Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage

Hoser, Christian; Fink, Christian; Brown, Charles H.; Reichkendler, M.; Hackl, Wolfgang; Bartlett, James C.

doi:10.1302/0301-620x.83b4.11364

Cited by 77 publications

(17 citation statements)

References 33 publications

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“…Injury or degeneration of the meniscus is associated with pain and joint dysfunction, and loss of meniscal function or surgical meniscectomy leads to relatively rapid and progressive osteoarthritis ( Fairbank, 1948 ). Partial meniscectomy is often utilized to treat meniscal tears; however, despite improvements in pain and function, this surgery does not protect against the development of osteoarthritis ( Andersson-Molina et al, 2002 ; Hall et al, 2014 ; Hoser et al, 2001 ). In addition, the menisci show little capacity for repair, except for certain types of injuries occurring in the peripheral vascularized region ( Arnoczky and Warren, 1983 ; Scott et al, 1986 ).…”

Section: Introductionmentioning

confidence: 99%

Mechanobiology of the meniscus

McNulty

Guilak

2015

Journal of Biomechanics

124

107

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a b s t r a c tThe meniscus plays a critical biomechanical role in the knee, providing load support, joint stability, and congruity. Importantly, growing evidence indicates that the mechanobiologic response of meniscal cells plays a critical role in the physiologic, pathologic, and repair responses of the meniscus. Here we review experimental and theoretical studies that have begun to directly measure the biomechanical effects of joint loading on the meniscus under physiologic and pathologic conditions, showing that the menisci are exposed to high contact stresses, resulting in a complex and nonuniform stress-strain environment within the tissue. By combining microscale measurements of the mechanical properties of meniscal cells and their pericellular and extracellular matrix regions, theoretical and experimental models indicate that the cells in the meniscus are exposed to a complex and inhomogeneous environment of stress, strain, fluid pressure, fluid flow, and a variety of physicochemical factors. Studies across a range of culture systems from isolated cells to tissues have revealed that the biological response of meniscal cells is directly influenced by physical factors, such as tension, compression, and hydrostatic pressure. In addition, these studies have provided new insights into the mechanotransduction mechanisms by which physical signals are converted into metabolic or pro/antiinflammatory responses. Taken together, these in vivo and in vitro studies show that mechanical factors play an important role in the health, degeneration, and regeneration of the meniscus. A more thorough understanding of the mechanobiologic responses of the meniscus will hopefully lead to therapeutic approaches to prevent degeneration and enhance repair of the meniscus.

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Section: Introductionmentioning

confidence: 99%

Mechanobiology of the meniscus

McNulty

Guilak

2015

Journal of Biomechanics

124

107

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“…However, when repair is not feasible, partial meniscectomy is frequently implemented to treat meniscal tears. While these patients report improvements in pain and function, the ability of this surgery to mitigate the risk of premature development of osteoarthritis may be limited (Andersson-Molina et al, 2002; Fauno and Nielsen, 1992; Hall et al, 2014; Hoser et al, 2001; Katz et al, 2006; Rangger et al, 1995). …”

Section: Introductionmentioning

confidence: 99%

In vivo cartilage strain increases following medial meniscal tear and correlates with synovial fluid matrix metalloproteinase activity

Carter

Taylor

Spritzer

et al. 2015

Journal of Biomechanics

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Meniscal tears are common injuries, and while partial meniscectomy is a frequent treatment option, general meniscus loss is a risk factor for the development of osteoarthritis. The goal of this study was to measure the in vivo tibiofemoral cartilage contact patterns in patients with meniscus tears in relation to biomarkers of cartilage catabolism in the synovial fluid of these joints. A combination of magnetic resonance imaging and biplanar fluoroscopy was used to determine the in vivo motion and cartilage contact mechanics of the knee. Subjects with isolated medial meniscus tears were analyzed while performing a quasi-static lunge, and the contralateral uninjured knee was used as a control. Synovial fluid was collected from the injured knee and matrix metalloproteinase (MMP) activity, sulfated glycosaminoglycan, cartilage oligomeric matrix protein, prostaglandin E2, and the collagen type II cleavage biomarker C2C were measured. Contact strain in the medial compartment increased significantly in the injured knees compared to contralateral control knees. In the lateral compartment, the contact strain in the injured knee was significantly increased only at the maximum flexion angle (105°). The average cartilage strain at maximum flexion positively correlated with total MMP activity in the synovial fluid. These findings show that meniscal injury leads to loss of normal joint function and increased strain of the articular cartilage, which correlated to elevated total MMP activity in the synovial fluid. The increased strain and total MMP activity may reflect, or potentially contribute to, the early development of osteoarthritis that is observed following meniscal injury.

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“…3 The goals of meniscal treatment at the time of ACL reconstruction are to create a favorable environment for knee stability while preventing subsequent articular cartilage damage. Due to this fact, as well as the clinical and radiographic deterioration of knees over time following partial meniscectomy, 6, 11, 13 meniscal preservation is favored when possible. Therefore, determining which tears are amenable to nonoperative management, meniscectomy, or repair is essential for successful outcomes in patients who undergo ACL reconstruction with concomitant meniscal tears noted at the time of surgery.…”

Section: Introductionmentioning

confidence: 99%

The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction

Duchman¹,

Westermann²,

Spindler³

et al. 2015

Am J Sports Med

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Background The management of meniscus tears identified at the time of primary ACL reconstruction is highly variable and includes repair, meniscectomy, and non-treatment. Hypothesis/Purpose The purpose of this study is to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with minimum follow-up of 6 years. We hypothesize that small, peripheral tears identified at the time of ACL reconstruction managed with “no treatment” will have successful clinical outcomes. Study Design Retrospective study of a prospective cohort; Level of Evidence, 3 Methods Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. Need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. Results There were 194 patients with 208 meniscus tears (71 medial; 137 lateral) left in situ without treatment with complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction and 7 tears (3.4%) underwent reoperation for isolated meniscus pathology. Patient age was significantly lower in patients requiring reoperation, while tears measuring ≥ 10 mm more frequently required reoperation. Conclusions Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings reemphasize the low reoperation rate following non-treatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment.

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Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage

Cited by 77 publications

References 33 publications

Mechanobiology of the meniscus

Mechanobiology of the meniscus

In vivo cartilage strain increases following medial meniscal tear and correlates with synovial fluid matrix metalloproteinase activity

The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction

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