Long-term assessment of meniscal extrusion after meniscal repair

Dujardin, D.; Kanagaratnam, Lukshe; Boisrenoult, Philippe; Beaufils, Philippe; Pujol, Nicolas

doi:10.1016/j.otsr.2016.12.014

Cited by 12 publications

(3 citation statements)

References 16 publications

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“…2 On injury, the meniscus often becomes displaced from its physiological position and extrudes from the tibial plateau 5,6,18 ; as such, meniscal extrusion/translation can be one of the features of a torn meniscus on magnetic resonance imaging (MRI) scans. 1,9,20,31 Liu et al 21 showed that displacement of the LM was associated with the occurrence of symptomatic osteoarthritis, but few other studies have investigated the relationship between extrusion of the LM and osteoarthritis in the clinical setting. In addition, any relationship between meniscal displacement and the degree of meniscal tear or load-transmission function of the LM remains unclear.…”

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confidence: 99%

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

et al. 2022

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Background: Meniscal extrusion/translation has been used as an index for meniscal treatment. However, the relationship between meniscal displacement and the degree of meniscal tear or load–transmission function of the lateral meniscus (LM) remains unclear. Purpose: To clarify the relationship between the width of the radial tear of the LM and (1) meniscal displacement or (2) resultant force through the meniscus under axial compressive load in the porcine model. Study Design: Controlled laboratory study. Methods: Eight intact porcine knees with or without a partial radial tear at the midbody of the LM (involving 30%, 60%, or 90% of its width) were investigated. Reflective markers were attached to the outer wall of the anterior, anteromiddle, posteromiddle, and posterior segments of the LM. A 300-N axial load was applied at 2 flexion angles (30° and 60°), and the 3–dimensional forces and trajectories of the knees were recorded. Marker movements were simultaneously tracked using a motion capture camera system. After total meniscectomy of the LM, the recorded knee trajectories were reproduced, and the resultant force through the LM was calculated (a force carried only by the meniscus in response to a load applied to the whole knee joint). Results: At both flexion angles, the change in distance (mean ± SD) between the anterior and posterior markers under load increased significantly more in the anteroposterior direction in LMs with a 90% tear than in intact LMs (30°, 0.4 ± 0.3 vs 1.4 ± 0.8 mm, P = .004; 60°, 0.1 ± 0.7 vs 1.4 ± 1.0 mm, P < .001 [intact vs 90% tear]). The change in distance between the anteromiddle and posteromiddle markers at 30° also significantly increased in LMs with a 90% tear (0.2 ± 0.2 vs 1.3 ± 1.2 mm, P = .02 [intact vs 90% tear]). The resultant force was significantly lower in LMs with a 90% tear than in intact LMs (30°, 125 ± 47 vs 48 ± 20 N, P < .001; 60°, 93 ± 46 vs 43 ± 11 N, P = .002 [intact vs 90% tear]). We found no significant differences in either meniscal displacements or resultant forces between intact LMs and those with 30% or 60% tears. Conclusion: LMs with a 90%-width midbody radial tear lost load–transmission function with their displacement relative to the tibia primarily in the anteroposterior direction in the porcine model. Clinical Relevance: Even 1 mm of displacement after meniscal injury is evidence that the load–transmission function of the meniscus is greatly impaired. When a displaced torn LM is diagnosed in preoperative imaging, meniscal repair surgery should be considered.

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confidence: 99%

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

et al. 2022

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“…While the suture anchor repair typically involves an all-inside technique with a suture anchor and additional sutures secured at the root attachment, the transtibial approach involves drilling a tunnel through the tibia to the native root attachment, shuttling sutures that are cinched to the torn meniscus through the tunnel, and then securing the sutures to the anterior aspect of the tibia 66,69,70 . Small case-control and cohort studies have demonstrated favorable clinical outcomes following meniscal repair utilizing either repair method, although the persistence and progression of extrusion remains a risk 66,69,71-75 . The transtibial approach is preferred by the senior author (B.J.C.)…”

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confidence: 99%

Meniscal Extrusion

et al. 2022

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Pathologic meniscal extrusion can compromise meniscal function, leading to increased contact forces in the tibiofemoral compartment and the acceleration of osteoarthritic changes.» Extrusion is typically defined as radial displacement of $3 mm outside the tibial border and is best diagnosed via magnetic resonance imaging, although ultrasonography has also demonstrated encouraging diagnostic utility.» Surgical management of meniscal extrusion is based on the underlying etiology, the patient's symptom profile, the preexisting health of the articular surface, and the risk of future chondral injury and osteoarthritis.

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“…With the improvements in CT [18] and MRI scanning [19], have been shown to improve diagnostic accuracy in many knee disorder. MRI scanning is first choice for diagnosis of meniscus tear rarely use of arthrograph.…”

Section: Imagingmentioning

confidence: 99%

Approach to Meniscal Tear by Clinical Examination and Its Management: A Review

Sah¹,

Bin²,

Sah³

et al. 2019

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It's quite difficult to diagnose the meniscus tear by clinical examination even the experienced orthopaedic surgeon, so this review has shortly focused on clinical examination and its treatment. How to overcome missed diagnosis of meniscus tear in clinical setting? This review article highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in Magnetic resonance imaging (MRI) and Arthroscopy. Although partial, subtotal and total meniscectomy is the choice for different types of meniscal tears, there are certain criteria to be meet for undergoing surgical treatment. The most common criteria for meniscal repair include: 1) A vertical longitudinal tear more than 1 cm in length located within vascular zone, 2) A tear which is unstable and displaceable into the joint, 3) An active informed and cooperative patient but younger than 40 years old, 4) A stable knee or wound stabilized with a ligamentous reconstruction. Chronically deformed or degenerative menisci are bottom-out candidates for repair. Most investigators report that only 10% to 15% of meniscal tears can be repaired and that most such repairs are done in association with an anterior cruciate ligament reconstruction. However, this article presents a review of the clinical relevant anatomic, function, repair and healing mechanism, description of the meniscus attachment as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus attachments.

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Long-term assessment of meniscal extrusion after meniscal repair

Abstract: IV, retrospective study.

Cited by 12 publications

References 16 publications

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

Meniscal Extrusion

Approach to Meniscal Tear by Clinical Examination and Its Management: A Review

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