após um ano relatou aumento do edema e da dor no local. Foi encaminhado ao especialista em joelho com suspeita de lesão meniscal. Ao exame, foram detectados edema intenso da articulação com limitação de movimento, dor exacerbada e punção articular negativa; como não apresentava alterações nas radiografias simples, foi solicitado exame de ressonância magnética do joelho. Ao exame de ressonância magnética, evidenciou-se volumoso acúmulo de líquido intra-articular, associado à acentuada proliferação sinovial, destacando-se espessamentos focais formando grumos com sinal intermediário em T1 e T2 e discreto hipossinal em T2 sugestivo de sinovite vilonodular pigmentada com meniscos e ligamentos íntegros. Paciente foi submetido a artroscopia do joelho esquerdo que evidenciou fragmentos irregulares e esbranquiçados, sendo então realizada artrotomia com retirada da lesão e sinovectomia ampla, o material foi enviado para exame anatomopatológico, o qual evidenciou presença de condromatose sinovial. Após oito meses de cirurgia, o paciente apresenta-se sem queixas, joelho esquerdo com amplitude de 130º sem derrame articular ou sinais inflamatórios. A condromatose sinovial é uma metaplasia benigna rara da membrana sinovial, originando a formação de corpos livres cartilaginosos no espaço articular de difícil diagnóstico, já que 95% dos nódulos, quando não calcificados, podem passar desapercebidos radiologicamente.Male patient, 34 years old, had severe pain in his left knee in association with functional incapacitation, with no apparent triggering factor. He sought medical attention in December 2006, at which time he was prescribed NSAIDS. After a year, reported increased swelling and pain at

  20. Tribology studies of the natural knee using an animal model in a new whole joint natural knee simulator.

    Science.gov (United States)

    Liu, Aiqin; Jennings, Louise M; Ingham, Eileen; Fisher, John

    2015-09-18

    The successful development of early-stage cartilage and meniscus repair interventions in the knee requires biomechanical and biotribological understanding of the design of the therapeutic interventions and their tribological function in the natural joint. The aim of this study was to develop and validate a porcine knee model using a whole joint knee simulator for investigation of the tribological function and biomechanical properties of the natural knee, which could then be used to pre-clinically assess the tribological performance of cartilage and meniscal repair interventions prior to in vivo studies. The tribological performance of standard artificial bearings in terms of anterior-posterior (A/P) shear force was determined in a newly developed six degrees of freedom tribological joint simulator. The porcine knee model was then developed and the tribological properties in terms of shear force measurements were determined for the first time for three levels of biomechanical constraints including A/P constrained, spring force semi-constrained and A/P unconstrained conditions. The shear force measurements showed higher values under the A/P constrained condition (predominantly sliding motion) compared to the A/P unconstrained condition (predominantly rolling motion). This indicated that the shear force simulation model was able to differentiate between tribological behaviours when the femoral and tibial bearing was constrained to slide or/and roll. Therefore, this porcine knee model showed the potential capability to investigate the effect of knee structural, biomechanical and kinematic changes, as well as different cartilage substitution therapies on the tribological function of natural knee joints.

  1. Healing results in meniscus and articular cartilage photochemically welded with 1,8-naphthalimide dyes

    Science.gov (United States)

    Judy, Millard M.; Jackson, Robert W.; Nosir, Hany R.; Matthews, James Lester; Loyd, John D.; Lewis, David E.; Utecht, Ronald E.; Yuan, Dongwu

    1997-05-01

    Meniscal tears and partial thickness defects in articular cartilage do not heal spontaneously. In this paper results are described of studies of a procedure for evoking the healing response in such lesions by a non-thermal tissue sparing photochemical weld using 1,8-naphthalimide dyes. Fifteen essentially mature Barbados sheep 40 - 60 pounds in weight received a 2 - 3 mm flap tear by incision in the red white zone of the medial meniscus oriented parallel to the table of the tibia. The animals were divided into four groups; Group I, no treatment; Group II, treatment by laser activated photoactive dyes; Group III, treatment by suturing; Group IV, treatment by laser irradiation only; Group V, treatment by photoactive dyes only. In another group of 12 sheep partial thickness flap tear was created by incision in the articular cartilage of the femoral condyle. These were divided into four groups as for the meniscus study, omitting the sutured control. Welds were made using the dimeric dye MBM Gold BW 012-012-012 at 12 mM in PBS, 457.9 nm argon ion laser radiation at 800 mW/cm2, 7.5 minutes (360 J/cm2) with approximately 2 kg/cm2 externally applied pressure. Animals were sacrificed at 24 hr, 4 weeks, 3 and 6 months postoperatively. Gross appearance of menisci and cartilage in all welded knees was normal and all welds resisted deformation or loosening under forceful probing. Histology of studies of both tissues out to 6 moths disclosed close bonding of welded area, continuing healing response in the form of cellular recruitment and protein deposition and the absence of inflammatory response. Tissue erosion and arthritic changes were evident in all unwelded controls.

  2. 超声在膝关节及周围病变诊断中的应用价值%The value of high frequency ultrasound in the diagnosis of knee and surrounding lesions

    Institute of Scientific and Technical Information of China (English)

    许晓华; 李皓; 郭国强; 陈水晶; 朱伟民; 李泉水; 王惠芳

    2012-01-01

    摘要目的观察膝关节及周围病变的声像图特征,探讨超声在此类疾病中的诊断价值.方法80例膝关节及周围病变,超声观察病变部位、大小、数目以及声像图改变等情况.结果80例患者中,膝关节腔积液38例,腘窝囊肿12例,半月板病变9例,膝关节韧带损伤6例,关节软骨退行性病变6例,软组织肿物3例,其他病变5例.结论超声具有方便、快捷、低廉等优点,可作为膝关节疾病的重要影像学检查方法.%Objective To observe the ultrasonographic features of knee and surrounding lesions and evaluate the the value of ultrasound examination in the diagnosis of knee diseases. Methods The site,size,number and ultrasonogram changes of lesions were examined by ultrasonography in 80 patients with knee disease. Results In 80 cases, 38 cases were knee joint cavity effusion, 12 cases were popliteal cyst, 9 cases were meniscal lesions, 6 cases were ligament of knee joint injury, 6 cases were degenerative articular cartilage lesions, 3 cases were soft tissue tumor, 5 cases were other lesions. Conclusion Ultrasound examination is a convenient, fast and cheap imaging method, which can be used for the diagnosis of knee joint diseases.

  3. Does marathon running cause acute lesions of the knee? Evaluation with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C.; Schueller, G.; Uffmann, M.; Bader, T.R. [Medical University of Vienna, Department of Radiology, Vienna (Austria)

    2006-10-15

    An investigation was conducted into whether running a marathon causes acute alterations in menisci, cartilage, bone marrow, ligaments, or joint effusions, which could be evaluated by magnetic resonance imaging (MRI). Twenty-two non-professional marathon runners underwent MRI of the knee before and immediately after running a marathon. Lesions of menisci and cartilage (five-point scale), bone marrow, ligaments (three-point scale), joint effusion, and additional findings were evaluated and a total score was assessed. Before the marathon, grade 1 lesions of the menisci were found in eight runners, and grade 2 lesions in five runners. After the marathon, an upgrading from a meniscal lesion grade 1 to grade 2 was observed in one runner. Before the marathon, grade 1 cartilage lesions were found in three runners, and grade 2 lesions in one runner, all of which remained unchanged after the marathon. Before and after the marathon, unchanged bone marrow edema was present in three runners and unchanged anterior cruciate ligament lesions (grade 1) were seen in two runners. Joint effusions were present in 13 runners in the pre-run scans, slightly increased in four runners after the marathon, and newly occurred in one runner after the marathon. A total score comprising all knee lesions in each runner showed an increase after the marathon in two runners, whereas no runner showed an improvement of the radiological findings (Wilcoxon signed-rank test, P>0.05). The evaluation of lesions of the knee with MRI shows that marathon running does not cause severe, acute lesions of cartilage, ligaments, or bone marrow of the knee in well-trained runners. Only subtle changes, such as joint effusions or increased intrameniscal signal alterations, were imaged after running a marathon. (orig.)

  4. Evaluation of the lesions of synovial-lined clefts in the Hoffa's infrapatella fat pad with MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Min Sun; Park, Jin Gyoon; Kim, Young Cheol; Hwang, Eai Hong; Joo, Jung Hyun; Chung, Tae Woong; Kang, Heoung Keun [Chonnam Univ., College of Medicine, Kwangju (Korea, Republic of); Oh, Hee Yeon [Namkwang Hospital, Kwangju (Korea, Republic of)

    1998-09-01

    Within Hoffa's infrapatellar fat pad there are two synovial clefts, horizontal and vertical, which communicate with the intra-articular space. Intra-articular lesions can also occur in these clefts, and are often difficult to differentiate from extra-articular lesions. The purpose of this study is to evaluate, using MR imaging, the lesions occurring in these synovial lined clefts, as well as associated abnormalities. Thirty-one knees of 31 patients with lesions in horizontal and vertical clefts in Hoffa's infrapatellar fat pad were retrospectively evaluated. Using a 1.5T MR imager, axial, sagittal, and coronal MR images of knees were obtained. Lesions in clefts, degree of joint effusion and associated knee abnormalities were analyzed. Horizontal cleft lesions were noted in 21 cases; there were 17 cystic dilatations, two loose bodies, one synovial chondroma, and one case of pigmented villonodular synovitis(PVNS). Vertical cleft lesions were noted in 15 cases; these comprised 11 cystic dilatations, two loose bodies, one synovial osteochondromatosis, and one PVNS. Among all cases, three cystic dilatations, one loose body, and one PVNS occurred in both horizontal and vertical clefts. Among 25 knees with cystic dilatations of clefts, five showed grade 1, joint effusion, ten grade 2, and ten grade 3, Associated abnormalities were meniscal tear in 16 cases, osteoarthritis in 13, cruciate ligament tear in five, osteochondritis dissecans in three, osteochondral fracture in two, osteonecrosis in one, loose body in one, and synovitis in one. Among synovial-lined clefts in Hoffa's fat pad, the most common lesion was cystic dilatation;there were various associated abnormalities and a close relationship to joint effusion. An awareness of the types of lesions found in clefts is helpful for narrowing the differential diagnosis of lesions occurring in the area of Hoffa's fat pad.=20.

  5. ARTHROSCOPIC DEBRIDEMENT IN OSTEOARTHROSIS OF KNEE JOINT - ANALYSIS OF SHORT TERM BENEFITS

    Directory of Open Access Journals (Sweden)

    Jayakrishnan

    2015-08-01

    Full Text Available BACKGROUND: Many studies have reported symptomatic relief after arthroscopic debridement of knee for osteoarthrosis. The purpose of the study is to find out the outcome of arthroscopic debridement in osteoarthrosis of knee and to arrive at a consensus regarding the subsets of patients with osteoarthrosis who will benefit from the procedure. MATERIALS AND METHODS : 30 patients with osteoarthrosis were subjected for arthroscopic debridement. Patients included were of age greater than 50 years. Standard antero - posterior and lateral radiographs of knee were taken and grading was done using Kellegren and Lawrence system. Arthroscopic grading was done using the Outer bridge classification. Outcomes were assessed at multiple intervals over a 12 month period with a knee score and a functional score. RESULTS: Results were analyzed based on Knee society clinical rating system (1989. At the end of 1month 86.6% had excellent to good results. At the end of 6 months 60% had excellent to good results. At the end of 1 year 37.6% had excellent to good results. At six months follow up results was also evaluated based on different variables - varus deformity, radiographic and arthroscopic grading. Patients with malalignment more than 10 degrees and those with radiographic grading 3 or more were associated with poor results. CONCLUSION: Patients with mild to moderate osteoarthrosis benefitted with excellent to good results from the procedur e. Results were good and long lasting particularly if there was minimal or no malalignment of knee or there was associated mechanical restriction of movement due to meniscal tear or loose bodies.

  6. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review.

    Science.gov (United States)

    Décary, Simon; Ouellet, Philippe; Vendittoli, Pascal-André; Desmeules, François

    2016-12-01

    Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73