No abstract

Background: Meniscal extrusion, referred to as an external displacement of the meniscus, is a commonly encountered but often overlooked magnetic resonance imaging finding in the knee joint. Meniscal extrusion alters the biomechanical properties of the meniscus, leading to accelerated cartilage degeneration and early osteoarthritic changes. The literature contains discrepancies about meniscal extrusion on topics ranging from definition to diagnosis. This narrative review outlines the pathogenesis, natural history, diagnosis, and treatment of meniscal extrusion. Purpose: To review the current literature on meniscal extrusion, from pathogenesis to treatment, and to provide recommendations for future research. Study Design: Narrative review. Methods: A computer-based search of the PubMed, Ovid Medline, and Cochrane Library databases was used to perform a comprehensive literature review on meniscal extrusion. A total of 81 studies was ultimately included in the review. Results: The literature review highlighted the current ambiguity in definition, difficulty in clinical diagnosis, and low level of awareness of this condition. This review covers all aspects related to meniscal extrusion and identifies many of its lesser known aspects. Conclusion: In the current literature, meniscal extrusion remains a lesser known albeit common condition because of its relatively silent nature along with lack of knowledge among orthopaedic surgeons. Further studies are warranted to provide better understanding and management of this condition.

Objectives: Lateral end of clavicle fractures is associated with coracoclavicular ligament disruption and, hence, poses a surgical challenge for the management. Surgical techniques already described have high failure rates and hardware-related complications. The objective of the study is to assess the clinical and radiological outcome of the novel surgical technique of arthroscopic coracoclavicular stabilization and indirect anatomical reduction of the lateral end of clavicle fracture using FiberWire and FiberTape. Materials and Methods: We conducted a retrospective review of 15 consecutive patients with displaced, unstable Neer Type II and V distal clavicle fractures who underwent this surgical technique from 2016 to 2020. Primary outcome variables were radiographic union, patient satisfaction, and post-operative shoulder function. Pre- operative and post-operative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, post-operative complications, and time to radiographic union. Results: In our study, 12 were male patients and three female patients, with a mean age of 43 years. The mean post-operative follow-up period was 23 months. Results were satisfactory in all 15 cases, all 15 were had excellent as per UCLA and ASES score. All fractures healed within a mean period of 6 weeks. Only one patient had developed malunion due to over-tightening of FiberWire, although his functional outcome was not compromised with this. Conclusion: We present a novel surgical technique for fixing displaced distal lateral clavicle with arthroscopic coracoclavicular stabilization with FiberWire and FiberTape that resulted in a 100% union rate and excellent clinical outcomes with minimal complications.

Doxycycline is a drug that has been proposed to modify osteoarthritis (OA) progression, in addition to its role as an antibiotic. However, available evidence thus far comprises sporadic reports, with no consensus on its benefits. Hence, this review attempts to analyze the evidence available thus far on the role of doxycycline as a disease-modifying osteoarthritis drug (DMOAD) in knee osteoarthritis. The earliest evidence of doxycycline in OA appeared in 1991 when doxycycline was found to inhibit the type XI collagenolytic activity of extracts from the human osteoarthritic cartilage, and gelatinase and tetracycline were found to inhibit this metalloproteinase activity in articular cartilage in vivo, which could modify cartilage breakdown in osteoarthritis. Apart from the inhibition of cartilage damage by metalloproteinases (MMPs) and other cartilage-related mechanisms, doxycycline also affects the bone and interferes with many enzyme systems. The most significant finding after reviewing various studies was that doxycycline has a definitive role in structural changes in osteoarthritis progression and radiological joint space width, but its role in the improvement of clinical outcomes as a DMOAD has not been established. However, there is much of a gap and lack of evidence in this regard. Doxycycline, as an MMP inhibitor, has theoretical advantages for clinical outcomes, but the present studies reveal only beneficial structural changes in osteoarthritis and very minimal or nonexistent advantages in clinical outcomes. Current evidence does not favor the regular use of doxycycline for the treatment of osteoarthritis as an individual treatment option or in combination with others. However, multicenter large cohort studies are warranted to determine the long-term benefits of doxycycline.