Purpose The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts. Methods Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied. Results The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to menis...

Menisci are not uniform structures. Anterior segments have lower cellularity and higher damping. Cyclic loads influence viscoelastic characteristics. Future TE therapies should consider segmental architecture, cellularity and biomechanics of fresh tissue.

Purpose Objective evaluation of both antero-posterior translation and rotatory laxity of the knee remains a target to be accomplished. This is true for both preoperative planning and postoperative assessment of different ACL reconstruction emerging techniques. The ideal measurement tool should be simple, accurate and reproducible, while enabling to assess both ''anatomy'' and ''function'' during the same examination. The purpose of this study is to evaluate the clinical effectiveness of a new in-housedeveloped testing device, the so-called Porto-knee testing device (PKTD). The PKTD is aimed to be used on the evaluation of both antero-posterior and rotatory laxity of the knee during MRI exams. Methods Between 2008 and 2010, 33 patients with ACLdeficient knees were enrolled for the purpose of this study. All patients were evaluated in the office and under anesthesia with Lachman test, lateral pivot-shift test and anterior drawer test. All cases were studied preoperatively with KT-1000 and MRI with PKTD, and examinations performed by independent observers blinded for clinical evaluation. During MRI, we have used a PKTD that applies antero-posterior translation and permits free tibial rotation through a standardized pressure (46.7 kPa) in the proximal posterior region of the leg. Measurements were taken for both knees and comparing side-to-side. Five patients with partial ruptures were excluded from the group of 33. Results For the 28 remaining patients, 3 women and 25 men, with mean age of 33.4 ± 9.4 years, 13 left and 15 right knees were tested. No significant correlation was noticed for Lachman test and PKTD results (n.s.). Pivot-shift had a strong positive correlation with the difference in anterior translation registered in lateral and medial tibia plateaus of injured knees (cor. coefficient = 0.80; p \ 0.05), and with the difference in this parameter as compared to side-to-side (cor. coefficient = 0.83; p \0.05). Considering the KT-1000 difference between injured and healthy knees, a very strong positive correlation was found for side-to-side difference in medial (cor. coefficient = 0.73; p \ 0.05) and lateral (cor. coefficient = 0.5; p \ 0.05) tibial plateau displacement using PKTD. Conclusion The PKTD proved to be a reliable tool in assessment of antero-posterior translation (comparing with KT-1000) and rotatory laxity (compared with lateral pivotshift under anesthesia) of the ACL-deficient knee during MRI examination. Level of evidence Therapeutic studies, Level IV.

Case-control study, Level III.

The meniscus has critical functions in the knee joint kinematics and homeostasis. Injuries of the 2 meniscus are frequent, and the lack of a functional meniscus between the femur and tibial plateau 3 can cause articular cartilage degeneration leading to osteoarthritis development and progression. 4Regeneration of meniscus tissue has outstanding challenges to be addressed. In the current study, 5 novel Entrapped in Cage (EiC) scaffolds of 3D-printed polycaprolactone (PCL) and porous silk 6 fibroin were proposed for meniscus tissue engineering. As confirmed by micro-structural 7 analysis the entrapment of silk fibroin was successful, and all scaffolds had excellent 8 interconnectivity (≥ 99%). The EiC scaffolds had more favorable microstructure compared with 9 the PCL cage scaffolds by improving the pore size while keeping the interconnectivity almost the 10 same. When compared with the PCL cage, the entrapment of porous silk fibroin into the PCL 11 cage decreased the high compressive modulus in a favorable matter in the wet state thanks to the 12 silk fibroin's high swelling properties. The in vitro studies with human stem cells or 13 meniscocytes seeded constructs, demonstrated that the EiC scaffolds had superior cell adhesion, 14 metabolic activity, and proliferation compared to the PCL cage scaffolds. Upon subcutaneous 15 implantation of scaffolds in nude mice, all groups were free of adverse incidents, and mildly 16 invaded by inflammatory cells with neovascularization, while the EiC scaffolds showed better 17 tissue infiltration. The results of this work indicated that the EiC scaffolds of PCL and silk 18 fibroin are favorable for meniscus tissue engineering, and the findings are encouraging for 19 further studies using a larger animal model.20

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