Objective To investigate the effectiveness of double-needle suture for mixed meniscus tear repair under arthroscope. Methods Between April 2006 and January 2011, 22 patients with mixed meniscus tear were treated with double-needle suture under arthroscope. There were 14 males and 8 females, aged 18-41 years (mean, 31.3 years). All injuries were caused by sports. The time between injury and admission ranged from 2 days to 4 years (median, 11 months). International Knee Documentation Committee (IKDC) score was 42.5 ± 15.2, Lysholm score was 45.5 ± 13.5, and Tegner score was 2.9 ± 1.6. Seventeen cases complicated with anterior cruciate ligament injury. Results Healing of incision by first intention was achieved in all patients. No injury of nerve and blood occurred. The patients were followed up 12-48 months with an average of 27.6 months. According to Barrett et al. standard, 19 cases (86%) got clinical healing. The IKDC, Lysholm, and Tegner scores were improved to 77.1 ± 8.9, 79.8 ± 9.9, and 6.8 ± 1.6 respectively at last follow-up, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Arthroscopic meniscus repair using double-needle suture can provide good effectiveness because it has high firmness.
【摘要】 目的 评价低场MRI对膝关节半月板撕裂的诊断准确性。 方法 2009年9月-2010年4月经关节镜检或手术确诊的膝关节损伤患者69例，其中35例41个半月板撕裂，回顾性分析、整理其临床、关节镜及MRI表现，以传统Reicher诊断的改良分级标准确定半月板撕裂的级别、形态并记录，同时对关节内其它伴随征象作统计。 结果 35例41个撕裂半月板中，17个为盘状半月板，MRI显示Ⅲa级撕裂信号24个，Ⅲb级撕裂信号5个，Ⅲc级撕裂信号4个，Ⅳ级撕裂信号1个，桶柄状撕裂信号7个。本组低场MRI诊断半月板撕裂的敏感度、特异度、准确度分别为93.18%、92.11%、92.68%。 结论 低场MRI诊断膝关节半月板撕裂与关节镜结果差异不大，是一种诊断半月板撕裂的可靠、无创性检查方法。【Abstract】 Objective To evaluate the accuracy of low-field MRI in the diagnosis of meniscus tears. Methods We collected the clinical data of 69 patients with knee joint injuries confirmed by surgical operation or arthroscopy from Septembe 2009 to April 2010. Among them, 35 patients had 41 cases of meniscus tears. We retrospectively analyzed their clinical symptoms, and their manifestations on low-field MRI and arthroscopy. According to the modified diagnostic criteria based on Reicher’s diagnosis, the grade and the shape of meniscus tears were determined and recorded, and other accompanying signs inside the joint were also analyzed statistically. Results Among the 41 cases of meniscus tears of 35 patients, 17 were discoid meniscus. MRI showed that there were 24 signals of Ⅲa tears, 5 of Ⅲb tears, 4 of Ⅲc tears, 1 of Ⅳ tears and 7 of bucket-handle tears. The sensitivity, specificity and accuracy of low-field MRI in the diagnosis of meniscus tears were 93.18%, 92.11%, and 92.68%, respectively. Conclusions There is no significant difference between the results of arthroscopy and low-field MRI in diagnosing meniscus tears. Consequently, MRI is a reliable and non-invasive method in the diagnosis of meniscus tears.
ObjectiveTo investigate the effectiveness of arthroscopic bipolar radiofrequency energy (bRFE) and lateral partial meniscectomy for lateral meniscus tear and cartilage lesion. MethodsBetween January 2011 and December 2012, 40 eligible patients with lateral meniscus tear and cartilage injury in the lateral knee compartment underwent arthroscopic treatment, and the clinical data were analysed retrospectively. There were 21 males and 19 females, aged 15-65 years (mean, 42.1 years). The left knee was involved in 22 cases and the right knee in 18 cases. The causes of injury included sport injuries in 5 cases and sprain of knee joints in 8 cases, the remaining patients had no history of trauma. The disease duration ranged from 1 month to 10 years (median, 10 months). The Lysholm score and Japanese Orthopaedic Association (JOA) score of the knee were 59.9±8.2 and 69.6±5.3. According to the Outerbridge classification, 2 cases were rated as grade I, 21 cases as grade II, 17 cases as grade III, and 10 cases as grade IV. The scores described by Noyes were 1-16 (mean, 6.52). The Noyes scores were from 1 to 6 points in 20 patients (group A) and 7 to 16 points in 20 patients (group B). During surgery, all patients underwent partial meniscectomy, and radiofrequency-based chondroplasty was used. Knee joint function was assessed using the Lysholm score and JOA score of the knee, and the clinical outcomes between different degrees of cartilage lesions were also compared. ResultsAll incisions healed primarily without complication. All the patients were followed up 8-31 months (mean, 18.1 months). The Lysholm and JOA scores of the knee at last follow-up (92.2±7.2 and 92.9±7.9, respectively) were significantly higher than those at preoperation (P<0.05). There was no significant difference in preoperative Lysholm and JOA scores of the knee between groups A and B (P>0.05), but significance difference was found between 2 groups at last follow-up (P<0.05). ConclusionArthroscopic bRFE and lateral partial meniscectomy have good effectiveness in treating lateral meniscus tear and cartilage lesion. The effectiveness is better in patients with mild cartilage lesion than in patients with severe cartilage lesion.
ObjectiveTo investigate the expressions of cartilage degenerative related genes in meniscus, and to evaluate the potential effect of meniscal damage on cartilage degeneration, and to analyze the relationship between microRNAs (miRNAs) expression and cartilage degeneration. MethodsMeniscal tissue was collected from 5 patients undergoing partial meniscectomy between September 2012 and October 2013 (experimental group), and normally meniscal tissue without tearing from amputees was used as controls (control group). Pathological changes of menisci were observed; and real-time fluorescent quatitative PCR was performed to examine the relative expression levels of cartilage degenerative related genes and miRNAs:Aggrecan (ACAN), type X collagen (COL10A1), matrix metalloproteinases 13 (MMP-13), CCAAT enhancer binding protein β (CEBP-β), a disintegrin and metalloproteinase with thrombospondinmotif 5 (ADAMTS-5), miR-193b, miR-92a, and miR-455-3p in meniscus. ResultsThere were varying degrees of degenerative pathological changes in torn meniscus of experimental group. Compared with normal meniscus of control group, the expression of ACAN was decreased, while the expressions of COL10A1, CEBP-β, ADAMTS-5, and MMP-13 were increased in torn meniscus of experimental group; and significant difference was found (P<0.05) except ACAN and MMP-13 (P>0.05). The expressions of miR-92a, miR-455-3p, and miR-193b in torn meniscus of experimental group were significantly higher than those in normal meniscus of control group (P<0.05). ConclusionMeniscal tissue has the intrinsic tendency of degeration after meniscus tear. The torn meniscus has greater stimulative impact on cartilage degeneration than normally morphological meniscus without tearing. The cartilage degenerative related miRNAs, including miR-193b, miR-92a, and miR-455-3p may contribute to the up-regulation of osteoarthritis.
ObjectiveTo explore the association of anterior cruciate ligament (ACL) degeneration with intercondylar notch impingement and the medial meniscus tear in knee osteoarthritis (KOA). MethodsBetween July 2014 and February 2016, 55 KOA patients (55 knees) with ACL degeneration (degeneration group) and 55 KOA patients (55 knees) without ACL degeneration (control group) were included in the study. No significant difference was found in gender, age, body mass index, and side between 2 groups (P > 0.05). The notch width index was measured on preoperative MRI to evaluate whether the intercondylar notch was narrow. The location of the medial and lateral meniscus tear and osteophyte of the ACL tibial insertion were observed under arthroscopy, and the incidences of the meniscus tear and osteophyte were calculated. ResultsThere was no significant difference in anterior horn and body tear of the medial meniscus and in anterior horn, body, posterior horn, and root tear of the lateral meniscus (P > 0.05). Significant difference was found in the posterior horn and root tear of the medial meniscus, osteophyte of the ACL tibial insertion, narrow intercondylar notch, and the notch width index between 2 groups (P < 0.05). The incidence of root tear of the medial meniscus was 53.8% (7/13) in 13 knees with osteophyte of the ACL tibial insertion and was 16.5% (16/97) in 97 knees without osteophyte, showing significant difference (χ2=9.671, P=0.002). ConclusionThere is a strong association of ACL degeneration with posterior horn and root tear of the medial meniscus and intercondylar notch impingement in KOA. And the high incidence of root tear of the medial meniscus in knee is correlated with osteophyte of the ACL tibial insertion.
ObjectiveTo systematically evaluate the effectiveness of arthroscopic debridement versus non-operative treatment for degenerative meniscal tear. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about arthroscopic debridement versus non-operative treatment for degenerative meniscal tear from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of nine RCTs involving 1 023 patients were included. The results of meta-analysis showed that:there were no significant differences between two groups at different follow-up time points in knee scoring scale (less than 6 months:SMD=0.12, 95%CI -0.11 to 0.35, P=0.30; 1 year:SMD=-0.03, 95%CI -0.18 to 0.11, P=0.65; 2 years:SMD=-0.07, 95%CI -0.32 to 0.19, P=0.61) and pain score (less than 6 months:MD=0.30, 95%CI -0.10 to 0.70, P=0.14; 1 year:MD=0.10, 95%CI -0.40 to 0.60, P=0.70; 2 years:MD=0.02, 95%CI -0.52 to 0.92, P=0.90). ConclusionCurrent evidence suggests that arthroscopic debridement hasn't better effective than non-operative treatment for degenerative meniscal tear, however, due to the limited quantity of the included studies, the above conclusion still need more high quality research to be verified.
ObjectiveTo establish a classification model based on knee MRI radiomics, realize automatic identification of meniscus tear, and provide reference for accurate diagnosis of meniscus injury. Methods A total of 228 patients (246 knees) with meniscus injury who were admitted between July 2018 and March 2021 were selected as the research objects. There were 146 males and 82 females; the age ranged from 9 to 76 years, with a median age of 53 years. There were 210 cases of meniscus injury in one knee and 18 cases in both knees. All the patients were confirmed by arthroscopy, among which 117 knees with meniscus tear and 129 knees with meniscus non-tear injury. The proton density weighted-spectral attenuated inversion recovery (PDW-SPAIR) sequence images of sagittal MRI were collected, and two doctors performed radiomics studies. The 246 knees were randomly divided into training group and testing group according to the ratio of 7∶3. First, ITK-SNAP3.6.0 software was used to extract the region of interest (ROI) of the meniscus and radiomic features. After retaining the radiomic features with intraclass correlation coefficient (ICC)>0.8, the max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were used for filtering the features to establish an automatic identification model of meniscus tear. The receiver operator characteristic curve (ROC) and the corresponding area under the ROC curve (AUC) was obtained; the model performance was comprehensively evaluated by calculating the accuracy, sensitivity, and specificity. Results A total of 1 316-dimensional radiomic features were extracted from the meniscus ROI, and the ICC within the group and ICC between the groups of the 981-dimensional radiomic features were both greater than 0.80. The redundant information in the 981-dimensional radiomic features was eliminated by mRMR, and the 20-dimensional radiomic features were retained. The optimal feature subset was further selected by LASSO, and 8-dimensional radiomic features were selected. The average ICC within the group and the average ICC between the groups were 0.942 and 0.920, respectively. The AUC of the training group was 0.889±0.036 [95%CI (0.845, 0.942), P<0.001], and the accuracy, sensitivity, and specificity were 0.873, 0.869, and 0.842, respectively; the AUC of the testing group was 0.876±0.036 [95%CI (0.875, 0.984), P<0.001], and the accuracy, sensitivity, and specificity were 0.862, 0.851, and 0.845, respectively. ConclusionThe model established by the radiomics method has good automatic identification performance of meniscus tear.