Rationale: Complete discoid medial meniscus is an extremely rare abnormality of the knee joint whose meniscus has a discoid shape rather than a normal semilunar one. Several medial meniscus anomalies including anomalous insertion have been reported in the literature. This report presents a rare case of symptomatic complete discoid medial meniscus whose anterolateral (apical) portion was completely coalesced with the ACL. MRI, radiographic and arthroscopic findings in the medial compartment are to be submitted.Patient concerns and diagnoses: A 29-year-old male presented with intermittent pain and swelling of the right knee for 2 years. Based on radiographic, MRI and physical examination findings, he was diagnosed with discoid medial meniscus tears. Interventions and outcomes: Arthroscopic saucerization were performed for the torn discoid medial meniscus of the right knee. Arthroscopic examination revealed a complete discoid medial meniscus and the anterolateral (apical) portion of which was completely coalesced with the ACL. Careful Probing of the meniscal surface revealed there was a longitudinal tear extending from the tibial spine to the midportion of the meniscus. Arthroscopic saucerization of the discoid meniscus were performed After closely cutting the meniscus around the ACL. The patient reported a satisfactory results at the 12-month follow-up.Lessons: Complete discoid medial meniscus is an extremely rare abnormality, and this case presents the third complete discoid medial meniscus whose anterolateral (apical) portion was completely coalesced with the ACL. The current case we present strongly supports the theory that ACL and meniscus were differentiated from the same mesenchyme.
Background: Excessive sedentary behaviors have been reported to be associated with increased risk of type 2 diabetes, but whether this association is causal remains unclear. In current study, we aimed to investigate the causal association between domain-specific sedentary behaviors and the risk of type 2 diabetes using a two-sample Mendelian randomization (MR) study. Methods: We identified 165 single nucleotide polymorphisms as instrumental variables for television watching, 43 for computer use and 5 for driving behavior from a recently published genome-wide association study (n = 408,815). Genetic association estimates for type 2 diabetes were obtained from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium (74,124 cases and 824,006 controls). The inverse variance-weighted method was used to estimate the effect of genetically predicted sedentary behaviors on the risk of type 2 diabetes. Reverse MR analysis was performed to investigate the reverse causation. The weighted median method, MR-Egger method, and MR Pleiotropy Residual Sum and Outlier method were employed in the sensitivity analyses. In addition, multivariable MR analysis and mediation analysis were conducted to explore the potential mechanistic elements.Results: Genetic predisposition to excessive television watching was associated with increased risk of type 2 diabetes. The OR (95% CI) per 1.5h (1 standard deviation) increment in television watching time was 1.82 (1.61, 2.07) for type 2 diabetes. This association was substantially attenuated after adjustment for anthropometric traits (adjusting BMI: OR = 1.35, 95% CI = 1.17 – 1.57, P = 4.1 × 10-5; adjusting WHR: OR = 1.26, 95% CI = 1.09 – 1.45, P = 1.4 × 10-3) and educational attainment (OR = 1.49, 95% CI = 1.16 – 1.91, P = 1.7 × 10-3). There was limited evidence of associations of computer use and driving behavior with the risk of type 2 diabetes. Conclusions: Our study clarifies the causal effect of excessive television watching on the increased risk of type 2 diabetes from a genetic perspective, which may be partly mediated via anthropometric and educational traits. Television watching may serve as a behavioral target to prevent incident diabetes.
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