Meniscal tears are the most common injury in the knee, affecting 66/100,000 people/year. Surgical treatment includes arthroscopic meniscectomy or meniscal repair. Little is known regarding medium-term outcomes following these procedures in isolated meniscal tears. This study aims to quantitatively evaluate patients with meniscal tears, and those who have undergone meniscectomy and meniscal repair using validated patient reported outcome measures (PROMs), further exploring factors which affect surgical outcomes. This observational study screened 334 patients who underwent arthroscopic surgery at South Tyneside Hospital since August 2013. 134 patients with isolated meniscal tears were invited to complete postal PROMs. A combination of patient notes and radiological imaging was used to collect information of interest including age, gender, knee-laterality, injured meniscus, tear pattern, procedure performed, complications, and associated injuries. A total of 115 patients (pre-operative patients with current meniscal tear (n=36), meniscectomy (n=63), meniscal repair (n=16)) were included in the analysis with 96% successful PROM completion. Both meniscectomy and meniscal repairs (mean 55-months follow-up) showed better outcomes than pre-operative patients with meniscal tears. Meniscal repairs demonstrated superior outcomes across all PROMs when compared to meniscectomy, with a greater mean overall KOOS score of 17.2 (p=0.009). Factors including higher pre-operative Kellgren-Lawrence Grade, pre-operative articular cartilage lesions and bilateral meniscectomies were shown to negatively influence outcomes. Both meniscectomy and meniscal repair maintain clinical benefit at mean 55-months follow-up, affirming their use for treatment of meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy in isolated meniscal tears. Identified predictive factors allow adequate treatment stratification in specific patient groups

Knee arthroscopy with meniscectomy is the third most common Orthopaedic surgery performed after TKA and THA, comprising up to 16.6% of all procedures. The efficiency of Orthopaedic care delivery with respect to waiting times and systemic costs is extremely concerning. Canadian Orthopaedic patients experience the longest wait times of any G7 country, yet perioperative surgical care constitutes a significant portion of a hospital's budget. In-Office Needle Arthroscopy (IONA) is an emerging technology that has been primarily studied as a diagnostic tool. Recent evidence shows that it is a cost-effective alternative to hospital- and community-based MRI with comparable accuracy. Recent procedure guides detailing IONA medial meniscectomy suggest a potential node for OR diversion. Given the high case volume of knee arthroscopy as well as the potential amenability to be diverted away from the OR to the office setting, IONA has the potential to generate considerable improvements in healthcare system efficiency with respect to throughput and cost savings. As such, the purpose of this study is to investigate the cost savings and impact on waiting times on a mid-sized Canadian community hospital if IONA is offered as an alternative to traditional operating room (OR) arthroscopy for medial meniscal tears. In order to develop a comprehensive understanding and accurate representation of the quantifiable operations involved in the current state for medial meniscus tear care, process mapping was performed that describes the journey of a patient from when they present with knee pain to their general practitioner until case resolution. This technique was then repeated to create a second process map describing the hypothetical proposed state whereby OR diversion may be conducted utilizing IONA. Once the respective process maps for each state were determined, each process map was translated into a Dupont decision tree. In order to accurately determine the total number of patients which would be eligible for this care pathway at our institution, the OR booking scheduling for arthroscopy and meniscectomy/repair over a four year time period (2016-2020) were reviewed. A sensitivity analysis was performed to examine the effect of the number of patients who select IONA over meniscectomy and the number of revision meniscectomies after IONA on 1) the profit and profit margin determined by the MCS-Dupont financial model and 2) the throughput (percentage and number) determined by the MCS-throughput model. Based on historic data at our institution, an average of 198 patients (SD 31) underwent either a meniscectomy or repair from years 2016-2020. Revenue for both states was similar (p = .22), with the current state revenue being $ 248,555.99 (standard deviation $ 39,005.43) and proposed state of $ 249,223.86 (SD $ 39,188.73). However, the reduction in expenses was significant (p < .0001) at 5.15%, with expenses in the current state being $ 281,415.23 (SD $ 44,157.80) and proposed state of $ 266,912.68 (SD $ 42,093.19), representing $14,502.95 in savings. Accordingly, profit improvement was also significant (p < .0001) at 46.2%, with current state profit being $ (32,859.24) (SD $ 5,153.49) and proposed state being $ (17,678.82) (SD $ 2,921.28). The addition of IONA into the care pathway of the proposed state produced an average improvement in throughput of 42 patients (SD 7), representing a 21.2% reduction in the number of patients that require an OR procedure. Financial sensitivity analysis revealed that the proposed state profit was higher than the current state profit if as few as 10% of patients select IONA, with the maximum revision rate needing to remain below 40% to achieve improved profits. The most important finding from this study is that IONA is a cost-effective alternative to traditional surgical arthroscopy for medial meniscus meniscectomy. Importantly, IONA can also be used as a diagnostic procedure. It is shown to be a cost-effective alternative to MRI with similar diagnostic accuracy. The role of IONA as a joint diagnostic-therapeutic tool could positively impact MRI waiting times and MRI/MRA costs, and further reduce indirect costs to society. Given the well-established benefit of early meniscus treatment, accelerating both diagnosis and therapy is bound to result in positive effects

The value of arthroscopic partial meniscectomy in the severely arthritic knee has been questioned. Some authors suggest that it may result in progression of osteoarthritis precipitating the need for joint replacement and that symptomatic improvement may occur from lavage alone. 126 patients with a torn meniscus and Outerbridge grade IV changes in the same compartment underwent arthroscopic partial meniscectomy and limited debridement of unstable articular cartilage. The indication for surgery was a symptomatic meniscal tear not osteoarthritis. A control group consisted of 13 patients with grade IV changes and intact but frayed menisci who underwent washout alone. Mean age and follow up were similar in the two groups. Initially meniscectomy improved symptoms in 82 cases (65%). Symptoms were unchanged in 26 cases (21%) and were made worse in 18 cases (14%). At a mean follow up of 55 months, 50 patients (40%) felt their knees were better than they were preoperatively. Their mean Lysholm score was 75. 5. 35 knees (28%) were not improved (mean Lysholm socre 59). 41 patients (32%) had undergone further surgery: 39 total knee replacements, 1 unicompartmental knee replacement and 1 tibial osteotomy. Older patients, those with varus/ valgus malalignment, and those with exposed bone on both articular surfaces fared worse. Outcome following meniscectomy was better than outcome following washout alone: more patients reported an improvement after meniscectomy and fewer had undergone further surgery on their knees (p=0. 04). The median time between arthroscopy and the decisions for joint replacement was the same in both groups (8 months in the meniscectomy group and 7. 5 months in the washout group) indicating meniscectomy did not precipitate joint replacement. These results suggest that arthroscopic partial men-iscectomy in the presence of Outerbridge grade IV changes can result in satisfactory long term outcomes for many patients, is more effective than washout alone and does not precipitate the need for joint replacement

INTRODUCTION: Loss of meniscus tissue leads to decreased clinical function and activity levels. However, no report has quantified the amount of meniscus tissue removed at meniscectomy and correlated meniscus tissue loss with clinical symptoms, function, and activity. We determined, prospectively, the amount of tissue loss at time of partial medial meniscectomy and then correlate extent of meniscus loss with clinical symptoms, function, and activity levels 2 years following the index meniscectomy. METHODS: In a randomized controlled investigational device clinical trial (Level of Evidence I), 149 patients 18 to 60 years old underwent partial medial meniscectomy and served as controls. There were 81 acute (no prior meniscus surgery) and 68 chronic (1 to 3 prior partial meniscectomies on the involved meniscus) patients. At index surgery, size of the meniscus defect was measured using specially designed instruments, and percent of meniscus loss was calculated based on actual measurements. Patients were followed clinically for a minimum of 2 years after meniscectomy. At each follow-up, every patient completed questionnaires including Lysholm and Tegner scores to assess function and activity. Amount of meniscus tissue at index surgery was correlated with the individual domains of the Lysholm scale. Tegner index was calculated to determine the amount of lost activity regained 2 years after surgical intervention. RESULTS: Two-year data were available for 127 patients (85% follow-up). There was a significant correlation between the amount of meniscus tissue remaining following the index meniscectomy and 2-year Lysholm domains of squatting (r=0.281, p=0.001), stair-climbing (r=0.251, p=0.004), and swelling (r=0.261, p=0.003). In particular, it is noteworthy that patients who had > 50% of their meniscus remaining had significantly better function than patients who had < 50% meniscus remaining. Patients who had worse or no improvement in pain symptoms at 2 years averaged 42% meniscus remaining, while patients who had improved pain scores had on average 51% meniscus remaining. Tegner index for patients with < 50% meniscus remaining averaged 24%, and for patients with > 50% meniscus remaining averaged 52% (p=0.017); hence, a greater amount of meniscus tissue remaining allowed patients to regain significantly more of their lost activity. CONCLUSIONS: There is a significant correlation between the amount of meniscus tissue removed at men-iscectomy and clinical symptoms, function, and activity 2 years after surgery. This study confirms the importance of preserving as much meniscus tissue as possible at the time of meniscus repair or meniscectomy as well as the potential positive benefits of regrowing or replacing lost meniscus tissue in order to minimize clinical symptoms that may be suggestive of early degenerative changes

There are a few reports in the literature that compare the results of medial and lateral meniscectomy, especially in older patients. Eighty three patients that underwent partial menis-cectomy were studied (45 men, 38 women), all older than 45 years. Forty eight cases considered medial and 35 cases lateral meniscectomy, mainly of the posterior horn. According to Outbridge and French Arthroscopic system criteria, there was not significant difference for the osteoarthritic changes that were found arthroscopically. 48% of the patients had no arthritic damage. Radiological evaluation of the results was done with Fairbank classification and International Knee Documentation Committee criteria, pre and postoperatively. Preoperatively, 50% of the patients had no pathologic radiological findings and postoperatively, both groups had similar radiological results. Tapper – Hoover criteria and Lysholm II Score were used for the evaluation of clinical results. 83% of medial and 78% of lateral meniscus tear’s repair had satisfactory clinical results and no statistical significance was documented in our series, despite reports from the literature of poorer clinical results for lateral meniscectomy. In both groups, clinical results were not influenced by the severity of cartilage lesions or by the age of patients, but by the amount of meniscus removal and the delay of arthroscopy, greater than 2 months

The aim of this study was to determine if patient reported outcome scores for arthroscopic meniscectomy are adversely affected by the degree of knee osteoarthritis or patient body mass index (BMI). All patients who underwent arthroscopic meniscectomy within the NHS in Scotland between 6th February and 29th April 2012 were audited as part of the Scottish Government Musculoskeletal Knee Arthroscopy Audit and were eligible for inclusion within this study. A total of 270 patients returned both their pre-operative and post-operative EuroQol 5Q5D5L descriptive questionnaire and Knee injury and Osteoarthritis Outcomes Scores. Patients were stratified according to BMI, degree of osteoarthritis, history of injury, and duration of knee symptoms. Pre-operative to post-operative EuroQol index scores [0.642±0.253 to 0.735±0.277, median±SD] and Knee injury and Osteoarthrtis Outcome Scores [44.63±18.78 to 62.28±24.94, median±SD] improved across all patients (p<0.0001). This was irrespective of degree of BMI, history of injury, or duration of symptoms. There was no such improvement in patients with moderate to severe osteoarthritis. Those patients with a BMI >35 kg/m2 had lower post-operative scores than the pre-operative scores of those of BMI <30 kg/m2. Arthroscopic meniscectomy is beneficial regardless of patient BMI, duration of symptoms, history of injury, or in the presence of mild arthritis

Purpose: The purpose of this study was to compare the bone-patellar-tendon-bone (BPTB) and the four-strand hamstring grafts for anterior cruciate ligament (ACL) reconstruction in patients aged less than 40 years and to evaluate the influence of meniscectomies performed before, during, or after the ACL reconstruction. Material and methods: Between March 1997 and March 2000, 114 patients who underwent ACL reconstruction (58 BPTB then 56 hamstring) were included. Exclusion criteria were: peripheral ligament repair or associated bone procedures, surgical revision. The continuous series was analysed retrospectively by two surgeons different from the operator. The BTPB group included 58 patients (mean age 28 years) evaluated at a mean 44 months; meniscectomy was associated in eleven cases. The hamstring group included 56 patients (mean age 27.5 years) evaluated at a mean 28 months; there were 19 associated meniscectomies. The IKDC score and laxity (KT2000, Telos) as well as the radiological aspect (AP, lateral and 30° flexion views) were used to assess outcome. Results: At last follow-up (89 patients, 78%) there were three failures in each group; 77% of patients were in IKDC classes A or B. Subjectively, 90% of the patients considered their knee was normal or nearly normal. For both types of grafts, the outcome was significantly better if the meniscus was preserved. For knees with preserved menisci, there was no difference between BTPB and hamstring reconstruction. Anterior pain was greater after BTPB and posterior thigh pain was greater after hamstring reconstruction. Mean deficit was 14% in extension force in the BTPB group and 25% in flexion force in the hamstring group. Discussion: Meniscectomy before, during or after ACL reconstruction has a negative effect on the graft outcome for both techniques. If the meniscus is preserved, there is no difference between BTPB and hamstring reconstruction; the morbidities are different, but equivalent (anterior pain for BTPB and posterior for hamstring) and muscle deficit is different (extension for BTPB and flexion for hamstring). Conclusion: More important than the type of transplant used to reconstruct the ACL, meniscal preservation is a major element affecting outcome

Purpose: To report on our early experience with a synthetic meniscal substitute inserted for symptomatic post meniscectomy medial or lateral knee pain. Methods and results: Six patients underwent underwent insertion of a collagen meniscal implant (Menaflex, Hospital Innovations, UK). These were inserted onto a trephinated rim of vascular meniscus to permit the structural incorporation of healing tissue. Specific rehabilitation included 8 weeks on crutches and restricted activity for 6 months. Patients were prospectively analysed documenting KOOS, IKDC, Lysholm and SF36 outcome scores. All patients were male, 4 patients had deficiencies in the right knee, 2 the left knee and the mean patient age was 28.8years (range 17–45). Four CMI were inserted for lateral meniscal deficiencies, two medial. The mean length of implant sutured in place was 41mm (range 35–55). Median pre op scores were KOOS P/S/ADL/QOL 53/100, 54/100, 66/100, 25/100, 44/100, IKDC 49.43%, Tegner 3, SF-36 35.38 PCS and 27.48 MCS and Lysholm 87/100. The mean elapsed time post meniscectomy was 20 months (range 2–51). All but one of the implants used were 9.5mm in width and sizes ranged 35–45mm. At early follow up there have been no complications and background pain has improved in all 6. MIR imaging has shown that none have separated. Post operative follow up suggest improved outcome. Conclusion: Though this is very early data, close scuritny of new treatment options is essential. So far the clinical outcome is favourable and we believe that CMI may be beneficial in reducing post menisectomy pain. Hopefully, in the future CMI may become a means of preventing post meniscectomy osteoarthrtitis

Purpose of the study: The purpose of this retrospective multicentric analysis was to study the functional and radiological outcomes at more than 20 years of 89 arthroscopic lateral menisectomy procedures performed on stable knees. Materialandmethod:The series included 89 arthroscopic lateral meniscectomies performed on knee with intact anterior cruciate ligaments (ACL). Mean follow-up was 22±3 years; 56 male, mean BMI 25±4, mean age at meniscectomy 35 years, mean age at last follow-up 57 years. Most of the injuries were vertical (41%), complex (22%) and radial (20%) lesions. The middle segment was involved in 79%. The meniscectomy removed more than one-third of the meniscus in 67%. All patients were reviewed by an independent operator for subjective assessment KOOS (100% normal) and IKDC, and for objective clinical and radiological measurements (IKDC). P< 0.05 was considered statistically significant. There was no independent control group. Results: Revisions were performed for 16% of the knees. Intense or moderate activity was maintained by all patients. The subjective IKDC score was 71.1±23, comparable with an age and gender matched population. The mean KOOS score was 82% for pain, 80% for symptoms, 85% for daily activities, 64% for sports, and 69% for quality of life. The rate of of osteoarthritis was 56%, and 44% of patients had a difference between the two knees for osteoarthritis. The incidence of osteoarthritis was 53% and shift to valgus on the arthritic side was significantly associated with osteoarthritis, while the opposite side was well aligned. The knee was pain free in 27% of patients. Significant factors for good prognosis were age less than 38 years at first operation, moderate BMI, and minimal cartilage damage (grade 0 or 1). Conclusion: After the first postoperative year after arthroscopic lateral meniscectomy on a stable knee, the results remain stable and satisfactory for more than 22 years. Nevertheless, patients aged over 40 with a high BMI and cartilage damage at the time of the first operation have a less encouraging prognosis

Total meniscectomy has been shown to induce osteoarthritic changes in the underlying articular cartilage(AC) and bone in the natural knee (Fairbank 1948; McDermott 2006). This indicates the meniscus plays an important protective role, providing joint congruity and distributing contact forces, hence reducing contact stress. However, no friction and wear studies have been performed on meniscectomy. The aim of this study was to study the tribological response of the medial compartmental natural knee with and without the intact meniscus, under physiological dynamic loading and motion. The effect of normal and reduced loading was investigated. Eighteen month old bovine medial compartmental knees were used. A pendulum friction simulator (Simulation Solutions, UK) was used to apply a dynamic axial loads with peak loads of 1000N (normal) and 260N (reduced). Flexion-extension of amplitude 23degrees was applied and the experiments ran for 3600 cycles at 1Hz. Lubricant was 25% bovine serum in saline. A 9.4 Tesla MRI (Bruker) scanner and Analyze software (Mayo Clinic, US) were used to calculate wear volumes. A surface profilometer (Talysurf, Taylor-Hobson, UK) was used to measure the surface roughness of the specimen before and after the test. Coefficient of friction was found to increase with increased loading, with and without meniscus. With meniscus intact, no wear was found on AC and contact stresses were 4.9MPa and 2.8MPa, for normal and reduced loading respectively. On removal of meniscus, friction was higher at both loading conditions and surface fibrillation found on some of the AC surfaces. Contact stresses rose to 17.2MPa and 8.6MPa for normal and reduced loading. This study has shown for the first time, the direct elevation of the coefficient of friction, immediate surface fibrillation and biomechanical wear of AC upon removal of the meniscus. On removal of meniscus, peak stresses rose and surface damage occurred on AC surfaces. The removal of the meniscus means forces act across smaller areas and contact stresses are increased. Wear is increased due to the subsequent increase in direct solid-solid contact and loss of fluid support due to the unique biphasic nature of AC. This further supports retaining meniscus whenever possible in knee joint surgery

Purpose: Classically reported, degenerative femorotibial remodelling after meniscectomy results from different biomechanical mechanisms depending on the compartment considered. Occurring in the medial compartment, the most frequent situation, the lesions result from punctual contact compression of the cartilage. In the lateral compartment the mechanism involves increased relative instability of the structures controlling mobility. Lateral meniscectomy disrupts femorotibial kinetics of the meniscotibial gliding articulation leading to horizontal instability and subsequent generation of osteoarthritic degeneration which explains the development of lateral decompensations without genu valgum. Based on work by Grammont and Rudy, we proposed a method to limit this horizontal instability and transfer part of the stress to the medial compartment by medial translocation of the tibial tubercle. Material and methods: Eighteen patients, mean age 44 years, underwent treatment for disabling degeneration without major misalignment (mean HKA 181°) a mean ten years after lateral meniscetomy. Degenerative remodelling of the lateral compartment was observed on the AP views in 30% of the knees and on the tangent views in 57% Five patients had early-stage lesions of the medial compartment and femoropatellar degradation was observed in 53%. Involvement of the lateral compartment was confirmed by systematic articular exploration and patellofemoral chondropathy was observed in eight knees. Translocation of the anterior tibial tubercle was associated with section of the lateral patellar wing in all knees associated with tension plasty medially. Results: In 88% of the knees, the postoperative period was uneventful. Weight-bearing supported with a Zimmer cast was maintained for 21 days. Functional outcome was assessed at mean 28 months. Eleven patients had a new clinical and radiographic work-up (mean 34 months). Pain was improved in 88% of the knees, allowing sustained resumption of occupational activities at three months (four knees completely forgotten). Radiographically, at mean 34 months, the lateral cartilage lesions had stabilised with no impact on the medial compartment. Discussion: In light of these results, we have decided to continue this therapeutic approach, reserving the technique for cases of symptomatic lateral decompensation in young subjects without major valgus malalignment

The fluorescent microsphere (FM) method is considered the best technique to determine regional bone blood flow (RBBF) in acute experiments. In this study we verified the accuracy and validitiy of this technique for measurement of RBBF in a long-term experiment and examined RBBF after meniscectomy. 24 anesthetized female New Zealand rabbits (3 groups, each n=8) received consecutive left ventricular injections of FM in defined time intervals after meniscectomy. Group 1 from preoperatively to 3 wks postoperatively, group 2 from 3 wks to 7 wks, and group 3 from 7 wks to 11 wks postoperatively. To test the precision of the FM-method in long-term experiments two FM-species were injected simultaneously at the first and last measurement. After the experiment both humeri, femora, and tibiae and reference organs (kidney, lung, brain) were removed and dissected according to standardized protocol. Fluorescence was determined in each reference blood and tissue sample and blood flow values were calculated. Blood flow in kidney, lung, and brain revealed no significant difference between right and left side and remained unchanged during the observation period excluding errors due to shunting and dislodging of spheres in our experiments. Comparison of relative bone blood flow values obtained by simultaneously injected FM showed an excellent correlation at the first and last injection indicating valid RBBF measurements in long-term experiment. We found a significant increase of RBBF 3 wks after meniscectomy in the right tibial condyles compared to the non-operated left side. Similar changes were found in the femoral condyles. RBBF in other regions of tibia, femur, and humerus revealed no significant difference between right and left bone samples of the same region. Our results demonstrate that the FM method is also valid for measuring regional bone blood flow in long-term experiments. In addition we could demonstrate that meniscectomy leads to an increase of RBBF in the tibial condyles very early. This increase might be caused by stress-induced alterations of the subchondral bone

Purpose: Meniscus loss leads to decreased clinical function and activity levels and increases rate of knee degeneration, thus leading to additional surgeries or even knee replacement, especially in chronic patients. Chronic patients are more focused on preserving their knees and avoiding additional surgeries. The purpose of this study was to determine if replacement of lost or irreparable meniscus tissue with the Collagen Meniscus Implant (CMI) decreased the need for additional surgeries in multiply operated chronic knee patients compared to meniscectomy only. We hypothesized that patients who gained meniscus tissue with the CMI would require fewer surgeries than meniscectomy only controls through five years. Methods: In this prospective randomized multicenter clinical trial (Level of Evidence I), patients 18 to 60 years old who had undergone one to three prior partial medial meniscectomies (PMM) and currently had clinical symptoms of meniscus pathology were randomized either to receive the CMI or have an additional PMM (control). Eighty-five CMI were implanted, but one was removed at 3 weeks after an incision wound infection, and two patients died. The remaining 82 CMI patients were compared to 66 controls over 5 years to determine survivorship. Survivorship was defined as not having an additional unplanned surgery outside the experimental protocol on the study knee. Results: Follow-up rate at 5 years was 96%. Eight CMI patients (9.5%) and 15 control patients (22.7%) required reoperation through 5 years. Survivorship at one year was 90% for control and 95% for CMI patients, 86% for control and 95% for CMI patients at 2 years, 83% and 92% at 3 years, 79% for control patients and 91% for CMI patients at 4 years, and 74% for control patients and 89% for CMI patients at 5 years. CMI patients had a significantly higher survivorship compared to controls (p=0.04). The risk (odds) of reoperation was 2.7 times greater for controls compared to CMI patients at 5 years (95% CI=1.2 to 6.7). Furthermore, the majority of control patient reoperations occurred prior to 24 months, but only four CMI reoperations occurred during the first 24 months. Conclusion: This study confirms that chronic patients who received the CMI required fewer additional surgeries in their multiply operated knees than PMM only controls through 5 years. The additional tissue regeneration supported by the CMI may decrease progression of degenerative changes and reduce necessity and frequency for additional surgeries. This study further confirms the importance of preserving as much meniscus tissue as possible at time of meniscus surgery, and clearly it supports potential positive benefits of regrowing or regenerating lost meniscus tissue. Our hypothesis was affirmed

Aims

The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee.

Early stabilisation after an anterior cruciate ligament (ACL) rupture reduces future meniscal injury. We may therefore expect protection of articular cartilage from ACL reconstruction, but this has yet to be shown.

Our aim wasto determine the effect of meniscal injury on the long term risk of osteoarthritis (OA) following ACL reconstruction using Single Photon Emission Computed Tomography (SPECT, a 3 dimensional radionuclide scan).

We studied a prospective series of 31 patients (mean age at injury of 29 years) who had bone-patellar tendon-bone ACL reconstruction for unstable, ACL deficient knees. Mean follow-up was 10 years (range 9-13). Patients were separated into two groups according to the status of their menisci at the time of ACL reconstruction, those with intact menisci in group 1 (n=15) and those who required partial meniscectomy in group 2 (n=16). The contra-lateral normal knee was used as a control.

All knees were clinically stable with high clinical scores (mean Lysholm score 93 and mean Tegner activity score 6). In group 1 (intact menisci) only one patient (7%) had clinical symptoms of OA and was the only patient with increased uptake on SPECT compatible with early OA. In group 2 (partial meniscectomy), two had clinical symptoms of osteoarthritis, and five patients (32%) had increased uptake on SPECT compatible with early OA. None of the control knees had early OA on SPECT.

The prevalence of OA 10 years post ACL reconstruction, using the most sensitive investigation available, is very low in patients who had intact menisci (7%), but increases 5 fold (32%) if a meniscal tear was present. We recommend early ACL reconstruction to preserve the menisci to minimise the long term risk of OA.

Aims. This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts. Methods. A case-control radiological study was undertaken comparing 500 healthy knees (250 adults) with a consecutive sample of 710 OA knees (355 adults) undergoing bilateral total knee arthroplasty. The mechanical hip-knee-ankle angle (mHKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were determined for each knee, and the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity, and Coronal Plane Alignment of the Knee (CPAK) types were calculated. WSD was defined as a varus mHKA of < -2° in one limb and a valgus mHKA of > 2° in the contralateral limb. The primary outcome was the proportional difference in WSD prevalence between healthy and OA groups. Secondary outcomes were the proportional difference in WSD prevalence between constitutional varus and valgus CPAK types, and to explore associations between predefined variables and WSD within the OA group. Results. WSD was more prevalent in the OA group compared to the healthy group (7.9% vs 0.4%; p < 0.001, relative risk (RR) 19.8). There was a significant difference in means and variance between the mHKA of the healthy and OA groups (mean -1.3° (SD 2.3°) vs mean -3.8°(SD 6.6°) respectively; p < 0.001). No significant differences existed in MPTA and LDFA between the groups, with a minimal difference in aHKA (mean -0.9° healthy vs -0.5° OA; p < 0.001). Backwards logistic regression identified meniscectomy, rheumatoid arthritis, and osteotomy as predictors of WSD (odds ratio (OR) 4.1 (95% CI 1.7 to 10.0), p = 0.002; OR 11.9 (95% CI 1.3 to 89.3); p = 0.016; OR 41.6 (95% CI 5.4 to 432.9), p ≤ 0.001, respectively). Conclusion. This study found a 20-fold greater prevalence of WSD in OA populations. The development of WSD is associated with meniscectomy, rheumatoid arthritis, and osteotomy. These findings support WSD being mostly an acquired condition following skeletal maturity. Cite this article: Bone Jt Open 2024;5(10):879–885

Partial meniscectomy patients have a greater likelihood for the development of early osteoarthritis (OA). To prevent the onset of early OA, patient-specific treatment algorithms need to be created that predict patient risk to early OA after meniscectomy. The aim of this work was to identify patient-specific risk factors in partial meniscectomy patients that could potentially lead to early OA. Partial meniscectomy patients operated between 01/2017 and 12/2019 were evaluated in the study (n=317). Exclusion criteria were other pathologies or surgeries for the evaluated knee and meniscus (n = 114). Following informed consent, an online questionnaire containing demographics and the “Knee Injury and Osteoarthritis Outcome Score” (KOOS) questionnaire was sent to the patient. Based on the KOOS pain score, patients were classified into “low” (> 75) and “high” (< 75) risk patients, indicating risk to symptomatic OA. The “high risk” patients also underwent a follow-up including an MRI scan to understand whether they have developed early OA. From 203 participants, 96 patients responded to the questionnaire (116 did not respond) with 61 patients considered “low-risk” and 35 “high-risk” patients. Groups that showed a significant increased risk for OA were patients aged > 40 years, females, overweight (BMI >25 kg/m2 ≤ 30 kg/m2), and smokers (*p < 0.05). The “high-risk”-follow-up revealed a progression of early osteoarthritic cartilage changes in seven patients, with the remaining nineteen patients showing no changes in cartilage status or pain since time of operation. Additionally, eighteen patients in the high-risk group showed a varus or valgus axis deviation. Patient-specific factors for worse postoperative outcomes after partial meniscectomy and indicators for an “early OA” development were identified, providing the basis for a patient-specific treatment approach. Further analysis in a multicentre study and computational analysis of MRI scans is ongoing to develop a patient-specific treatment algorithm for meniscectomy patients

Meniscal tears commonly co-occur with ACL tears, and many studies address their side, pattern, and distribution. Few studies assess the patient's short-term functional outcome concerning tear radial and circumferential distribution based on the Cooper et al. classification. Meniscal tears require primary adequate treatment to restore knee function. Our hypothesis is to preserve the meniscal rim as much as possible to maintain the load-bearing capacity of the menisci after meniscectomy. The purpose of this study is to document the location and type of meniscal tears that accompany anterior cruciate ligament (ACL) tears and their effect on patient functional outcomes following arthroscopic ACL reconstruction and meniscectomy. This prospective cross-sectional observational study was conducted at AL-BASRA Teaching Hospital in Iraq between July 2018 and January 2020 among patients with combined ipsilateral ACL injury and meniscal tears. A total of 28 active young male patients, aged 18 to 42 years, were included. All patients were subjected to our questionnaire, full history, systemic and regional examination, laboratory investigations, imaging studies, preoperative rehabilitation, and were followed by Lysholm score 6 months postoperatively. All 28 patients were males, with a mean age of 27 ± 0.14 years. The right knee was the most commonly affected in 20/28 patients (71.4%). The medial meniscus was most commonly injured in 11 patients, 7 patients had lateral meniscal tears, and 10 patients had tears in both menisci. The most common tear pattern of the medial meniscus was a bucket handle tear (36.4%), while longitudinal tears were the most frequent in the lateral meniscus (71.4%) (P-value = 0.04). The most common radial tear location was zone E-F (5/28, 17.8%), and the most common circumferential zone affected was the middle and inner third, reported in 50% of tears. Good and excellent outcomes using the Lysholm score after 6 months were obtained in 42.9% and 17.9% of patients, respectively. Better functional scores were associated with lateral meniscal tears, bucket handle tears, tears extending to a more peripheral vascular area, and if no more than one-third of the meniscus was resected (P-value = 0.002). Less favourable outcomes were reported in smokers, posterior horn tears, and when surgery was delayed more than 1 year (P-value = 0.03). We conclude that there is a negative correlation between the amount of meniscus resected and functional outcome. Delayed ACL reconstruction increases the risk of bimeniscal tears. Bucket handle tears are the most common tears, mostly in the medial meniscus, while longitudinal tears are most common in the lateral meniscus. We recommend performing early ACL reconstruction within 12 months to reduce the risk of bimeniscal injuries

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing