Statistical evaluation of the diagnostic criteria for meniscal tears

Summary The accuracy of diagnosis was tested in a prospective study of 145 patients who were arthroscoped because a meniscal tear was suspected clinically. Multiple variate analysis was used to evaluate 68 different clinical parameters. The clinical accuracy was 61% as a tear was demonstrated in 88 knees; 73 of these tears were associated with other intraarticular abnormalities. Thirteen knees were entirely normal at arthroscopy. It was possible to predict a meniscal tear in 8 out of 10 patients.

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Résumé Une enquête prospective portant sur 145 malades chez qui a été pratiquée une arthroscopie en raison d'une suspicion clinique de lésion méniscale a permis d'étudier la justesse du diagnostic. On a eu recours à une analyse statistique multivariée pour évaluer 68 paramètres cliniques différents. L'exactitude clinique était de 61% puisqu'une déchirure du ménisque a été découverte dans 88 genoux; 78 d'entre elles s'accompagnaient d'une autre lésion intra-articulaire. Treize genoux étaient strictement normaux à l'arthroscopie. Il apparaît donc que la prédiction d'une lésion méniscale est possible dans 8 cas sur 10.

     

Lack of posteromedial tibiofemoral congruence at full flexion as a causative factor in isolated medial meniscal tears

The aim of the current study was to investigate posteromedial tibiofemoral congruence at full flexion of the knee in control knee joints and those affected by an isolated medial meniscal tear, to examine whether lack of such congruence was a causative factor in isolated medial meniscal tears. In this study, 1677 knee joints in 875 subjects were evaluated. The joints were classified as a control group (1345 joints), an isolated medial meniscal tear group (224 joints), and a contralateral isolated medial meniscal tear group (108 joints). Posteromedial tibiofemoral congruence was examined on a lateral radiograph of the knee joint at full flexion. The tangent touching the anterior and posterior parts of the articular surface of the medial tibial condyle was assumed to be the X-axis. To evaluate posteromedial tibiofemoral congruence, we measured the angle formed by the tangent that maximized the gradient of the tangent on the articular surface of the medial femoral condyle, and the tangent that maximized the gradient of the tangent on the articular surface of the medial tibial condyle. The mean angle differed significantly between the control and the isolated medial meniscal tear groups, regardless of sex. Isolated medial meniscal tears were found to be strongly related to an abnormally decreased angle, and, therefore, incongruence of the posteromedial tibiofemoral articulation at full flexion was considered to be one of the causes of isolated medial meniscal tears. Received: May 22, 2001/ Accepted: October 24, 2001     

Epidemiology of meniscal injury associated with ACL tears in young athletes

The epidemiologic characteristics of concomitant meniscal tears that occur at the time of anterior cruciate ligament (ACL) injury have been variably reported. The purpose of this study was to assess the epidemiology of meniscal tears that occur in the ACL-injured knee of a young, athletic population at a single institution. We were unable to find a difference in meniscal tear incidence based on sex, mechanism of injury, sport, or time to surgery. In addition, we found that the cumulative incidence of isolated medial meniscal tears was significantly higher than the cumulative incidence of isolated lateral meniscal tears. Our prospective study design and ability to identify and follow all patients in our study population make this a unique study.     

The radiographic position of medial and lateral meniscal horns as a basis for meniscal reconstruction.

This investigation attempted to determine the radiographic position of human meniscal horn bony insertion sites. This information would prove vital for anatomically correct osseous tunnel placement necessary for the restoration of a functional meniscus after reconstructive surgery. The native bony insertion sites of the medial and lateral meniscus in 13 fresh-frozen human cadaver knees were radiographically examined. After insertion site outline with 22-gauge fine wire, anteroposterior and lateral radiographs were obtained. Radiographic landmarks were then described in detail. Each meniscal horn was found to have a distinct bony insertion site with characteristic and consistent radiographic landmarks defining its margins. Using an arthroscopic guide, 3/32-inch fine wires were drilled into the center of the lateral (5 specimens) and medial (5 specimens) meniscal horns to validate these locations and to establish the clinical usefulness of these measures. Improved understanding of meniscal horn insertion site locations should improve osseous tunnel placements during meniscal transplantation. In the presence of a properly sized allograft, anatomically correct tunnel placement increases the likelihood of restoring normal meniscal function.     

Magnetic resonance imaging as a screening procedure to avoid arthroscopy for meniscal tears

The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) as a screening procedure before arthroscopy of meniscal tears. Forty-one knees in 40 patients underwent MRI and arthroscopy. Compared with arthroscopy, the sensitivity, specificity, positive predictive value and negative predictive value for MRI for the nmedial meniscus were 100%, 77%, 71% and 100%, respectively, while the values for the lateral meniscus were 40%, 89%, 33% and 91%, respectively. The overall accuracy for MRI of the medial and lateral menisci combined was 84%. On the basis of the high predictive value of negative MRI, we conclude that MRI is useful to exclude patients from unnecessary arthroscopy.     

Bilateral bucket handle medial meniscal tears of the knee: A case report

INTRODUCTIONMeniscal tears may cause knee pain and functional impairment. Bilateral bucket-handle meniscal tears is an uncommon condition.PRESENTATION OF CASEThis report presents the case of a 35-year-old male patient with bilateral bucket handle medial meniscal tears that occurred nonsimultaneously. The lesions were treated arthroscopically with partial resection in one knee and meniscal suture in the other.DISCUSSIONBucket handle meniscal tear of meniscus without underlying meniscal, ligamentous pathology or lower limb deformity is a rare condition.CONCLUSIONTo our knowledge, bilateral bucket handle medial meniscal tears without underlying meniscal anomalies have been reported in only two cases before, and our case is the third one.     

Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears

BACKGROUND: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. METHODS: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. RESULTS: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. CONCLUSIONS: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.     

An unusual case of meniscal hematoma mimicking a medial meniscal cyst

This is a case report of a so-called meniscal hematoma that mimicked a meniscal cyst. A literature search found no previous report of it before. Treatment with arthroscopic intra-articular decompression alone is enough. We discuss the possibility of its pathogenesis and treatment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: E22     

Reliability of clinical diagnosis in meniscal tears

This retrospective study was conducted to analyse the reliability of clinical diagnosis in meniscal tear injuries. All patients attending our clinic with knee pain from January 2003 to December 2004 underwent systematic and thorough clinical assessment. One hundred and fifty patients were clinically diagnosed to have meniscal tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The accuracy of clinical diagnosis in our study was 88% for medial meniscal tears and 92% for lateral meniscal tears. The results of this study demonstrate that clinical diagnosis of meniscal tears is as reliable as the results published by other authors for magnetic resonance imaging (MRI) scan. We recommend the use of MRI for more doubtful, difficult and complex knee injuries.

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Résumé Cette étude rétrospective analyse la fiabilité du diagnostic clinique dans les lésions méniscales. De janvier 2003 à décembre 2004 tous les patients présentant des gonalgies ont eu un examen clinique minutieux. 150 avaient des signes de déchirure méniscale et ils ont eu une arthroscopie thérapeutique qui a permis de calculer l’exactitude, la sensibilité et la spécificité du diagnostic. L’exactitude était de 88% pour les lésions méniscales médiales et de 92% pour les lésions latérales. Les résultats montrent que le diagnostic clinique était aussi fiable que le diagnostic par IRM d’après des résultats publiés par d’autres auteurs.

     

The medial meniscal root as a landmark for tibial tunnel position in posterior cruciate ligament reconstruction

As a result of improved basic science knowledge and operative techniques, posterior cruciate ligament (PCL) reconstructions have steadily increased over the past 10 years. Even for the experienced arthroscopist, PCL reconstruction surgery can be technically challenging and fraught with complications. The most technically demanding aspect of the procedure may be placement and drilling of the tibial tunnel. Reasons for this include unfamiliarity with the posterior aspect of the knee, neurovascular risk, and the relative infrequency of the procedure being performed by most surgeons. We propose that the root of the posterior horn of the medial meniscus is an easily identifiable visible landmark that can not only aid in the localization of the position of the tibial tunnel in PCL reconstruction but also assist navigation in the posterior aspect of the knee arthroscopically.     

Biodegradable arrows for arthroscopic repair of meniscal tears

Thirty-two meniscal tears in 32 patients were repaired using biodegradable meniscus arrows. The tears were fixed arthroscopically using an all-inside technique. Ten patients had a simultaneous anterior cruciate ligament (ACL) reconstruction. The period of follow-up was an average of 25 (10-40) months. Twenty-six patients were clinically stable and asymptomatic at follow-up. Six patients were considered clinically unstable and all had associated ACL reconstruction and required a repeat arthroscopy. Two meniscal repairs failed to heal, and the broken meniscus arrow was retrieved arthroscopically 6 months after the primary operation. In four cases the meniscal tear healed completely (two cases) or partially. Otherwise, there were no objective signs of complications. The use of meniscus arrows is a simple, safe, and reliable method for repair of properly selected meniscal tears.     

Allograft ligament transplantation in anterior cruciate ligament reconstruction patients with meniscal tears

Background

It currently remains unclear whether the meniscal repair clinical results were affected by the graft used in anterior cruciate ligament (ACL) reconstruction. This retrospective study designed to evaluate the difference in clinical outcomes of meniscal repair using autograft and allograft for the ACL reconstruction.

Methods

The injury of the ACL and meniscus was evaluated with MRI and treated simultaneously. One hundred and eighty-nine cases were initially fulfilled the study criteria, and had the surgery in the period June 2007 and July 2010. Thirty-four patients were lost to follow-up. Seventy-five patients underwent meniscus repair with autograft reconstruction of the ACL (autograft group) and 80 patients underwent meniscus repair with allograft reconstruction of the ACL (allograft group).

Results

The meniscus healing rate based on the clinical examination of Barrett’s criteria was 81.3 % (61/75) in the autograft group and 80.0 % (64/80) in the allograft (P > 0.05). There was no significant difference in the Lysholm scores in the allograft group compared to the allograft group (89.1 ± 10.6 versus 88.7 ± 11.2, P > 0.05). The values of immunoglobulin’s and complements (IgG, IgA, IgM, C3 and C4) were not significantly different between the two groups (P > 0.05).

Conclusion

The data support our assumption that patients undergoing meniscal repair associated with ACL reconstruction with allograft had good clinical outcomes. Although allograft implantation induces an immunological response on a subclinical level, there were no signs of allograft affecting the nature of meniscus healing.     

Treatment options for irreparable postero-superior cuff tears in young patients

Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.     

关节镜下可吸收性半月板箭治疗半月板损伤的初步报告

目的关节镜下应用可吸收性半月板箭治疗半月板损伤并评价其近期疗效。方法2002年2～10月,关节镜下采用半月板箭缝合固定12例12侧半月板损伤,男5例,女7例;年龄18～58岁,平均33.2岁。左膝4例,右膝8例。内侧半月板损伤4例,外侧半月板损伤8例;前角损伤2例,体部损伤3例,后角损伤7例。红区损伤10例,红-白区损伤2例。病程3d～5个月,平均2.3个月,其中急性损伤(病程<1个月)9例。关节镜下采用新型全内半月板箭技术固定,共使用25枚半月板箭(平均每例2.1枚)。5例同时施行其它类型手术。结果所有病例术后均无早期并发症发生。全部患者均获得随访,随访时间7～13个月,平均10.2个月。随访时所有患者膝关节稳定,无疼痛、绞锁等症状,6周后关节活动度全面恢复。Lysholm评分由术前的平均(45.6±13.4)分增加到术后平均(82.4±16.3)分,差异有显著性(P< 0.05)。2例分别于术后8个月和9个月出现关节积液,考虑为滑膜炎,经治疗后消失。结论对于半月板损伤,如撕裂类型和部位适当,可选择可吸收性半月板箭治疗。半月板箭技术是一种简便快捷、安全有效的半月板缝合方法。