Changes in Tibiofemoral Contact Mechanics Following Radial Split and Vertical Tears of the Medial Meniscus

Muriuki, Muturi; Tuason, Dominick; Tucker, Brad; Harner, Christopher D.

doi:10.2106/jbjs.i.01241

Cited by 80 publications

(72 citation statements)

References 12 publications

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“…Recently, there has been an increased effort to determine a more durable alternative to meniscectomy, because the procedure results in higher contact stresses at the articular surface of the knee [1,2,7,15,16,23,25]. Meniscal repairs have been extensively studied but continue to fail for varied reasons.…”

Section: Discussionmentioning

confidence: 99%

“…One treatment option for the injured meniscus is partial or total meniscectomy, although well-established data suggest that increased contact stresses occurring long term can lead to poor outcomes in many cases [2,3,11,[23][24][25]. Such findings have led to a renewed focus on meniscal preservation strategies to prevent articular cartilage degeneration.…”

Section: Introductionmentioning

confidence: 99%

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Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Griffin

Hadeed

Werner

et al. 2015

Clinical Orthopaedics &Amp; Related Research

124

160

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Background Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. Questions/purposes We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Methods Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was À1.1 (À2.1 to À0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. Results There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Griffin

Hadeed

Werner

et al. 2015

Clinical Orthopaedics &Amp; Related Research

124

160

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“…By assuming that a normal lamellar layer is relatively homogeneous and somewhat stiffer than underlying layers, it would be logical that a thicker layer would result in higher indentation stiffness. Also, we presume that, even within an individual, the lamellar layer thicknesses could vary depending on meniscal regions such as anterior, middle, and posterior horn because the compressive loading is known to be heterogeneous throughout the meniscus (23).…”

Section: Comparison Of Mean Values Of Normal and Abnormal Samplesmentioning

confidence: 99%

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

Choi¹,

Biswas²,

Bae³

et al. 2016

Radiology

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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 boardapproved study. Nine meniscal pieces were obtained from seven donors without gross meniscal pathologic results (mean age, 57.4 years 6 14.5 [standard deviation]). UTE MR imaging and T2, UTE T2*, and UTE T1r 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 mm 6 85 and indentation peak force of 1.37 g 6 0.87. Four abnormally thick lamellar layers showed mean thickness of 353.14 mm 6 98.36 and peak force 0.72 g 6 0.31. In most cases, normal thicknesses showed highly positive correlation with the indentation peak force (r = 0.493-0.912; P , .001 to .05). However, the thickness in two abnormal lamellar layers showed highly negative correlation (r = 20.90, P , .001; and r = 20.23, P = .042) and no significant correlation in the others. T2, UTE T2*, and UTE T1r values in abnormally thick lamellar layers were increased compared with values in normal lamellar layers, although only the UTE T2* value showed significant difference (P = .010).

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“…In biomechanical studies, peak contact pressure was shown to increase by up to 235% after total meniscectomy9,10) and by up to 165% even after partial meniscectomy10). In contrast, the contact pressure after meniscal repair decreases almost down to the intact level10,11,12). In terms of clinical outcomes, meniscectomy has been associated with lower clinical outcome scores than meniscal repair13,14,15).…”

Section: Introductionmentioning

confidence: 99%

Meniscal Repair

Yoon

Park

2014

Knee Surg Relat Res

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The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

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Changes in Tibiofemoral Contact Mechanics Following Radial Split and Vertical Tears of the Medial Meniscus

Cited by 80 publications

References 12 publications

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

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

Meniscal Repair

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