SciCombinator

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Concept: Tear of meniscus

485

 To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.

Concepts: Randomized controlled trial, Tears, Jury, Tear of meniscus

332

To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease.

Concepts: Medicine, Anterior cruciate ligament, Arthroscopy, Tear of meniscus

90

Background Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking. Methods We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure. Results In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, -1.6 points; 95% confidence interval [CI], -7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, -2.5 points; 95% CI, -9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, -0.1; 95% CI, -0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively). Conclusions In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172 .).

Concepts: Medicine, Surgery, Knee, Anesthesia, Orthopedic surgery, Knee replacement, Arthroscopy, Tear of meniscus

70

Knee osteoarthritis affects more than 250 million people and is a leading contributor to disability worldwide.(1) Persuasive evidence from randomized, controlled trials indicates that arthroscopic débridement, lavage, or both are no more effective than sham surgery and nonoperative alternatives for symptomatic knee osteoarthritis.(2),(3) Nevertheless, arthroscopic surgery is often still performed. A common justification for arthroscopic surgery is the presence of symptoms due to mechanical factors. These symptoms, such as locking or clicking or acute pain localized to one joint, are generally regarded as arising from a torn meniscus. However, asymptomatic meniscal tears are highly prevalent among people with knee . . .

Concepts: Randomized controlled trial, Greek loanwords, Knee, Anterior cruciate ligament, Joint, Surface tension, Arthroscopy, Tear of meniscus

48

Meniscal cartilage tears are common and predispose to osteoarthritis (OA). Most occur in the avascular portion of the meniscus where current repair techniques usually fail. We described previously the use of undifferentiated autologous mesenchymal stem cells (MSCs) seeded onto a collagen scaffold (MSC/collagen-scaffold) to integrate meniscal tissues in vitro. Our objective was to translate this method into a cell therapy for patients with torn meniscus, with the long-term goal of delaying or preventing the onset of OA. After in vitro optimization, we tested an ovine-MSC/collagen-scaffold in a sheep meniscal cartilage tear model with promising results after 13 weeks, although repair was not sustained over 6 months. We then conducted a single center, prospective, open-label first-in-human safety study of patients with an avascular meniscal tear. Autologous MSCs were isolated from an iliac crest bone marrow biopsy, expanded and seeded into the collagen scaffold. The resulting human-MSC/collagen-scaffold implant was placed into the meniscal tear prior to repair with vertical mattress sutures and the patients were followed for 2 years. Five patients were treated and there was significant clinical improvement on repeated measures analysis. Three were asymptomatic at 24 months with no magnetic resonance imaging evidence of recurrent tear and clinical improvement in knee function scores. Two required subsequent meniscectomy due to retear or nonhealing of the meniscal tear at approximately 15 months after implantation. No other adverse events occurred. We conclude that undifferentiated MSCs could provide a safe way to augment avascular meniscal repair in some patients. Registration: EU Clinical Trials Register, 2010-024162-22. Stem Cells Translational Medicine 2017;6:1237-1248.

Concepts: Bone, Stem cell, Mesenchymal stem cell, Bone marrow, Magnetic resonance imaging, Knee, Iliac crest, Tear of meniscus

42

To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.

Concepts: Randomized controlled trial, Placebo, Tear of meniscus

29

BACKGROUND:Anterior cruciate ligament (ACL) and meniscus injuries are common in female athletes participating in cutting and pivoting sports such as basketball. The epidemiological characteristics of injury in athletes seen at the Women’s National Basketball Association (WNBA) combine and the effect of ACL reconstruction and meniscus surgery on longevity in the WNBA are unknown. PURPOSE:To evaluate the details and spectrum of injuries in athletes entering the WNBA combine and to assess the potential effect of specific injuries on the round drafted into the WNBA and career length. STUDY DESIGN:Descriptive epidemiology study. METHODS:Demographic data and the documented collegiate injury profile were reviewed from the WNBA database for all players entering the WNBA combine in 2000-2008. The study included injury data on 506 athletes. Complete demographic data were available for 496 players. RESULTS:Of the athletes taking part in the combine, 45.2% were guards, 33.7% were forwards, and 21.1% were centers. Ankle sprain (47.8% of players), hand injury (20.8%), patellar tendinitis (17.0%), ACL injury (15.0%), meniscus injury (10.5%), stress fracture (7.3%), and concussion (7.1%) were the most common injuries reported. Seventy-three athletes (14.4%) reported ACL reconstruction before entering the WNBA combine, and meniscus surgery was the next most common surgery (n = 50 players; 9.9%). There were no differences in ACL or meniscus surgery when analyzed by player position or round drafted. History of ACL or meniscus surgery did not affect career length in the WNBA. Excluding ACL and meniscus surgery, other reported surgical procedures were knee arthroscopic surgery (11.7%), ankle reconstruction (2.6%), and shoulder stabilization (2.0%). CONCLUSION:The ankle is the most common site of injury and ACL reconstruction is the most common surgery in elite female athletes participating in the WNBA combine. A history of injury or surgery did not affect the round drafted or career length.

Concepts: Surgery, Knee, Anterior cruciate ligament, Injuries, Injury, Arthroscopy, Tear of meniscus, National Basketball Association

28

Four normal variants of meniscomeniscal ligaments have been previously reported in the anatomy, arthroscopy, and radiology literature. The anterior and posterior transverse meniscal ligaments are the 2 most commonly observed, with a reported frequency of 58% and 1% to 4%, respectively. The last 2 variants include the medial and lateral oblique meniscomeniscal ligaments and account for a combined frequency of 1% to 4%.This article describes 2 patients with unilateral meniscomeniscal ligaments observed on magnetic resonance imaging. One patient had a unilateral lateral meniscomeniscal ligament extending from the anterior horn of the lateral meniscus to the posterior horn of the lateral meniscus and underwent conservative management. The second patient had a unilateral medial meniscomeniscal ligament with a concomitant medial meniscus tear and underwent arthroscopic intervention. The ligament was stable intraoperatively and, therefore, was not resected. Both patients had resolution of their symptoms.These 2 variants are additions to the previously described 4 normal intermeniscal ligament variants. The functions of the 2 new variants described in this article are poorly understood but are thought to involve meniscal stability. Accurate descriptions of normal variants can lead to the proper management of anomalous rare structures and prevent false imaging interpretations because these structures can closely mimic a double posterior cruciate ligament sign. Furthermore, an understanding of the various normal variants of intermeniscal ligaments can prevent unnecessary surgery that could result in further iatrogenic meniscus injury.

Concepts: Magnetic resonance imaging, Knee, Anterior cruciate ligament, Radiology, Ligament, Ligaments, Tear of meniscus, Medial meniscus

27

To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease.

Concepts: Medicine, Anterior cruciate ligament, Arthroscopy, Tear of meniscus

23

 To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears.

Concepts: Tear of meniscus