Meniscus Treatment Research

  • Diagnosis: MRI research outcomes and accuracy of seeing the meniscus injury

A November 2022 study writes: “Surgery to treat a torn meniscus is a common orthopedic procedure, and radiologists are frequently asked to image patients with new or recurrent knee pain after meniscus surgery. However, surgery alters the MR imaging appearance of the meniscus, making the diagnosis of recurrent tear a diagnostic challenge.” (3)

  • Types of meniscus injury: Traumatic meniscal Injuries
  • Types of meniscus injury: Root tear
  • Types of meniscus injury: Radial Tear
  • Types of meniscus injury: Horizontal Tear
  • Types of meniscus injury: Incomplete Tear
  • Types of meniscus injury: Complex Tear
  • Types of meniscus injury: Flap Tear
  • Types of meniscus injury:  O’Donoghue’s Triad, also known as Terrible Triad
  • ACL and Meniscus injury

“Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. . . .” (8)

  • Types of meniscus injury: Injury caused by Meniscectomy
  • Types of Meniscus surgeries
  • Types of Meniscus surgeries: Total Meniscectomy
  • Total Meniscectomy outcomes: Total Meniscectomy complications
  • Types of Meniscus surgeries: Partial Meniscectomy
  • Partial Meniscectomy outcomes: Partial Meniscectomy complications

An August 2022 paper (7) compared the effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise for degenerative meniscal tears in knee function at 5-year follow-up. In examining the data of four previously published studies, the researchers found no significant between-group differences, activities of daily living and quality of life. Conclusion: Moderate certainty of evidence suggests that the addition of arthroscopic partial meniscectomy to an exercise program adds no benefits in knee function at 5-year follow-up.

A November 2022 study (1) of elite athletes with isolated meniscal injury, found that partial meniscectomy and meniscal suture exhibited similar rates of return to sport and return to pre-injury levels. The study also found “athletes required more time for return to sport after meniscal repair and exhibited an increased rate of revision surgery associated with a reduced rate of return to sport after the subsequent surgery. For lateral meniscus tears, meniscectomy was associated with a high rate of revision surgery and risk of chondrolysis, whereas partial medial meniscectomy allowed for rapid return to sport but with the potential risk of developing knee osteoarthritis over the years.”

In August 2022, doctors published their findings (9) on the the effect of patient age on joint survivorship after arthroscopic partial meniscectomy for degenerative medial meniscus tears. A total of 633 knees were included. The study population was divided into older and younger groups, the cutoff age was 60 years old. A significant difference in the joint survival rates was noted between the groups. Joint survivorship after arthroscopic partial meniscectomy was affected by other factors associated with the aging process, such as cartilage status and meniscal tear pattern, rather than age itself. Advanced age should not be the only reason for precluding arthroscopic partial meniscectomy in treatment of degenerative medial meniscus tears. Arthroscopic partial meniscectomy is a viable option when treating degenerative medial meniscus tear in elderly patients if adopted with caution.

A July 2022 study (11) found “no evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms.” The study writes: “It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review.

Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The average age of the patients was about 53 years old, the patients were considered , the average Body Mass Index was 27. The patients were considered overweight on average.

  • The current evidence suggests no difference in functional and clinical patient reported outcomes, pain, quality of life, physical performance measures, and osteoarthritis progression between the arthroscopic partial meniscectomy and structured physical therapy groups. Conclusions: “The benefits of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms are limited.”
  • Types of Meniscus surgeries: Arthroscopic Meniscus Repair
An October 2022 editorial (10) in the journal Arthroscopy writes: “Patients do not do as well after meniscectomy as after repair. Although saving the meniscus is not always easy and the success rate of repair is not 100%, repair-when possible-remains the best option for patients in the long run. Meniscal repair rates are on the rise, especially in younger patients, but are not high enough. Recent research has shown that more than 95% of meniscal procedures are partial meniscectomies. Improved surgical techniques and instrumentation, as well as a continued increase in understanding the importance of repair, are leading to an increase in meniscal repair rates. Preserve as much meniscus as possible and as often as possible.”
  • Arthroscopic Meniscus Repair outcomes: Arthroscopic Meniscus Repair complications

 

An October 2022 study (5) “Although meniscus repairs augmented with PRP led to significantly lower failure rates and better postoperative pain control compared with those of the non-PRP group, there is insufficient RCT evidence to support PRP augmentation of meniscus repair improving functional outcomes.”

  1. Types of Meniscus surgeries: Meniscal allograft transplantation
  2. Meniscal allograft transplantation outcomes: Meniscal allograft transplantation complications

A November 2022 paper (2) looked at meniscal allograft transplant (MAT), “an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy.” The researchers explored this surgical option because there is not much research assessing the survival rate and prognostic factors of soft tissue Meniscal allograft transplant. In this study of 324 consecutive patients, the survivorship of arthroscopic Meniscal allograft transplant (MAT) using the soft tissue technique was assessed and the variables that could potentially influence failures and outcomes were investigated.

Of the 324 patients, 189 (58%) underwent an associated surgical procedure at an average 5 year follow up.

    • A total of 22 patients (6.8%) were considered to have experienced surgical failure
    • 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures and anterior cruciate ligament (ACL) reconstruction were predictors of failure.
    • Finally, a lower survival rate was reported in female patients compared with male patients
    • Conclusion: Female sex and the need to combine Meniscal allograft transplant (MAT) with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up.
  1. Non-surgical meniscus tear and injury treatments: Conservative care options
  2. Non-surgical meniscus tear and injury treatments: Conservative care options: REST
  3. Non-surgical meniscus tear and injury treatments: PRICE
  4. Non-surgical meniscus tear and injury treatments: Conservative care options: Physical therapy and exercise
  5. Non-surgical meniscus tear and injury treatments: Anti-inflammatories and painkillers

 

  1. Non-surgical meniscus tear and injury treatments: Knee braces
  2. Non-surgical meniscus tear and injury treatments: Chiropractic care
  3. Non-surgical meniscus tear and injury treatments: Weight loss
  4. Non-surgical meniscus tear and injury treatments: Cortisone injections

A November 2022 paper (4) Writes: “Consensus guidelines recommend administering a corticosteroid injection (CSI) for patients with a symptomatic degenerative meniscus lesion prior to arthroscopic partial meniscectomy. A recent study found that corticosteroid injection administered within 1 month prior to meniscectomy is associated with an increased risk of postoperative infection. However, infections may range in severity from superficial infections to serious infections requiring surgical interventions. Serious infections requiring a surgical intervention are rare after a meniscectomy, occurring in 0.1% of APMs in a matched cohort of patients over 35. Patients were five times more likely to return to the operating room for infection after APM if they had a corticosteroid injection in the month before or had multiple corticosteroid injection in the year before surgery. The risk of infection was no longer significant if there was at least a 2-month interval between preoperative corticosteroid injection and arthroscopic partial meniscectomy.”

A May 2022 report (6) evaluated the risk of post-operative infection after intra-articular steroid injection at the time of knee arthroscopy. The patients in this study were included if they underwent more simple arthroscopic procedures: diagnostic arthroscopy, meniscectomy, loose body removal, synovectomy, or microfracture. Patients were excluded if they underwent more complex procedures, such as ligament reconstruction, meniscus repair, or any open procedures.

A total of 6889 patients were identified for study inclusion, including 2416 (35.1%) who were given intra-articular steroid at the time of knee arthroscopy.

Conclusions: “Knee infection following arthroscopic surgery is rare. Intra-operative steroid injection during arthroscopic knee surgery is associated with a 4.3-fold increased risk of subsequent knee infection. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed.

  1. Non-surgical meniscus tear and injury treatments: Local painkiller injection
  2. Non-surgical meniscus tear and injury treatments: Hyaluronic acid injections
  3. Non-surgical meniscus tear and injury treatments: Regenerative medicine
  4. Non-surgical meniscus tear and injury treatments: Stem cell therapy
  5. Non-surgical meniscus tear and injury treatments: Donated cell therapy
  6. Non-surgical meniscus tear and injury treatments: Cell tissue therapy
  7. Non-surgical meniscus tear and injury treatments: Platelet Rich Plasma therapy

A December 2021 paper (12) “When (knee pain from meniscus damage is) symptomatic, it represents a challenge since arthroscopic surgery provides unpredictable results: recent evidence has shown that partial meniscectomy is not better than conservative management up to 2 years of follow-up, and the removal of meniscal tissue may accelerate osteoarthritis progression toward osteoarthritis. Intra-articular injection of corticosteroids or hyaluronic acid may help in providing temporary symptomatic relief, but no influence should be expected on the quality of the meniscal tissue. Biologic agents have been adopted to treat a variety of degenerative musculoskeletal pathologies, and the use of platelet-derived growth factors (a form of platelet rich plasma treatments) has become routine. Preclinical studies have documented that platelet-derived growth factors may play a beneficial role in stimulating meniscal repair and regeneration by triggering anabolic pathways and stimulating local mesenchymal stem cells from synovium. Furthermore, also mechanical stimulation (e.g., arthroscopic trephination or percutaneous needling) in the red-red or red-white zone may further promote tissue healing.”

  1. Non-surgical meniscus tear and injury treatments: Prolotherapy

1 D’Ambrosi R, Meena A, Raj A, Ursino N, Mangiavini L, Herbort M, Fink C. In elite athletes with meniscal injuries, always repair the lateral, think about the medial! A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Nov 2:1-1.
2 Grassi A, Di Paolo S, Coco V, Romandini I, Filardo G, Lucidi GA, Marcacci M, Zaffagnini S. Survivorship and Reoperation of 324 Consecutive Isolated or Combined Arthroscopic Meniscal Allograft Transplants Using Soft Tissue Fixation. The American Journal of Sports Medicine. 2022 Nov 9:03635465221131522.
3 Malik MA, Baker JC. Postoperative MR Imaging of the Knee Meniscus. Magnetic Resonance Imaging Clinics. 2022 Nov 1;30(4):723-31.
4 Forsythe B, Berlinberg EJ, Forlenza EM, Oeding JF, Patel HH, Mascarenhas R. Corticosteroid injections 2 months before arthroscopic meniscectomy increases the rate of postoperative infections requiring surgical irrigation and debridement. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 May 27:1-9.
5 Li Z, Weng X. Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies. Journal of Orthopaedic Surgery and Research. 2022 Dec;17(1):1-4.
6 Kohls M, Magnussen R, Fitzpatrick S, Kaeding C, Flanigan D, Duerr R. Intra-articular steroid injection at the time of knee arthroscopy increases risk of post-operative infection. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 May;30(5):1846-53.
7 Fernández-Matías R, García-Pérez F, Gavín-González C, Martínez-Martín J, Valencia-García H, Flórez-García MT. Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2022 Aug 22.
8 Vadhera AS, Lee JS, Singh H, Gursoy S, Kunze KN, Verma NN, Chahla J. Injury to the Posterior Horn of the Lateral Meniscus from a Misplaced Tibial Tunnel for Anterior Cruciate Ligament Reconstruction: A Case Report. The American Journal of Case Reports. 2022;23:e937581-1.
9 Song JH, Bin SI, Kim JM, Lee BS, Park JG, Lee SM. Age alone does not affect the joint survivorship after arthroscopic partial meniscectomy for degenerative medial meniscus tears: a propensity-score matched survival analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Aug 9:1-7.
10 DeFroda S. Editorial Commentary: Meniscal Repair, When Possible, Is Better for Patients Than Meniscectomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022 Oct 1;38(10):2884-6.
11 Migliorini, F., Oliva, F., Eschweiler, J., Cuozzo, F., Hildebrand, F. and Maffulli, N., 2022. No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, pp.1-11.
12 Di Matteo B, Altomare D, Garibaldi R, La Porta A, Manca A, Kon E. Ultrasound-Guided Meniscal Injection of Autologous Growth Factors: A Brief Report. Cartilage. 2021 Dec;13(1_suppl):387S-91S.

2026


 

 

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