ObjectiveTo investigate the medium-term effectiveness of both side stereo suture for meniscus bucket handle tear under arthroscopy. MethodsBetween January 2009 and December 2012, 38 patients with combined injury of meniscus bucket handle tear underwent arthroscope surgery by the method of both side stereo suture. There were 26 males and 12 females with an average age of 32 years (range, 19-42 years). The injury causes included sports injury in 21 cases, traffic accident injury in 11 cases, and other trauma in 6 cases. The left knee was involved in 15 cases and the right knee in 23 cases. The interval between injury and operation was 2 days to 6 months (mean, 2.5 months). MRI examination showed meniscus injury at grade Ⅲ, including 22 cases of internal injury and 16 cases of lateral injury. The Barrett standard, Lysholm score of knee joint, and joint mobility were used to assess the function recovery of the knee joint. ResultsAll incisions healed primarily with no complication. All cases were followed up 24.5 months on average (range, 18-36 months). Based on the Barrett standard, meniscus bucket handle tear was successfully repaired in all cases. The Lysholm scores and range of motion of the knee at 6 months, 12 months, and last follow-up were significantly better than preoperative ones (P<0.05). ConclusionThe both side stereo suture of meniscus bucket handle tear under arthroscopy has an excellent medium-term effectiveness, with the advantages of firm suture and high healing rate.
Objective To elucidate the latest research progress and application of tissue engineered meniscus. Methods The literature concerning the advance in tissue engineered meniscus was extensively reviewed, then closely-related issues including seed cells, scaffolds, and bioreactors were analyzed. Results With more and more attention being paid to meniscus tissue engineering, different approaches and strategies for seed cells, scaffolds, and bioreactors have contributed to the generation of meniscal constructs, which are capable of restoring meniscal lesions to some extent, but translating successes in basic science research to clinical application is still limited. Conclusion More research for the optimal combination of the appropriate cell source, the scaffold type, and the proper physical and chemical factors for the stimulation of cells differentiation into tissue with optimal phenotypes in tissue engineered meniscus is still in needed, but the overall future looks promising.
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.
Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05). Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.
Objective To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury. Methods Between January 2010 and May 2011, 38 patients (42 knees) with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males (24 knees) and 15 females (18 knees), aged 7-62 years (median, 32.8 years). The disease duration was 7 days to 40 years (median, 8.6 months). According to Watanabe’s classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients (28 knees), partial meniscectomy in 12 patients (13 knees), and complete meniscectomy in 1 patient (1 knee). After operation, the rehabilitation training programs (including straight-leg-raising exercise and range of motion exercise) were carried out. Results All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months (mean, 14.3 months). No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation (P lt; 0.05). Based on Ikeuchi’s grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 ± 2.95 at immediate, 91.02 ± 4.17 at 3 months, 92.90 ± 3.36 at 6 months, and 94.74 ± 3.52 at 12 months after operation from 69.38 ± 4.59 before operation (P lt; 0.05). C onclusion Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.
Objective To observe the changes of force bearing area and pressures of the rabbit tibiofemoral contact area and the biomechanical reconstruction level of joint after meniscal allograft. Methods A total of 28 Japanese rabbits were involved, weighing 3.0-3.5 kg, male or female. Of 28 rabbits, 7 were selected as meniscus donors, the remaining 21 rabbits were randomized into group A (n=7), group B (n=7), and group C (n=7). Group A underwent single knee opening and suturing, group B underwent medial meniscus excision and suturing, and group C underwent medial meniscus allograft after medial meniscus excision and suturing. The rabbits were sacrified at 12 weeks after operation for biomechanical observation through biomechanical machine and color imaging system. The meniscus tissue specimens were harvested from groups A and C to perform histological and immunohistochemical staining. Results After operation, all rabbits in 3 groups survived to the end of experiment. There were significant differences in the force bearing area and pressures at 0-90° flexion between group B and groups A, C (P lt; 0.05) at 12 weeks, showing no significant difference between group A and group C (P gt; 0.05); and there were significant differences in the force bearing area and pressures at 120° flexion among 3 groups (P lt; 0.05). The histological observation showed that the number of cartilage cells and collagen fibers returned to normal in group C, and the immunohistochemical staining showed that transplanted meniscus of group C contained large amounts of collagen fibers consisting of collagen type I and collagen type II. After 12 weeks of operation, the collagen type I contents were 0.612 5 ± 0.059 8 in group A and 0.587 2 ± 0.063 9 in group C, showing no significant difference (t=0.765, P=0.465); the collagen type II contents were 0.772 4 ± 0.081 5 and 0.814 3 ± 0.051 7, respectively, showing no significant difference (t= —0.136, P=0.894). Conclusion The allograft of rabbit meniscus can significantly increase the force bearing area of the tibiofemoral contact area and reduce the average pressure. Therefore, biomechanically speaking, the meniscus allograft can protect the articular cartilage and reconstruct the biomechanical balance.
【Abstract】 Objective To compare the short-term effects of arthroscopic partial meniscectomy in treating medial versuslateral meniscus injuries. Methods From January 2003 to January 2006, 207 patients with meniscus injury(without intraarticularligament injury) underwent arthroscopic partial meniscectomy. The medial meniscus injury group included 115 cases, 50males and 65 females; aged 14 to 78 years(mean 46.9 years); 66 left knees and 49 right knees. Twenty-six cases had injury histories,the delayed time from injury to surgery ranged from 6 d to 6 months (mean 2.1 months). The lateral meniscus injury group included92 cases, 18 males and 74 females; aged 16 to 62 years (mean 41.1 years); 57 left knees and 35 right knees. Twenty-four caseshad injury histories, the delayed time from injury to surgery ranged from 9 d to 6 months (mean 1.9 months). Lysholm score systemwas applied and the scors of pre- and post-operation and were compared between two groups. Results The period of followupranged from 12 to 45 months (mean 31.5 months). In medial meniscus injury group and lateral meniscus injury roup, theLysholm score increased from 61.3±16.9 and 57.4±17.6 preoperation to 95.0±7.9 and 93.3±7.4 postoperation respectively. Therewas statistically significant difference between preoperation and postoperation (P lt; 0.01), and there was no statistically significantdifference between two groups（P gt; 0.05）. The excellent and good rates for function of knee joint were 97.39% (excellent in 107cases, good in 5 cases and fair in 3 cases) in medial meniscus injury group and 100%(excellent in 80 cases and good in 12 cases)in lateral meniscus injury group. Conclusion Arthroscopic partial meniscectomy is a safe and effective treatment for meniscusinjury, there is no diference in short-term effects in treating medial versus lateral meniscus injuries.
To design a new suit of instruments for meniscal suture with tondon, and then authenticate their feasibil ity and the therapeutic effect of the new technique. Methods Instruments were developed, including new ones and others which was improved according to the current instruments. From October 2005 to December 2006, 45 patients with meniscal injury were treated by meniscal suture with tendon. There were 29 males and 16 females, aged 17-40 years (mean 28 years). Injury was caused by sports in 33 cases, by traffic accident in 5 cases, by fall ing in 3 case and others in 4 cases. The disease course was 3 days to 6 months (mean 2 months). There were 23 cases accompanying with anterior cruciate l igament injury and 6 cases accompanying with posterior cruciate l igament injury. E-MRI showed 2 cases of degree II and 43 cases of degree III. Arthroscope showed that injury was at medial meniscus in 39 cases and at lateral meniscus in 6 cases. The pre-operationalLysholm score was 53.0 ± 10.3. Autogeneic or xenogenic tendon was made into suture l ine guided by stitch at the two ends. Thetherapeutic effect of the new technique was authenticated by cl inical results, including the change of symptoms and phy sical signs, and by comparing the pre-operational Lysholm score with the post one. Results Nineteen pieces of instruments weredeveloped. All the operation were successful, with no harm to nerves and vessels. The follow-up was 6 months to 24 mo nths (mean15 months). At the last follow-up, all the symptoms disappeared, including pain, swell ing and locking, etc. The Lysholm sc oreafter 6 months of operation was 87.8 ± 9.2, showing statistically significant difference when compared with per-operati on ( P lt; 0.01). Conclusion It is feasible to suture injured menisci with the new instruments and technique. It is an effective way to repair menisci with tendon according to the short-term results.
Objective To investigate the effects of the insulin-like growth factor 1 (IGF-1), the transforming growth factor β1(TGFβ1), and the basic fibroblast growth factor (bFGF) on proliferation and cell phenotype of the human fetal meniscal cells, and to find out the best combination and concentration of the growth factors for the meniscus tissue engineering. Methods The fetus came from the healthy woman accidental abortion and the procedure had got her approval.The human fetal meniscal fibrochondrocytes were cultured in vitro. The cell phenotype was identifiedby the collagen type Ⅱ immunohistochemistry and Aggrecan immunofluorescence. Inthe growth factor groups, the 3rd passage meniscal cells synchronized by the serum starvation method and were mixed with IGF-1 (1, 10, 50, 100 μg/L), TGF-β1 (0.1, 1.0, 5.0, 10.0, 50.0 μg/L), and bFGF (5, 10, 50, 100, 200 μg/L), respectively, and in the combination groups, the combinations of bFGF and TGF-β1, bFGF and IGF-1, TGF-β1 and IGF-1 were established at their optimal effect concentrations. The control group was also established for comparison. The dose-response relationship was studied at 48 h and 72 h bythe MTT colorimetric method. Results The 3rd passage meniscalcells could express collagen type Ⅱ and Aggrecan before and after the addition of the three growth factors. The proliferating effects of the growth factors (IGF-1 50 μg/L，TGF-β1 5 μg/L，bFGF 50 μg/L) on the 3rd passage cells at 48 h and 72 h were significantly better in the growth factor groups than in the control group (Plt;0.05)，and the combination groups of bFGF 50 μg/L and IGF-1 50 μg/L, IGF-1 50 μg/L and TGF-β1 5 μg/L showed a significantly higher proliferatingeffect than that in the single growth factor group (Plt;0.05). bFGF 50 μg/L and TGF-β1 5 μg/L had no synergetic effect (Pgt;0.05). Conclusion IGF-1, TGF-β1 and bFGF can promote the proliferation of the human fetal meniscal cells, respectively, and the combinations of bFGF and IGF-1, IGF-1 and TGF-β1 at their optimal concentrations can have better proliferating effects than the single growth factor. They can be used for the in vitro amplification of the meniscal seed cells.
Objective To investigate the result of the arthroscopicrepair of the meniscus tears with the absorbable sutures. Methods From June 1998 to May2003，the meniscus tears in 110 patients (78 males, 32 females; aged 1466 years, averaged 27.5 years) were repaired with absorbable sutures under an arthroscope. In the patients, there were 93 vertical split injuries, 12 transverse split injuries, and 5 hidden split injuries. There were 78 tears in the lateral margin of the meniscus, 23 tears in the anterior angle of the meniscus, and 9 tears in the posterior angle of the meniscus. Ninetyone patients had 2 sutures, 13 patients had 4 sutures, 4 patients had 6 sutures, and 2 patients had 8 sutures. The rehabilitation program was performed in all the patients postoperatively, and the clinical outcome was observed. The Lysholm score was 57±12 preoperatively. Results Thefollow-up for an average of 26 months (range,12-67 months) showed that 3 patients had a light pain on exertion in the surgically-treated knee;1 patientunderwent an operation again for recurrence of the symptoms due to a failure in the healing of the meniscus tear, so a second arthroscopic operation was performed; and the other patients had a satisfactory result with an excellent knee function. The Lysholm score was 92±7 after operation. Conclusion The arthroscopic repair of the meniscustears has advantages of safety and reliability in the suturing and easier to perform. The repaired meniscus can play much better physiological and biomechanical functions, and will not limit the normal movement of the meniscus during the knee flexion after the sutures are absorbed.