10 (6), 757762. Due to the lubrication function of the knee joint fluid, we set the tangential contact to frictionless and normal contact to hard contact in ABAQUS. Brjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E. Physiotherapy in knee osteoarthrosis: effect on pain and walking. AX, ZM: Methodology, Investigation, Formal analysis, Writingoriginal draft. FIGURE 3. J. Exp. The kneecap (patella) sits in front of the joint to provide some protection. There was little effect on the axial load distribution of the medial and lateral compartments of the rabbit knee joint among the IMM, HTMM, and different resections. Both the inside and outside of the knee have a meniscus. J. Orthop. After an HTMM, Amano et al. [in chinese]. doi:10.2106/JBJS.I.00539, Bedrin, M. D., Kartalias, K., Yow, B. G., and Dickens, J. F. (2021). All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Bone, cartilage, and menisci were defined as linear elastic isotropic materials. Cabaud HE, Rodkey WG, Fitzwater JE. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. The aim of this study was to investigate the biomechanical effects of horizontal meniscal tears and different resection strategies on a rabbit knee joint by finite element analysis and to provide reference for animal Meniscus Tears Here are the highlights: Meniscus repair has good to excellent results in young pediatric and adolescent athletes at a 17-year follow-up. When this happens, your knee can actually become stuck because the torn part of your meniscus is blocking normal knee motion. Ann. A cadaveric study has demonstrated that only the peripheral 10%-25% of the meniscus benefits from a blood supply in the mature skeleton[9]. The .gov means its official. Summary. (2017). All image data were from Peking University Third Hospital. Significant improvements in all outcomes were found at follow-up. Horizontal tears split the meniscus into an upper and lower part and can exist without clinical symptoms[14]. Lateral meniscus horizontal tear These results can improve our understanding of the relationship between meniscal horizontal tears, meniscectomies, and osteoarthritis and provide a reference for the future selection of experimental studies and clinical surgery strategies. Kohn D, Moreno B. Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Sports Traumatol. Meanwhile, the progressive rate of degenerative changes of knee cartilage in rabbits is faster than that in large animals or humans, which can be used as a reference for long-term results of future clinical applications (Roland et al., 1973; Jiang et al., 2018). 28 (11), 34743480. Lateral 30, 789802. Proc. Ligaments used the T3D2 truss grid type. Bonneux I, Vandekerckhove B. Arthroscopic partial lateral meniscectomy long-term results in athletes. Eng. After the STM, the load on the medial menisci was only 0.1 N, which was similar to the TTM. In a study[49] comparing meniscal repair plus trephination with meniscal repair alone, there was a significantly lower re-tear rate in the group who had additional trephination. The results showed that the HTMM had little effect on the medial tibial cartilage. A., Lane, N. E., et al. 1, e3. The lateral posterior meniscal root is the primary restraint to meniscal extrusion under axial load. Arthrosc. (2015). Authors found a clinical success rate of 76%. Modeling the steady-state deformation of the solid phase of articular cartilage. J. The strength of the menisci of the knee as it relates to their fine structure. In the absence of a meniscus there is greater tendency to point loading. The decline was also related to the patients BMI. ACL Tear Treatment and Reconstruction Barber FA, Schroeder FA, Oro FB, Beavis RC. P- Reviewers: Serhan H, Sadoghi P S- Editor: Wen LL L- Editor: A E- Editor: Lu YJ, National Library of Medicine A curette was used to prepare the footprint of the lateral meniscal root on the posterolateral tibia for the 2-tunnel transtibial pull-out tunnels, and a grasper was used to position the torn meniscal root back into its anatomical site. Discoid lateral meniscus: A simple horizontal tear was associated with less articular cartilage degeneration compared to other types of tear. also found that root tears caused a greater degree of spontaneous osteonecrosis of the knee (Sung et al., 2013). Meniscal tears are often classified according to their orientation. Biotechnol. 1,215 open operations in Copenhagen 1982-84. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. Magnetic resonance images (MRI) were obtained from the right hind limb of a healthy New Zealand rabbit (male, 6 months, 4kg). The biomechanical changes following meniscal tears and surgery could lead to or accelerate the occurrence of osteoarthritis. Results of open meniscus repair. A study[55] evaluating healing after meniscal repair using artho-CT scan also found that posterior segment healing rate was lower compared to middle portion tears. The output of the load in the axial direction between cartilage to menisci and cartilage to cartilage was exported. It usually takes less than an hour. Meniscal repair techniques. The presence of a lateral meniscus root tear (LMRT) in patients with an anterior cruciate ligament (ACL) tear makes the knee more unstable and increases the risk of osteoarthritis and osteonecrosis. The biomechanical changes following meniscal tears and surgery could lead to osteoarthritis (Lau et al., 2018). It absorbs shock in your knee and keeps it stable. Toward tailored rehabilitation by implementation of a novel musculoskeletal finite element analysis pipeline. doi:10.1016/j.orthres.2005.01.005, Haemer, J. M., Wang, M. J., Carter, D. R., and Giori, N. J. This review explores the evidence for managing meniscal tears and when to consider each treatment option based on current available evidence. The meniscus is an important component of the knee joint, and its main functions are to absorb shock, transmit load, lubricate the joint, and improve the matching degree of the femur and tibia (Lau et al., 2018; Kani et al., 2021; Patsch et al., 2021). Large tears (1 cm) and those with root involvement rarely heal spontaneously and are treated The average follow-up period was just over 10 years. For better observing and calculating the biomechanical changes between cartilage and meniscus, as well as between cartilages, and effectively reduce computational costs, an improved 10 nodes tetrahedral element (C3D10M) is used for cartilage and meniscus. ISI. Medial and Lateral Meniscus Tears | Cedars-Sinai Correspondence to: Dr. Simon C Mordecai, Imperial College NHS Trust, St Marys and Charing Cross Hospitals, Praed St, London W21NY, United Kingdom. Arnoczky SP, Lavagnino M. Tensile fixation strengths of absorbable meniscal repair devices as a function of hydrolysis time. WebStart New Search ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS What is a meniscus tear? Having knee pain or stiffness or a swollen knee. The present study constructed a detailed finite element model of the rabbit knee joint, including bones, cartilages, menisci, and major ligaments, to evaluate the biomechanical changes after a horizontal tear of the medial meniscus (HTMM) and different resection strategies. The contact pressure was also mainly located in the remaining edge of the medial meniscus, which contacted the articular cartilage. After the HTMM, SLPM, ILPM, DLPM, and STM, the axial load on medial menisci decreased 11.4%, 42.2%, 35.4% 48.7%, and 97.0%, respectively; the maximum von Mises stress on medial menisci increased 53.9%, 62.6%, 156.5%, and 65.5%, respectively, and the STM decreased 57.8%, compared to IMM. Prognostic factors for the treatment of meniscus horizontal tear 6 Types of Meniscus Tears and Treatments - Verywell Health The reason was that the posterior root and outer edge of the meniscus were destroyed, and the hoop stress function was lost after the STM (Kedgley et al., 2019). Get news & offers from Mayo Clinic Sports Medicine, Mayo Clinic Orthopedics and Sports Medicine. ACS Appl. (2014). (2005). Also potential benefits of meniscal repair must be weighed up against significant differences in post-operative rehabilitation. Authors recommend a trial of supervised exercise alone as first line treatment. Relat. They found no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Sports Traumatol. Recovery of muscle strength following arthroscopic meniscectomy. The fibres help to absorb the energy by converting axial loading forces across the joint into hoop stresses within the tissue. Meniscus tears may be treated with rest, physical therapy, and/or surgery. Only 6% failed to heal. However care of neurovascular structures in particular the saphenous nerve medially and the common peroneal nerve laterally must be taken when making the accessory incisions[59]. It was noted that modern all-inside repair devices were not included in the review and long term results are still awaited before firm conclusion on the best repair technique and device can be made. Another study[23] following the effect of supervised exercise therapy on 37 patients with degenerative tears of the medial meniscus found improvement in functional knee scores up to 6 mo, after which there was decline and progression of osteoarthritis. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Risk of total/subtotal meniscectomy for respective medial and lateral meniscus injury: Correlation with tear type, duration of complaint, age, gender and ACL rupture in 6034 asian patients. Drawbacks associated with suture based devices include, increased costs, retained polymer fragments, chondral injury and a significant learning curve with a high rate of anchor pullout during insertion[66]. PubMed. Treatment Located on the outer side of the knee, the lateral meniscus is a C-shaped piece of cartilage that attaches to the shin. Grant JA, Wilde J, Miller BS, Bedi A. Authors concluded a long term survival for 79% with radiographic evidence for the biomechanical function of successful meniscal repairs. Defining whether or not a meniscal tear has healed post-operatively is difficult. Biomechanical effects of a horizontal medial meniscal tear and subsequent leaflet resection. Further evidence that bleeding can aid meniscal repair is from a study by Cannon and Vittori[50]. doi:10.1243/095441105X34329, Tan, Z. W., Wang, B. doi:10.1007/s00167-019-05782-y, Ozeki, N., Koga, H., and Sekiya, I. Matsusue Y, Thomson NL. None of the 12 menisci in the stable knees sustained re-tears, compared with 7 of 21 (33%) menisci in nearly stable or unstable knees. After the ILPM, SLPM, and DLPM, the contact areas of MFC-MM were 0.9 mm2, 0.3mm2 and 0.5 mm2, which were 37.7%, 76.1%, and 65.2% lower than that of the IMM (1.4mm2), respectively. Eight-one patients were assigned to either repair or resection. Seven models were finally established, including intact medial meniscus (IMM), horizontal tear of the medial meniscus (HTMM), superior leaf partial meniscectomy (SLPM), inferior leaf partial meniscectomy (ILPM), double-leaf partial meniscectomy (DLPM), subtotal meniscectomy (STM), and total meniscectomy (TTM). A meniscus can become damaged due to sudden trauma. Lateral Rockbom and Gillquist[58] report on a 13 year follow-up of 31 patients who underwent open meniscal repair. Hede A, Larsen E, Sandberg H. The long term outcome of open total and partial meniscectomy related to the quantity and site of the meniscus removed. Because of the lack of posterior root connections of the menisci, the maximum radial displacement was 0.4mm after the STM, which increased by 21.7% compared to the IMM. J. moc.liamg@iacedrom.nomis, Telephone: +44-020-33130970 Fax: +44-020-33130971. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Knee Surg. Orthop. Treatment Abbreviation: MC-medial compartment, LC-lateral compartment, MFC-medial femoral cartilage, MTC-medial tibial cartilage, LFC-lateral femoral cartilage, LTC-lateral tibial cartilage, MM-medial meniscus, LM-lateral meniscus, TD-total displacement, RD-radial displacement, IMM-intact medial meniscus, HTMM-horizontal tear of medial meniscus, SLPM-superior leaf partial meniscectomy, ILPM-inferior leaf partial meniscectomy, DLPM-double-leaf partial meniscectomy, STM-subtotal meniscectomy, TTM-total meniscectomy. 33 (3), 617624. Katz et al[44] reviewed 105 patients following partial medial meniscectomy with aim to establish multiple predictors of functional outcome. 26 (4), 160164. A partial meniscectomy with an intact posterior root achieved fewer biomechanical changes than a subtotal meniscectomy. After the HTMM, the total and radial displacements of the medial menisci were 5.9% and 6.1% lower than those after the IMM, respectively (Figure 2E, Figure 3C). Knee 23 (3), 472477. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. doi:10.1177/0363546513488518, Zhang, K., Li, L., Yang, L., Shi, J., Zhu, L. Y., Liang, H. X., et al. J. We describe the technique of diagnosis and treatment of a large displaced lateral meniscus flap tear, presenting as a Second, soft tissues, including the joint capsule, nonmajor ligament, fat, and muscle, were not included in the model, which might lead to some deviations in the simulation. horizontal Burks et al[36] also found good or excellent results in 88% of patients after partial meniscectomy and Jaureguito et al[37] report 90% of patients report good or excellent results with 85% resuming pre-injury level of activities at 2 years after surgery. The intact knee joint was flexed to the degree consistent with Tans model, and the axial load was 80N. The results showed that the maximum von Mises stress on the femoral cartilage was 5.7 MPa, which was basically consistent with Tans research (7.9 2.5MPa). A prospective study of 93 cases. Selecting the correct treatment can be challenging and involves multiple factors. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts. Horizontal tears split the meniscus into an upper and lower part and can exist without clinical symptoms. Pujol N, Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. It is larger and closer to a full circle than the medial meniscus and in turn covers more surface. Modern treatment of meniscal tears - PMC - National Center for A biomechanical study[62] of rigid biodegradable devices found that at 24 wk hydrolysis was responsible for a significant decrease in failure strength. The menisci the medial meniscus and lateral meniscus - are Degenerative Meniscus Tear For the contact area, the difference between the MFC-MM and MTC-MM varied greatly among the seven models (Figure 2D). Difficulty bending and straightening the leg. This can occur with turning, twisting, or pivoting activities or sports. Aspiration and injection for meniscal cysts. Am. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY. At the first follow-up around half were asymptomatic but this reduced to around one third at final follow-up. Meniscal repair has grown in popularity and boasts excellent long-term results. Muddu BN, Barrie JL, Morris MA. Front. No patients were lost to follow-up. Open meniscal repair through an incision posterior to the collateral ligaments is now rarely performed due to associated neurovascular injury. Selecting the correct treatment can be challenging and involves multiple factors. It usually takes less than an hour. Clinical success was based on history of pain, physical examination and bilateral standing radiographs. The purpose of this review was to systematically assess the outcomes and complications for patients WebThese treatments may include: resting the knee using crutches wearing a brace wrapping ice in a towel and putting it on the knee for 15 minutes a few times a day propping up the leg when sitting down This is due to the convexity of lateral tibial plateau mirroring the convexity of the distal femoral condyle. An in vitro experimental study. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. The radiated deep-frozen xenogenic meniscal tissue regenerated the total meniscus with chondroprotection. WebMeniscus tears & repairs. Johnson et al[51] reviewed a consecutive series of 48 patients who had arthroscopically assisted repair of medial meniscal tears. Another study[52] with long term follow-up over 10 years also report encouraging results. doi:10.1007/s00330-020-06960-0, Roland, W. M., Wirt, D., James, S., Mark, M., Jack, B., Michaael, M., et al. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. Ahmed AM, Burke DL. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. Therefore, additional simulations were performed, one of which followed the study of Tan et al. 2015;21:13451349. Lateral Meniscus Tear - Symptoms, Causes, Treatment These results demonstrated the reliability of the model used in this study. These tears are usually not amenable to repair. All authors contributed to the article and approved the submitted version. 27 (1), 206214. The mesh of the model had undergone convergence verification. Torn or Frayed Meniscus Healing and Treatment - Verywell Health This work was supported by the National Natural Science Foundation of China (11072021, 82072428, 11772038), the National Key Research and Development Program (2016YFC1103202, 2019YFB1706900). 6 Lateral meniscal doi:10.1002/art.1780160317, Seil, R., and Pape, D. (2010). Single-leaf partial meniscectomy in extensive horizontal tears of the discoid lateral meniscus: Does decreased peripheral meniscal thickness affect outcomes? Tears Pitfalls associated with FasT-Fix meniscal repair. doi:10.1002/jor.20869, Cho, W. J., Kim, J. M., Lee, B. S., Kim, H. J., and Bin, S. I. Disord. The radial displacement of the medial meniscal middle body was larger than that of any other part in all the models, and the radial displacement after the ILPM was the minimum, while after the STM, the radial displacement was the most obvious. Sometimes the meniscus damage occurs more gradually as part of degeneration. 27 (10), 33903395. 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: affects treatment decision making. Bullough PG, Munuera L, Murphy J, Weinstein AM. Mangione KK, McCully K, Gloviak A, Lefebvre I, Hofmann M, Craik R. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. Both the inside and outside of the knee have a meniscus. Experimentally induced degenerative joint lesions following partial meniscectomy in the rabbit. TABLE 1. The consequences of meniscectomy. Bucket Handle Meniscus Tear: What It Is, Causes Menisci are considered to act as shock absorbers, load bearers, and Written informed consent was obtained from the owners for the participation of their animals in this study. The meniscus is a firm, elastic, shock absorber that helps stabilize the knee and is important Prognostic factors for the treatment of meniscus horizontal tear Introduction. Success rates of 83%-88%[63,64] have been reported so far. These tears may be difficult to visualize on arthroscopy. Considering the anatomical characteristics of the rabbit knee joint, the femur flexion was 45 (Mansour et al., 1998), and the load was 40N, which was approximately the weight of a whole rabbit (Anderson et al., 1990). The axial load on the medial tibial cartilages and medial menisci was redistributed in the medial compartment (Figure 2A). The https:// ensures that you are connecting to the It's a tear in the crescent-shaped wedge of tough, rubbery cartilage in your knee called your meniscus. Damaging or losing part of the meniscus can lead to short-term symptoms related to the meniscus damage and/or longer-term symptoms of arthritis due to the lack of the knees normal shock absorber.

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