Aims. We studied the outcomes following arthroscopic primary repair of bucket handle meniscus tears to determine the incidence of re-tears and the functional outcomes of these patients. Methodology. Prospective cohort study. Over a 4-year period (2016 to 2020), 35 adult patients presented with a bucket handle tear of the meniscus. Arthroscopic meniscal repair was performed using either the all inside technique or a combination of all-inside and inside-out techniques. 15 patients also underwent simultaneous arthroscopic anterior cruciate ligament reconstruction. Functional knee scores were assessed using IKDC and Lysholm scores. Results. Mean patient age at surgery was 27 years (range, 17 to 53years). Medial meniscus was torn in 20 and lateral in 15 cases. Zone of tear was white on white in 19, red on white in 9 and red on red in 7 cases. Average delay from injury to surgery was 4 months. At a mean follow-up of 4.5 years, the meniscus repair failed in 3 patients (8.5 %). Outcome following re-tear was meniscus excision. Average IKDC scores in patients with intact repair were 74.04 against 56.67 in patients with a failed repair (p< 0.0001). Similarly, Lyshlom scores were 88.96 and 67.333, respectively (p<0.0001). Conclusion. The survivorship of primary repair of bucket handle meniscus tears in our series was 91.5% at medium term follow-up. Functional outcomes were significantly poor in patients with a failed repair compared to those with an intact repair

Meniscus tears in adult patients do not heal spontaneously and represent a risk factor for OA development. PDGF is well known as an enhancer of meniscal cell biosynthetic activity and also has chemotactic activity for mesenchymal cells. PDGF incorporation into scaffolds should be efficient for recruitment of cells to initiate repair in the injured meniscus. We recently developed decellularized meniscus sheet for use in the treatment of meniscus tears. The aim of this study is to examine the potential of PDGF-coated decellularized meniscus scaffold in mediating integrative healing by endogenous cell migration. Fresh bovine meniscus was chemically decellularized. Round sheets were made from the decellularized tissue. Heparin was covalently conjugated with decellularized meniscus scaffold (DMS). PDGF-BB was immobilized by binding to the heparin-conjugated DMS. In vitro, PDGF release kinetics was analyzed by ELISA. DMS was transplanted into the injured meniscus explants and cultured for 2 and 4 weeks. The numbers of migrated cells at the border between DMS and injured explant were counted on DAPI stained sections and PDGFRb expressing cells were counted after immunohistochemical staining. The newly produced ECM and collagen fiber alignment was detected by histology on Safranin-O and picrosirius red stained sections. The explants were also tested for tensile properties. PDGF release kinetics showed sustained slow release in heparin-conjugated DMS, with 11.2% release at day- 16th compared to 26.1% release from the DMS without heparin. Insertion of the PDGF-treated DMS into the meniscus tears in bovine meniscus explants led to the migration of endogenous meniscus cells to the defect zone. The migrated cells expressed PDGFRb and produced new ECM in the defect area. Safranin-O and pircrosirius red staining showed tissue integration between DMS and injured explants. Moreover, the higher concentration of PDGF promoted cell integration into the DMS. Tensile properties of injured explants treated with PDGF coated DMS were significantly higher than in DMS without PDGF. Heparin-conjugated DMS showed strong immobilization of PDGF, which was released slowly. PDGF coated DMS promoted migration of endogenous meniscus cells to the defect area and into the scaffold. New matrix was formed that bridged the space between the native meniscus and the scaffold and this was associated with improved biomechanical properties. The PDGF coated DMS is a novel, feasible and efficient approach for the treatment of meniscus tears

Introduction. Knee injuries are common amongst footballers. The aim of this study was to establish frequency and variation of knee injuries within one English Premier League (EPL) professional football club over two seasons, to assess number of days missed due to injury, and analyse current treatment regimen for each injury type. Method. Data was collected prospectively for injuries suffered by players between 2009 and 2011, spanning two EPL seasons at one EPL club. Demographics were recorded along with various factors influencing injury, including playing surface, pitch condition, dominant side, type of injury, ability to continue playing, and mechanism of injury. Time taken for return to play, and treatment received was recorded. Results. 35 injuries occurred that were severe enough to cause players to miss at least one competitive match. The commonest injury was to the medial collateral ligament (MCL) in 34%. Patella tendon injuries were seen in 29%, other injuries included meniscus tears, ACL ruptures, and osteochondral defects. All grade II MCL Injuries received sclerosant injections. 40% of patella tendon injuries were given plasma-rich protein (PRP) injections, and 30% underwent surgery. The mean recovery time following MCL and patella tendon injuries was 44 days and 77 days respectively. 60% of injuries were sustained during training and 40% were suffered in competitive games. 26% were recurring injuries, recurrent meniscus and patella tendon injuries took twice as long to recover compared to the initial injury. Conclusion. Our findings suggest that MCL and patella tendon injuries are the most common knee injuries amongst professional footballers and that meniscus tears and ligament ruptures are relatively rare in comparison. Injuries appear to occur more frequently during training. A high proportion of injuries in the study received injection therapy in the form of PRP or sclerosant. The study suggests recurrent injuries can prolong recovery two-fold

Anterior cruciate ligament (ACL) injuries are one of the most common ligament injury occurring in young and active individuals. Reconstruction of the torn ligament is the current standard of care. Of the many factors which determine the surgical outcome, fixation of the graft in the bony tunnels has significant role. This study compared the clinical and functional outcome in patients who underwent ACL reconstruction by standard anteromedial portal technique with single bundle hamstring graft anchored in the femoral tunnel using rigidfix and cortical button with adjustable loops. The tibial fixation and rehabilitation protocol were same in both groups. 107 patients underwent ACL reconstruction over a two-year period (87 males, 20 females, 44 after motor vehicle accident, 34 after sports injuries, 79 isolated ACL tear, 21 associated medial meniscus tear, 16 lateral meniscus tear and 11 both menisci). Rigid fix group had 47 patients and adjustable loop 60 patients. Clinical evaluation at end of one year showed better stability in rigid fix group regarding Lachman, anterior drawer, pivot shift tests, KT 1000 arthrometer side to side difference and hop limb symmetry index. However, the differences were not statistically significant. Functional evaluation using IKDC 2000 subjective score and Lysholm score showed better results in rigidfix group than variable loop, but was not statistically significant. However, lower scores were noted in patients with concomitant meniscal injury than in isolated acl tear patients and this was statistically significant in both groups. Rigidfix seems to give better graft fixation on femoral side than variable loop, but by the end of one year the functional outcome is comparable in isolated acl reconstructions

Meniscal root tears can result from traumatic injury to the knee or gradual degeneration. When the root is injured, the meniscus becomes de-functioned, resulting in abnormal distribution of hoop stresses, extrusion of the meniscus, and altered knee kinematics. If left untreated, this can cause articular cartilage damage and rapid progression of osteoarthritis. Multiple repair strategies have been described; however, no best fixation practice has been established. To our knowledge, no study has compared suture button, interference screw, and HEALICOIL KNOTLESS fixation techniques for meniscal root repairs. The goal of this study is to understand the biomechanical properties of these fixation techniques and distinguish any advantages of certain techniques over others. Knowledge of fixation robustness will aid in surgical decision making, potentially reducing failure rates, and improving clinical outcomes. 19 fresh porcine tibias with intact medial menisci were randomly assigned to four groups: 1) native posterior medial meniscus root (PMMR) (n = 7), 2) suture button (n = 4), 3) interference screw (n = 4), or 4) HEALICOIL KNOTLESS (n = 4). In 12 specimens, the PMMR was severed and then refixed by the specified group technique. The remaining seven specimens were left intact. All specimens underwent cyclic loading followed by load-to-failure testing. Elongation rate; displacement after 100, 500, and 1000 cycles; stiffness; and maximum load were recorded. Repaired specimens had greater elongation rates and displacements after 100, 500, and 1000 cycles than native PMMR specimens (p 0.05). The native PMMR showed greater maximum load than all repair techniques (p 0.05). In interference screw and HEALICOIL KNOTLESS specimens, failure occurred as the suture was displaced from the fixation and tension was gradually lost. In suture button specimens, the suture was either displaced or completely separated from the button. In some cases, tear formation and partial failure also occurred at the meniscus luggage tag knot. Native PMMR specimens failed through meniscus or meniscus root tearing. All fixation techniques showed similar biomechanical properties and performed inferiorly to the native PMMR. Evidence against significant differences between fixation techniques suggests that the HEALICOIL KNOTLESS technique may present an additional option for fixation in meniscal root repairs. While preliminary in vitro evidence suggests similarities between fixation techniques, further research is required to determine if clinical outcomes differ

BACKGROUND. Injuries of the both menisci and complete ACL tear is quite common. In the literature, functional outcome in these patients is often variable and less than satisfactory. We studied the functional outcome of this group of patients (retrospective study of prospectively followed case series). MATERIAL AND METHODS. All patients who were diagnosed with ACL injury by arthroscopy at an tertiary hospital in southern India between January2013 and june2017 were enrolled in the study. From the total of 189 consecutive patients who had ACL tears with either one meniscus or both meniscus tear, 41 patients had injuries of both menisci of the same knee with ACL tear. 6 patients were lost to follow up. All patients underwent repair/balancing of one/both meniscus and reconstruction of ACL. There were 29 males and 6 females with age ranging from 18 – 60yrs (mean 25.2) years available for final analysis. RESULTS. In 45.71% of patients (n=16) both meniscal tear was diagnosed by arthroscopic examination only. Bucket handle tear was observed in 5 knees (medial: 4 knees, lateral: 1 knee) in fresh group, and 4 knees (medial: 3 knees, lateral: 1 knees) in delayed presentation. PMMRT was noted in 6 patients and PLMRT was noted in 3 patients. All patients were evaluated using lysholm score. CONCLUSION. The incidence of both meniscal tear associated with ACL injury has significant effect on the post operative management and the overall functional outcome. The incidence of injuries of both menisci is higher in acute injuries in our series

Introduction. Persistent pain after medial unicompartmental knee arthroplasty (UKA) is a prevailing reason for revision to total knee arthroplasty (TKA). Many of these pathologies can be addressed arthroscopically. The purpose of this study is to examine the outcomes of patients who undergo an arthroscopy for any reason after medial UKA. Methods. A query of our practice registry revealed 58 patients who had undergone medial UKA between October 2003 and June 2015 with subsequent arthroscopy. Mean interval from UKA to arthroscopy was 22 months (range, 1–101 months). Indications for arthroscopy were acute anterior cruciate ligament tear (1), arthrofibrosis (7), synovitis (12), recurrent hemarthrosis (2), lateral compartment degeneration including isolated lateral meniscus tears (11), and loose cement fragments (25). Results. Mean follow-up after arthroscopy was 37 months (range, 1–134 months). Twelve patients have been revised from UKA to TKA. Relative risk of revision after arthroscopy for lateral compartment degeneration was 4.27 (6 of 11; 55%; p=0.002) and for retrieval of loose cement fragments was 0.05 (0 of 25; 0%; p=0.03). Relative risk for revision after arthroscopy for anterior cruciate ligament tear, arthrofibrosis, synovitis, or recurrent hemarthrosis did not meet clinical significance secondary to the low number of patients in these categories. Conclusions. The results of this study suggest that arthroscopic retrieval of cement fragments does not compromise UKA longevity. However, arthroscopy for lateral compartment degradation after UKA predicts a high risk of revision to TKA regardless of its relative radiographic insignificance

Aim. To find out the usefulness of knee arthroscopy with debridement in patients of 60 years or more. Materials and Methods. We retrospectively looked at the patients of 60 years or more age who under went knee arthroscopy between Jan 2012 and Dec 2012 and collected demographic data, indications for arthroscopy, grading of preoperative knee x-rays (Kellgren-Lawrence), intra-operative findings, post operative relief of symptoms and any further surgeries till the time of study. Results. n=58, mean age was 67.3 years (60 – 81), male: female ratio 36:26, side 26:36 (R: L). Mean follow up 14.8 weeks (2–52). Most common indication was medial meniscus pathology (60%). More than 50% of the cases were of Grade III and IV (Kellgren-Lawrence). Intra-operative findings showed 62% tri-compartment and 12% bi-compartment arthritic involvement. 59% had medial, 7% had lateral and 7% had both meniscus tears. 75% of the patients felt symptomatically better at the time of last follow up and only 14% of the patients under went arthroplasty till the time of study. Conclusion. We conclude that knee arthroscopy with debridement offers symptomatic relief in majority (75%) of patients of 60 years or more of age with only few (14%) requiring early arthroplasty

Introduction:. This is a case report of a 78 year old male who underwent outpatient mini-incision medial UKA using the haptic robotic guidance. The patient subsequently suffered a traumatic lateral meniscus tear and underwent a lateral compartment UKA with the same robotic system instead of converting to a total knee replacement at one year post op and is now 2 years post op on the lateral side as well. Methods:. The patient is a 74 year old male with a BMI of 27, suffering from OA of the right knee. He had a previous TKA on his left side by another surgeon that was followed with a lateral release by still another surgeon with fair to good satisfaction currently; however he did not want another TKA. He had multiple aspirations and injections of corticosteroids for arthritic effusions on his right knee that were moderate to severe and painful. On 7/6/2010 he underwent a right medial UKA using with robotic guidance. The patient had a subsequent injury to his lateral meniscus causing pain for which multiple options were discussed with the patient. The informed patient chose to have a lateral compartment arthroplasty. On 6/21/2011 a lateral compartment UKA was performed on the same patient's right knee through a second mini-lateral incision again using robotic guidance. Results:. The patient is now 35 months after his right medial UKA and 24 months after his right lateral UKA. His function is excellent, his range of motion is excellent at 0–135° compared to 120° pre-operatively, his satisfaction is excellent and he has no self-reported limitations with his right knee. Conclusions:. The complexity of patient-specific planning, the ability to adjust that plan intra-operatively to optimize kinematics and the safety of implementing this plan using haptically guided robotic bone resection provides many advantages in partial knee arthroplasty. In the case presented here, a post-operative lateral meniscal injury subsequent to medial UKA in the same knee was treated with a lateral UKA. Accurate placement of the components and balancing the knee with the existing medial UKA provided by the robotic platform was critical to the excellent post-operative outcomes

Introduction. 47 yrs male patient had a prior history. 2005 Fx. proximal tibia (open Fx.). 2007 Metal removal. 2008 Arthroscopic debridement (2 times). He visited out hospital with severe pain and tenderness X-ray (Fig 1) and MRI (Fig 2) findings as follows. Conclusively, He had a chorinic osteomylitis of proximal tibia with soft tissue absess. 1st Surgery. I did arthroscopic debridement Arthroscopic finding shows synovitis, meniscus tear and chondromalacia. I did meticulous debridement (irrigation & curettage). 2nd Surgery. He did primary total knee arthro-plasty instead of two-stage exchange arthroplasty in may, 2010 at the another hospital. 3rd Surgery. After 7 months since he had did total knee arthroplasty, he visited to my hospital again with sudden onset of painful swelling & heating sensation. 4th Surgery. I did second stage reimplantation for infected total Knee arthroplasty after 7 weeks. Now he got a pain relief & ROM restroration. Results. Follow up 12 months X-ray showing all implants to be well-positioned and stable. Clinically, there was no implant considered to be loose. In this study, the knee society and functional scores at final follow up were 82 and 68. Conclusion. The infection after sequales of open proximal tibia fracture is treated by two-stage exchange total knee arthroplasty instead of primary total knee arthroplasty. Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control and improvement in the clinical result 3). We use an antibiotic-loaded cement spacer(ALACS) preserved knee function between stages, resulting in effective treatment of infection, facilitation of reimplantation, and improved patient satisfaction 1). The principle surgical technique used for two-stage revision of infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers 2

Background. Unicompartmental knee arthroplasty provides a good alternative to total knee arthroplasty in patients with isolated medial compartment osteoarthritis. Reported ten-year survival for the Oxford medial unicompartmental knee arthroplasty is variable, ranging from 80.2% to 97.7% in the originator series. The aim of this study was to determine the survival and reasons for revision of the Oxford medial unicompartmental knee arthroplasty when performed at a specialist orthopaedic centre. Methods. Details of consecutive patients undergoing Oxford unicompartmental knee arthroplasty at our centre between January 2000 and December 2009 were collected prospectively. Failure of the implant was defined as conversion to total knee arthroplasty. Survival was determined using the Kaplan-Meier method. Results. There were 494 Oxford unicompartmental knee arthroplasties implanted in 425 patients for isolated medial compartment osteoarthritis. Mean age was 62.8 yrs (range 34.6-90.1 yrs) and 53.4% were female. During a mean follow-up time of 3.0 yrs (range 0.5-9.2 yrs), twenty-two knees (4.5%) were revised to a total knee arthroplasty. Reasons for revision were aseptic loosening of the femoral (n=8) or tibial component (n=2), undiagnosed pain (n=5), patellofemoral pain (n=2), infection (n=1), lateral meniscus tear (n=1), periprosthetic fracture (n=1), joint instability (n=1), and dislocation of meniscal bearing (n=1). Mean time to revision surgery from the primary procedure was 3.0 yrs. Eight-year survival for the cohort was 87.4%. The median pre-operative Oxford knee score was 62.5% which reduced to 27.7% at four years post-operatively. Conclusion. This study has demonstrated our revision rate for the Oxford unicompartmental knee replacement is comparable to independent series and national registry data. Post-operative function in patients not revised was good. The commonest reason for failure was aseptic component loosening which usually occurred within two to four years. Extended follow-up may therefore be beneficial in these patients so these cases are identified early and subsequently revised

The meniscus is at the cornerstone of knee joint function, imparting stability and ensuring shock absorption, load transmission, and stress distribution within the knee joint. However, it is very vulnerable to injury and age-related degeneration. Meniscal tears are reported as the most common pathology of the knee with a mean annual incidence of 66 per 100,000. Knee osteoarthritis progresses more rapidly in the absence of a functional meniscus. Historically, tears extending to the avascular inner portion of the meniscus (white-white zone, “WW”), such as radial tears were considered as untreatable and were often resected, due to the lack of vascularity in the WW zone. Perfusion-based anatomical studies performed on cadaveric menisci in the 1980s shaped the current dogma that human meniscus has poor regenerative capacity, partly due to limited blood supply that only reaches 10 to 25% of the meniscus, commonly referred to as red-red zone (“RR”). Previous studies, including those utilizing animal models have shown mobilization of Mesenchymal Stem Cells (MSCs) upon injury into the WW zone, and successful MSC recruitment when administered externally to the injury site. We and others have recently reported positive outcomes of repaired tears in the inner zone of patients. We hypothesized that the “avascular” white-white zone of the meniscus possesses regenerative capacity due to a resident stem/progenitor cell population. Further, we sought to redefine the presence of microvessels in all meniscal zones using advanced stereology and imaging modalities. Fifteen menisci from fresh human cadaveric knees (mean age: 21.53±6.53 years) without evidence of previous injury were obtained from two tissue banks (JRF, Centennial, CO) and Biosource Medical (Lakeland, FL) and utilized for this study. The use of cadaveric specimens for research purposes was approved by the institutional review board. Tibial plateaus were dissected to harvest medial and lateral menisci along their entire length. The RR, red-white (RW) and WW zones were dissected and separated into three thirds from the inner aspect to the marginal border of the meniscus and their wet weights recorded (Fig.1A). Meniscus tissue cellular content in each zone was obtained from dissociation of meniscus tissue using 0.02% w/v pronase (Millipore) for 1h at 37oC, followed by 18h 0.02% w/v collagenase II (Worthington) at 37oC with shaking. Isolated cells were characterized immediately after harvest using flow cytometry with antibodies against MSCs surface markers (CD105, CD90, CD44 and CD29) as well as respective isotype controls. Further, meniscal cells were cultured and split twice when confluence was reached, characterized at P2 and compared to bone marrow-derived MSCs (BM-MSCs) using the same markers. Self-renewal of cells was assessed using colony forming unit (CFU) assay. Differentiation assays were performed to assess whether colony-forming cells retained multilineage potential. For morphological examination of bigger vessels, samples were fixed in 10% formalin for 1 week, paraffin embedded, sectioned (4 μm thick) and stained with H&E and Masson's trichrome. Presence of microvessels was assessed by CD31 immunofluorescence staining. Further, menisci were cleared using the uDisco protocol labeled with the TO-PRO®-3 stain, a fluorescent dye that stains cell nuclei and imaged using light-sheet microscopy. All continuous data are presented as mean ±standard deviation. Non-repeated measures analysis of variance (ANOVA) and Tukey-Kramer HSD post hoc analysis were performed on sample means for continuous variables. Statistical significance was set at p < 0 .05. Menisci were successfully cleared using a modified uDISCO procedure, imaged and analyzed for total cell density. As expected, bigger vessels were observed in RR but not in WW. However, immunofluorescent staining for CD31 showed a subset of CD31+endothelial cells present in the WW zone, indicating the presence of small vessels, most likely capillaries. In order to assess whether enzymatic digestion had a differential result depending on meniscus zone due to cellular content, we analyzed yields per meniscus per zone. The wet weight of different zones (WW:RW:RR) was at a ratio of ∼1:3:5 respectively, however, the ratio of cells isolated from each zone was at ∼1:4:20, indicating that RR has a denser population of mononuclear cells. However, the difference between all zones in cell yields was not significant. The clonogenic potential of isolated cells was shown to be non-significantly different between the three zones. Differentiation of isolated cells to osteogenic lineage using osteogenic media in vitroshowed no difference between the three zones. Flow cytometry analysis of cells from the three meniscal zones displayed presence of two distinct subpopulations of cells immediately after isolation. One subpopulation was positive to MSC surface markers and the other negative. Additionally, flow cytometry of cultured meniscal cells at P2 displayed that the entire cell population was CD44+CD105+CD29+CD90+, suggesting that culturing meniscal cells results in selection of stem/progenitor cells (plastic adherence). Surface marker expression analysis showed differential expression patterns between markers depending on zone. Similar fraction of cells was detected to express both MSC markers CD90 and CD105 (7–10%) and similar fraction of cells expressed both MSC markers CD29 and CD44 (1–2%) in all three zones, indicating similar density of resident stem/progenitor cells in each zone. Importantly, WW showed significantly higher expression for all four MSC markers compared to the RR zone, indicating higher relative density of stem/progenitor resident cells in the WW zone. Our results determine that CD31-expressing microvessels were present in all zones, including the WW zone, which was previously considered completely avascular. Additionally, stem/progenitor cells were shown to be present in all three zones of the menisci, including the WW zone, showcasing its regenerative potential. For any figures or tables, please contact the authors directly