The February 2024 Knee Roundup. 360. looks at: Do patients with hypoallergenic total knee arthroplasty implants for metal allergy do worse? An analysis of healthcare utilizations and patient-reported outcome measures; Defining a successful total knee arthroplasty; Incidence, microbiological studies, and factors associated with periprosthetic joint infection after total knee arthroplasty; A modified Delphi consensus statement on patellar instability; Cause for concern? Significant cement coverage in retrieved metaphyseal cones after revision total knee arthroplasty; Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques; Cost-effectiveness of
Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support
Cite this article:
Aims. The aim of this study was to evaluate the cost-effectiveness of
Abstract. Background. Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an
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.
The December 2022 Knee Roundup. 360. looks at: Effect of physical therapy versus
Aims. The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone
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. A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group.Aims
Materials and Methods
Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic meniscectomy is frequently performed,
although the benefits are debatable. Recent studies have concluded
that there is no role for arthroscopic washout in osteoarthritis
of the knee. Our aim was to perform a systematic review to assess
the evidence for the efficacy of arthroscopic meniscectomy in patients
with meniscal tears and degenerative changes in the knee. A literature search was performed, using the PubMed/MEDLINE database,
for relevant articles published between 1975 and 2015. A total of
six studies, including five randomised controlled trials and one
cross-sectional study of a prospective cohort, met the inclusion
criteria. Relevant information including study design, operations,
the characteristics of the patients, outcomes, adverse events and
further operations were extracted.Aims
Patients and Methods
Introduction. Meniscal tears in middle-aged patients are common. There is a lack of consensus regarding the optimum management of these injuries. Although
The lateral compartment is predominantly affected
in approximately 10% of patients with osteoarthritis of the knee. The
anatomy, kinematics and loading during movement differ considerably
between medial and lateral compartments of the knee. This in the
main explains the relative protection of the lateral compartment
compared with the medial compartment in the development of osteoarthritis.
The aetiology of lateral compartment osteoarthritis can be idiopathic,
usually affecting the femur, or secondary to trauma commonly affecting
the tibia. Surgical management of lateral compartment osteoarthritis
can include osteotomy, unicompartmental knee replacement and total
knee replacement. This review discusses the biomechanics, pathogenesis
and development of lateral compartment osteoarthritis and its management. Cite this article:
Purpose: The purpose of this study was to review the clinical results of a series of 108 children treated artroscopically for symptomatic discoid lateral menisci. Methods: The medical records of more than 100 consecutive patients who underwent arthroscopic treatment for symptomatic discoid meniscus between 1990 and 2005 were reviewed. Results: The mean patient age was 8.7 years (range, 2,5 to 14 years), with 55% female and 45% male patients. The mean duration of symptoms before surgery was 20 months (range, 2 to 48 months), with 95% having pain and 38% having mechanical impingment. All patients were treated arthroscopically. Partial or subtotal arthroscopic meniscectomy was performed. Operative classification of the menisci revealed 64 complete, 18 Wrisberg type and 26 incomplete discoid menisci, with meniscal tears being present in 48 knees (45%). At final follow-up, all patients exhibited full knee flexion beyond 135 degrees. Three patients reported residual knee pain, and four reported intermittent mechanical symptoms. At final follow-up, 3 years minimum, according to Ikeuchi clinical score more than 50 % of the patients were considered very good and 25 % good. Only 8 patients felt that their activity level remained partially limited. Conclusions: Our results show the middle-term efficacy of arthroscopic partial or subtotal meniscectomy in cases of symptomatic lateral discoid menisci.
Objectives: Partial meniscectomy is the current standard of care for torn menisci not suitable for repair.